October 1, 2006 Texas Medicaid & Healthcare Partnership Dear Texas Medicaid Provider: The enclosed information entitled 2007 ICD-9-CM GROUPER Version 24 provides GROUPER and Diagnosis Related Group () information based on the following publications: Federal Register Vol. 71, No. 160, August 18, 2006 2007 International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) The enclosed document also provides information regarding Texas Medicaid relative weights, mean length of stay, and day thresholds, which is effective for admission dates occurring on and after October 1, 2006. Additional information concerning 2007 ICD 9-CM updates and information will be made available in the November/December 2006 edition of the Texas Medicaid Bulletin, the November 2006 edition of the Children with Special Health Care Needs (CSHCN) Bulletin, and on the Texas Medicaid & Healthcare Partnership (TMHP) website at. Please carefully review and distribute this information to the appropriate personnel at your facility. Thank you for your participation in the Texas Medicaid Program. If we can be of further assistance in this matter, you may call the TMHP Customer Service Provider Helpline, toll free, at 1-800-925-9126. Sincerely, Texas Medicaid & Healthcare Partnership
2007 ICD-9-CM GROUPER Version 24 CMS Changes Overview Each year, the Centers for Medicare & Medicaid Services (CMS) issue its changes to the hospital inpatient prospective payment system and new fiscal year rates. These changes result in new, revised, or invalid diagnosis codes, procedure codes, diagnosis related groups (s), and major diagnostic categories (MDCs), published annually in the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM). In Federal Register Vol. 71, No. 160, August 18, 2006, CMS outlined changes to the current classifications for GROUPER Version 24. The changes outlined in this document are effective for Texas Medicaid admission dates on or after October 1, 2006. New s New s involving 13 different clinical areas were identified and found to improve the CMS system s recognition of severity of illness. Twelve of the new s are medical and eight are surgical. These s are constructed through a combination of approaches used in the proposed CMS s to refine the base s such as: Subdividing existing s through the use of diagnosis codes. Subdividing s based on specific surgical procedures. Selecting cases with specific diagnosis and/or procedure codes and assigning them to a new which better accounts for their resource use and severity. MDC Affiliation MDC 1 Nervous System) 560 BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM MDC 1 Nervous System) MDC 1 Nervous System) MDC 1 Nervous System) MDC 1 561 NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS 562 SEIZURE AGE > 17 W 563 SEIZURE AGE > 17 W/O 564 HEADACHES AGE > 17
MDC Affiliation Nervous System) MDC 4 Respiratory System): Respiratory System Diagnosis With Ventilator Support MDC 4 Respiratory System): Respiratory System Diagnosis With Ventilator Support MDC 6 Digestive System) MDC 6 Digestive System) MDC 6 (Diseases and Digestive System) MDC 6 Digestive System) MDC 6 Digestive System) MDC 6 Digestive System) MDC 11 Kidney and Urinary Tract): Major 565 RESPIRATORY STSTEM DIAGNOSIS WITH VENTILATOR SUPPORT 96+ HOURS 566 RESPIRATORY STSTEM DIAGNOSIS WITH VENTILATOR SUPPORT 96< HOURS 567 STOMACH, ESOPHAGEAL & DUODENAL PROC AGE > 17 W W MAJOR GI DX 568 STOMACH, ESOPHAGEAL & DUODENAL PROC AGE > 17 W/O W MAJOR GI DX 569 SURG MAJOR SMALL & LARGE BOWEL PROCEDURES W W MAJOR GI 570 SURG MAJOR SMALL & LARGE BOWEL PROCEDURES W W/O MAJOR GI DX 571 MED MAJOR ESOPHAGEAL DISORDERS 572 MED MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS 573 SURG MAJOR BLADDER PROCEDURES
MDC Affiliation Bladder Procedures MDC 16 Blood and Blood Forming Organs and Immunological Disorders): Major Hematological and Immunological Diagnoses MDC 18 (Infections and Parasitic Diseases (Systemic or Unspecified Sites)): O.R. Procedure for Patients With Infectious and Parasitic Diseases MDC 18 (Infections and Parasitic Diseases (Systemic or Unspecified Sites)): O.R. Procedure for Patients With Infectious and Parasitic Diseases MDC 1 Nervous System) MDC 18 (Infections and Parasitic Diseases (Systemic or Unspecified Sites)): O.R. Procedure for Patients With Infectious and Parasitic Diseases MDC 18 (Infections and Parasitic Diseases (Systemic or Unspecified Sites)): 574 MED MAJOR HEMATOLOGIC/IMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS & COAGUL CMS also assigned the following new ICD-9-CM diagnosis codes to new 574: 284.01, 284.09, 288.00, 288.01, 288.02, 288.03, 288.04, and 288.09. 575 MED SEPTICEMIA W MV96+ HOURS AGE >17 576 MED SEPTICEMIA W/O MV96+ HOURS AGE >17 577 SURG CAROTID ARTERY STENT PROCEDURE 578 SURG INFECTIOUS & PARASITIC DISEASES W OR PROCEDURE 579 18 SURG POSTOPERATIVE OR POSTTRAUMATIC INFECTIONS W OR PROCEDURE
MDC Affiliation O.R. Procedure for Patients With Infectious and Parasitic Diseases Revised s The following existing s were modified to better capture differences in severity. MDC Affiliation Previous New LTC- 386 : EXTREME IMMATURITY CMS revised the s description: EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE Pre-MDC 541 : TRACHEOSTOMY WITH MECHANICAL VENTILATION 96+ HOURS OR PRINCIPAL DIAGNOSIS EXEPT FACE, MOUTH AND NECK DIAGNOSES WITH MAJOR O.R. PROCEDURE CMS revised the s description: ECMO OR TRACH W MV 96+HRS OR PDX EXC FACE, MOUTH & NECK W MAJ O.R. MDC 1 Nervous System) Implantation of Intracranial Neurostimulator System for Deep Brain Stimulation (DBS) MDC 1 Nervous System) Carotid Artery Stents 543 : CRANIOTOMY WITH IMPLANTATION OF CHEMOTHERAPEUTIC AGENT OR ACUTE COMPLEX CENTRAL NERVOUS SYSTEM PRINCIPAL DIAGNOSIS 547 : PERCUTANEOUS CARDIOVASCULAR PROCEDURE WITH AMI WITH CMS revised the s description: CRANIOTOMY W MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PDX CMS revised the s description: CORONARY BYPASS W CARDIAC CATH W MAJOR CV DX LTC- 548 : PERCUTANEOUS CARDIOVASCULAR PROCEDURE WITH AMI WITHOUT CMS revised the s description: CORONARY BYPASS W CARDIAC CATH W/O MAJOR CV DX MDC 6 Digestive System) 174 175 182 183 184 188 189 CMS created new 571 with the following ICD 9 CM diagnosis codes (removing them from s 174, 175, 182, 183, 184, 188, 189, and 190): 017.80, 017.81, 017.82, 017.83, 017.84, 017.85, 017.86, 112.84, 456.0, 456.1, 456.20, 530.4, 530.7, 530.82, 530.84,
MDC Affiliation Previous New 190 750.3, 750.4, 862.22, and 947.2. CMS also created new 572 with the following ICD 9 CM diagnosis codes (removing them from s 182, 183, 184, 188, 189, and 190): 001.0, 001.1, 001.9, 003.0, 004.0, 004.1, 004.2, 004.3, 004.8, 004.9, 005.0, 005.2, 005.3, 005.4, 005.81, 005.89, 006.0, 006.1, 006.2, 007.0, and 007.1. MDC 11 Kidney and Urinary Tract): Major Bladder Procedures MDC 16 Blood and Blood Forming Organs and Immunological Disorders): Major Hematological and Immunological Diagnoses Pre-MDC Heart Transplant or Implant of Heart Assist System: Addition of Procedure to 103 303 304 305 308 309 395 396 398 399 103 The implantation and removal of an external heart assist device in the same hospitalization was grouped to 103. CMS created new descriptions for the following s: 303 - Kidney and Ureter Procedures for Neoplasm 304 - Kidney and Ureter Procedures for Non-Neoplasm With 305 - Kidney and Ureter Procedures for Non-Neoplasm Without CMS also removed the following procedure codes from 303 305, 308, and 309 and assigned them to new 573: 57.6, 57.71, 57.79, 57.83, 57.84, 57.85, 57.86, 57.87, 57.88, and 57.89. CMS created new 574 with the following ICD 9 CM diagnosis codes (removing them from s 395, 396, 398, and 399): 279.11, 279.12, 279.13, 279.19, 279.2, 283.0, 283.10, 283.19, 283.2, 2839, 284.8, 284.9, 288.1, 288.2, and 996.85. CMS also assigned the following new ICD-9-CM diagnosis codes to new 574: 284.01, 284.09, 288.00, 288.01, 288.02, 288.03, 288.04, and 288.09. CMS has reconfigured 103 in the following manner: Those patients who have both the replacement of an external heart assist system (code 37.63) and the explanation of that system (code 37.64) prior to the hospital discharge will be assigned to 103.
MDC Affiliation Previous New Pre-MDC Pancreas Transplants 513 The following ICD-9-CM diagnosis codes are currently required as a principal or secondary diagnosis for 513: 403.11, 403.91, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 585.1, 585.2, 585.3, 585.4, 585.5, 585.6, 585.9, V42.0, and V43.89. Texas Medicaid & Healthcare Partnership CMS has modified the logic for principal and secondary diagnosis designations for 513. Therefore, the following ICD-9-CM diagnosis codes will no longer be required as a principal or secondary diagnosis for 513: 403.11, 403.91, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 585.1, 585.2, 585.3, 585.4, 585.5, 585.6, 585.9, V42.0, and V43.89. MDC 5 Circulatory System) Insertion of Epicardial Leads for Defibrillator Devices 515 535 536 CMS has added the following combinations of device and lead procedure codes to s 515, 535, and 536: code 37.74 and code 00.54; code 37.74 and code 37.96; and code 37.74 and code 37.98. Other Issues: Chronic Kidney Disease 315 316 331 333 The following ICD-9-CM diagnosis codes were being classified to s 331, 332, and 333 in MDC 11 (Diseases and Kidney and Urinary Tract): 403.00, 403.90, and 403.10. The three ICD-9-CM diagnosis codes (403.00, 403.90, and 403.10) were modified to include the concept of chronic kidney disease. As such, CMS assigned these ICD-9-CM diagnosis codes to 315 (Other Kidney and Urinary Tract Procedures) and 316 (Renal Failure), and not to s 331 through 333. Discontinued s 8 existing s were deleted based on the additions and modifications to s. MDC Affiliation New MDC 1 Disorders of the Nervous System) 020 NERVOUS SYSTEM INFECTION EXCEPT VIRAL MENINGITIS 560 (new) 561 (new) MDC 1 Disorders of the Nervous System) MDC 1 Disorders of the Nervous System) MDC 6 Disorders of the Digestive System) 024 SEIZURE & HEADACHE AGE >17 W 025 SEIZURE & HEADACHE AGE >17 W/O 148 MAJOR SMALL & LARGE BOWEL PROCEDURES W 562 (new) 563 (new) 564 (new) 569 (new) 570 (new)
MDC Affiliation New MDC 6 Disorders of the Digestive System) 154 STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES AGE >17 W Texas Medicaid & Healthcare Partnership 567 (new) 568 (new) MDC 18 (Infections and Parasitic Diseases (Systemic or Unspecified Sites)): O.R. Procedure for Patients With Infectious and Parasitic Diseases 415 O.R. PROCEDURE FOR INFECTIOUS & PARASITIC DISEASES 578 (new) 579 (new) MDC 18 (Infections and Parasitic Diseases (Systemic or Unspecified Sites)): O.R. Procedure for Patients With Infectious and Parasitic Diseases Infectious and Parasitic Diseases 416 SEPTICEMIA AGE >17 575 (new) 576 (new) MDC 4 Disorders of the Respiratory System): Respiratory System Diagnosis With Ventilator Support 475 RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT 565 (new) 566 (new)
MDC Changes In addition, due to the 8 deleted s and 20 new s, CMS has reordered the following s in MDC 1 disorders of the Nervous System), MDC 6 Digestive System), MDC 11 Kidney and urinary Tract), and MDC 18 (Infectious and Parasitic Diseases (Systemic or Unspecified Sites)): In MDC 1, CMS has reordered 577 (Carotid Artery Stent Procedure) above 533 (Extracranial Procedures With ). In MDC 6, CMS has reordered s 567 and 568 (Stomach, Esophageal and Duodenal Procedures Age >17 With With and Without Major GI Diagnoses, respectively) above 155 (Stomach, Esophageal and Duodenal Procedures Age >17 Without ). In MDC 6, CMS has reordered s 569-570 (Major Small and Large Bowel Procedures With With and Without Major GI Diagnoses, respectively) above 149 (Major Small and Large Bowel Procedures Without ). In MDC 11, CMS has reordered 573 (Major Bladder Procedures) above 303 (Kidney, Ureter and Major Bladder Procedures for Neoplasm). In MDC 18, CMS has reordered 578 (Infections and Parasite DiseasesWith O.R. Procedure) above 579 (Postoperative or Post-Traumatic Infections With O.R. Procedure). Additional CMS Reclassification for GROUPER Version 24 More information regarding the final rules of CMS reclassifications can be found in Federal Register Vol. 71, No. 160, August 18, 2006.
Texas Medicaid Information The following information is effective for Texas Medicaid inpatient admissions with date of service October 1, 2006 and after. 001 CRANIOTOMY AGE >17 W 5.3073 12.5 32 002 CRANIOTOMY AGE > 17 W/O 6.2418 16 47 003 CRANIOTOMY AGE 0-17 4.5742 9.3 25 004 INVALID 0 0 0 005 INVALID 0 0 0 006 CARPAL TUNNEL RELEASE 0.8242 2.9 9 007 PERIPH & CRANIAL NERVE & OTHER NERV SYST 3.4299 10.1 21 PROC W 008 PERIPH & CRANIAL NERVE & OTHER NERV SYST 2.232 3 6 PROC W/O 009 SPINAL DISORDERS & INJURIES 3.062 11.5 29 010 NERVOUS SYSTEM NEOPLASMS W 1.6293 6.7 15 011 NERVOUS SYSTEM NEOPLASMS W/O 1.3703 4.4 10 012 DEGENERATIVE NERVOUS SYSTEM DISORDERS 1.8212 7.8 19 013 MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA 1.7161 6.5 14 014 INTRACRANIAL HEMORRHAGE OR CEREBRAL 2.3415 8.6 21 INFARCTION 015 NONSPECIFIC CVA & PRECEREBRAL 1.2488 3.9 7 OLUSION W/O INFARCT 016 NONSPECIFIC CEREBROVASCULAR DISORDERS 1.8572 6.8 14 W 017 NONSPECIFIC CEREBROVASCULAR DISORDERS 1.2566 3.7 7 W/O 018 CRANIAL & PERIPHERAL NERVE DISORDERS W 1.3586 5.7 12 019 CRANIAL & PERIPHERAL NERVE DISORDERS 0.9833 4.5 9 W/O 020 INVALID 0 0 0 021 VIRAL MENINGITIS 0.8762 3.9 8 022 HYPERTENSIVE ENCEPHALOPATHY 2.6814 7 14 023 NONTRAUMATIC STUPOR & COMA 0.9259 3 6 024 INVALID 0 0 0 025 INVALID 0 0 0 026 SEIZURE & HEADACHE AGE 0-17 0.8074 2.9 5 027 TRAUMATIC STUPOR & COMA, COMA >1 HR 2.6093 7.7 21 028 TRAUMATIC STUPOR & COMA, COMA <1 HR AGE 2.9764 8.1 19 >17 W 029 TRAUMATIC STUPOR & COMA, COMA <1 HR AGE 1.4844 4.9 10 >17 W/O 030 TRAUMATIC STUPOR & COMA, COMA <1 HR AGE 0.8845 3 5 0-17 031 CONCUSSION AGE >17 W 1.11 3 6
032 CONCUSSION AGE >17 W/O 0.8384 2.1 3 033 CONCUSSION AGE 0-17 0.7897 2.1 4 034 OTHER DISORDERS OF NERVOUS SYSTEM W 1.6711 6.2 14 035 OTHER DISORDERS OF NERVOUS SYSTEM W/O 1.098 4.2 8 036 RETINAL PROCEDURES 3.0596 6.3 6 037 ORBITAL PROCEDURES 2.0738 4.4 10 038 PRIMARY IRIS PROCEDURES 0.5418 2.5 7 039 LENS PROCEDURES WITH OR WITHOUT 0.5936 1.9 6 VITRECTOMY 040 EXTRAOCULAR PROCEDURES EXCEPT ORBIT 0.8756 3.6 11 AGE >17 041 EXTRAOCULAR PROCEDURES EXCEPT ORBIT 1.1113 3.4 7 AGE 0-17 042 INTRAOCULAR PROCEDURES EXCEPT RETINA, 1.7855 3.7 8 IRIS & LENS 043 HYPHEMA 0.4992 3 8 044 ACUTE MAJOR EYE INFECTIONS 0.6173 3.4 6 045 NEUROLOGICAL EYE DISORDERS 1.0116 4 7 046 OTHER DISORDERS OF THE EYE AGE >17 W 1.182 5.9 13 047 OTHER DISORDERS OF THE EYE AGE >17 W/O 1.1416 5 14 048 OTHER DISORDERS OF THE EYE AGE 0-17 0.5378 3.1 6 049 MAJOR HEAD & NECK PROCEDURES 2.8076 5.1 11 050 SIALOADENECTOMY 0.8332 1.8 5 051 SALIVARY GLAND PROCEDURES EXCEPT 0.9461 3.1 12 SIALOADENECTOMY 052 CLEFT LIP & PALATE REPAIR 1.0455 2.4 4 053 SINUS & MASTOID PROCEDURES AGE >17 2.4647 5.5 11 054 SINUS & MASTOID PROCEDURES AGE 0-17 0.4795 3.2 8 055 MISCELLANEOUS EAR, NOSE, MOUTH & THROAT 1.8047 4 8 PROCEDURES 056 RHINOPLASTY 0.9666 3 11 057 T&A PROC, EXCEPT TONSILLECTOMY &/OR 1.0936 2.8 6 ADENOIDECTOMY ONLY, AGE >17 058 T&A PROC, EXCEPT TONSILLECTOMY &/OR 1.6783 4.1 6 ADENOIDECTOMY ONLY, AGE 0-17 059 TONSILLECTOMY &/OR ADENOIDECTOMY ONLY, 0.7528 2.6 9 AGE >17 060 TONSILLECTOMY &/OR ADENOIDECTOMY ONLY, 1.2004 3.2 8 AGE 0-17 061 MYRINGOTOMY W TUBE INSERTION AGE >17 1.3065 4.8 16 062 MYRINGOTOMY W TUBE INSERTION AGE 0-17 1.4789 5.3 8 063 OTHER EAR, NOSE, MOUTH & THROAT O.R. 1.8197 3.6 8 PROCEDURES 064 EAR, NOSE, MOUTH & THROAT MALIGNANCY 1.5916 6.3 13
065 DYSEQUILIBRIUM 0.8139 3.1 6 066 EPISTAXIS 0.7878 2.4 4 067 EPIGLOTTITIS 0.8475 3.1 6 068 OTITIS MEDIA & URI AGE >17 W 1.0056 3.9 7 069 OTITIS MEDIA & URI AGE >17 W/O 0.5924 2.6 4 070 OTITIS MEDIA & URI AGE 0-17 0.5602 2.7 4 071 LARYNGOTRACHEITIS 0.6066 2.2 3 072 NASAL TRAUMA & DEFORMITY 0.7185 3.6 11 073 OTHER EAR, NOSE, MOUTH & THROAT 1.1827 4.5 8 DIAGNOSES AGE >17 074 OTHER EAR, NOSE, MOUTH & THROAT 0.7289 3.2 6 DIAGNOSES AGE 0-17 075 MAJOR CHEST PROCEDURES 5.4443 12.8 29 076 OTHER RESP SYSTEM O.R. PROCEDURES W 4.2938 12.8 28 077 OTHER RESP SYSTEM O.R. PROCEDURES W/O 2.1854 6 16 078 PULMONARY EMBOLISM 2.328 8.2 15 079 RESPIRATORY INFECTIONS & INFLAMMATIONS 2.8522 9.4 20 AGE >17 W 080 RESPIRATORY INFECTIONS & INFLAMMATIONS 2.1154 12.4 44 AGE >17 W/O 081 RESPIRATORY INFECTIONS & INFLAMMATIONS 2.0411 6.4 15 AGE 0-17 082 RESPIRATORY NEOPLASMS 2.4059 8 18 083 MAJOR CHEST TRAUMA W 1.6245 5.7 12 084 MAJOR CHEST TRAUMA W/O 0.5125 3.2 8 085 PLEURAL EFFUSION W 1.857 6.5 14 086 PLEURAL EFFUSION W/O 1.2787 5 11 087 PULMONARY EDEMA & RESPIRATORY FAILURE 2.0037 6.4 14 088 CHRONIC OBSTRUCTIVE PULMONARY DISEASE 1.2716 4.4 8 089 SIMPLE PNEUMONIA & PLEURISY AGE >17 W 1.6013 5.4 11 090 SIMPLE PNEUMONIA & PLEURISY AGE >17 W/O 0.988 3.7 7 091 SIMPLE PNEUMONIA & PLEURISY AGE 0-17 0.8851 3.4 6 092 INTERSTITIAL LUNG DISEASE W 1.8866 6.6 13 093 INTERSTITIAL LUNG DISEASE W/O 1.0224 4.1 9 094 PNEUMOTHORAX W 1.7433 6.2 13 095 PNEUMOTHORAX W/O 0.921 3.8 7 096 BRONCHITIS & ASTHMA AGE >17 W 1.0781 3.9 7 097 BRONCHITIS & ASTHMA AGE >17 W/O 0.8417 3.1 6 098 BRONCHITIS & ASTHMA AGE 0-17 0.8197 3.1 5 099 RESPIRATORY SIGNS & SYMPTOMS W 1.4518 4.2 10 100 RESPIRATORY SIGNS & SYMPTOMS W/O 0.7217 2.6 5 101 OTHER RESPIRATORY SYSTEM DIAGNOSES W 1.4436 4.7 10
102 OTHER RESPIRATORY SYSTEM DIAGNOSES 0.8882 2.8 6 W/O 103 HEART TRANSPLANT OR IMPLANT OF HEART 20.5419 52.1 181 ASSIST SYSTEM 104 CARDIAC VALVE & OTH MAJ CARDIOTHORACIC 9.5438 14.1 31 PROC W CARD CATH 105 CARDIAC VALVE & OTH MAJ CARDIOTHORACIC 7.9631 13.9 37 PROC W/O CARD CATH 106 CORONARY BYPASS WITH PTCA 8.3561 10.6 14 107 INVALID 0 0 0 108 OTHER CARDIOTHORACIC PROCEDURES 7.7759 11 25 109 INVALID 0 0 0 110 MAJOR CARDIOVASCULAR PROCEDURES W 6.7744 12.1 29 111 MAJOR CARDIOVASCULAR PROCEDURES W/O 2.9281 4.7 9 112 INVALID 0 0 0 113 AMPUTATION FOR CIRC SYSTEM DISORDERS 4.0701 14.6 32 EXCEPT UPPER LIMB & TOE 114 UPPER LIMB & TOE AMPUTATION FOR CIRC 2.1184 7.8 15 SYSTEM DISORDERS 115 INVALID 0 0 0 116 INVALID 0 0 0 117 CARDIAC PACEMAKER REVISION EXCEPT 1.3345 4.2 15 DEVICE REPLACEMENT 118 CARDIAC PACEMAKER DEVICE REPLACEMENT 1.5689 2.9 10 119 VEIN LIGATION & STRIPPING 1.6581 4.4 11 120 OTHER CIRCULATORY SYSTEM O.R. 2.4928 7.5 19 PROCEDURES 121 CIRCULATORY DISORDERS W AMI & MAJOR 2.6173 6.5 13 COMP DISCH ALIVE 122 CIRCULATORY DISORDERS W AMI W/O MAJOR 1.7721 3.8 7 COMP DISCH ALIVE 123 CIRCULATORY DISORDERS W AMI, EXPIRED 3.0043 3.7 10 124 CIRCULATORY DISORDERS EXCEPT AMI, W 2.18 5 11 CARD CATH & COMPLEX DIAG 125 CIRCULATORY DISORDERS EXCEPT AMI, W 1.7429 3.4 6 CARD CATH W/O COMPLEX DIAG 126 ACUTE & SUBACUTE ENDOCARDITIS 4.7004 17.4 40 127 HEART FAILURE & SHOCK 1.5713 5.2 11 128 DEEP VEIN THROMBOPHLEBITIS 1.1072 5.9 11 129 CARDIAC ARREST, UNEXPLAINED 2.8094 3.6 7 130 PERIPHERAL VASCULAR DISORDERS W 1.6675 6.6 13 131 PERIPHERAL VASCULAR DISORDERS W/O 1.0261 4.7 9 132 ATHEROSCLEROSIS W 1.062 3.2 6 133 ATHEROSCLEROSIS W/O 1.1019 3 6 134 HYPERTENSION 1.0126 3.3 6 135 CARDIAC CONGENITAL & VALVULAR 1.4123 5.2 11
DISORDERS AGE >17 W 136 CARDIAC CONGENITAL & VALVULAR 0.5711 2.6 6 DISORDERS AGE >17 W/O 137 CARDIAC CONGENITAL & VALVULAR 1.2242 4.5 11 DISORDERS AGE 0-17 138 CARDIAC ARRHYTHMIA & CONDUCTION 1.2935 4.1 8 DISORDERS W 139 CARDIAC ARRHYTHMIA & CONDUCTION 0.8477 2.7 5 DISORDERS W/O 140 ANGINA PECTORIS 0.9347 2.6 5 141 SYNCOPE & COLLAPSE W 0.9663 3.3 6 142 SYNCOPE & COLLAPSE W/O 0.7992 2.4 4 143 CHEST PAIN 0.8894 2.4 4 144 OTHER CIRCULATORY SYSTEM DIAGNOSES W 1.8756 6.1 13 145 OTHER CIRCULATORY SYSTEM DIAGNOSES 1.1231 4 8 W/O 146 RECTAL RESECTION W 4.4163 10.9 23 147 RECTAL RESECTION W/O 2.5824 6.9 14 148 INVALID 0 0 0 149 MAJOR SMALL & LARGE BOWEL PROCEDURES 2.5244 7 11 W/O 150 PERITONEAL ADHESIOLYSIS W 3.5308 9.9 17 151 PERITONEAL ADHESIOLYSIS W/O 1.6093 4.4 9 152 MINOR SMALL & LARGE BOWEL PROCEDURES 2.8745 11.2 18 W 153 MINOR SMALL & LARGE BOWEL PROCEDURES 1.3876 4.9 8 W/O 154 INVALID 0 0 0 155 STOMACH, ESOPHAGEAL & DUODENAL 1.7095 3.9 8 PROCEDURES AGE >17 W/O 156 STOMACH, ESOPHAGEAL & DUODENAL 2.2146 6.7 19 PROCEDURES AGE 0-17 157 ANAL & STOMAL PROCEDURES W 2.0523 5.8 13 158 ANAL & STOMAL PROCEDURES W/O 1.0002 3.3 6 159 HERNIA PROCEDURES EXCEPT INGUINAL & 2.1483 6.2 12 FEMORAL AGE >17 W 160 HERNIA PROCEDURES EXCEPT INGUINAL & 1.2358 3.2 6 FEMORAL AGE >17 W/O 161 INGUINAL & FEMORAL HERNIA PROCEDURES 1.439 4.2 9 AGE >17 W 162 INGUINAL & FEMORAL HERNIA PROCEDURES 1.0827 2.4 4 AGE >17 W/O 163 HERNIA PROCEDURES AGE 0-17 1.3033 3.9 9 164 APPENDECTOMY W COMPLICATED PRINCIPAL 2.7469 8 15 DIAG W 165 APPENDECTOMY W COMPLICATED PRINCIPAL 1.652 5 9 DIAG W/O 166 APPENDECTOMY W/O COMPLICATED PRINCIPAL 1.5611 3.8 7
DIAG W 167 APPENDECTOMY W/O COMPLICATED PRINCIPAL 1.0973 2.4 4 DIAG W/O 168 MOUTH PROCEDURES W 2.6981 6.4 13 169 MOUTH PROCEDURES W/O 1.0896 2.9 5 170 OTHER DIGESTIVE SYSTEM O.R. PROCEDURES 4.0098 11.4 26 W 171 OTHER DIGESTIVE SYSTEM O.R. PROCEDURES 1.7508 4.5 10 W/O 172 DIGESTIVE MALIGNANCY W 1.9476 7.6 17 173 DIGESTIVE MALIGNANCY W/O 1.0469 4.2 8 174 G.I. HEMORRHAGE W 1.4913 4.4 9 175 G.I. HEMORRHAGE W/O 0.8016 2.9 5 176 COMPLICATED PEPTIC ULCER 1.5016 5.1 12 177 UNCOMPLICATED PEPTIC ULCER W 1.1708 4.7 9 178 UNCOMPLICATED PEPTIC ULCER W/O 0.8715 3.4 6 179 INFLAMMATORY BOWEL DISEASE 1.8071 6.5 13 180 G.I. OBSTRUCTION W 1.3314 5.2 11 181 G.I. OBSTRUCTION W/O 0.7042 3.2 6 182 ESOPHAGITIS, GASTROENT & MISC DIGEST 1.0865 3.9 8 DISORDERS AGE >17 W 183 ESOPHAGITIS, GASTROENT & MISC DIGEST 0.8792 3.1 6 DISORDERS AGE >17 W/O 184 ESOPHAGITIS, GASTROENT & MISC DIGEST 0.5187 2.7 5 DISORDERS AGE 0-17 185 DENTAL & ORAL DIS EXCEPT EXTRACTIONS & 1.1356 3.9 7 RESTORATIONS, AGE >17 186 DENTAL & ORAL DIS EXCEPT EXTRACTIONS & 0.6221 2.9 4 RESTORATIONS, AGE 0-17 187 DENTAL EXTRACTIONS & RESTORATIONS 1.2079 3 7 188 OTHER DIGESTIVE SYSTEM DIAGNOSES AGE 1.6444 6 13 >17 W 189 OTHER DIGESTIVE SYSTEM DIAGNOSES AGE 0.9174 3.2 6 >17 W/O 190 OTHER DIGESTIVE SYSTEM DIAGNOSES AGE 0-0.9512 3.6 8 17 191 PANCREAS, LIVER & SHUNT PROCEDURES W 5.8002 14.7 35 192 PANCREAS, LIVER & SHUNT PROCEDURES W/O 2.1393 6.1 14 193 BILIARY TRACT PROC EXCEPT ONLY 4.8126 13.2 27 CHOLECYST W OR W/O C.D.E. W 194 BILIARY TRACT PROC EXCEPT ONLY 3.0278 7.8 17 CHOLECYST W OR W/O C.D.E. W/O 195 CHOLECYSTECTOMY W C.D.E. W 3.006 7.3 14 196 CHOLECYSTECTOMY W C.D.E. W/O 2.0389 5 9 197 CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W 3.0108 7.9 16
198 CHOLECYSTECTOMY EXCEPT BY 1.5853 3.9 7 LAPAROSCOPE W/O C.D.E. W/O 199 HEPATOBILIARY DIAGNOSTIC PROCEDURE FOR 3.7517 14.8 29 MALIGNANCY 200 HEPATOBILIARY DIAGNOSTIC PROCEDURE FOR 4.2861 9.9 26 NON-MALIGNANCY 201 OTHER HEPATOBILIARY OR PANCREAS O.R. 5.2649 17.1 43 PROCEDURES 202 CIRRHOSIS & ALCOHOLIC HEPATITIS 1.8835 6 13 203 MALIGNANCY OF HEPATOBILIARY SYSTEM OR 1.9428 7.1 15 PANCREAS 204 DISORDERS OF PANCREAS EXCEPT 1.5924 5.6 11 MALIGNANCY 205 DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC 1.6049 5.6 12 HEPA W 206 DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC 0.9622 3.6 7 HEPA W/O 207 DISORDERS OF THE BILIARY TRACT W 1.5043 5.4 12 208 DISORDERS OF THE BILIARY TRACT W/O 0.8795 2.8 5 209 INVALID 0 0 0 210 HIP & FEMUR PROCEDURES EXCEPT MAJOR 3.2537 10 22 JOINT AGE >17 W 211 HIP & FEMUR PROCEDURES EXCEPT MAJOR 2.0012 4.8 9 JOINT AGE >17 W/O 212 HIP & FEMUR PROCEDURES EXCEPT MAJOR 1.8203 4.8 9 JOINT AGE 0-17 213 AMPUTATION FOR MUSCULOSKELETAL SYSTEM 2.8516 10.4 23 & CONN TISSUE DISORDERS 214 INVALID 0 0 0 215 INVALID 0 0 0 216 BIOPSIES OF MUSCULOSKELETAL SYSTEM & 2.9571 12.4 32 CONNECTIVE TISSUE 217 WND DEBRID & SKN GRFT EXCEPT HAND,FOR 4.5921 15.1 40 MUSCSKELET & CONN TISS DIS 218 LOWER EXTREM & HUMER PROC EXCEPT 2.5859 7 16 HIP,FOOT,FEMUR AGE >17 W 219 LOWER EXTREM & HUMER PROC EXCEPT 1.6097 3.6 7 HIP,FOOT,FEMUR AGE >17 W/O 220 LOWER EXTREM & HUMER PROC EXCEPT 1.125 2.5 4 HIP,FOOT,FEMUR AGE 0-17 221 INVALID 0 0 0 222 INVALID 0 0 0 223 MAJOR SHOULDER/ELBOW PROC, OR OTHER 1.6738 4.6 10 UPPER EXTREMITY PROC W 224 SHOULDER,ELBOW OR FOREARM PROC,EXC 1.2095 2.6 5 MAJOR JOINT PROC, W/O 225 FOOT PROCEDURES 1.5857 5 10 226 SOFT TISSUE PROCEDURES W 2.401 9.1 24 227 SOFT TISSUE PROCEDURES W/O 1.3755 3.2 6
228 MAJOR THUMB OR JOINT PROC,OR OTH HAND 1.9358 5.3 13 OR WRIST PROC W 229 HAND OR WRIST PROC, EXCEPT MAJOR JOINT 1.2447 2.6 5 PROC, W/O 230 LOCAL EXCISION & REMOVAL OF INT FIX 2.1327 5.4 14 DEVICES OF HIP & FEMUR 231 INVALID 0 0 0 232 ARTHROSCOPY 1.0011 2.7 11 233 OTHER MUSCULOSKELET SYS & CONN TISS 3.6606 9.4 21 O.R. PROC W 234 OTHER MUSCULOSKELET SYS & CONN TISS 2.1206 3.8 9 O.R. PROC W/O 235 FRACTURES OF FEMUR 1.0809 5.6 15 236 FRACTURES OF HIP & PELVIS 1.5564 6.8 14 237 SPRAINS, STRAINS, & DISLOCATIONS OF HIP, 1.3572 4.7 11 PELVIS & THIGH 238 OSTEOMYELITIS 1.5192 7.8 15 239 PATHOLOGICAL FRACTURES & 2.0774 7.2 15 MUSCULOSKELETAL & CONN TISS MALIGNANCY 240 CONNECTIVE TISSUE DISORDERS W 2.3655 7.6 17 241 CONNECTIVE TISSUE DISORDERS W/O 1.0545 4.2 9 242 SEPTIC ARTHRITIS 1.1153 5.3 11 243 MEDICAL BACK PROBLEMS 1.0255 4.7 9 244 BONE DISEASES & SPECIFIC ARTHROPATHIES 1.3297 5.7 13 W 245 BONE DISEASES & SPECIFIC ARTHROPATHIES 0.981 4.8 8 W/O 246 NON-SPECIFIC ARTHROPATHIES 0.922 4.1 10 247 SIGNS & SYMPTOMS OF MUSCULOSKELETAL 1.1225 4.1 9 SYSTEM & CONN TISSUE 248 TENDONITIS, MYOSITIS & BURSITIS 1.1219 4 8 249 AFTERCARE, MUSCULOSKELETAL SYSTEM & 0.9558 4.9 10 CONNECTIVE TISSUE 250 FX, SPRN, STRN & DISL OF FOREARM, HAND, 0.9912 3.6 6 FOOT AGE >17 W 251 FX, SPRN, STRN & DISL OF FOREARM, HAND, 0.658 2.4 4 FOOT AGE >17 W/O 252 FX, SPRN, STRN & DISL OF FOREARM, HAND, 0.5616 1.5 2 FOOT AGE 0-17 253 FX, SPRN, STRN & DISL OF UPARM,LOWLEG EX 1.6174 5.4 12 FOOT AGE >17 W 254 FX, SPRN, STRN & DISL OF UPARM,LOWLEG EX 0.6506 2.7 5 FOOT AGE >17 W/O 255 FX, SPRN, STRN & DISL OF UPARM,LOWLEG EX 0.7091 2.4 4 FOOT AGE 0-17 256 OTHER MUSCULOSKELETAL SYSTEM & 1.1745 5.2 10 CONNECTIVE TISSUE DIAGNOSES 257 TOTAL MASTECTOMY FOR MALIGNANCY W 1.6369 3.3 6 258 TOTAL MASTECTOMY FOR MALIGNANCY W/O 1.235 2.5 5
259 SUBTOTAL MASTECTOMY FOR MALIGNANCY W 2.8569 8.3 14 260 SUBTOTAL MASTECTOMY FOR MALIGNANCY 1.2873 3 10 W/O 261 BREAST PROC FOR NON-MALIGNANCY EXCEPT 1.5282 2.5 6 BIOPSY & LOCAL EXCISION 262 BREAST BIOPSY & LOCAL EXCISION FOR NON- 1.4536 4.5 11 MALIGNANCY 263 SKIN GRAFT &/OR DEBRID FOR SKN ULCER OR 3.1373 14.4 35 CELLULITIS W 264 SKIN GRAFT &/OR DEBRID FOR SKN ULCER OR 1.745 7.2 15 CELLULITIS W/O 265 SKIN GRAFT &/OR DEBRID EXCEPT FOR SKIN 2.9963 7.7 16 ULCER OR CELLULITIS W 266 SKIN GRAFT &/OR DEBRID EXCEPT FOR SKIN 1.3122 4.3 10 ULCER OR CELLULITIS W/O 267 PERIANAL & PILONIDAL PROCEDURES 0.8652 2.5 4 268 SKIN, SUBCUTANEOUS TISSUE & BREAST 1.1026 3.6 13 PLASTIC PROCEDURES 269 OTHER SKIN, SUBCUT TISS & BREAST PROC W 2.2081 7.7 16 270 OTHER SKIN, SUBCUT TISS & BREAST PROC 1.4502 4.3 9 W/O 271 SKIN ULCERS 1.475 8.1 19 272 MAJOR SKIN DISORDERS W 1.4956 5.9 12 273 MAJOR SKIN DISORDERS W/O 0.6882 4.4 10 274 MALIGNANT BREAST DISORDERS W 2.2675 9.6 26 275 MALIGNANT BREAST DISORDERS W/O 0.5526 3 9 276 NON-MALIGANT BREAST DISORDERS 1.0148 4.5 10 277 CELLULITIS AGE >17 W 1.2475 5.5 11 278 CELLULITIS AGE >17 W/O 0.8505 4.1 7 279 CELLULITIS AGE 0-17 0.69 3.5 6 280 TRAUMA TO THE SKIN, SUBCUT TISS & BREAST 1.4951 4.8 12 AGE >17 W 281 TRAUMA TO THE SKIN, SUBCUT TISS & BREAST 0.9126 2.4 4 AGE >17 W/O 282 TRAUMA TO THE SKIN, SUBCUT TISS & BREAST 0.7465 2.2 4 AGE 0-17 283 MINOR SKIN DISORDERS W 0.9547 4 8 284 MINOR SKIN DISORDERS W/O 0.6298 3 5 285 AMPUTAT OF LOWER LIMB FOR 2.8826 10.7 23 ENDOCRINE,NUTRIT,& METABOL DISORDERS 286 ADRENAL & PITUITARY PROCEDURES 3.5732 7.9 16 287 SKIN GRAFTS & WOUND DEBRID FOR ENDOC, 2.5581 9.6 18 NUTRIT & METAB DISORDERS 288 O.R. PROCEDURES FOR OBESITY 2.2239 5.4 19 289 PARATHYROID PROCEDURES 2.3396 4.7 9
290 THYROID PROCEDURES 1.3892 3 5 291 THYROGLOSSAL PROCEDURES 0.6331 1.6 4 292 OTHER ENDOCRINE, NUTRIT & METAB O.R. 3.8619 12.9 23 PROC W 293 OTHER ENDOCRINE, NUTRIT & METAB O.R. 1.3164 5.1 16 PROC W/O 294 DIABETES AGE >35 1.0789 4.3 9 295 DIABETES AGE 0-35 0.9056 3.3 6 296 NUTRITIONAL & MISC METABOLIC DISORDERS 1.2124 4.8 11 AGE >17 W 297 NUTRITIONAL & MISC METABOLIC DISORDERS 0.7951 3.1 5 AGE >17 W/O 298 NUTRITIONAL & MISC METABOLIC DISORDERS 0.4949 2.8 5 AGE 0-17 299 INBORN ERRORS OF METABOLISM 1.3388 5 11 300 ENDOCRINE DISORDERS W 1.5578 5.4 12 301 ENDOCRINE DISORDERS W/O 0.826 3.3 7 302 KIDNEY TRANSPLANT 9.8867 11.2 23 303 KIDNEY,URETER & MAJOR BLADDER 3.5008 9.6 18 PROCEDURES FOR NEOPLASM 304 KIDNEY,URETER & MAJOR BLADDER PROC FOR 3.4101 8.4 19 NON-NEOPL W 305 KIDNEY,URETER & MAJOR BLADDER PROC FOR 1.5794 4.3 8 NON-NEOPL W/O 306 PROSTATECTOMY W 1.2709 5.5 18 307 PROSTATECTOMY W/O 0.6323 2.2 7 308 MINOR BLADDER PROCEDURES W 2.3222 11.2 22 309 MINOR BLADDER PROCEDURES W/O 1.0711 2.9 5 310 TRANSURETHRAL PROCEDURES W 1.7566 5.2 10 311 TRANSURETHRAL PROCEDURES W/O 1.0997 2.2 4 312 URETHRAL PROCEDURES, AGE >17 W 1.0623 4.5 14 313 URETHRAL PROCEDURES, AGE >17 W/O 0.6703 2.1 6 314 URETHRAL PROCEDURES, AGE 0-17 0.4921 2.3 6 315 OTHER KIDNEY & URINARY TRACT O.R. 2.9832 9.2 20 PROCEDURES 316 RENAL FAILURE 1.9421 6.2 13 317 ADMIT FOR RENAL DIALYSIS 1.028 3.2 6 318 KIDNEY & URINARY TRACT NEOPLASMS W 1.8187 5.9 11 319 KIDNEY & URINARY TRACT NEOPLASMS W/O 0.6017 2.8 8 320 KIDNEY & URINARY TRACT INFECTIONS AGE >17 W 321 KIDNEY & URINARY TRACT INFECTIONS AGE >17 W/O 322 KIDNEY & URINARY TRACT INFECTIONS AGE 0-17 323 URINARY STONES W, &/OR ESW LITHOTRIPSY 1.1873 4.7 9 0.7512 3.1 6 0.6733 3.7 6 0.9641 2.9 5
Texas Medicaid & Healthcare Partnership 324 URINARY STONES W/O 0.6458 2.1 4 325 KIDNEY & URINARY TRACT SIGNS & SYMPTOMS 0.9375 4.1 8 AGE >17 W 326 KIDNEY & URINARY TRACT SIGNS & SYMPTOMS 0.6588 2 4 AGE >17 W/O 327 KIDNEY & URINARY TRACT SIGNS & SYMPTOMS 0.6076 3.2 6 AGE 0-17 328 URETHRAL STRICTURE AGE >17 W 0.7321 3.8 10 329 URETHRAL STRICTURE AGE >17 W/O 0.4904 2.2 6 330 URETHRAL STRICTURE AGE 0-17 0.317 1.6 4 331 OTHER KIDNEY & URINARY TRACT DIAGNOSES 1.5758 5.7 12 AGE >17 W 332 OTHER KIDNEY & URINARY TRACT DIAGNOSES 0.9313 3.5 7 AGE >17 W/O 333 OTHER KIDNEY & URINARY TRACT DIAGNOSES 0.9706 4 8 AGE 0-17 334 MAJOR MALE PELVIC PROCEDURES W 3.1785 6.9 17 335 MAJOR MALE PELVIC PROCEDURES W/O 1.7075 3.7 7 336 TRANSURETHRAL PROSTATECTOMY W 1.4984 5 11 337 TRANSURETHRAL PROSTATECTOMY W/O 0.9451 2.4 4 338 TESTES PROCEDURES, FOR MALIGNANCY 1.2293 5.6 18 339 TESTES PROCEDURES, NON-MALIGNANCY AGE 2.403 7.1 11 >17 340 TESTES PROCEDURES, NON-MALIGNANCY AGE 0.8186 1.6 3 0-17 341 PENIS PROCEDURES 1.81 4.6 7 342 CIRCUMCISION AGE >17 0.7922 3.2 9 343 CIRCUMCISION AGE 0-17 0.247 1.6 3 344 OTHER MALE REPRODUCTIVE SYSTEM O.R. 1.2658 2.4 10 PROCEDURES FOR MALIGNANCY 345 OTHER MALE REPRODUCTIVE SYSTEM O.R. 1.1852 4.8 17 PROC EXCEPT FOR MALIGNANCY 346 MALIGNANCY, MALE REPRODUCTIVE SYSTEM, 1.8641 6.3 11 W 347 MALIGNANCY, MALE REPRODUCTIVE SYSTEM, 0.5649 2.7 7 W/O 348 BENIGN PROSTATIC HYPERTROPHY W 0.7106 4.2 11 349 BENIGN PROSTATIC HYPERTROPHY W/O 0.3974 2.5 7 350 INFLAMMATION OF THE MALE REPRODUCTIVE 0.9394 3.9 8 SYSTEM 351 STERILIZATION, MALE 0.2349 1.3 3 352 OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES 353 PELVIC EVISCERATION, RADICAL HYSTERECTOMY & RADICAL VULVECTOMY 354 UTERINE,ADNEXA PROC FOR NON- OVARIAN/ADNEXAL MALIG W 355 UTERINE,ADNEXA PROC FOR NON- OVARIAN/ADNEXAL MALIG W/O 1.3376 3.5 5 2.0151 5.7 9 1.9964 4.8 9 1.2091 2.8 5
356 FEMALE REPRODUCTIVE SYSTEM 1.07 2.6 4 RECONSTRUCTIVE PROCEDURES 357 UTERINE & ADNEXA PROC FOR OVARIAN OR 2.6831 7.9 18 ADNEXAL MALIGNANCY 358 UTERINE & ADNEXA PROC FOR NON- 1.5818 4.1 7 MALIGNANCY W 359 UTERINE & ADNEXA PROC FOR NON- 1.1268 2.7 4 MALIGNANCY W/O 360 VAGINA, CERVIX & VULVA PROCEDURES 1.324 4.3 8 361 LAPAROSCOPY & INCISIONAL TUBAL 1.3151 2.9 5 INTERRUPTION 362 ENDOSCOPIC TUBAL INTERRUPTION 0.3003 1.4 2 363 D&C, CONIZATION & RADIO-IMPLANT, FOR 1.4415 3.6 7 MALIGNANCY 364 D&C, CONIZATION EXCEPT FOR MALIGNANCY 1.145 3.2 6 365 OTHER FEMALE REPRODUCTIVE SYSTEM O.R. 1.595 4.5 7 PROCEDURES 366 MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM 1.7319 6.6 14 W 367 MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM 0.9789 2.8 7 W/O 368 INFECTIONS, FEMALE REPRODUCTIVE SYSTEM 0.9642 3.5 7 369 MENSTRUAL & OTHER FEMALE REPRODUCTIVE 0.6734 2.5 5 SYSTEM DISORDERS 370 CESAREAN SECTION W 1.1789 4.3 7 371 CESAREAN SECTION W/O 0.9254 3.1 4 372 VAGINAL DELIVERY W COMPLICATING 0.7581 2.9 5 DIAGNOSES 373 VAGINAL DELIVERY W/O COMPLICATING 0.5078 1.9 3 DIAGNOSES 374 VAGINAL DELIVERY W STERILIZATION &/OR D&C 0.7512 2.2 3 375 VAGINAL DELIVERY W O.R. PROC EXCEPT 1.0926 4.2 6 STERIL &/OR D&C 376 POSTPARTUM & POST ABORTION DIAGNOSES 0.7633 3 5 W/O O.R. PROCEDURE 377 POSTPARTUM & POST ABORTION DIAGNOSES 1.6136 3.8 8 W O.R. PROCEDURE 378 ECTOPIC PREGNANCY 1.1697 2.6 4 379 THREATENED ABORTION 0.6087 3.5 7 380 ABORTION W/O D&C 0.619 1.9 3 381 ABORTION W D&C, ASPIRATION CURETTAGE OR 0.7977 1.7 3 HYSTEROTOMY 382 FALSE LABOR 0.332 1.6 3 383 OTHER ANTEPARTUM DIAGNOSES W MEDICAL COMPLICATIONS 384 OTHER ANTEPARTUM DIAGNOSES W/O MEDICAL COMPLICATIONS 385 NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY 0.6367 3.3 6 0.5989 3.1 7 2.5965 5.3 18
386 EXTREME IMMATURITY OR RESPIRATORY 14.9357 30 105 DISTRESS SYNDROME, NEONATE 387 PREMATURITY W MAJOR PROBLEMS 4.1502 17.6 41 388 PREMATURITY W/O MAJOR PROBLEMS 0.8442 5.7 14 389 FULL TERM NEONATE W MAJOR PROBLEMS 1.1612 5.4 11 390 NEONATE W OTHER SIGNIFICANT PROBLEMS 0.3182 2.8 5 391 NORMAL NEWBORN 0.1204 1.8 3 392 SPLENECTOMY AGE >17 3.6499 9.5 19 393 SPLENECTOMY AGE 0-17 3.0541 5.8 11 394 OTHER O.R. PROCEDURES OF THE BLOOD AND 2.0994 7.1 16 BLOOD FORMING ORGANS 395 RED BLOOD CELL DISORDERS AGE >17 1.4205 5.5 12 396 RED BLOOD CELL DISORDERS AGE 0-17 1.1911 4.1 9 397 COAGULATION DISORDERS 1.4359 4.2 8 398 RETICULOENDOTHELIAL & IMMUNITY 2.0825 6 12 DISORDERS W 399 RETICULOENDOTHELIAL & IMMUNITY 0.771 3.6 7 DISORDERS W/O 400 INVALID 0 0 0 401 LYMPHOMA & NON-ACUTE LEUKEMIA W OTHER 4.0598 10.8 21 O.R. PROC W 402 LYMPHOMA & NON-ACUTE LEUKEMIA W OTHER 1.1248 3.9 12 O.R. PROC W/O 403 LYMPHOMA & NON-ACUTE LEUKEMIA W 2.8535 8.7 22 404 LYMPHOMA & NON-ACUTE LEUKEMIA W/O 2.3445 6.5 15 405 ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE 7.8522 13.9 43 AGE 0-17 406 MYELOPROLIF DISORD OR POORLY DIFF NEOPL 6.2428 10.7 27 W MAJ O.R.PROC W 407 MYELOPROLIF DISORD OR POORLY DIFF NEOPL 1.2905 4.1 10 W MAJ O.R.PROC W/O 408 MYELOPROLIF DISORD OR POORLY DIFF NEOPL 3.1266 9 27 W OTHER O.R.PROC 409 RADIOTHERAPY 1.1269 5.1 10 410 CHEMOTHERAPY W/O ACUTE LEUKEMIA AS 2.0048 4.3 8 SECONDARY DIAGNOSIS 411 HISTORY OF MALIGNANCY W/O ENDOSCOPY 0.3898 2.9 8 412 HISTORY OF MALIGNANCY W ENDOSCOPY 0.2792 2 5 413 OTHER MYELOPROLIF DIS OR POORLY DIFF 2.0375 7 16 NEOPL DIAG W 414 OTHER MYELOPROLIF DIS OR POORLY DIFF 0.6931 4 12 NEOPL DIAG W/O 415 INVALID 0 0 0 416 INVALID 0 0 0 417 SEPTICEMIA AGE 0-17 1.1168 4.7 9 418 POSTOPERATIVE & POST-TRAUMATIC INFECTIONS 1.2203 5.6 12
419 FEVER OF UNKNOWN ORIGIN AGE >17 W 1.0959 4.1 8 420 FEVER OF UNKNOWN ORIGIN AGE >17 W/O 0.9515 3.6 8 421 VIRAL ILLNESS AGE >17 1.2081 4.2 8 422 VIRAL ILLNESS & FEVER OF UNKNOWN ORIGIN 0.5337 2.8 4 AGE 0-17 423 OTHER INFECTIOUS & PARASITIC DISEASES 1.5045 5.9 13 DIAGNOSES 424 O.R. PROCEDURE W PRINCIPAL DIAGNOSES OF 2.318 13.6 33 MENTAL ILLNESS 425 ACUTE ADJUST REACT & PSYCHOLOGICAL 0.9036 3.4 7 DYSFUNCTION OF MENTAL ILLNESS 426 DEPRESSIVE NEUROSES 0.7353 4.5 9 427 NEUROSES EXCEPT DEPRESSIVE 0.9693 6.8 15 428 DISORDERS OF PERSONALITY & IMPULSE 1.2026 8.1 16 CONTROL 429 ORGANIC DISTURBANCES & MENTAL 1.9737 11.1 28 RETARDATION 430 PSYCHOSES 1.1351 7.5 16 431 CHILDHOOD MENTAL DISORDERS 1.346 8.2 14 432 OTHER MENTAL DISORDER DIAGNOSES 0.7046 3.5 8 433 ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT 0.4942 2.4 4 AMA 434 INVALID 0 0 0 435 INVALID 0 0 0 436 INVALID 0 0 0 437 INVALID 0 0 0 438 INVALID 0 0 0 439 SKIN GRAFTS FOR INJURIES 2.6285 9.8 21 440 WOUND DEBRIDEMENTS FOR INJURIES 2.349 8.1 17 441 HAND PROCEDURES FOR INJURIES 1.4965 3.8 8 442 OTHER O.R. PROCEDURES FOR INJURIES W 3.98 9.1 21 443 OTHER O.R. PROCEDURES FOR INJURIES W/O 1.145 3.6 7 444 TRAUMATIC INJURY AGE >17 W 0.8839 3.5 7 445 TRAUMATIC INJURY AGE >17 W/O 1.6137 4.5 9 446 TRAUMATIC INJURY AGE 0-17 0.7116 2.5 4 447 ALLERGIC REACTIONS AGE >17 1.1031 3.1 10 448 ALLERGIC REACTIONS AGE 0-17 0.7606 2.4 4 449 POISONING & TOXIC EFFECTS OF DRUGS AGE 1.3972 3.9 9 >17 W 450 POISONING & TOXIC EFFECTS OF DRUGS AGE 0.7058 2.1 4 >17 W/O 451 POISONING & TOXIC EFFECTS OF DRUGS AGE 0.7191 2.2 4 0-17 452 COMPLICATIONS OF TREATMENT W 1.4901 6.3 14 453 COMPLICATIONS OF TREATMENT W/O 0.7536 3.5 7
454 OTHER INJURY, POISONING & TOXIC EFFECT 1.9869 5 11 DIAG W 455 OTHER INJURY, POISONING & TOXIC EFFECT 0.5965 2.2 4 DIAG W/O 456 INVALID 0 0 0 457 INVALID 0 0 0 458 INVALID 0 0 0 459 INVALID 0 0 0 460 INVALID 0 0 0 461 O.R. PROC W DIAGNOSES OF OTHER CONTACT 1.3696 4.5 10 W HEALTH SERVICES 462 REHABILITATION 2.6231 16.4 34 463 SIGNS & SYMPTOMS W 1.0409 4.3 9 464 SIGNS & SYMPTOMS W/O 0.7671 2.8 5 465 AFTERCARE W HISTORY OF MALIGNANCY AS 0.6786 2.9 14 SECONDARY DIAGNOSIS 466 AFTERCARE W/O HISTORY OF MALIGNANCY AS 0.9352 3.8 10 SECONDARY DIAGNOSIS 467 OTHER FACTORS INFLUENCING HEALTH 0.5337 2.4 4 STATUS 468 EXTENSIVE O.R. PROCEDURE UNRELATED TO 4.9614 13.2 35 PRINCIPAL DIAGNOSIS 469 INVALID 0 0 0 470 INVALID 0 0 0 471 BILATERAL OR MULTIPLE MAJOR JOINT PROCS 5.0707 10 19 OF LOWER EXTREMITY 472 INVALID 0 0 0 473 ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE 5.441 13.5 33 AGE >17 474 INVALID 0 0 0 475 INVALID 0 0 0 476 PROSTATIC O.R. PROCEDURE UNRELATED TO 2.7026 17.5 21 PRINCIPAL DIAGNOSIS 477 NON-EXTENSIVE O.R. PROCEDURE UNRELATED 2.8277 8.8 21 TO PRINCIPAL DIAGNOSIS 478 INVALID 0 0 0 479 OTHER VASCULAR PROCEDURES W/O 2.1773 4.4 10 480 LIVER TRANSPLANT 22.5678 22.4 42 481 BONE MARROW TRANSPLANT 15.4614 25.7 46 482 TRACHEOSTOMY FOR FACE,MOUTH & NECK 6.4457 16.3 36 DIAGNOSES 483 INVALID 0 0 0 484 CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA 485 LIMB REATTACHMENT, HIP AND FEMUR PROC FOR MULTIPLE SIGNIFICANT TR 486 OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA 9.2762 15.4 45 6.8445 15.2 35 7.9213 15.8 39
487 OTHER MULTIPLE SIGNIFICANT TRAUMA 3.2629 8.9 20 488 HIV W EXTENSIVE O.R. PROCEDURE 6.2383 18.7 39 489 HIV W MAJOR RELATED CONDITION 2.9157 9.8 22 490 HIV W OR W/O OTHER RELATED CONDITION 1.509 5.5 11 491 MAJOR JOINT & LIMB REATTACHMENT 2.3961 4.9 6 PROCEDURES OF UPPER EXTREMITY 492 CHEMOTHERAPY W ACUTE LEUKEMIA AS 2.6658 5.8 11 SECONDARY DIAGNOSIS 493 LAPAROSCOPIC CHOLECYSTECTOMY W/O 2.2211 5.2 10 C.D.E. W 494 LAPAROSCOPIC CHOLECYSTECTOMY W/O 1.5172 2.8 5 C.D.E. W/O 495 LUNG TRANSPLANT 9.2016 17.3 41 496 COMBINED ANTERIOR/POSTERIOR SPINAL 6.2977 9.2 21 FUSION 497 SPINAL FUSION EXCEPT CERVICAL W 4.3655 7.9 20 498 SPINAL FUSION EXCEPT CERVICAL W/O 2.6679 3.2 6 499 BACK & NECK PROCS EXCEPT SPINAL FUSION 2.4795 8.7 24 W 500 BACK & NECK PROCS EXCEPT SPINAL FUSION 1.3685 3 6 W/O 501 KNEE PROC W PDX OF INFECTION W 3.6921 13.8 36 502 KNEE PROC W PDX OF INFECTION W/O 1.3864 5.6 10 503 KNEE PROCEDURES W/O PDX OF INFECTION 1.9533 4.4 9 504 EXTENSIVE BURNS OR FULL THICKNESS BURNS 17.1359 30 74 WITH MECHANICAL VENT 96+ W SKIN GRAFT 505 EXTENSIVE BURNS OR FULL THICKNESS BURNS 2.0178 3.7 14 WITH MECHANICAL VENT 96+ W/O SKIN GRAFT 506 FULL THICK BURN W SK GRAFT OR INHAL INJ W 6.9267 20.8 60 OR SIG TR 507 FULL THICK BURN W SK GRAFT OR INHAL INJ 2.4503 9.2 18 W/O OR SIG TR 508 FULL THICK BURN W/O SK GRAFT OR INHAL INJ 1.2622 6.5 15 W OR SIG TR 509 FULL THICK BURN W/O SK GRAFT OR INHAL INJ 0.8961 4.3 9 W/O OR SIG TR 510 NON-EXTENSIVE BURNS W OR SIGNIFICANT 1.4267 6.2 14 TRAUMA 511 NON-EXTENSIVE BURNS W/O OR 1.0005 5.3 10 SIGNIFICANT TRAUMA 512 SIMULTANEOUS PANCREAS/KIDNEY 5.8613 14.5 40 TRANSPLANT 513 PANCREAS TRANSPLANT 6.3271 10.8 24 514 INVALID 0 0 0 515 CARDIAC DEFIBRILLATOR IMPLANT W/O 5.0562 5.5 19 CARDIAC CATH 516 INVALID 0 0 0 517 INVALID 0 0 0 518 PERC CARDIO PROC W/O CORONARY ARTERY 1.7297 3.4 11
Texas Medicaid & Healthcare Partnership STENT OR AMI 519 CERVICAL SPINAL FUSION W 2.3551 5.2 17 520 CERVICAL SPINAL FUSION W/O 1.5389 2.1 6 521 ALCOHOL/DRUG ABUSE OR DEPENDENCE W 0.73 5.8 17 522 ALC/DRUG ABUSE OR DEPEND W/O 0.5818 9.5 23 REHABILITATION THERAPY W/O 523 ALC/DRUG ABUSE OR DEPEND W/O 0.3999 4.1 12 REHABILITATION THERAPY W/O 524 TRANSIENT ISCHEMIA 0.7238 3.4 9 525 OTHER HEART ASSIST SYSTEM IMPLANT 11.6479 16.6 62 526 INVALID 0 0 0 527 INVALID 0 0 0 528 INTRACRANIAL VASCULAR PROC W PDX 7.2205 17.5 39 HEMORRHAGE 529 VENTRICULAR SHUNT PROCEDURES W 2.2529 8.2 25 530 VENTRICULAR SHUNT PROCEDURE W/O 1.2017 3.6 10 531 SPINAL PROCEDURES W 3.0552 9.9 29 532 SPINAL PROCEDURES W/O 1.4482 4 11 533 EXTRACRANIAL PROCEDURES W 1.6678 4.1 15 534 EXTRACRANIAL PROCEDURES W/O 1.0748 2 6 535 CARDIAC DEFIB IMPLANT W CARDIAC CATH W 8.156 11 29 AMI/HF/SHOCK 536 CARDIAC DEFIB IMPLANT W CARDIAC CATH W/O 6.2775 5.8 17 AMI/HF/SHOCK 537 LOCAL EXCIS & REMOV OF INT FIX DEV EXCEPT 1.8185 7 23 HIP & FEMUR W 538 LOCAL EXCIS & REMOV OF INT FIX DEV EXCEPT 0.9919 2.9 9 HIP & FEMUR W/O 539 LYMPHOMA & LEUKEMIA W MAJOR OR 3.3846 11.2 32 PROCEDURE W 540 LYMPHOMA & LEUKEMIA W MAJOR OR 1.2891 4 11 PROCEDURE W/O 541 TRACH W MV 96+HRS OR PDX EXC MTH, FACE & 20.0414 45.9 104 NECK DX W/MAJOR OR 542 TRACH W MV 96+HRS OR PDX EXC FACE, MTH, 12.0286 34 82 & NECK DX W/O MAJOR OR 543 CRANIOTOMY W/IMPLANT OF CHEMO AGENT OR 4.4579 12.4 29 ACT COMPLEX CNS PDX 544 MAJOR JOINT REPLACEMENT OR 1.9643 4.5 10 REATTACHMENT OF LOWER EXTREMITY. 545 REVISION OF HIP OR KNEE REPLACEMENT. 2.4827 5.2 13 546 SPINAL FUSION EXC CERV WITH CURVATURE OF THE SPINE OR MALIG. 547 CORONARY BYPASS W CARDIAC CATH W MAJOR CV DX. 548 CORONARY BYPASS W CARDIAC CATH W/O MAJOR CV DX. 549 CORONARY BYPASS W/O CARDIAC CATH W MAJOR CV DX. 5.0739 8.8 23 6.1948 12.3 27 4.7198 9 18 5.098 10.3 26
550 CORONARY BYPASS W/O CARDIAC CATH W/O 3.6151 6.9 15 MAJOR CV DX. 551 PERMANENT CARDIAC PACEMAKER IMPL W MAJ 3.1007 6.4 18 CV DX OR AICD LEAD OR GNRTR. 552 OTHER PERMANENT CARDIAC PACEMAKER 2.0996 3.5 10 IMPLANT W/O MAJOR CV DX. 553 OTHER VASCULAR PROCEDURES W W 3.0957 9.7 29 MAJOR CV DX. 554 OTHER VASCULAR PROCEDURES W W/O 2.0721 5.9 18 MAJOR CV DX. 555 PERCUTANEOUS CARDIOVASCULAR PROC W 2.4315 4.7 14 MAJOR CV DX. 556 PERCUTANEOUS CARDIOVASCULAR PROC W 1.9132 2.1 6 NON-DRUG-ELUTING STENT W/O MAJ CV DX. 557 PERCUTANEOUS CARDIOVASCULAR PROC W 2.8717 4.1 12 DRUG-ELUTING STENT W MAJ CV DX. 558 PERCUTANEOUS CARDIOVASCULAR PROC W 2.2108 1.9 5 DRUG-ELUTING STENT W/O MAJ CV DX. 559 ACUTE ISCHEMIC STROKE WITH USE OF 2.2473 7.2 18 THROMBOLYTIC AGENT. 560 BACTERIAL & TUBERCULOUS INFECTIONS OF 2.9031 10.6 28 NERVOUS SYSTEM 561 NON-BACTERIAL INFECTIONS OF NERVOUS 2.2176 9.6 24 SYSTEM EXCEPT VIRAL MENINGITIS 562 SEIZURE AGE > 17 W 1.0582 4.9 14 563 SEIZURE AGE > 17 W/O 0.6432 3.2 8 564 HEADACHES AGE > 17 0.6933 3.4 10 565 RESPIRATORY STSTEM DIAGNOSIS WITH 5.2294 15.8 37 VENTILATOR SUPPORT 96+ HOURS 566 RESPIRATORY STSTEM DIAGNOSIS WITH 2.3335 7.8 21 VENTILATOR SUPPORT 96< HOURS 567 STOMACH, ESOPHAGEAL & DUODENAL PROC 5.2173 16 40 AGE > 17 W W MAJOR GI DX 568 STOMACH, ESOPHAGEAL & DUODENAL PROC 3.3635 11.5 32 AGE > 17 W/O W MAJOR GI DX 569 SURG MAJOR SMALL & LARGE BOWEL 4.3425 14.6 35 PROCEDURES W W MAJOR GI 570 SURG MAJOR SMALL & LARGE BOWEL 2.6978 10.1 25 PROCEDURES W W/O MAJOR GI DX 571 MED MAJOR ESOPHAGEAL DISORDERS 1.1126 4.8 13 572 MED MAJOR GASTROINTESTINAL DISORDERS 1.3378 7.1 18 AND PERITONEAL INFECTIONS 573 SURG MAJOR BLADDER PROCEDURES 3.3457 11.1 28 574 MED MAJOR HEMATOLOGIC/IMMUNOLOGIC 1.2698 5.7 16 DIAG EXC SICKLE CELL CRISIS & COAGUL 575 MED SEPTICEMIA W MV96+ HOURS AGE >17 5.9388 16.1 39 576 MED SEPTICEMIA W/O MV96+ HOURS AGE >17 1.5953 7.3 19 577 SURG CAROTID ARTERY STENT PROCEDURE 1.7844 2.3 9 578 SURG INFECTIOUS & PARASITIC DISEASES W OR PROCEDURE 4.8492 16.7 45
579 18 SURG POSTOPERATIVE OR POSTTRAUMATIC 2.8386 11.5 33 INFECTIONS W OR PROCEDURE 999 NON-PAYABLE INFORMATIONAL 0 0 0