dhmh 17-06.pdf · 135 cardiac congenital & valvular disorders age >17 w cc 4 136 cardiac...

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STATE OF MARYLAND PT 17-06

DHMHMaryland Department of Health and Mental Hygiene201 w. Preston Street. Baltimore, Maryland 21201Robert L. Ehrlich, Jr., Governor -Michael S. Steele, Lt. Governor -S. Anthony McCann, Secretary

MARYLAND MEDICAL ASSISTANCE PROGRAMHospital Transmittal #192

November 30, 2005

To: Hospital prov~ ~Jtv--

From: Susan Tucker, Executive DirectorOffice of Health Services

~ (.\oN' ~.-QJJ1JJr.r- \ ~.jBrian Hepburn, M.D., DirectorMental Hygiene Administration

Re: Fee-for-Service Hospital Day Limits

The purpose of this transmittal is to inform you of changes in the hospital day limits. Foradmissions on or after January 1,2006, the day limits will be adjusted from 100% of theaverage length of stay to 105% of the average length of stay by diagnosis related groups. SeeAttachment A for the new day limits.

The Health Services Cost Review Commission assisted the Department in establishing thenew day limits, which are based on the Centers for Medicare and Medicaid DRG GrouperVersion 23. The Department has submitted proposed regulations that reflect the new daylimits (COMAR 10.09.06.04) to the Administrative, Executive and Legislative ReviewCommittee. The new regulations establish an effective date of January 1, 2006.

The procedure of how day limits Will be processed by Medical Assistance will not change.The only change is that the day limits Will be higher for some diagnosis related groups.

Any questions regarding this transmittal for non-psychiatric acute care services should bedirected to Stephanie Oliver, Division Chief, at 410-767-1722. For psychiatric services,please direct questions to Susan Steinberg, Mental Hygiene Administration, 410-402-8451.

If you have specific questions for Delmarva Foundation for Medical Care, please call PegBarnaba at 410-712-7405 (email: barnabapdfmc.org). If you have questions for MAPs,please call Nancy Calvert at 410-277-0513.

attachment

Toll Free 1-877-4MD-DHMH .TTY for Disabled -Maryland Relay Service 1-800-735-2258Web Site: www.dhmh.st;ite.md.us

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ATTACHMENT A DAY LIMITS BY DIAGNOSIS RELATED GROUP(based on 105% of the average length of stay)

DIAGNOSISRELATEDGROUP DIAGNOSIS RELATED GROUP DESCRIPTIONS DAY LIMIT

1 CRANIOTOMY AGE >17 W CC 11

2 CRANIOTOMY AGE >17 W/O CC 6

""( I:> _~~_I~I::I_.&. ~t'.~~~~!-- ~~ _F3~~ -~- ~T -~~_13 -~- ~~'!- ~_'!'.s.~ -I:> _F3~g- '!!_.c.g 98. I:>~~.I~I::I_.&. ~t'.~~~~!-_~~_F3~~ _~_~T_~~_13 -~-~~'!- ~_'!'.s.~_I:>_F3~g- ,!!!~_CC 39 SPINAL DISORDERS & INJURIES 5

1-0 N-ERVOUS-SYSTEM-NEOPLASMS W CC 5

~-~ ~-~~-y~~~ -~-,!,~-~~-~-~~-q~~~~~-,!!!.C? -g-~ 312 DEGENERATIVE NERVOUS SYSTEM DISORDERS 8

13 MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA 414 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION 7

15 NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT 4

16 NONSPECIFIC CEREBROVASCULAR DISORDERS W CC 1-0

~-""( ~-q~??~_~!fl9._~~_I3_~~_F3~'!_~~-<;;-~~~-~~~~~_1? -~~-~-~{<?- .c.g 318 CRANIAL & PERIPHERAL NERVE DISORDERS W CC 4

::::::::::::~:~ 32_0. ~-~t'.Y~~~_?_,!,~-~~-~_!~£~-~~I~~--~':<_~~I:>]::;{~I3.P:~-1y1-~~~~~!~!~ 1-02_~ Ylt'.~!-_~~_~l~_':3.1T.I.s ::: 322 HYPERTENSIVE ENCEPHALOPATHY 4

23 NONTRAUMATic-STUPOR -&-C-OMA 424 SEIZU-RE -& -H-EAOAC-HEAGE-;-1-7-W -CC 42-5 SEIZU-RE -& -H-EAOAC-HEAGE- ;-1-7-wio- cc 32-i -' 62'8 --' 529 ' "3

3-1' C-ONCUSS-ION-AGE->17W -cc-"- 332 c'oNcussioN- AG- E ->1'i'wio -cc 134 o-TH-ER-ois'oRDERs- OF'NERVOUSSYSTEM-W CC 53-5 OTHER'ois'oRDERS-OF-NERVOUS SYSTEM W/O -c-c 3

'-'3'6 R'ETiNALPR'OCE- OURES 23-i ORBITAL-PRO-CEO-URES"'- 33-8 PRiM-ARY-iRis-PR-OCE-OURES 3

'3'9 LENS'PROCEO'URE-S -wiTH-oR -wiTHo'uT VITRECTOMY--- 3

4-0 EXTRAOCULAR'P'ROCEDU'RES- EXCE-PT-OR-BiT-AGE -;17""- 342 INTRAO-CULAR'PRocE'ouR'EsExcEPTRETiNA--- 24-3 HVP-HEMA """"" "" "" 5

44 ACUTE MAjoR- EYE iNFECTioNS- 44-5 N -EUROL-oGicAL-EYEOisORO'ERS 4

46 OTHER DISORDERS OF THE EYE AGE >17 W CC 347 OTHER DISORDERS OF THE EYE AGE >17 W/O CC 44-9 MAjOR-HEAO-&-N-ECi<-PROCE-OUR-ES 650 SIALOADENECTOMY 251 SALIVARY GLAND PROCEDURES EXCEPT SIALOADENECTOMY 252 CLEFT LIP & PALATE REPAIR 153 SINUS & MASTOID PROCEDURES AGE >17 855 MISCELLANEOUS EAR 456 RHINOPLASTY 2

57 T&A PROC 559 TONSILLECTOMY &IOR ADENOIDECTOMY ONLY 261 MYRINGOTOMY W TUBE INSERTION AGE >17 8

63 OTHER EAR 564 EAR 5

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65 DYSEQUILIBRIUM 3

:::::::::::::~~ :::::::::::::~68 o.Titis.MEDiA.&-URi.AGE>17.w.cc 36-9 oTiTis.MEDiA-&-URi.AGE>17.wiG-cc ' ' ' 2-

72 NASAL TRAUMA & DEFORMITY 4::::::::~~~~~?:~ ' 475 MAJOR CHEST PROCEDURES ' 1.2-

76 OTHER RESP SYSTEM O.R. PROCEDURES W CC 1077 OTHER RESP SYSTEM O.R. PROCEDURES W/O CC 47-8 pUlMONARYEMBGliS.M 679 RESPIRATORY INFECTIONS & INFLAMMATIONS AGE >17 W CC 980 RESPIRATORY INFECTIONS & INFLAMMATIONS AGE >17 W/O CC '--68.2 R.ES-piRATORY. NEOPLASMS. 683 MAJOR CHEST TRAUMA W CC 384 MAJOR CHEST TRAUMA W/O CC ' 2-

85 PLEURAL EFFUSION W CC 5-::~~~~~~~~~~~~~ 3

?_~ 1:>_l:!~~Q~-ft;.~Y.~I?~~ft;.-~--~~-~~I.~~.~9.~-,( _~~I_L.~.~~... ~~ 588 CHRONIC OBSTRUCTIVE PULMONARY DISEASE 48-9 SiMp.LE.P.NEU-MONIA'&.P.LE.URISYAG.E. ;1.iw-cc 4'-'9.0 ' 3

9-2 INTERSTITIAL' lU N. G. DISEASE -w-c'c' 69-3 I-NTERSTITIAl.lUN. G- D I-S EAsE. wiocc- 494 PNE-UMGT.HGRAX W ct 6

'-.'9.5 PNE.UMGT.HGR-;.:y:. W/O.C.C 396 BRON-CHITis.&. ASTHMA AGE -;-1- j.W.CC.. 39.i BRON-CHiTiS-&-ASTHMAAGE-; -1- i-wiD-ct. 2-9-9 R-ESpiRATORY.SIGNS. & SYMPTOMS.wcc.. 3

100 R.ES.piRATORY.SIGNS- & SYMPTOMS. WIG -cc 2-10-1- O-THER.RES.piRATORY- SYS'TE.M. DIAGN-OSE-S-W.cc.. 410.2 O-THER-RESpiRATORY- SYSTE-M- DIAGN.osE.s-wiD- cc' 2-10.3 H.EARTTRANSPLANT ORiMPLANTOF.HEART.AssisT.SYSTEM... 31104 -.'-' 1-9

10-5 1-510.6 C .oRoNARY -BYPASS -w -PTCA 1.110-8 O-THER-CAROioTHO.RACic .PRO.cED.uRE-s ' 9

110 1.0---' 11.1. 5

11.3 AMPUTATioN.FGRCiRC -SYSTEM -Diso.RDE.Rs.Ex.cEPTUPPER- liMB- &TO.E 1.1114 1-011.i CARDiAC -PACEMAKER REvisioN' EXCE.PT. DEVicE.REPLACEMENT 8118 CARDIAC PACEMAKER DEVICE REPLACEMENT 711-9 VEiN-LiGATION"& -STRip'piNG. 1.312.0 O.THER. ciRcUlATORY. SYSTE. M. G.. R~. PRocEDuRE- S 1- ()12-1- C-IRC-ULAT-ORYDI-SOR-OER-S-W -AMi "&-M-AjoR-CGMP. 6122 CIRCULATORY DISORDERS W AMI W/O MAJOR COMP 3123 CIRCULATORY DISORDERS W AMI 7124 CIRCULATORY DISORDERS EXCEPT AMI, W CARDIAC CATH & COMP DIAGNOSIS 4

:::::::~~:::1?~~ :::~:~~~~::::~126 ACUTE & SUBACUTE ENDOCARDITIS 11

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127 HEART FAILURE & SHOCK 5128 DEEP VEIN THROMBOPHLEBITIS 6129 CARDIAC ARREST 4'--13-0 PERIPH-ERAL VASCULAR-DisORDERs-w- cc '-- 5

131 PERIPHERAL VASCULAR DISORDERS WIO CC '--3132 ATH-EROSCLEROSIS W -cc 2133 ATHEROSCLEROSIS WIO cc 2134 HYPERTENSION ' 3

135 CARDIAC CONGENITAL & VALVULAR DISORDERS AGE >17 W CC 4136 CARDIAC CONGENITAL & VALVULAR DISORDERS AGE >17 WIO CC 5138 CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC 4139 CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WIO CC ' 2

'14-0 ANGI-NA PE-CTORis 214-1- SYN-COPE' &- CO-CLAPSE-W- CC 3142 SYNCOPE & COLLAPSE WIO CC 214-3 C-HEST PAiN 2144 OTHER CIRCULATORY SYSTEM DIAGNOSES W CC 6145 OTHER CIRCULATORY SYSTEM DIAGNOSES WIO CC 3146 RECTAL RESECTION W CC ' 1-6

14-7 R-ECTAL -RES-ECTio-r\j-wio cc 614-8 1-314-9 MAjoR -sMACL -&-LARG-E- BowEL-P-RocEDu-REs-wio-cc 515-0 PERiTo-NEALAo-HEsioLysis-w-cc- '--915-1- PERITO-NEAL AO-HESioLysis-wio-cc 4152 MINOR- SM-AL-C &-LARGE BOWE-C-PRO-CEO-URE-S -W-CC-- 815-3 MINOR' SM-AL-C & -LARGE BOWE-C-PRO-CEO-URE-S -wio-cc- ' 4

154 STO-MACH -W-CC '1-4'15-5 STO-MACH -wio-cc"' 8157 ANAC -& -sTo-MAL-P-RocEDu-REs-w- cc' 415-8 ANAC -s: -sTo-MAL-P-RocEDu- RES-wio -CC 215-9 5' 16-0 2

' 16-1- 3

16-2 3164 '716-5 316-6 316-7 216-8 Mo-uTH -P-RO CEO U-RES-W- cc 416-9 Mo-uTH- P-RocEou-REs-wio -CC 317-0 O-THER -DiGEstiv-E-sYSTEM -o.R~PRo-cEDUREs-w-cc 1-617-1- oTHER-DiGEstiv-E -SYSTEM -O.'R~PROCE6URES wi6-cc 317-2 OiGE-Si-iYE-MALIGNANCY-W- CC 717-3 oiGE-si-iYE-MALIGNANCy-wiocc 2174 G-.i.-HE-MORR-HAG-E-W -c-c 4175 G-.i.-HE-MORR-HAGE-wio CC 3176 COMPLICATED PEPTIC ULCER 5177 U-NCOM-PLicATEO -PEPTIC-U-LCERWCC 4178 UNCOMPLICATED PEPTIC ULCER WIO CC 4179 INFLAMMATORY BOWEL DISEASE 5180 G.I. OBSTRUCTION W CC 5

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181 G.I. OBSTRUCTION WIO CC 3

::::::::::::~;~ :::::::::::::~185 DENTAL & ORAL DIS EXCEPT EXTRACTIONS & RESTORATIONS 318-7 6-ENTAC-EXTRAC;-ioN-S -&-RESTORATIONS- 4

188 OTHER DIGESTIVE SYSTEM DIAGNOSES AGE >17 W CC 6189 OTHER DIGESTIVE SYSTEM DIAGNOSES AGE >17 WIO CC 3

::::::::::::~~~ ::::::::::::~:~193 BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR WIO C.D.E. W CC 1-3194 BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR WIO C.D.E. WIO CC 5195 CHOLECYSTECTOMY W C.D.E. W CC 1-2196 CHOLECYSTECTOMY W C.D.E. WIO cc 9197 CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WIO C.D.E. W CC 9198 CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WIO C.D.E. WIO CC 4

199 HEPATOBILIARY DIAGNOSTIC PROCEDURE FOR MALIGNANCY 1420-6 1-420-1- O-fH-ER-HEPATOBILIAR-Y-OR-PANC-REAS-6~R.-P-ROCEDU-RES- 2020-2 CiRR-HOSiS&-AL-COHO-Cic-H-EPATITIS-- 6

:::::::::::?9:~ 7204 DISORDERS OF PANCREAS EXCEPT MALIGNANCY 520-5 6iso-RDERsoF-LNER -EXC-EPf -M-ALiG-w -CC 5206 6iso-RDE-RsoF-LNER -ExcEPT -MALiG-wi6 -CC 4

20-7 6iso-RDE-RsoF-THE -siCiARYTRACT-W-CC 4208 6iso-RDE-RsoF-THE-siCiARYTRACT-wi6- CC 2

21-6 821-1- 5213 1-021-6 BioPSI-ES OF MUSCULOS-KECETA-C SYS;--EM -& -C-6NNECTivE-TissU-E 1-0

21-7 wN6-DE-BRID-&-S-KN- GRFT EXCEPT HAND 1-221-8 LOWER-EXTREM&- HUME-R-P-ROt- EXCEPT Hip 5219 LOWER-EXTREM& -HUME-R-P-ROt-EXCEPTHip 3

22.-3 MAjOR-SHO-ULDER/ELBOW-PRO-c 222.4 sHou-C6-ER 2

22.-5 FoOT -P-RocEDu-REs 5

22.-6 SOFT -fissU-E -PRoc-EDuRE-s -w-t-c-- 822.-7 SOFT-fissU-E -PRocEDu-REs -wiocc- 2

22.8 MAjoR-fH-uMs-6R -jOIN;--PROC 422.-9 HAND-oR-w-RisT-PRo-c 323-6 LOCAL-Excisio-N-&- REMoVAL of-iNT-Fix -6-EVICE-S- O-F-Hip& -FEMuR "7232 AR;--HRO-SCOPY 6233 OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W CC 8234 OTHER-M-USC-ULOSKELET-SYS- &CON-N -Tis-s-O-.R.- PR-6c-wi6- CC 323-5 FRA-cTuRE-s -6-F-FEM-UR 3

23-6 FRA-CTURE-S-6-F -Hip-&-PE-Cvis- 523-7 SPRAiN-S 5238 OSTEOMYELITIS 8239 PATHOLOGICAL FRACTURES & MUSCULOSKELETAL & CONN TISS MALIGNANCY 6240 CONNECTIVE TISSUE DISORDERS W CC 9

241 CONNECTIVE TISSUE DISORDERS WIO CC 4242 SEPTIC ARTHRITIS 5

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DIAGNOSISRELATED

GROUP DIAGNOSIS RELATED GROUP DESCRIPTIONS DAY LIMIT

243 MEDICAL BACK PROBLEMS 4244 BONE DISEASES & SPECIFIC ARTHROPATHIES W CC 4245 BONE DISEASES & SPECIFIC ARTHROPATHIES WIO CC 3246 NON-SPECIFIC ARTHROPATHIES 4247 SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE 3

::::::::::::?~:~ 4249 AFTERCARE 4250 FX FOREARM, HAND AND FOOT W CC 3251 FX FOREARM, HAND AND FOOT WIO CC 2

:::::::::::?~:~ 4254 FX UPPER ARM AND LOWER LEG, EXCEPT FOOT WIO CC 2256 OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES 525-7 ToTAL-MAsTECTOMY -F-oR-MALiGNANCY-W-CC-- 325-8 ToTAL-MAsTEc-foMY -FoR-MALiGNANCY wio-cc-- 225-9 suBToTAL- MAsTECTOMY-FOR MALic;- NAN-CYWCC 4260 226-1- 226-2 426-3 8264 526-5 1-126-6 526-7 PERIANAL-&PI-Co-Nio-AL-PROCE-OUR-Es--- 526-8 SKiN 3269 oTH-ER -SKIN-li.j-CC--- 727-6 oTH-ER-sKIN-li.jio.cc- 327-1- sKiN-u-Cc-ERs 5272 M-AjOR-SKIN-oiso-RDERS- WCC- 627-3 MAjOR-SKIN-oiso-RDERS-W/O-CC 327-4 M-AL-IGNANT-B-REAST-OISOR-OERS -W-CC-- 627-5 MALiGNANT-B-REAST-OISOR-OE-RS -wio-cc- 3276 N-oN:M-ALiGN-ANT-B-REASi"-DISORDERS 427-7 C-ELLULITIS AGE-;-1-j-li.j-t-c 427-8 C-ELLULITIS AGE-;-1-j-li.jio CC 328-6 TRA-uMA To-T-HE SKIN-W-CC.- 228-1- TRA-uMA To-THE SKIN-wio-cc- :: 2

28-3 MINOR-SKiN-oisOROERS-W-t-c 428-4 MINOR-SKiN DisoRo-ERs -wiocc. 228-5 AMPuTAT -OF-CO-WE-R-LiMB -FOR-ENOOCRINE- 1-628-6 ADRENA-C"& -pii"uif ARY -PRo-cEo- URES 1-628-7 SKiN-GRAFTS -&-WOUNO-DEBRio-FOR- EN-ooc- 728-8 O-.R.-PR-OCE-OURESFOR-OBES-ITY--- 428-9 PARATHYR-oioPR-ocE-ouREs 429-6 THYRoio-p-RocEDu-REs 4291 THYROGLOSSAL PROCEDURES 129-2 OTHER-ENO-OCRINEWCC-. 8293 OTHER ENDOCRINE WIO CC 3294 DIABETES AGE >35 4295 DIABETES AGE 0-35 3296 NUTRITIONAL & MISC METABOLIC DISORDERS AGE >17 W CC 4297 NUTRITIONAL & MISC METABOLIC DISORDERS AGE >17 WIO CC 3

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299 INBORN ERRORS OF METABOLISM 430.0 ENOO.CRiNE-oisORO.ERS-W-CC 5301 ENDOCRINE DISORDERS WIO CC 3302 KIDNEY TRANSPLANT 9303 KIDNEY 8304 KIDNEY W CC 6305 KIDNEY WIO CC 4306 PROSTATECTOMY W CC 9307 PROSTATECTOMY WIO CC 2308 MINOR BLADDER PROCEDURES W cc 530.9 MINOR-BLAODE.R. P-RocEDu.REs-wio 'cc 2310 TRANSURETHRAL PROCEDURES W cc 5311 TRANSURETHRAL PROCEDURES WIO CC 3312 URETHRAL PROCEDURES W CC 531.3 U.RETHRAl. P.RocEDuR-Es.wio.cc-- 4315 OTHER KIDNEY & URINARY TRACT PROCEDURES 1-431.6 R.ENALFAiLUR.E 7317 ADMIT FOR RENAL DIALYSIS 8~).8. 15!~.t:J.~,:(_.&_.l:!~I_~~f3X.~~.f2.~"!" -~-~~~.~.s.~?_yy-~c:::- 6319 KIDNEY & URINARY TRACT NEOPLASMS WIO CC 132.0 KiDNEY. & URINARY TRACT. iNFEcTioN.s.AG E >1 7 -w'cc'.. 432-1- KiDNEY. & URINARY TRACT .iNFEcTioN.s.AGE>1 7- wiocc 332.3 u.RiNARY-STONES.W.CC 3324 u-RiNARY.STONES. wio-cc 232.5 4326 332.8 U.RETHRAl.STRICT-URE.AGE.;17WCC 333.1. 5332 3334 M-AjOR-MAlE.PELVIC .PROCEO.URE.S.W 'cc 4335 MAjOR.MAlE.PELVIC- PROCEO.URE.S-wio-cc 333-6 TRA-NSURETHRAL. P.ROS-TATE-CTOMY W 'CC--- 333.7 TRA.N SUR ETH.RAL. P.ROSTATE.CTOMywio.cc... 2338 2533-9 534-1- PENis .PRO.CEO.URES... 8344 1-6345 1.134.6 MALIGNANCY 6348 BENiGN.PROSTATicHYPERTR-OPH-Y. W 'c'c' 434-9 BEN-IGN-PRO.STATic HYPERTR.OPH.y.wio-cc.- 135-0 4352 O-THER -MAlE.REP-ROO-UCTivE.SYSTE.M.DIAGNOSES 335-3 PELVIC -EvisCERATio-N- 4354 UTE-RiN-E -w -cc 535.5 UTE.RiN.E.wio. cc'.. 3356 FEMALE-R-EP-ROOUCTIVE-SYSTEM-RECON-STRUCTivE.PRO.CEO.URES 235-7 8358 UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W CC 3359 UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WIO CC 2360 VAGINA 3

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~?_~ ~-~~~.q.s.~-q~,!_.&- !~_~1.sJ.C?~_A:!-_T-~.B.~-~ ~~T~~.F3~I:>!I_q!,!.. 3~?2. ~!':!~.C?_~~C?~~~. !.~.B.~_~1~_T~.I3.F3~_~!I.C?~... ~~ ~~ ~ ~ ~ 1363 D&C, CONIZATION AND RADIO-IMPLANT, FOR MALIGNANCY "-5

~?_4. I?~~.'.~. C?~~~T19-~.~.>.<~~~T.f_q.F3_~.A:~153.~_A:~~-'(.. 3~?~ C?~tJ_~.F3 -~~-~!':~.~.I3~I:>.F39.~_~~T1Y.~.~X.s~~.~.9...F3; ?~C?~~I?~~~-~~~~~~..- '6

:::::::::H~ :::::::::::::]369 MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDER-S ' 2

~?q ~-~.s_A:~~.A.~. .s.~.~!J.C?~_YY-~~ '...5~?~ ~.~.s_A:~~.A.~- .s.~.~!J.C?~.~!.C? -~-~ ~ 4372 VAGINAL DELIVERY W COMPLICATING DIAGNOSES ' 3

~?_~ Y.A.<;?JJ.~~~ .I?~~!Y_~~-,(-~~C? ~9-~.~!-J.C:~~I.~~.1?1~.~_~9..s.~.s.. 2~?4. Y.A.<;?JJ_~~~ _1?~~~Y.~~.,(.~-~!~.F3~~~~.~~C?~-~!9.~ ~~.~ ~ ~ ~ ~ ~ 3375 VAGINAL DELIVERY W O.R. PROC EXCEPT STERIL &/OR D&C 437.6 poSTPARTUM -&-POST.ABoRTioN-6iAGNos.Es- w/o.o..R..PRocEoUR.E... 3377 posTPARTUM.& -POST.ABORTION.6iAGNOS'ES. W.O~R~- PRoc.EDuRE- 437.8 ECTOPIC -PRE-G-NANCY 2

'37.9 THR.EATENEo. ABoRTioN 3

"38.0 ABoRTioN-wio- D&C 2

38.1. ABORTI-ON-W-6&c 2382 FALSE.LABOR " ' 2'38.3 -' 3

384 3

392 sPLEN-ECTOMY. AGE .;17 7394 8395 R-EDBLooo-cE.LL.6iso.RDE.Rs AGE-;1-i- 439.i COAG.U"LATloN.6isoRO.ERS--- 539-8 --" 5

39-9 3

40.1. '1'1402 ' 1"40.3 " 9

404 --.' 5

40.6 1'1407 -'."' 4

40.8 940-9 RADIoTHERAPY 8

'.-41.0 4413 OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W CC 7414 OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W/O CC 3415 O.R. PROCEDURE FOR INFECTIOUS & PARASITIC DISEASES 13

416 SEPTICEMIA AGE >17 8

418 POSTOPERATIVE & POST-TRAUMATIC INFECTIONS 5419 FEVER OF UNKNOWN ORIGIN AGE >17 W CC 3420 FEVER OF UNKNOWN ORIGIN AGE >17 W/O CC 4421 VIRAL ILLNESS AGE >17 3423 OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES 8424 O.R. PROCEDURE W PRINCIPAL DIAGNOSES OF MENTAL ILLNESS 17425 ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION 3426 DEPRESSIVE NEUROSES 4

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DIAGNOSISRELATED

GROUP DIAGNOSIS RELATED GROUP DESCRIPTIONS DAY LIMIT

427 NEUROSES EXCEPT DEPRESSIVE 4

428 DISORDERS OF PERSONALITY & IMPULSE CONTROL 7

429 ORGANIC DISTURBANCES & MENTAL RETARDATION 1-3

:::::::::::~~:q 7432 OTHER MENTAL DISORDER DIAGNOSES 8

:::::::::::~~:~ 2439 SKIN GRAFTS FOR INJURIES 1-6

44-0 wou-No-oEB-Rio-EME-NTs-FoRiNju-RiE-s 1-6

441 HAND PROCEDURES FOR INJURIES 5

442 OTHER O.R. PROCEDURES FOR INJURIES W CC 8

443 OTHER O.R. PROCEDURES FOR INJURIES W/O CC 3

444 TRA-UMATI-C -i Nj-URY-AG-E- >17WCC 2

44-5 TRAUMATic -i Nj-URY-AG-E-> 17 W/O- c-c 2

44-7 ALLE-RGic -REACTI-ONSAGE ->1-7 2

44-9 poiSONiNG -8.- TOXIC-EFFECTS-OF-O-RUGS-AGE ->17-WCC- 4

45-0 poiSONiNG -8.- TOXIC -EF- FECTS -OF -0- RUGS-AGE ->17- WID -CC 2

452 COMPLicATioN-S-O-F-TREATMENTW -CC 5

45-3 C-OMPLicATioN-S -O-FTREATMENTWio -CC 3

454 OTHER iNjURY -W -CC 4

45-5 OTH-ERiNjURy-wio-cc 2

46-1- 1-5

462 R-EHABiuTATioN 1-3

46.3 SiGN-S-8.-SYMPTOriA-S -w -c-c--- 3

464 SiGN-S-8.-SYMPTOriA-S -wio-cc- 3

46-5 1466 3

46-7 O-THER .FA-cTo-RsiNFL-uENciN-G- H- EALT-H-STATUS--- 346-8 EXTEN-sivE -O~R.-P-ROCEOURE-UNREi.AT-ED TO PRiNciPAL 0 iAG NO-S is ' i"so;* 47-1- BiLATERAL-OR-MULTIPLEMAjOR- jOiNT-PRO-CS-OFLOWE-R-EXTRE-MifY- ' 9

47-3 ACUTELEUK-EMIA-wioMAjOR-O.-R:-PRoCEO-URE-AG-E-;17 21

47-5 R-ES-piRATORY- SYSTEMOiAGNO-sis-wiTi.:j-VENTI-CAToR-S-UPPORT- 1-147-6 PROSTATIC- O-.R.- PRocE-oURE-U.NRE-LATEO-TO-PRINciPAL-DiAGNosis- ' i"-so;* 47-7 ' i"-so;* 47-9 oTHERvAscu-CA-R.p.RocEDu-REs-wio-cc ' 4

48-0 LivER-TRAN-SPLANT AN-oioR-iNTESTiNAL- TRAN-SpCA-NT--- 1-9

48-1- BONE- MARRow-TRANs- PLANT-- 23

48-2 TRAcHEOSTOMY-F-OR-FAcE 1-5

484 1-7

48-5 LiriA-i3-R-EATTACHMENT 1-5

486 1-5

48-7 OTH-ER-M-ULTiPL-E -siGNiFiCANT- T-RAU-MA 6

488 HIV W EXTENSIVE O.R. PROCEDURE 22

489 HIV W MAJOR RELATED CONDITION 8

490 HIV W OR W/O OTHER RELATED CONDITION 5

491 MAJOR JOINT & LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITY 4

492 CHEMO W ACUTE LEUKEMIA AS SDX OR W USE OF HIGH DOSE CHEMO AGENT 19

493 LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W CC 5

494 LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W/O CC 2

495 LUNG TRANSPLANT 24

496 COMBINED ANTERIORIPOSTERIOR SPINAL FUSION 12

497 SPINAL FUSION EXCEPT CERVICAL W CC 6

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498 SPINAL FUSION EXCEPT CERVICAL W/O CC 349-9 4

500 BACK & NECK PROCEDURES EXCEPT SPINAL FUSION W/O CC 2501 KNEE PROCEDURES W POX OF INFECTION W cc 8502 KNEE PROCEDURES W POX OF INFECTION W/O CC 8503 KNEE PROCEDURES W/O POX OF INFECTION 3504 EXTENSIVE BURNS OR FULL THICKNESS BURNS W MV 96+ HRS W SKiN-GRAFT-- 32505 EXTENSIVE BURNS OR FULL THICKNESS BURNS W MV 96+ HRS W/O SKIN G-RAF- 2506 FULL THICKNESS BURN W SKIN GRAFT OR INHAL INJ W CC OR SIG TRAUMA 1-7507 FULL THICKNESS BURN W SKIN GRFT OR INHAL INJ W/O CC OR SIG TRAUMA 1-2508 FULL THICKNESS BURN W/O SKIN GRFT OR INHAL INJ W CC OR SIG-TRAUMA 5

509 FULL THICKNESS BURN W/O SKIN GRFT OR INH INJ W/O CC OR SIG TRAUMA 6510 NON-EXTENSIVE BURNS W CC OR SIGNIFICANT TRAUMA 7

511 NON-EXTENSIVE BURNS W/O CC OR SIGNIFICANT TRAUMA 4

515 CARDIAC DEFIBRILLATOR IMPLANT W/O CARDIAC CATH 6518 PERCUTANEOUS CARDIOVASC PROC W/O CORONARY ARTERY STENT OR AMI 3519 CERVICAL SPINAL FUSION W CC 652-6 c-ERvic-AL-spiN-AL- F-USION-wi6- CC--- 252-1- ALCOHOUORUG-ABUS-E-6-R- b-E PEN DENc-E-w-c-c 4

522 ALCOHOUDRUG ABUSE OR DEPENDENCE W REHABILITATION THERAPY W/O CC 352-3 3

524 TRA-r,jSIENTisc-HEMIA 3

:::::::::::$~~ 24528 INTRACRANIAL VASCULAR PROCEDURES W POX HEMORRHAGE 21

_:::::::::::$?:~ 9530 VENTRICULAR SHUNT PROCEDURES W/O cc 3

53-1- spiNAL-PRoc-EDu-REs oW-CoG 1-153-2 spiNAL-PRoc-EDu-REs-wiocc 3533 EXTRA-CRA-r,jiALPR-6cE-OURES W-CC-- 4534 EXTRA-CRA-r,jiAL PR-6cE-OUREswio-cc 253-5 1-253-6 8

53-j 853-8 453-9 1-254-6 354-1- ECMO OR TRACH-WMV 96+-HRS -6-R-pox EXC-FACE 41

542 TRACHW-MY-96+-HRS-OR-P-OX-EX-C-FAC-E 34

54-3 1-2544 454-5 R-EVISION-6-r=-Hip-OR- KN-EERE-PLACEMENT 5

546 1-554-j 1-154-8 1-654-9 1-655-6 C-ORONARY-SYPASS -wiocARoiAc-cATH-wi6 -MAJ-6-R-cv -OX 7551 PERMANENT CARDIAC PACEMAKER IMPL W MAJ CV OX OR AICD LEAD OR GNRT 7

552 4

55-3 1-1554 7555 PERCUTANEOUS CARDIOVASCULAR PROC W MAJOR CV OX 4

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556 PERCUTANEOUS CARDIOVASC PROC W NON-DRUG-ELUTING STENT W/O MAJ C 2557 355-8 255-9 ACUTEisCHE-Mic STROK-E-wiTH-USE-OF-THR-OMBOLYTiC-AGENT 9

** The combined medical and surgical DRG day limits will form the day limit for DRGs 468, 476, and

Note: DRGs specific to children have been excluded. Day limit only applies to adults.The day limits are based on version 23 of the CMS-DRGs.

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