PHC4 35 Diseases, Procedures, and Medical Conditions for which Laboratory Data is Required Effective 10/1/2015

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1 PHC4 35 Diseases, Procedures, and Medical Conditions for which Laboratory Data is Required Effective 10/1/2015 Laboratory data is to be submitted for discharges in the following conditions: 1. Heart Attack MS-DRG 280 MS-DRG 281 MS-DRG 282 MS-DRG 283 MS-DRG 284 MS-DRG 285 Acute myocardial infarction, discharged alive with MCC Acute myocardial infarction, discharged alive with CC Acute myocardial infarction, discharged alive without CC/MCC Acute myocardial infarction, expired with MCC Acute myocardial infarction, expired with CC Acute myocardial infarction, expired without CC/MCC 2. Heart Failure MS-DRG 291 MS-DRG 292 MS-DRG 293 Heart failure and shock with MCC Heart failure and shock with CC Heart failure and shock without CC/MCC 3. Chest Pain MS-DRG 313 Chest pain 4. Abnormal Heartbeat MS-DRG 242 MS-DRG 243 MS-DRG 244 MS-DRG 245 MS-DRG 258 MS-DRG 259 MS-DRG 260 MS-DRG 261 MS-DRG 262 MS-DRG 265 MS-DRG 286 MS-DRG 287 MS-DRG 308 MS-DRG 309 MS-DRG 310 Permanent cardiac pacemaker implant with MCC Permanent cardiac pacemaker implant with CC Permanent cardiac pacemaker implant without CC/MCC AICD generator procedures Cardiac pacemaker device replacement with MCC Cardiac pacemaker device replacement without MCC Cardiac pacemaker revision except device replacement with MCC Cardiac pacemaker revision except device replacement with CC Cardiac pacemaker revision except device replacement without CC/MCC AICD lead procedures Circulatory disorders except AMI with cardiac cath with MCC Circulatory disorders except AMI with cardiac cath without MCC Cardiac arrhythmia and conduction disorders with MCC Cardiac arrhythmia and conduction disorders with CC Cardiac arrhythmia and conduction disorders without CC/MCC 5. Coronary Bypass MS-DRG 001 MS-DRG 002 MS-DRG 215 MS-DRG 222 MS-DRG 223 MS-DRG 224 MS-DRG 225 MS-DRG 226 MS-DRG 227 MS-DRG 228 MS-DRG 229 MS-DRG 230 MS-DRG 231 MS-DRG 232 MS-DRG 233 MS-DRG 234 MS-DRG 235 MS-DRG 236 Heart transplant or implant of heart assist system with MCC Heart transplant or implant of heart assist system without MCC Other heart assist system implant Cardiac defibrillator implant with cardiac cath with AMI, heart failure or shock with MCC Cardiac defibrillator implant with cardiac cath with AMI, heart failure or shock without MCC Cardiac defibrillator implant with cardiac cath without AMI, heart failure or shock with MCC Cardiac defibrillator implant with cardiac cath without AMI, heart failure or shock without MCC Cardiac defibrillator implant without cardiac cath with MCC Cardiac defibrillator implant without cardiac cath without MCC Other cardiothoracic procedures with MCC Other cardiothoracic procedures with CC Other cardiothoracic procedures without CC/MCC Coronary bypass with PTCA with MCC Coronary bypass with PTCA without MCC Coronary bypass with cardiac cath with MCC Coronary bypass with cardiac cath without MCC Coronary bypass without cardiac cath with MCC Coronary bypass without cardiac cath without MCC Page 1

2 6. Heart Valve Replacement MS-DRG 216 MS-DRG 217 MS-DRG 218 MS-DRG 219 MS-DRG 220 MS-DRG 221 MS-DRG 266 MS-DRG 267 Cardiac valve and other major cardiothoracic procedure with cardiac cath with MCC Cardiac valve and other major cardiothoracic procedure with cardiac cath with CC Cardiac valve and other major cardiothoracic procedure with cardiac cath without CC/MCC Cardiac valve and other major cardiothoracic procedure without cardiac cath with MCC Cardiac valve and other major cardiothoracic procedure without cardiac cath with CC Cardiac valve and other major cardiothoracic procedure without cardiac cath without CC/MCC Endovascular cardiac valve replacement with MCC Endovascular cardiac valve replacement without MCC 7. Percutaneous Transluminal Coronary Angioplasty MS-DRG 246 MS-DRG 247 MS-DRG 248 MS-DRG 249 MS-DRG 250 MS-DRG 251 MS-DRG 273 MS-DRG 274 Percutaneous cardiovascular procedure with drug-eluting stent with MCC or 4+ vessels/stents Percutaneous cardiovascular procedure with drug-eluting stent without MCC Percutaneous cardiovascular procedure with non-drug-eluting stent with MCC or 4+ vessels/stents Percutaneous cardiovascular procedure with non-drug-eluting stent without MCC Percutaneous cardiovascular procedure without coronary artery stent with MCC Percutaneous cardiovascular procedure without coronary artery stent without MCC Percutaneous intracardiac procedures with MCC Percutaneous intracardiac procedures without MCC 8. Pneumonia MS-DRG 177 MS-DRG 178 MS-DRG 179 MS-DRG 193 MS-DRG 194 MS-DRG 195 Respiratory infections and inflammations with MCC Respiratory infections and inflammations with CC Respiratory infections and inflammations without CC/MCC Simple pneumonia and pleurisy with MCC Simple pneumonia and pleurisy with CC Simple pneumonia and pleurisy without CC/MCC 9. Asthma MS-DRG 190 MS-DRG 191 MS-DRG 192 MS-DRG 202 MS-DRG 203 Chronic obstructive pulmonary disease with MCC Chronic obstructive pulmonary disease with CC Chronic obstructive pulmonary disease without CC/MCC Bronchitis and asthma with CC/MCC Bronchitis and asthma without CC/MCC 10. Respiratory Failure MS-DRG 189 Pulmonary and respiratory failure 11. Blood Clot in Lung MS-DRG 175 MS-DRG 176 Pulmonary embolism with MCC Pulmonary embolism without MCC 12. Lung Repair MS-DRG 163 MS-DRG 164 MS-DRG 165 MS-DRG 166 MS-DRG 167 MS-DRG 168 Major chest procedures with MCC Major chest procedures with CC Major chest procedures without CC/MCC Other respiratory system O.R. procedures with MCC Other respiratory system O.R. procedures with CC Other respiratory system O.R. procedures without CC/MCC 13. Hypotension MS-DRG 312 Syncope and collapse Page 2

3 14. Blood Clot in Extremities MS-DRG 294 MS-DRG 295 MS-DRG 299 MS-DRG 300 MS-DRG 301 Deep vein thrombophlebitis with CC/MCC Deep vein thrombophlebitis without CC/MCC Peripheral vascular disorders with MCC Peripheral vascular disorders with CC Peripheral vascular disorders without CC/MCC 15. Vascular Repair MS-DRG 252 MS-DRG 253 MS-DRG 254 MS-DRG 268 MS-DRG 269 MS-DRG 270 MS-DRG 271 MS-DRG 272 Other vascular procedures with MCC Other vascular procedures with CC Other vascular procedures without CC/MCC Aortic and heart assist procedures except pulsation balloon with MCC Aortic and heart assist procedures except pulsation balloon without MCC Other major cardiovascular procedures with MCC Other major cardiovascular procedures with CC Other major cardiovascular procedures without CC/MCC 16. Stroke MS-DRG 061 MS-DRG 062 MS-DRG 063 MS-DRG 064 MS-DRG 065 MS-DRG 066 MS-DRG 067 MS-DRG 068 Acute ischemic stroke with use of thrombolytic agent with MCC Acute ischemic stroke with use of thrombolytic agent with CC Acute ischemic stroke with use of thrombolytic agent without CC/MCC Intracranial hemorrhage or cerebral infarction with MCC Intracranial hemorrhage or cerebral infarction with CC or tpa in 24 hours Intracranial hemorrhage or cerebral infarction without CC/MCC Nonspecified cerebrovascular accident and precerebral occlusion without infarct with MCC Nonspecified cerebrovascular accident and precerebral occlusion without infarct without MCC 17. Removal of Blockage in Head and Neck Vessel MS-DRG 034 MS-DRG 035 MS-DRG 036 MS-DRG 037 MS-DRG 038 MS-DRG 039 Carotid artery stent procedure with MCC Carotid artery stent procedure with CC Carotid artery stent procedure without CC/MCC Extracranial procedures with MCC Extracranial procedures with CC Extracranial procedures without CC/MCC 18. Craniotomy MS-DRG 020 MS-DRG 021 MS-DRG 022 MS-DRG 023 MS-DRG 024 MS-DRG 025 MS-DRG 026 MS-DRG 027 MS-DRG 031 MS-DRG 032 MS-DRG 033 Intracranial vascular procedures with principal diagnosis of hemorrhage with MCC Intracranial vascular procedures with principal diagnosis of hemorrhage with CC Intracranial vascular procedures with principal diagnosis of hemorrhage without CC/MCC Craniotomy with major device implant/acute complex central nervous system principal diagnosis with MCC or chemo implant Craniotomy with major device implant/acute complex central nervous system principal diagnosis without MCC Craniotomy and endovascular intracranial procedures with MCC Craniotomy and endovascular intracranial procedures with CC Craniotomy and endovascular intracranial procedures without CC/MCC Ventricular shunt procedures with MCC Ventricular shunt procedures with CC Ventricular shunt procedures without CC/MCC 19. Diabetes ICD-10-CM principal diagnosis of: E09.00 Drug or chemical induced diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC) E09.01 Drug or chemical induced diabetes mellitus with hyperosmolarity with coma E09.10 Drug or chemical induced diabetes mellitus with ketoacidosis without coma E09.11 Drug or chemical induced diabetes mellitus with ketoacidosis with coma E09.21 Drug or chemical induced diabetes mellitus with diabetic nephropathy E09.22 Drug or chemical induced diabetes mellitus with diabetic chronic kidney disease E09.29 Drug or chemical induced diabetes mellitus with other diabetic kidney complication continued Page 3

4 E Drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy with macular E Drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy without macular E Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular E Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular E Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular E Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular E Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular E Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular E Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular E Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular E09.36 Drug or chemical induced diabetes mellitus with diabetic cataract E09.39 Drug or chemical induced diabetes mellitus with other diabetic ophthalmic complication E09.40 Drug or chemical induced diabetes mellitus with neurological complications with diabetic neuropathy, unspecified E09.41 Drug or chemical induced diabetes mellitus with neurological complications with diabetic mononeuropathy E09.42 Drug or chemical induced diabetes mellitus with neurological complications with diabetic polyneuropathy E09.43 Drug or chemical induced diabetes mellitus with neurological complications with diabetic autonomic (poly)neuropathy E09.44 Drug or chemical induced diabetes mellitus with neurological complications with diabetic amyotrophy E09.49 Drug or chemical induced diabetes mellitus with neurological complications with other diabetic neurological complication E09.51 Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy without gangrene E09.52 Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy with gangrene E09.59 Drug or chemical induced diabetes mellitus with other circulatory complications E Drug or chemical induced diabetes mellitus with diabetic neuropathic arthropathy E Drug or chemical induced diabetes mellitus with other diabetic arthropathy E Drug or chemical induced diabetes mellitus with diabetic dermatitis E Drug or chemical induced diabetes mellitus with foot ulcer E Drug or chemical induced diabetes mellitus with other skin ulcer E Drug or chemical induced diabetes mellitus with other skin complications E Drug or chemical induced diabetes mellitus with periodontal disease E Drug or chemical induced diabetes mellitus with other oral complications E Drug or chemical induced diabetes mellitus with hypoglycemia with coma E Drug or chemical induced diabetes mellitus with hypoglycemia without coma E09.65 Drug or chemical induced diabetes mellitus with hyperglycemia E09.69 Drug or chemical induced diabetes mellitus with other specified complication E09.8 Drug or chemical induced diabetes mellitus with unspecified complications E09.9 Drug or chemical induced diabetes mellitus without complications E10.10 Type 1 diabetes mellitus with ketoacidosis without coma E10.11 Type 1 diabetes mellitus with ketoacidosis with coma E10.21 Type 1 diabetes mellitus with diabetic nephropathy E10.22 Type 1 diabetes mellitus with diabetic chronic kidney disease E10.29 Type 1 diabetes mellitus with other diabetic kidney complication E Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular E Type 1 diabetes mellitus with unspecified diabetic retinopathy without macular E Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular E Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular E Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular E Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular E Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular E Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular E Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular E Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular E10.36 Type 1 diabetes mellitus with diabetic cataract continued Page 4

5 E10.39 Type 1 diabetes mellitus with other diabetic ophthalmic complication E10.40 Type 1 diabetes mellitus with diabetic neuropathy, unspecified E10.41 Type 1 diabetes mellitus with diabetic mononeuropathy E10.42 Type 1 diabetes mellitus with diabetic polyneuropathy E10.43 Type 1 diabetes mellitus with diabetic autonomic (poly)neuropathy E10.44 Type 1 diabetes mellitus with diabetic amyotrophy E10.49 Type 1 diabetes mellitus with other diabetic neurological complication E10.51 Type 1 diabetes mellitus with diabetic peripheral angiopathy without gangrene E10.52 Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene E10.59 Type 1 diabetes mellitus with other circulatory complications E Type 1 diabetes mellitus with diabetic neuropathic arthropathy E Type 1 diabetes mellitus with other diabetic arthropathy E Type 1 diabetes mellitus with diabetic dermatitis E Type 1 diabetes mellitus with foot ulcer E Type 1 diabetes mellitus with other skin ulcer E Type 1 diabetes mellitus with other skin complications E Type 1 diabetes mellitus with periodontal disease E Type 1 diabetes mellitus with other oral complications E Type 1 diabetes mellitus with hypoglycemia with coma E Type 1 diabetes mellitus with hypoglycemia without coma E10.65 Type 1 diabetes mellitus with hyperglycemia E10.69 Type 1 diabetes mellitus with other specified complication E10.8 Type 1 diabetes mellitus with unspecified complications E10.9 Type 1 diabetes mellitus without complications E11.00 Type 2 diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC) E11.01 Type 2 diabetes mellitus with hyperosmolarity with coma E11.21 Type 2 diabetes mellitus with diabetic nephropathy E11.22 Type 2 diabetes mellitus with diabetic chronic kidney disease E11.29 Type 2 diabetes mellitus with other diabetic kidney complication E Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular E Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular E Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular E Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular E Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular E Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular E Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular E Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular E Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular E Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular E11.36 Type 2 diabetes mellitus with diabetic cataract E11.39 Type 2 diabetes mellitus with other diabetic ophthalmic complication E11.40 Type 2 diabetes mellitus with diabetic neuropathy, unspecified E11.41 Type 2 diabetes mellitus with diabetic mononeuropathy E11.42 Type 2 diabetes mellitus with diabetic polyneuropathy E11.43 Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy E11.44 Type 2 diabetes mellitus with diabetic amyotrophy E11.49 Type 2 diabetes mellitus with other diabetic neurological complication E11.51 Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene E11.52 Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene E11.59 Type 2 diabetes mellitus with other circulatory complications E Type 2 diabetes mellitus with diabetic neuropathic arthropathy E Type 2 diabetes mellitus with other diabetic arthropathy E Type 2 diabetes mellitus with diabetic dermatitis E Type 2 diabetes mellitus with foot ulcer E Type 2 diabetes mellitus with other skin ulcer E Type 2 diabetes mellitus with other skin complications E Type 2 diabetes mellitus with periodontal disease E Type 2 diabetes mellitus with other oral complications E Type 2 diabetes mellitus with hypoglycemia with coma E Type 2 diabetes mellitus with hypoglycemia without coma E11.65 Type 2 diabetes mellitus with hyperglycemia E11.69 Type 2 diabetes mellitus with other specified complication E11.8 Type 2 diabetes mellitus with unspecified complications E11.9 Type 2 diabetes mellitus without complications E13.00 Other specified diabetes mellitus with hyperosmolarity without nonketotic hyperglycemichyperosmolar coma (NKHHC) continued Page 5

6 E13.01 Other specified diabetes mellitus with hyperosmolarity with coma E13.10 Other specified diabetes mellitus with ketoacidosis without coma E13.11 Other specified diabetes mellitus with ketoacidosis with coma E13.21 Other specified diabetes mellitus with diabetic nephropathy E13.22 Other specified diabetes mellitus with diabetic chronic kidney disease E13.29 E Other specified diabetes mellitus with other diabetic kidney complication Other specified diabetes mellitus with unspecified diabetic retinopathy with macular E Other specified diabetes mellitus with unspecified diabetic retinopathy without macular E Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular E Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular E Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular E Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular E Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular E Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular E Other specified diabetes mellitus with proliferative diabetic retinopathy with macular E E13.36 Other specified diabetes mellitus with proliferative diabetic retinopathy without macular Other specified diabetes mellitus with diabetic cataract E13.39 Other specified diabetes mellitus with other diabetic ophthalmic complication E13.40 Other specified diabetes mellitus with diabetic neuropathy, unspecified E13.41 Other specified diabetes mellitus with diabetic mononeuropathy E13.42 Other specified diabetes mellitus with diabetic polyneuropathy E13.43 Other specified diabetes mellitus with diabetic autonomic (poly)neuropathy E13.44 Other specified diabetes mellitus with diabetic amyotrophy E13.49 Other specified diabetes mellitus with other diabetic neurological complication E13.51 Other specified diabetes mellitus with diabetic peripheral angiopathy without gangrene E13.52 Other specified diabetes mellitus with diabetic peripheral angiopathy with gangrene E13.59 Other specified diabetes mellitus with other circulatory complications E Other specified diabetes mellitus with diabetic neuropathic arthropathy E Other specified diabetes mellitus with other diabetic arthropathy E Other specified diabetes mellitus with diabetic dermatitis E Other specified diabetes mellitus with foot ulcer E Other specified diabetes mellitus with other skin ulcer E Other specified diabetes mellitus with other skin complications E Other specified diabetes mellitus with periodontal disease E Other specified diabetes mellitus with other oral complications E Other specified diabetes mellitus with hypoglycemia with coma E Other specified diabetes mellitus with hypoglycemia without coma E13.65 Other specified diabetes mellitus with hyperglycemia E13.69 Other specified diabetes mellitus with other specified complication E13.8 Other specified diabetes mellitus with unspecified complications E13.9 Other specified diabetes mellitus without complications 20. Digestive Disease MS-DRG 368 MS-DRG 369 MS-DRG 370 MS-DRG 371 MS-DRG 372 MS-DRG 373 MS-DRG 377 MS-DRG 378 MS-DRG 379 MS-DRG 388 MS-DRG 389 MS-DRG 390 MS-DRG 391 MS-DRG 392 MS-DRG 393 MS-DRG 394 MS-DRG 395 Major esophageal disorders with MCC Major esophageal disorders with CC Major esophageal disorders without CC/MCC Major gastrointestinal disorders and peritoneal infections with MCC Major gastrointestinal disorders and peritoneal infections with CC Major gastrointestinal disorders and peritoneal infections without CC/MCC GI hemorrhage with MCC GI hemorrhage with CC GI hemorrhage without CC/MCC GI obstruction with MCC GI obstruction with CC GI obstruction without CC/MCC Esophagitis, gastroenteritis and miscellaneous digestive disorders with MCC Esophagitis, gastroenteritis and miscellaneous digestive disorders without MCC Other digestive system diagnoses with MCC Other digestive system diagnoses with CC Other digestive system diagnoses without CC/MCC Page 6

7 21. Liver Disease MS-DRG 432 MS-DRG 433 MS-DRG 434 MS-DRG 435 MS-DRG 436 MS-DRG 437 MS-DRG 438 MS-DRG 439 MS-DRG 440 MS-DRG 441 MS-DRG 442 MS-DRG 443 Cirrhosis and alcoholic hepatitis with MCC Cirrhosis and alcoholic hepatitis with CC Cirrhosis and alcoholic hepatitis without CC/MCC Malignancy of hepatobiliary system or pancreas with MCC Malignancy of hepatobiliary system or pancreas with CC Malignancy of hepatobiliary system or pancreas without CC/MCC Disorders of pancreas except malignancy with MCC Disorders of pancreas except malignancy with CC Disorders of pancreas except malignancy without CC/MCC Disorders of liver except malignancy, cirrhosis, alcoholic hepatitis with MCC Disorders of liver except malignancy, cirrhosis, alcoholic hepatitis with CC Disorders of liver except malignancy, cirrhosis, alcoholic hepatitis without CC/MCC 22. Colorectal Repair MS-DRG 329 MS-DRG 330 MS-DRG 331 MS-DRG 332 MS-DRG 333 MS-DRG 334 Major small and large bowel procedures with MCC Major small and large bowel procedures with CC Major small and large bowel procedures without CC/MCC Rectal resection with MCC Rectal resection with CC Rectal resection without CC/MCC 23. Gallbladder Removal MS-DRG 411 MS-DRG 412 MS-DRG 413 MS-DRG 414 MS-DRG 415 MS-DRG 416 MS-DRG 417 MS-DRG 418 MS-DRG 419 Cholecystectomy with common duct exploration with MCC Cholecystectomy with common duct exploration with CC Cholecystectomy with common duct exploration without CC/MCC Cholecystectomy except by laparoscope without common duct exploration with MCC Cholecystectomy except by laparoscope without common duct exploration with CC Cholecystectomy except by laparoscope without common duct exploration without CC/MCC Laparoscopic cholecystectomy without common duct exploration with MCC Laparoscopic cholecystectomy without common duct exploration with CC Laparoscopic cholecystectomy without common duct exploration without CC/MCC 24. Stomach and Small Intestine Repair MS-DRG 326 MS-DRG 327 MS-DRG 328 MS-DRG 619 MS-DRG 620 MS-DRG 621 Stomach, esophageal and duodenal procedures with MCC Stomach, esophageal and duodenal procedures with CC Stomach, esophageal and duodenal procedures without CC/MCC O.R. procedures for obesity with MCC O.R. procedures for obesity with CC O.R. procedures for obesity without CC/MCC 25. Kidney Failure MS-DRG 682 MS-DRG 683 MS-DRG 684 Renal failure with MCC Renal failure with CC Renal failure without CC/MCC 26. Kidney and Urinary Tract Infection MS-DRG 689 MS-DRG 690 Kidney and urinary tract infections with MCC Kidney and urinary tract infections without MCC 27. Prostatectomy MS-DRG 665 MS-DRG 666 MS-DRG 667 MS-DRG 707 MS-DRG 708 MS-DRG 713 MS-DRG 714 Prostatectomy with MCC Prostatectomy with CC Prostatectomy without CC/MCC Major male pelvic procedures with CC/MCC Major male pelvic procedures without CC/MCC Transurethral prostatectomy with CC/MCC Transurethral prostatectomy without CC/MCC Page 7

8 28. Medical Back MS-DRG 551 MS-DRG 552 Medical back problems with MCC Medical back problems without MCC 29. Major Joint Repair MS-DRG 461 MS-DRG 462 MS-DRG 466 MS-DRG 467 MS-DRG 468 MS-DRG 469 MS-DRG 470 MS-DRG 480 MS-DRG 481 MS-DRG 482 MS-DRG 485 MS-DRG 486 MS-DRG 487 MS-DRG 488 MS-DRG 489 Bilateral or multiple major joint procedures of lower extremity with MCC Bilateral or multiple major joint procedures of lower extremity without MCC Revision of hip or knee replacement with MCC Revision of hip or knee replacement with CC Revision of hip or knee replacement without CC/MCC Major joint replacement or reattachment of lower extremity with MCC Major joint replacement or reattachment of lower extremity without MCC Hip and femur procedures except major joint with MCC Hip and femur procedures except major joint with CC Hip and femur procedures except major joint without CC/MCC Knee procedure with principal diagnosis of infection with MCC Knee procedure with principal diagnosis of infection with CC Knee procedure with principal diagnosis of infection without CC/MCC Knee procedure without principal diagnosis of infection with CC/MCC Knee procedure without principal diagnosis of infection without CC/MCC 30. Neck/Back Repair MS-DRG 453 MS-DRG 454 MS-DRG 455 MS-DRG 456 MS-DRG 457 MS-DRG 458 MS-DRG 459 MS-DRG 460 MS-DRG 471 MS-DRG 472 MS-DRG 473 MS-DRG 518 MS-DRG 519 MS-DRG 520 Combined anterior/posterior spinal fusion with MCC Combined anterior/posterior spinal fusion with CC Combined anterior/posterior spinal fusion without CC/MCC Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusion with MCC Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusion with CC Spinal fusion except cervical with spinal curvature, malignancy, infection or extensive fusion without CC/MCC Spinal fusion except cervical with MCC Spinal fusion except cervical without MCC Cervical spinal fusion with MCC Cervical spinal fusion with CC Cervical spinal fusion without CC/MCC Back and neck procedures except spinal fusion with MCC or disc device/neurostimulator Back and neck procedures except spinal fusion with CC Back and neck procedures except spinal fusion without CC/MCC 31. Breast Cancer MS-DRG 576 MS-DRG 577 MS-DRG 578 MS-DRG 579 MS-DRG 580 MS-DRG 581 MS-DRG 582 MS-DRG 583 MS-DRG 584 MS-DRG 585 Skin graft except for skin ulcer or cellulitis with MCC Skin graft except for skin ulcer or cellulitis with CC Skin graft except for skin ulcer or cellulitis without CC/MCC Other skin, subcutaneous tissue and breast procedures with MCC Other skin, subcutaneous tissue and breast procedures with CC Other skin, subcutaneous tissue and breast procedures without CC/MCC Mastectomy for malignancy with CC/MCC Mastectomy for malignancy without CC/MCC Breast biopsy, local excision and other breast procedures with CC/MCC Breast biopsy, local excision and other breast procedures without CC/MCC 32. Hysterectomy MS-DRG 734 MS-DRG 735 MS-DRG 736 MS-DRG 737 MS-DRG 738 MS-DRG 739 MS-DRG 740 MS-DRG 741 MS-DRG 742 MS-DRG 743 Pelvic evisceration, radical hysterectomy and radical vulvectomy with CC/MCC Pelvic evisceration, radical hysterectomy and radical vulvectomy without CC/MCC Uterine and adnexa procedure for ovarian or adnexal malignancy with MCC Uterine and adnexa procedure for ovarian or adnexal malignancy with CC Uterine and adnexa procedure for ovarian or adnexal malignancy without CC/MCC Uterine and adnexa procedure for non-ovarian/adnexal malignancy with MCC Uterine and adnexa procedure for non-ovarian/adnexal malignancy with CC Uterine and adnexa procedure for non-ovarian/adnexal malignancy without CC/MCC Uterine and adnexa procedure for non-malignancy with CC/MCC Uterine and adnexa procedure for non-malignancy without CC/MCC Page 8

9 33. Infectious Disease MS-DRG 853 MS-DRG 854 MS-DRG 855 MS-DRG 856 MS-DRG 857 MS-DRG 858 MS-DRG 862 MS-DRG 863 MS-DRG 870 MS-DRG 871 MS-DRG 872 Infectious and parasitic diseases with O.R. procedure with MCC Infectious and parasitic diseases with O.R. procedure with CC Infectious and parasitic diseases with O.R. procedure without CC/MCC Postoperative or post-traumatic infections with O.R. procedure with MCC Postoperative or post-traumatic infections with O.R. procedure with CC Postoperative or post-traumatic infections with O.R. procedure without CC/MCC Postoperative and post-traumatic infections with MCC Postoperative and post-traumatic infections without MCC Septicemia or severe sepsis with mechanical ventilation >96 hours Septicemia or severe sepsis without mechanical ventilation >96 hours with MCC Septicemia or severe sepsis without mechanical ventilation >96 hours without MCC 34. Ventilation for Respiratory Disease MS-DRG 207 MS-DRG 208 Respiratory system diagnosis with ventilator support >96 hours Respiratory system diagnosis with ventilator support <96 hours 35. Tracheostomy MS-DRG 003 MS-DRG 004 ECMO or tracheostomy with mechanical ventilation >96 hours or principal diagnosis except face, mouth, and neck with major O.R. procedure Tracheostomy with mechanical ventilation >96 hours or principal diagnosis except face, mouth, and neck without major O.R. procedure Page 9

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