BUNDLED PAYMENTS FOR CARE IMPROVEMENT (BPCI) PRELIMINARY LIST OF EPISODES FOR ALL MODELS

Transcription

1 BUNDLED PAYMENTS FOR CARE IMPROVEMENT (BPCI) PRELIMINARY LIST OF EPISODES FOR ALL MODELS This list contains the 48 clinical episodes and their associated anchor MS-DRGs that the Innovation Center is interested in testing under BPCI Models 2, 3, and 4. A Medicare beneficiary is identified for inclusion in an episode based on an acute care hospitalization for an MS-DRG. The preliminary list of 48 clinical episodes was constructed based upon input from applications to the program. From this list, model candidates have been asked to identify the clinical episodes they are interested in testing. Major joint upper extremity 483 Major joint and limb reattachment procedure of upper extremity with complication or comorbidity or major complication or comorbidity Major joint and limb reattachment procedure of upper extremity without 484 complication or comorbidity or major complication or comorbidity Amputation for circulatory system disorder Amputation 239 except upper limb and toe with major complication or comorbidity 240 Amputation for circulatory system disorder except upper limb and toe with complication or comorbidity Amputation for circulatory system disorder except upper limb and toe without complication or comorbidity or major complication or 241 comorbidity 255 Upper limb and toe amputation for circulatory system disorder with major complication or comorbidity 256 Upper limb and toe amputation for circulatory system disorder with complication or comorbidity 257 Upper limb and toe amputation for circulatory system disorder without complication or comorbidity or major complication or comorbidity 474 Amputation for musculoskeletal system and connective tissue disease with major complication or comorbidity 475 Amputation for musculoskeletal system and connective tissue disease with complication or comorbidity Amputation for musculoskeletal system and connective tissue disease without complication or comorbidity or major complication or 476 comorbidity Amputation of lower limb for endocrine,nutritional,and metabolic disease with 616 major complication or comorbidity Amputation of lower limb for endocrine,nutritional,and metabolic disease with 617 complication or comorbidity Amputation of lower limb for endocrine,nutritional,and metabolic disease without complication or comorbidity or major complication or 618 comorbidity Urinary tract infection 689 Kidney and urinary tract infections with major complication or comorbidity 690 Kidney and urinary tract infections without major complication or comorbidity Stroke 61 Acute ischemic stroke with use of thrombolytic agent with major complication or comorbidity 62 Acute ischemic stroke with use of thrombolytic agent with complication or comorbidity 63 Acute ischemic stroke with use of thrombolytic agent without complication or comorbidity or major complication or comorbidity 64 Intracranial hemorrhage or cerebral infarction with major complication or comorbidity 65 Intracranial hemorrhage or cerebral infarction with complication or comorbidity 66 Intracranial hemorrhage or cerebral infarction without complication or comorbidity or major complication or comorbidity Chronic obstructive pulmonary disease, bronchitis/asthma 190 Chronic obstructive pulmonary disease with major complication or comorbidity 191 Chronic obstructive pulmonary disease with complication or comorbidity 192 Chronic obstructive pulmonary disease without complication or comorbidity or major complication or comorbidity 202 Bronchitis and asthma with complication or comorbidity or and major complication or comorbidity 203 Bronchitis and asthma without complication or comorbidity or major complication or comorbidity Coronary artery bypass graft surgery 231 Coronary bypass with percutaneous transluminal coronary angioplasty with major complication or comorbidity 232 Coronary bypass with percutaneous transluminal coronary angioplasty without major complication or comorbidity

2 233 Coronary bypass with cardiac catheterization with major complication or comorbidity 234 Coronary bypass with cardiac cathetererization without major complication or comorbidity 235 Coronary bypass without cardiac catheterization with major complication or comorbidity 236 Coronary bypass without cardiac catheterization without major complication or comorbidity Major joint replacement of the lower extremity 469 Major joint replacement or reattachment of lower extremity with major complication or comorbidity 470 Major joint replacement or reattachment of lower extremity without major complication or comorbidity Percutaneous coronary intervention 246 Percutaneous cardiovascular procedure with drug-eluting stent with major complication or comorbidity 247 Percutaneous cardiovascular procedure with drug-eluting stent without major complication or comorbidity 248 Percutaneous cardiovascular procedure with non-drug-eluting stent with major complication or comorbidity 249 Percutaneous cardiovascular procedure with non-drug-eluting stent without major complication or comorbidity 250 Percutaneous cardiovascular procedure without coronary artery stent with major complication or comorbidity 251 Percutaneous cardiovascular procedure without coronary artery stent without major complication or comorbidity Pacemaker 242 Permanent cardiac pacemaker implant with major complication or comorbidity 243 Permanent cardiac pacemaker implant with complication or comorbidity 244 Permanent cardiac pacemaker implant without complication or comorbidity or major complication or comorbidity Cardiac defibrillator implant with cardiac catheterization with acute myocardial infarction/heart failure/shock with major complication or Cardiac defibrillator 222 comorbidity Cardiac defibrillator implant with cardiac catheterization with acute myocardial infarction/heart failure/shock without major complication 223 or comorbidity Cardiac defibrillator implant with cardiac catheterization without acute myocardial infarction/heart failure/shock with major complication 224 or comorbidity Cardiac defibrillator implant with cardiac catheterization without acute myocardial infarction/heart failure/shock without major 225 complication or comorbidity 226 Cardiac defibrillator implant without cardiac catheterization with major complication or comorbidity 227 Cardiac defibrillator implant without cardiac catheterization without major complication or comorbidity Pacemaker Device replacement or revision 258 Cardiac pacemaker device replacement with major complication or comorbidity 259 Cardiac pacemaker device replacement without major complication or comorbidity 260 Cardiac pacemaker revision except device replacement with major complication or comorbidity 261 Cardiac pacemaker revision except device replacement with complication or comorbidity 262 Cardiac pacemaker revision except device replacement without complication or comorbidity or major complication or comorbidity Automatic implantable cardiac defibrillator generator or lead 245 Automatic implantable cardioverter defibrillator generator procedures 265 Automatic implantable cardioverter defibrillator lead procedures Congestive heart failure 291 Heart failure and shock with major complication or comorbidity 292 Heart failure and shock with complication or comorbidity 293 Heart failure and shock without complication or comorbidity or major complication or comorbidity Acute myocardial infarction 280 Acute myocardial infarction, disease/discharged alive with major complication or comorbidity 281 Acute myocardial infarction, disease/discharged alive with complication or comorbidity 282 Acute myocardial infarction, disease/discharged alive without complication or comorbidity or major complication or comorbidity Cardiac arrhythmia 308 Cardiac arrhythmia and conduction disorders with major complication or comorbidity 309 Cardiac arrhythmia and conduction disorders with complication or comorbidity 310 Cardiac arrhythmia and conduction disorders without complication or comorbidity or major complication or comorbidity

3 Cardiac valve 216 Cardiac valve and other major cardiothoracic procedure with cardiac catheterization with major complication or comorbidity 217 Cardiac valve and other major cardiothoracic procedure with cardiac catheterization with complication or comorbidity Cardiac valve and other major cardiothoracic procedure with card catheter without complication or comorbidity and major complication or 218 comorbidity 219 Cardiac valve and other major cardiothoracic procedure without cardiac catheterization with major complication or comorbidity 220 Cardiac valve and other major cardiothoracic procedure without cardiac catheterization with complication or comorbidity Cardiac valve and other major cardiothoracic procedure without cardiac cathetererization without complication or comorbidity or major 221 complication or comorbidity Other vascular surgery 252 Other vascular procedures with major complication or comorbidity 253 Other vascular procedures with complication or comorbidity 254 Other vascular procedures without complication or comorbidity or major complication or comorbidity Major cardiovascular procedure 237 Major cardiovascular procedures with major complication or comorbidity 238 Major cardiovascular procedures without major complication or comorbidity Gastrointestinal hemorrhage 377 Gastrointestinal hemorrhage with major complication or comorbidity 378 Gastrointestinal hemorrhage with complication or comorbidity 379 Gastrointestinal hemorrhage without complication or comorbidity or major complication or comorbidity Major bowel 329 Major small and large bowel procedures with major complication or comorbidity 330 Major small and large bowel procedures with complication or comorbidity 331 Major small and large bowel procedures without complication or comorbidity or major complication or comorbidity Fractures femur and hip/pelvis 533 Fractures of femur with major complication or comorbidity 534 Fractures of femur without major complication or comorbidity 535 Fractures of hip and pelvis with major complication or comorbidity 536 Fractures of hip and pelvis without major complication or comorbidity Medical non-infectious orthopedic 537 Sprains, strains, and dislocations of hip, pelvis and thigh with complication or comorbidity or major complication or comorbidity 538 Sprains, strains, and dislocations of hip, pelvis and thigh without complication or comorbidity or major complication or comorbidity 551 Medical back problems with major complication or comorbidity 552 Medical back problems without major complication or comorbidity 553 Bone diseases and arthropathies with major complication or comorbidity 554 Bone diseases and arthropathies without major complication or comorbidity 555 Signs and symptoms of musculoskeletal system and connective tissue with major complication or comorbidity 556 Signs and symptoms of musculoskeletal system and connective tissue without major complication or comorbidity 557 Tendonitis, myositis and bursitis with major complication or comorbidity 558 Tendonitis, myositis and bursitis without major complication or comorbidity 559 Aftercare, musculoskeletal system and connective tissue with major complication or comorbidity 560 Aftercare, musculoskeletal system and connective tissue with complication or comorbidity 561 Aftercare, musculoskeletal system and connective tissue without complication or comorbidity or major complication or comorbidity 562 Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh with major complication or comorbidity 563 Fracture, sprais, strain and dislcation except femur, hip, pelvis and thigh without major complication or comorbidity Double joint replacement of the lower extremity 461 Bilateral or multiple major joint procedures of lower extremity with major complication or comorbidity 462 Bilateral or multiple major joint procedures of lower extremity without major complication or comorbidity Revision of the hip or knee 466 Revision of hip or knee replacement with major complication or comorbidity 467 Revision of hip or knee replacement with complication or comorbidity

4 468 Revision of hip or knee replacement without complication or comorbidity oe major complication or comorbidity Spinal fusion (non-cervical) 459 Spinal fusion except cervical with major complication or comorbidity 460 Spinal fusion except cervical without major complication or comorbidity Hip and femur procedures except major joint 480 Hip and femur procedures except major joint with major complication or comorbidity 481 Hip and femur procedures except major joint with complication or comorbidity 482 Hip and femur procedures except major joint without complication or comorbidity or major complication or comorbidity Cervical spinal fusion 471 Cervical spinal fusion with major complication or comorbidity 472 Cervical spinal fusion with complication or comorbidity 473 Cervical spinal fusion without complication or comorbidity or major complication or comorbidity Other knee procedures 485 Knee procedures with primary diagnosis of infection with major complication or comorbidity 486 Knee procedures with primary diagnosis of infection with complication or comorbidity 487 Knee procedures with primary diagnosis of infection without complication or comorbidity or major complication or comorbidity 488 Knee procedures without primary diagnosis of infection with complication or comorbidity or major complication or comorbidity 489 Knee procedures without primary diagnosis of infection without complication or comorbidity or major complication or comorbidity Complex non-cervical spinal fusion 456 Spinal fusion except cervical with spinal curvature/malignancy/infection or 9+ fusions with major complication or comorbidity 457 Spinal fusion except cervical with spinal curvature/malignancy/infection or 9+ fusions with complication or comorbidity Spinal fusion except cervical with spinal curvature/malignancy/infection or 9+ fusions without complication or comorbidity or major 458 complication or comorbidity Combined anterior posterior spinal fusion 453 Combined anterior/posterior spinal fusion with major complication or comorbidity 454 Combined anterior/posterior spinal fusion with complication or comorbidity 455 Combined anterior/posterior spinal fusion without complication or comorbidity or major complication or comorbidity Back and neck except spinal fusion Back and neck procedures except spinal fusion with complication or comorbidity or major complication or comorbidiy or disc 490 device/neurostimulator 491 Back and neck procedures except spinal fusion without complication or comorbidity or major complication or comorbidity Lower extremity and humerus procedure except hip, foot, femur 492 Lower extremity and humerus procedures except hip,foot,femur with major complication or comorbidity 493 Lower extremity and humerus procedures except hip,foot,femur with complication or comorbidity 494 Lower extremity and humeusr procedurse except hip,foot,femur without complication or comorbidity or major complication or comorbidity Removal of orthopedic devices 495 Local excision and removal internal fixation devices except hip and femur with major complication or comorbidity 496 Local excision and removal internal fixation devices except hip and femur with complication or comorbidity Local excision and removal internal fixation devices except hip and femur without complication or comorbidity or major complication or 497 comorbidity Local excision and removal internal fixation devices of hip and femur with complication or comorbidity or major complication or 498 comorbidity 499 Local excision and removal internal fixation devices of hip and femur without complication or comorbidity or major complication or comorbidity Sepsis 870 Septicemia or severe sepsis with mechanical ventilation 96+ hours 871 Septicemia or severe sepsis without mechanical ventilation 96+ hours with major complication or comorbidity 872 Septicemia or severe sepsis without mechanical ventilation 96+ hours without major complication or comorbidity Diabetes 637 Diabetes with major complication or comorbidity

5 638 Diabetes with complication or comorbidity 639 Diabetes without complication or comorbidity or major complication or comorbidity Simple pneumonia and respiratory infections 177 Respiratory infections and inflammations with major complication or comorbidity 178 Respiratory infections and inflammations with complication or comorbidity 179 Respiratory infections and inflammations without complication or comorbidity or major complication or comorbidity 193 Simple pneumonia and pleurisy with major complication or comorbidity 194 Simple pneumonia and pleurisy with complication or comorbidity 195 Simple pneumonia and pleurisy without complication or comorbidity or major complication or comorbidity Other respiratory 189 Pulmonary edema and respiratory failure 204 Respiratory signs and symptoms 205 Other respiratory system diagnoses with major complication or comorbidity 206 Other respiratory system diagnoses without major complication or comorbidity 207 Respiratory system diagnosis with ventilator support 96+ hours 208 Respiratory system diagnosis with ventilator support <96 hours 186 Pleural effusion with major complication or comorbidity 187 Pleural effusion with complication or comorbidity 188 Pleural effusion without complication or comorbidity or major complication or comorbidity Chest pain 313 Chest pain Medical peripheral vascular disorders 299 Peripheral vascular disorders with major complication or comorbidity 300 Peripheral vascular disorders with complication or comorbidity 301 Peripheral vascular disorders without complication or comorbidity or major complication or comorbidity Atherosclerosis 302 Atherosclerosis with major complication or comorbidity 303 Atherosclerosis without major complication or comorbidity Gastrointestinal obstruction 388 Gastrointestinal obstruction with major complication or comorbidity 389 Gastrointestinal obstruction with complication or comorbidity 390 Gastrointestinal obstruction without complication or comorbidity or major complication or comorbidity Syncope and collapse 312 Syncope and collapse Renal failure 682 Renal failure with major complication or comorbidity 683 Renal failure with complication or comorbidity 684 Renal failure without complication or comorbidity or major complication or comorbidity Nutritional and metabolic disorders 640 Miscellabeous disorders of nutrition, metabolism, fluid/electrolytes with major complication or comorbidity 641 Miscellabeous disorders of nutrition, metabolism, fluid/electrolytes without major complication or comorbidity Cellulitis 602 Cellulitis with major complication or comorbidity 603 Cellulitis without major complication or comorbidity Red blood cell disorders 811 Red blood cell disorders with major complication or comorbidity 812 Red blood cell disorders without major complication or comorbidity Transient ischemia 69 Transient ischemia Esophagitis, gastroenteritis and other digestive disorders 391 Esophagitis, gastroenteritis and miscellaneous digestive disorders with major complication or comorbidity 392 Esophagitis, gastroenteritis and miscellaneous digestive disorders without major complication or comorbidity