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ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
ICD-9-Codes and DRG Updates FY 2005
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ICD-9-Codes and DRG Updates FY 2005

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  • 1. ICD-9-Codes and DRG Updates FY 2005 Barry Libman, RHIA, CCS, CCS-P President, Barry Libman Inc
  • 2. Federal Register, August 11, 2004 Volume 69, Number 154 <ul><li>Medicare Program; Changes to the Hospital Inpatient Prospective Payment, Final Rule </li></ul><ul><li>http://www.access.gpo.gov/su_docs/fedreg/a040811c.html </li></ul><ul><li>effective on October 1, 2004 </li></ul>
  • 3. CMS DRG V.22 <ul><li>150 new diagnosis codes </li></ul><ul><li>21 new V codes </li></ul><ul><li>54 new procedure codes </li></ul><ul><li>3 new DRGs </li></ul><ul><li>Changes in grouper logic </li></ul><ul><li>Changes in code text </li></ul>
  • 4. New Diagnosis Codes <ul><li>6 Infectious Diseases </li></ul><ul><li>8 Endocrine Disorders </li></ul><ul><li>5 Nervous and Sense Organs </li></ul><ul><li>3 Circulatory System </li></ul><ul><li>2 Respiratory System </li></ul><ul><li>78 Digestive System </li></ul><ul><li>24 Genitourinary System </li></ul><ul><li>12 Skin and Subcutaneous Tissue </li></ul><ul><li>4 Congenital Anomalies </li></ul><ul><li>8 Symptoms, Signs and Ill-defined Conditions </li></ul>
  • 5. Infectious Diseases <ul><li>Arthropod-Borne Viral Diseases </li></ul><ul><li>066.40 West Nile Fever, unspecified </li></ul><ul><li>066.41 … w/ encephalitis </li></ul><ul><li>066.42 … w/ other neurologic manifestation </li></ul><ul><li>066.49 … w/ other complications </li></ul><ul><li>Viral Hepatitis </li></ul><ul><li>070.70 Unspecified viral hepatitis C w/o hepatic coma, CC </li></ul><ul><li>070.71 …w/ hepatic coma, CC </li></ul>
  • 6. Endocrine Disorders <ul><li>Disorders of Parathyroid Gland </li></ul><ul><li>252.00 Hyperparathyroidism, unspecified </li></ul><ul><li>252.01 Primary hyperparathyroidism </li></ul><ul><li>252.02 Secondary hyperparathyroidism, non-renal </li></ul><ul><li>252.08 Other hyperparathyroidism </li></ul>
  • 7. Endocrine Disorders <ul><li>Other Metabolic and Immunity Disorders </li></ul><ul><li>273.4 Alpha-1-antitrypsin deficiency </li></ul><ul><li>277.85 Disorders of fatty acid oxidation </li></ul><ul><li>277.86 Peroxisomal disorders </li></ul><ul><li>277.87 Disorders of mitochondrial metabolism </li></ul>
  • 8. Nervous System and Sense Organs <ul><li>Other disorders of the Central Nervous System </li></ul><ul><li>347.00 Narcolepsy, w/o cataplexy </li></ul><ul><li>347.01 …w/ cataplexy </li></ul><ul><li>347.10 …in conditions classified elsewhere, w/o cataplexy </li></ul><ul><li>347.11 …in conditions classified elsewhere, w/ cataplexy </li></ul><ul><li>Diseases of the Ear and Mastoid Process </li></ul><ul><li>380.03 Chondritis of pinna </li></ul>
  • 9. Circulatory System <ul><li>Diseases of Veins and Lymphatics, and Other Diseases of Circulatory System </li></ul><ul><li>453.40 Venous embolism and thrombosis of unspecified deep vessels of lower extremity, CC </li></ul><ul><li>453.41 … of deep vessels of proximal lower extremity, CC </li></ul><ul><li>453.42 … of deep vessels of distal lower extremity, CC </li></ul>
  • 10. Respiratory System <ul><li>Other Diseases of the Upper Respiratory Tract </li></ul><ul><li>477.2 Allergic rhinitis, due to animal (cat) (dog) hair and dander </li></ul><ul><li>Chronic Obstructive Pulmonary Diseases and Allied Conditions </li></ul><ul><li>491.22 Obstructive chronic bronchitis w/ acute bronchitis, CC </li></ul>
  • 11. Digestive System <ul><li>Diseases of Oral Cavity, Salivary Glands, and Jaws </li></ul><ul><li>521.06-08 Dental caries </li></ul><ul><li>521.10-15 Excessive attrition </li></ul><ul><li>521.20-25 Abrasion </li></ul><ul><li>521.30-35 Erosion </li></ul><ul><li>521.40-42 Pathological resorption </li></ul><ul><li>521.49 Other pathological resorption </li></ul><ul><li>523.20-25 Gingival recession </li></ul>
  • 12. Digestive System <ul><li>Diseases of Oral Cavity, Salivary Glands, and Jaws (cont.) </li></ul><ul><li>524.07 Excessive tuberosity of jaw </li></ul><ul><li>524.20 Unspecified anomaly of dental arch relationship </li></ul><ul><li>524.21-23 Angle’s class I-III </li></ul><ul><li>524.24 Open anterior occlusal relationship </li></ul><ul><li>524.25 Open posterior occlusal relationship </li></ul><ul><li>524.26 Excessive horizontal overlap </li></ul><ul><li>524.27 Reverse articulation </li></ul><ul><li>524.28 Anomalies of interarch distance </li></ul><ul><li>524.29 Other anomalies of dental arch relationship </li></ul><ul><li>524.30-37, 39 Anomaly of tooth position </li></ul>
  • 13. Digestive System <ul><li>Diseases of Oral Cavity, Salivary Glands, and Jaws (cont.) </li></ul><ul><li>524.50 Dentofacial functional abnormality, unspecified </li></ul><ul><li>524.51 Abnormal jaw closure </li></ul><ul><li>524.52 Limited mandibular range of motion </li></ul><ul><li>524.53 Deviation in opening and closing of the mandible </li></ul><ul><li>524.54 Insufficient anterior guidance </li></ul><ul><li>524.55 Centric occlusion maximum intercuspation discrepancy </li></ul><ul><li>524.56 Non-working side interference </li></ul><ul><li>524.57 Lack of posterior occlusal support </li></ul><ul><li>524.59 Other dentofacial functional abnormalities </li></ul>
  • 14. Digestive System <ul><li>Diseases of Oral Cavity, Salivary Glands, and Jaws (cont.) </li></ul><ul><li>524.64 Temporomandibular joint sounds on opening and/or closing the jaw </li></ul><ul><li>524.75 Vertical displacement of alveolus and teeth </li></ul><ul><li>524.76 Occlusal plane deviation </li></ul><ul><li>524.81 Anterior soft tissue impingement </li></ul><ul><li>524.82 Posterior soft tissue impingement </li></ul><ul><li>524.89 Other specified dentofacial anomalies </li></ul><ul><li>525.20-26 Atrophy </li></ul><ul><li>528.71 Minimal keratinized residual ridge mucosa </li></ul><ul><li>528.72 Excessive keratinized residual ridge mucosa </li></ul><ul><li>528.79 Other disturbances of oral epithelium, including tongue </li></ul>
  • 15. Digestive System <ul><li>Diseases of Esophagus, Stomach and Duodenum </li></ul><ul><li>530.86 Infection of esophagostomy, CC </li></ul><ul><li>530.87 Mechanical complication of esophagostomy, CC </li></ul>
  • 16. Genitourinary System <ul><li>Nephritis, Nephrotic Syndrome, and Nephrosis </li></ul><ul><li>588.81 Secondary hyperparathyroidism (of renal origin) </li></ul><ul><li>588.89 Other specified disorders resulting from impaired renal function </li></ul>
  • 17. Genitourinary System <ul><li>Other Disorders of Female Genital Tract </li></ul><ul><li>618.00 Unspecified prolapse of vaginal walls </li></ul><ul><li>618.01 Cystocele, midline </li></ul><ul><li>618.02 Cystocele, lateral </li></ul><ul><li>618.03 Urethrocele </li></ul><ul><li>618.04 Rectocele </li></ul><ul><li>618.05 Perineocele </li></ul><ul><li>618.09 Other prolapse of vaginal walls w/o mention of uterine prolapse </li></ul>
  • 18. Genitourinary System <ul><li>Other Disorders of Female Genital Tract (continued) </li></ul><ul><li>618.81 Incompetence or weakening of pubocervical tissue </li></ul><ul><li>618.82 Incompetence or weakening of rectovaginal tissue </li></ul><ul><li>618.83 Pelvic muscle wasting </li></ul><ul><li>618.89 Other specified genital prolapse </li></ul><ul><li>621.30 Endometrial hyperplasia, unspecified </li></ul><ul><li>621.31 Simple endometrial hyperplasia w/o atypia </li></ul><ul><li>621.32 Complex endometrial hyperplasia w/o atypia </li></ul><ul><li>621.33 Endometrial hyperplasia w/ atypia </li></ul>
  • 19. Genitourinary System <ul><li>Other Disorders of Female Genital Tract (continued) </li></ul><ul><li>622.10 Dysplasia of cervix, unspecified </li></ul><ul><li>622.11 Mild dysplasia of cervix </li></ul><ul><li>622.12 Moderate dysplasia of cervix </li></ul><ul><li>629.20-23 Female genital mutilation status </li></ul>
  • 20. Skin and Subcutaneous Tissue <ul><li>Other Inflammatory Conditions of Skin and Subcutaneous Tissue </li></ul><ul><li>692.84 Contact dermatitis and other eczema due to animal (cat) (dog) dander </li></ul><ul><li>Other Diseases of Skin and Subcutaneous Tissue </li></ul><ul><li>705.21 Primary focal hyperhidrosis </li></ul><ul><li>705.22 Secondary focal hyperhidrosis </li></ul>
  • 21. Skin and Subcutaneous Tissue <ul><li>Other Diseases of Skin and Subcutaneous Tissue (cont.) </li></ul><ul><li>707.00 Decubitus ulcer, unspecified site, CC </li></ul><ul><li>707.01 … elbow, CC </li></ul><ul><li>707.02 … upper back, CC </li></ul><ul><li>707.03 … lower back, CC </li></ul><ul><li>707.04 … hip, CC </li></ul><ul><li>707.05 … buttock, CC </li></ul><ul><li>707.06 … ankle, CC </li></ul><ul><li>707.07 … heel, CC </li></ul><ul><li>707.09 … other site, CC </li></ul>
  • 22. Congenital Anomalies <ul><li>758.31 Cri-du-chat syndrome </li></ul><ul><li>758.32 Velo-cardio-facial syndrome </li></ul><ul><li>758.33 Other microdeletions </li></ul><ul><li>758.39 Other autosomal deletions </li></ul>
  • 23. Symptoms, Signs, and Ill-Defined Conditions <ul><li>780.58 Sleep related movement disorder </li></ul><ul><li>788.38 Overflow incontinence </li></ul><ul><li>790.95 Elevated C-reactive protein (CRP) </li></ul>
  • 24. Symptoms, Signs, and Ill-Defined Conditions <ul><li>795.03 Papanicolaou smear of cervix w/ low grade squamous intraepithelial lesion (LGSIL) </li></ul><ul><li>795.04 …w/ high grade squamous intraepithelial lesion (HGSIL) </li></ul><ul><li>795.05 Cervical high risk human papillomavirus (HPV) DNA test positive </li></ul><ul><li>795.08 Nonspecific abnormal papanicolaou smear of cervix, unsatisfactory smear </li></ul><ul><li>796.6 Nonspecific abnormal findings on neonatal screening </li></ul>
  • 25. New V Codes <ul><li>V-Codes: Factors influencing Health Status and Contact with Health Services </li></ul><ul><li>Contact with or Exposure to Communicable Diseases </li></ul><ul><li>V01.71 Contact or exposure to varicella </li></ul><ul><li>V01.79 … other viral diseases </li></ul><ul><li>V01.83 … escherichia coli (E. coli) </li></ul><ul><li>V01.84 … meningococcus </li></ul>
  • 26. New V Codes <ul><li>Other Dependence on Machines </li></ul><ul><li>V46.11 Dependence on respirator, status, CC </li></ul><ul><li>V46.12 Encounter for respirator dependence during power failure, CC </li></ul><ul><li>Other Conditions Influencing Health Status </li></ul><ul><li>V49.83 Awaiting organ transplant status, CC </li></ul>
  • 27. New V Codes <ul><li>Encounter for Other and Unspecified Procedures and Aftercare </li></ul><ul><li>V58.44 Aftercare following organ transplant </li></ul><ul><li>V58.66 Long-term (current) use of aspirin </li></ul><ul><li>V58.67 Long-term (current) use of insulin </li></ul><ul><li>Problems Related to Life Style </li></ul><ul><li>V69.4 Lack of adequate sleep </li></ul>
  • 28. New V Codes <ul><li>Special Investigations and Examinations </li></ul><ul><li>V72.31 Routine gynecological examination </li></ul><ul><li>V72.32 Encounter for Papanicolaou cervical smear to confirm findings of recent normal smear following initial abnormal smear </li></ul><ul><li>V72.40 Pregnancy examination or test, pregnancy unconfirmed </li></ul><ul><li>V72.41 … negative result </li></ul>
  • 29. New V Codes <ul><li>Genetic Susceptibility </li></ul><ul><li>V84.01 Genetic susceptibility to malignant neoplasm of breast </li></ul><ul><li>V84.02 … malignant neoplasm of ovary </li></ul><ul><li>V84.03 … malignant neoplasm of prostate </li></ul><ul><li>V84.04 … malignant neoplasm of endometrium </li></ul><ul><li>V84.09 … other malignant neoplasm </li></ul><ul><li>V84.8 … other disease </li></ul>
  • 30. New Procedure Codes <ul><li>00.16 Pressurized treatment of venous bypass graft [conduit] w/ pharmaceutical substance </li></ul><ul><ul><ul><ul><ul><li>E2F Decoy (edifoligide) procedure </li></ul></ul></ul></ul></ul><ul><li>00.17 Infusion of vasopressor agent </li></ul><ul><ul><ul><ul><ul><li>Intended for use w/ severe sepsis codes </li></ul></ul></ul></ul></ul>
  • 31. New Procedure Codes <ul><li>00.21 Intravascular imaging of extracranial cerebral vessels </li></ul><ul><li>00.22 … intrathoracic vessels </li></ul><ul><li>00.23 … peripheral vessels </li></ul><ul><li>00.24 … coronary vessels </li></ul><ul><li>00.25 … renal vessels </li></ul><ul><li>00.28 … other specified vessel(s) </li></ul><ul><li>00.29 … unspecified vessel(s) </li></ul>
  • 32. New Procedure Codes <ul><li>00.31 Computer assisted surgery w/ CT/CTA </li></ul><ul><li>00.32 … w/ MR/MRA </li></ul><ul><li>00.33 … w/ fluoroscopy </li></ul><ul><li>00.34 Imageless computer assisted surgery </li></ul><ul><li>00.35 Computer assisted surgery w/ multiple datasets </li></ul><ul><li>00.39 Other computer assisted surgery </li></ul>
  • 33. New Procedure Codes <ul><li>00.61 Percutaneous angioplasty or atherectomy of precerebral (extracranial) vessel(s) </li></ul><ul><li>00.62 …of intracranial vessel(s) </li></ul><ul><li>DRG 533, 534 </li></ul><ul><li>Extracranial Procedures w/ and w/o CC </li></ul>
  • 34. New Procedure Codes <ul><li>00.63 Percutaneous insertion of carotid artery stent(s) </li></ul><ul><li>00.64 … other precerebral (extracranial) artery stent(s) </li></ul><ul><li>00.65 … intracranial vascular stent(s) </li></ul>
  • 35. New Procedure Codes <ul><li>00.91 Transplant from live related donor </li></ul><ul><li>00.92 …live non-related donor </li></ul><ul><li>00.93 …cadaver </li></ul><ul><li>27.64 Insertion of palatal implant </li></ul>
  • 36. New Procedure Codes <ul><li>37.68 Insertion of percutaneous external heart assist device </li></ul><ul><li>DRG 104, 105 </li></ul><ul><li>Cardiac Valve and Other Major Cardiothoracic Procedure w/ and w/o Cardiac Catheterization </li></ul><ul><li>37.90 Insertion of left atrial appendage device </li></ul><ul><li>DRG 518 </li></ul><ul><li>Percutaneous Cardiovascular Procedure w/o Coronary Artery Stent or AMI </li></ul>
  • 37. New Procedure Codes <ul><li>Laparoscopic </li></ul><ul><li>44.38 gastroenterostomy </li></ul><ul><li>44.67 procedures for creation of esophagogastric sphincteric competence </li></ul><ul><li>44.68 gastroplasty </li></ul><ul><li>DRG 154, 155, 156 </li></ul><ul><li>Stomach, Esophageal and Duodenal Procedures, w/ and w/o CC, and age 0-17 </li></ul>
  • 38. New Procedure Codes <ul><li>Laparoscopic </li></ul><ul><li>44.95 gastric restrictive procedure </li></ul><ul><li>44.96 revision of gastric restrictive procedure </li></ul><ul><li>44.97 removal of gastric restrictive device(s) </li></ul><ul><li>44.98 adjustment of size of adjustable gastric restrictive device </li></ul><ul><li>DRG 288 </li></ul><ul><li>OR Procedures for Obesity </li></ul>
  • 39. New Procedure Codes <ul><li>81.65 Vertebroplasty </li></ul><ul><li>81.66 Kyphoplasty </li></ul><ul><li>DRG 233, 234 </li></ul><ul><li>Other Musculoskeletal System and Connective Tissue OR Procedure w/ and w/o CC </li></ul><ul><li>DRG 442, 443 </li></ul><ul><li>Other OR Procedures for Injuries, w/ and w/o CC </li></ul>
  • 40. New Procedure Codes <ul><li>84.53 Implantation of internal limb lengthening device w/ kinetic distraction </li></ul><ul><li>84.54 Implantation of other internal limb lengthening device </li></ul><ul><li>84.55 Insertion of bone void filler </li></ul>
  • 41. New Procedure Codes <ul><li>84.59 Insertion of other spinal devices </li></ul><ul><li>84.60 … spinal disc prosthesis, not otherwise specified </li></ul><ul><li>84.61 … partial spinal disc prosthesis, cervical </li></ul><ul><li>84.62 … total spinal disc prosthesis, cervical </li></ul><ul><li>84.63 … spinal disc prosthesis, thoracic </li></ul><ul><li>84.64 … partial spinal disc prosthesis, lumbosacral </li></ul><ul><li>84.65 … total spinal disc prosthesis, lumbosacral </li></ul><ul><li>DRG 531, 532 Spinal Procedures, w/ and w/o CC </li></ul><ul><li>DRG 499, 500 Back and Neck Procedures Except Spinal Fusion, w/ and w/o CC </li></ul>
  • 42. New Procedure Codes <ul><li>84.66 Revision or replacement of artificial spinal disc prosthesis, cervical </li></ul><ul><li>84.67 … thoracic </li></ul><ul><li>84.68 … lumbosacral </li></ul><ul><li>84.69 … not otherwise specified </li></ul><ul><li>DRG 531, 532 Spinal Procedures, w/ and w/o CC </li></ul><ul><li>DRG 499, 500 Back and Neck Procedures Except Spinal Fusion, w/ and w/o CC </li></ul>
  • 43. New Procedure Codes <ul><li>86.94 Insertion or replacement of single array neurostimulator pulse generator </li></ul><ul><li>86.95 …dual array neurostimulator pulse generator </li></ul><ul><li>86.96 …other neurostimulator pulse generator </li></ul><ul><li>DRG 7, 8 </li></ul><ul><li>Peripheral and Cranial Nerve and other Nervous System Procedure, w/ and w/o CC </li></ul>
  • 44. New Procedure Codes <ul><li>89.49 Automatic implantable cardioverter/ defibrillator (AICD) check </li></ul><ul><li>99.78 Aquapheresis </li></ul>
  • 45. New DRGs <ul><li>DRG 541 and 542 </li></ul><ul><li>Tracheostomy w/ Mechanical Ventilation 96+hours or Principal Diagnosis except Face Mouth and Neck Diagnosis, w/ and w/o Major OR Procedure </li></ul><ul><li>541 wt 20.0414 </li></ul><ul><li>542 wt 12.0286 </li></ul><ul><li>Replaces DRG 483 </li></ul><ul><li>Tracheostomy w/ Mechanical Ventilation 96+ hours or Principal Diagnosis except Face, Mouth and Neck Diagnosis </li></ul>
  • 46. New DRGs <ul><li>DRG 543 </li></ul><ul><li>Craniotomy w/ Implant of Chemotherapeutic Agent or Acute Complex Central Nervous System Principal Diagnosis </li></ul><ul><li>543 wt 4.4579 </li></ul><ul><li>FY 2004 </li></ul><ul><ul><li>DRG 1 Craniotomy, age>17, w/ CC wt 3.6186 </li></ul></ul><ul><ul><li>DRG 2 … w/o CC wt 2.0850 </li></ul></ul><ul><li>FY 2005 </li></ul><ul><ul><li>DRG 1 wt 3.3344 </li></ul></ul><ul><ul><li>DRG 2 wt 1.9467 </li></ul></ul>
  • 47. Changes in Grouper Logic Spinal Fusion <ul><li>Procedure Code 81.61 </li></ul><ul><li>360 º Spinal Fusion Single Incision </li></ul><ul><li>Moved out of DRG 496 </li></ul><ul><li>Combined Anterior/Posterior Spinal Fusion </li></ul><ul><li>496 wt 5.8072 </li></ul><ul><li>Moved to DRG 497 and 498 </li></ul><ul><li>Spinal Fusion except w/ and w/o CC </li></ul><ul><li>497 wt 3.5251, 498 wt 2.6527 </li></ul>
  • 48. Changes in Grouper Logic Newborn DRGs <ul><li>New codes added to major problem list for </li></ul><ul><ul><li>DRG 387 Prematurity with Major Problems </li></ul></ul><ul><ul><li>DRG 389 Full-term Neonate with Major Problems </li></ul></ul>
  • 49. Changes in Grouper Logic Newborn DRGs 387 and 389 <ul><li>398.91 Rheumatic heart failure (congestive) </li></ul><ul><li>402.01 Malignant hypertensive heart disease, with heart failure </li></ul><ul><li>402.11 Benign hypertensive heart disease, with heart failure </li></ul><ul><li>402.91 Unspecified hypertensive heart disease, with heart failure </li></ul>
  • 50. Changes in Grouper Logic Newborn DRGs 387 and 389 <ul><li>404.01 Malignant hypertensive heart and renal disease, with heart failure </li></ul><ul><li>404.03 … with heart failure and renal failure </li></ul><ul><li>404.11 Benign hypertensive heart and renal disease, with heart failure </li></ul><ul><li>404.13 …with heart failure and renal failure </li></ul><ul><li>404.91 Unspecified hypertensive heart and renal disease, with heart failure </li></ul><ul><li>404.93 …with heart failure and renal failure </li></ul><ul><li>428.9 Heart failure, unspecified </li></ul>
  • 51. Changes in Grouper Logic CRT-P Implantation or Replacement <ul><li>Pacemaker device and lead procedure code combinations added to: </li></ul><ul><li>DRG 115 Permanent Cardiac Pacemaker Implant w/ Acute Myocardial Infarction, Heart Failure, or Shock or AICD Lead or Generator Procedures </li></ul><ul><li>DRG 116 Other Permanent Cardiac Pacemaker Implant </li></ul><ul><li>Moved out of DRG 118 </li></ul>
  • 52. Changes in Grouper Logic CRT-P -- DRGs 115 and 116 <ul><li>Pacemaker device and lead procedure code combinations </li></ul><ul><li>00.53 Implantation or Replacement of Cardiac Resynchronization Pacemaker Pulse Generator Only (CRT-P) </li></ul><ul><li>00.53 & 37.70 </li></ul><ul><li>00.53 & 37.71 </li></ul><ul><li>00.53 & 37.72 </li></ul><ul><li>00.53 & 37.73 </li></ul><ul><li>00.53 & 37.74 </li></ul><ul><li>00.53 & 37.76 </li></ul>
  • 53. Changes in Grouper Logic Intestinal Transplantation <ul><li>46.97 Intestinal Transplantation </li></ul><ul><li>Moved out of DRGs 148 and 149 </li></ul><ul><ul><li>148 wt 3.3871, 149 wt 1.4352 </li></ul></ul><ul><li>Moved to DRG 480 </li></ul><ul><ul><li>480 wt 9.8696 </li></ul></ul><ul><li>DRG 480 renamed “Liver Transplant and/or Intestinal Transplant” </li></ul>
  • 54. Changes in Grouper Logic Pancreatic Islet Cell Transplantation <ul><li>Pancreatic Islet Cell Transplantation </li></ul><ul><li>52.84 Autotransplantation </li></ul><ul><li>52.85 Allotransplantation </li></ul><ul><li>Moved to DRG 315 “Other Kidney and Urinary Tract OR Procedure” </li></ul><ul><li>315 wt 2.0861 </li></ul><ul><li>Previously these codes had no surgical DRG assignment </li></ul>
  • 55. Changes in Grouper Logic Burns w/ mechanical ventilation <ul><li>Cases with </li></ul><ul><ul><li>PDX Extensive Third Degree Burns or Full Thickness Burns and </li></ul></ul><ul><ul><li>Procedure Code 96.72 continuous mechanical ventilation for 96+ hours </li></ul></ul><ul><li>DRG 504 Extensive Burns or Full Thickness Burns w/ Mechanical Ventilation 96+ hrs w/ skin graft </li></ul><ul><li>DRG 505 … w/o skin graft </li></ul><ul><li>Moved out of DRGs 506-509 </li></ul>
  • 56. Changes in Diagnosis Code Titles <ul><li>203 changes to code titles – most minor </li></ul><ul><li>Includes </li></ul><ul><ul><li>Diabetes – 40 changes </li></ul></ul><ul><ul><li>Mental Disorders - 144 changes </li></ul></ul><ul><ul><li>Newborns – 8 changes </li></ul></ul><ul><ul><li>CVA – 1 change </li></ul></ul>
  • 57. Changes in Diagnosis Code Titles <ul><li>Diabetes – remove references to non-insulin dependent, insulin dependent, and to adult-onset </li></ul><ul><ul><li>Example : 250.00 Diabetes Mellitus w/o Mention of Complication, Type II (Non-insulin Dependent Type) (NIDDM Type) (Adult-onset Type) or Unspecified Type, not Stated as Uncontrolled </li></ul></ul><ul><ul><li>Example : 250.01 Diabetes Mellitus w/o Mention of Complication, Type I (Insulin Dependent Type) (IDDM) (Juvenile Type), not Stated as Uncontrolled </li></ul></ul><ul><li>( Italics indicates text no longer in title) </li></ul>
  • 58. Changes in Diagnosis Code Titles <ul><li>CVA </li></ul><ul><li>The inclusion terms of stroke and CVA under code 436 have been removed and re-indexed to code 434.91 </li></ul><ul><li>Code 436 now reads “Acute, but ill-defined cerebrovascular disease” </li></ul>
  • 59. What Now? <ul><li>Read the Federal Register </li></ul><ul><li>Study the new coding book for text changes </li></ul><ul><li>Share this information with </li></ul><ul><ul><li>your peers </li></ul></ul><ul><ul><li>departments that utilize coding </li></ul></ul><ul><ul><li>medical staff </li></ul></ul>
  • 60. Questions? <ul><li>contact: </li></ul><ul><ul><li>Barry Libman, RHIA, CCS, CCS-P </li></ul></ul><ul><ul><li>Barry Libman Inc. </li></ul></ul><ul><ul><li>[email_address] arrylibmaninc.com </li></ul></ul><ul><ul><li>978-369-7180 </li></ul></ul>

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