Principles of Healthcare Reimbursement Student Workbook Chapter 6 Medicare-Medicaid Prospective Payment Systems for Inpatients 2 Activities Theory into Practice and Real-World Case The Medicare Provider Analysis and Review (MedPAR) file is a database that the Centers for Medicare and Medicaid Services maintains. For each year, it includes the records from all the claims for hospital discharges of Medicare beneficiaries. The MedPAR file contains several gigabytes of data per year. Rather than being an inert archive, these data can be used to improve the quality of care for Medicare beneficiaries (Ash et al. 2003; Stringham and Young 2005). The MedPAR file is an administrative database. The data include many administrative fields, such as diagnosis and procedure codes, claim costs and charges, the diagnosis-related group (DRG) and—as of fiscal year 2008—MS-DRGs, and the length of stay. However, as an administrative database, it has limitations to its usefulness as a means of assessing the quality of patient care. The database does not include some clinical risk factors, such as the results of diagnostic tests. The number of other diagnoses used to record complications and comorbidities is restricted to eight. The benefits of using the database, though, far outweigh the limitations. Cost is minimal. The database already exists. No forms or procedures need to be created. No data collectors need to be hired nor trained. Data collection occurs in the usual course of business. Finally, though, research has found that the MedPAR file can be used to assess the quality of patient care for both Medicare patients and other-payer patients (Needleman et al. 2003). Ash and colleagues used MedPAR claims data to predict mortality in patients who had suffered acute myocardial infarction (AMI). They studied the years 1995 through 1999 with more than 300,000 cases per year (305,468; 308,997; 306,224; 304,882; 306,175; totaling 1,531,746). The validation data showed up to 80 percent mortality one year post-AMI for cases in the highest risk group. Moreover, the authors found that, prior to the AMI in the study, the patients had had a previous AMI, diabetes, or congestive heart failure. This information about health status at admission is important for the care of patients and for the improvement of care outcomes (Ash et al. 2003). Stringham and Young used the MedPAR file to examine rates of urinary tract infections (UTI) at acute inpatient hospitals (Stringham and Young 2005). The authors noted that Medicare makes additional payments for complications, even complications that are possibly preventable. Frequently, the Medicare payment system has paired DRGs: one DRG for the condition and one DRG for the condition with a complication or comorbidity (CC). The relative weight of the DRG with the CC is higher than the relative weight for the DRG without the CC. Nosocomial UTIs are an example of a potentially pr.

1. Principles of Healthcare
Reimbursement
Student Workbook
Chapter 6
Medicare-Medicaid Prospective
Payment Systems for Inpatients
2
Activities
Theory into Practice and Real-World Case
The Medicare Provider Analysis and Review (MedPAR) file is a
database that the
Centers for Medicare and Medicaid Services maintains. For
each year, it includes the
records from all the claims for hospital discharges of Medicare
beneficiaries. The
MedPAR file contains several gigabytes of data per year. Rather
than being an inert
archive, these data can be used to improve the quality of care
for Medicare beneficiaries
(Ash et al. 2003; Stringham and Young 2005).

2. The MedPAR file is an administrative database. The data
include many
administrative fields, such as diagnosis and procedure codes,
claim costs and charges,
the diagnosis-related group (DRG) and—as of fiscal year
2008—MS-DRGs, and the
length of stay. However, as an administrative database, it has
limitations to its
usefulness as a means of assessing the quality of patient care.
The database does not
include some clinical risk factors, such as the results of
diagnostic tests. The number of
other diagnoses used to record complications and comorbidities
is restricted to eight.
The benefits of using the database, though, far outweigh the
limitations. Cost is minimal.
The database already exists. No forms or procedures need to be
created. No data
collectors need to be hired nor trained. Data collection occurs in
the usual course of
business. Finally, though, research has found that the MedPAR
file can be used to assess
the quality of patient care for both Medicare patients and other-
payer patients
(Needleman et al. 2003).
Ash and colleagues used MedPAR claims data to predict
mortality in patients
who had suffered acute myocardial infarction (AMI). They
studied the years 1995
through 1999 with more than 300,000 cases per year (305,468;
308,997; 306,224; 304,882;
306,175; totaling 1,531,746). The validation data showed up to
80 percent mortality one
year post-AMI for cases in the highest risk group. Moreover,

3. the authors found that,
prior to the AMI in the study, the patients had had a previous
AMI, diabetes, or
congestive heart failure. This information about health status at
admission is important
for the care of patients and for the improvement of care
outcomes (Ash et al. 2003).
Stringham and Young used the MedPAR file to examine rates of
urinary tract
infections (UTI) at acute inpatient hospitals (Stringham and
Young 2005). The authors
noted that Medicare makes additional payments for
complications, even complications
that are possibly preventable. Frequently, the Medicare payment
system has paired
DRGs: one DRG for the condition and one DRG for the
condition with a complication or
comorbidity (CC). The relative weight of the DRG with the CC
is higher than the relative
weight for the DRG without the CC.
Nosocomial UTIs are an example of a potentially preventable
complication. The
authors explained that more expensive anti-infective catheters
and staff training can
reduce the rate of nosocomial UTIs. The authors’ study was
designed as follows:
• All patients discharged during October 1, 2001 through
September 30, 2002 as
reported in the MedPAR file
• Identification of all cases with ICD-9-CM codes of 599.0
(urinary tract infection)
or 996.64 (infection and inflammatory reaction due to

4. indwelling urinary
catheter)
3
• Elimination of cases in which urinary tract infection was the
principal diagnosis or in
which the Major Diagnostic Category was 18 (Infectious and
Parasitic Diseases)
The total cases that resulted with qualifying UTIs were
1,012,041 of the 12,502,700
discharges. For the 1,000 hospitals with the most discharges in
the MedPAR data set, the
rate of secondary UTI ranged from 3.10 percent to 15.49
percent.
The authors examined the cases of one New York hospital in
detail. They found
that the hospital received approximately $675,000 more in
Medicare payments because
of the nosocomial UTIs. The more expensive, anti-infective
catheters would have cost
approximately $50,000. The authors hypothesized that payment
policies of the Centers
for Medicare and Medicaid Services (CMS) discouraged the
implementation of
initiatives to reduce nosocomial complications. Finally, the
authors concluded that
patients would benefit from improved quality of healthcare if
the CMS ceased paying
extra for nosocomial infections.
The MedPAR file is a valuable tool to study the quality of
patient care. Therefore,
in addition to being an abstract payment system for some

5. people, Medicare’s
prospective payment system affects the health of all of us.
Application Exercises
1. IPF PPS: Use the information found in figures 1 and 2
(below), Tables 6.5-6.9 and
figure 6.7 from the textbook to complete table 1 and workbooks
A&B in order to
determine the IPF PPS reimbursement for this encounter.
Additionally a Microsoft
Excel file is provided if your instructor would like you to
complete via Excel.
Figure 1: Facility Information
Bed size: 350 beds Location: Columbus, Ohio
Classification: Rural Wage Index: .9806
Full Service ED: Yes Per-diem unadjusted rate (RY 2015):
$728.31
Figure 2: Claim Information
Admit Date: January 1, 2015 Discharge Date: January 15, 2015
LOS: 14 days
Patient Age: 62
Principal Diagnosis: 295.34* Paraphrenic schizophrenia,
chronic with acute
exacerbation
Secondary Diagnosis: 301.6 Dependent personality disorder
Secondary Diagnosis: 250.02 Type II diabetes mellitus

6. uncontrolled
MS-DRG: 885 Psychoses
ECT treatments: 90870 3 units $315.55 per unit (RY 2015)
*Diagnosis not converted to ICD-10-CM because service dates
for this claim are prior to
implementation of ICD-10-CM/PCS
4
IPFPPS Payment Determination Steps (Use figure 6.7 from the
textbook.)
Table 1
Step Methodology Total
A Wage Index:
$
B COLA:
$
C Base rate adjusted for geographic factors (Add steps A + B)

7. $
D Apply facility and patient adjustments - Use Worksheet A
E Base rate adjusted for facility and patient adjustments
(Multiply
steps C*D)
$
F If full service ED then choose higher Day 1 adjustment in step
7
If not full service ED then choose lower Day 1 adjustment in
step 7
G Adjust for daily costs - Use Worksheet B
H Enter the results from Worksheet B $
I Calculate ECT payment – Remember to WI ECT payment
$
J Add the total from step H to the total ECT payment (step I) to
calculate total IPF PPS Payment
$
Worksheet A
Table 1

8. Step D
A. Enter adjustment factor if rural location:
Enter PPS
adjustment
factor in
Table 1
Step D.
B. Enter adjustment factor if teaching facility:
C. Enter adjustment factor for DRG:
D. Enter adjustment factor for comorbidity:
E. Enter adjustment factor for age:
Multiply applicable adjustment factors
together to determine PPS adjustment factor:
5
Worksheet B
Table 1
Steps
G&H
Day Adjustment
Factor (Step D)
Base rate
adjusted for
facility and
patient

9. characteristics
(Step C)
Multiply
Adjustment
Factor *
Adjusted Base
Rate
Day one
Day two
Day three
Day four
Day five
Day six
Day seven
Day eight
Day nine
Day ten
Day eleven
Day twelve
Day thirteen
Day fourteen
TOTAL $
2. IPPS: High cost devices are used in many inpatient surgery
cases. The Safe-Cross®,
radio frequency total occlusion crossing system, is such a
device.
The Safe-Cross® guidewire is present on the following claim.
First, complete an

10. inpatient payment calculation to determine whether this claim
would qualify for a
high cost outlier add-on payment. Second, calculate the total
reimbursement for this
claim, including the additional amount that the facility would
receive for the high
cost outlier if applicable. Does this facility have a profit or loss
for this encounter?
The 2015 IPPS high-cost outlier threshold is $24,758; the
hospital specific CCR is:
0.429; the hospital base rate is $6,200.00.
6
Inpatient Claim
Admit Date: January 1,
2015
Discharge
Date:
January 10,
2015
Length of
Stay:
9 days
Principal

11. Diagnosis: 410.71 Subendocardial infarction, initial episode of
care
Secondary
Diagnosis: 414.01 Coronary atherosclerosis of native coronary
artery
Secondary
Diagnosis: 427.1 Paroxysmal ventricular tachycardia
Secondary
Diagnosis: 272.0 Pure hypercholesterolemia
Principal
Procedure:
00.66
Percutaneous transluminal coronary angioplasty
Secondary
Procedure: 36.07 Insertion of drug-eluting coronary artery stent
Secondary
Procedure: 39.29 Other vascular shunt or bypass
Secondary
Procedure: 37.22 Left heart cardiac catheterization
MS-DRG:
246
RW: 3.2368
Percutaneous cardiovascular procedure with drug-eluting stent
with
major complication/comorbidity or 4+vessels/stents

12. Claim Detail
Revenue
Code
Revenue Code Description Charge
110 Room & board – private $8,375.00
120 Room & board – semi private $3,700.00
200 Intensive care – general $5,910.00
206 Intensive care – intermediate ICU $2,780.00
250 Pharmacy – general $1,486.66
255 Pharmacy – drugs incident to radiology $728.13
258 Pharmacy – IV solutions $1,583.60
259 Pharmacy – other pharmacy $7,766.18
270 Medical/surgical supplies – general $8,256.00
272 Medical/surgical supplies – sterile supply $8,366.25
272 The Safe-Cross® guidewire $15,000.00
278 Medical/surgical supplies – other implants $28,623.00
301 Laboratory –chemistry $2,739.00
302 Laboratory – Immunology $648.00
305 Laboratory – Hematology $2,335.00
323 Laboratory – Arteriography $2,491.00
360 Operating room – general $23,875.00
361 Operating room – minor surgery $517.00
370 Anesthesia - general $209.00
7
390 Blood and blood component admin, process, storage - gen
$668.00
410 Respiratory services – general $21.00
420 Physical therapy - general $314.00
430 Occupational therapy – general $441.00

13. 480 Cardiology – general $5,629.00
481 Cardiology – cardiac cath lab $6,249.00
483 Cardiology - echocardiology $1,786.00
710 Recovery room – general $1,648.00
730 EKG/ECG - general $1,098.00
921 Other diagnostic services – peripheral vascular lab $359.00
TOTAL CHARGE: $143,601.80
IPPS Outlier: If the cost of the case is greater than the fixed-
loss cost threshold then
an outlier add-on payment is warranted. The fixed-loss cost
threshold equals the
MS-DRG payment + the HC outlier threshold amount for the
applicable year.
Outlier Add-on Amount is equal to 80 percent of the difference
between the cost of
the case and the fixed-loss cost threshold.
3. IPPS: Calculating Case Mix Index. This exercise includes
three data sets. The first is
an example of how to calculate CMI. The second and third data
sets are for student
completion. Additionally, the data sets are available via Excel
for completion.
CMI Calculation Example
Collect the applicable relative weight and volume for each MS-
DRG included in

14. study period.
MS-
DRG MDC TYPE MS-DRG Title 2015 RW Vol
Weighted
Volume
405 07 SURG
PANCREAS, LIVER & SHUNT
PROCEDURES W MCC 5.5387 15
406 07 SURG
PANCREAS, LIVER & SHUNT
PROCEDURES W CC 2.8067 55
407 07 SURG
PANCREAS, LIVER & SHUNT
PROCEDURES W/O CC/MCC 1.9472 78
Calculate the weighted volume for each MS-DRG by
multiplying the MS-DRG relative
weight by the Volume.
8
MS-
DRG MDC TYPE MS-DRG Title
2015
RW Vol

15. Weighted
Volume
405 07 SURG
PANCREAS, LIVER & SHUNT
PROCEDURES W MCC 5.5387 15 5.5387 x 15
406 07 SURG
PANCREAS, LIVER & SHUNT
PROCEDURES W CC 2.8067 55 2.8067 x 55
407 07 SURG
PANCREAS, LIVER & SHUNT
PROCEDURES W/O CC/MCC 1.9472 78 1.9472 x 78
MS-
DRG MDC TYPE MS-DRG Title
2015
RW Vol
Weighted
Volume
405 07 SURG
PANCREAS, LIVER &
SHUNT PROCEDURES W
MCC 5.5387 15 83.0805
406 07 SURG
PANCREAS, LIVER &
SHUNT PROCEDURES W

16. CC 2.8067 55 154.3685
407 07 SURG
PANCREAS, LIVER &
SHUNT PROCEDURES
W/O CC/MCC 1.9472 78 151.8816
Once all of the weighted volumes have been calculated sum
them.
MS-
DRG MDC TYPE MS-DRG Title
2015
RW Vol
Weighted
Volume
405 07 SURG
PANCREAS, LIVER &
SHUNT PROCEDURES W
MCC 5.5387 15 83.0805
406 07 SURG
PANCREAS, LIVER &
SHUNT PROCEDURES W
CC 2.8067 55 154.3685
407 07 SURG

17. PANCREAS, LIVER &
SHUNT PROCEDURES
W/O CC/MCC 1.9472 78 151.8816
TOTALS 148 389.3306
CMI
To calculate the CMI for the data set, divide the Total Weighted
Volume by the Total
Volume.
9
MS-
DRG MDC TYPE MS-DRG Title
2015
RW Vol
Weighted
Volume
405 07 SURG
PANCREAS, LIVER &
SHUNT PROCEDURES W
MCC 5.5387 15 83.0805

18. 406 07 SURG
PANCREAS, LIVER &
SHUNT PROCEDURES W
CC 2.8067 55 154.3685
407 07 SURG
PANCREAS, LIVER &
SHUNT PROCEDURES
W/O CC/MCC 1.9472 78 151.8816
TOTALS 148 389.3306
CMI
389.3306 /
148
MS-
DRG MDC TYPE MS-DRG Title
2015
RW Vol
Weighted
Volume
405 07 SURG
PANCREAS, LIVER &
SHUNT PROCEDURES W
MCC 5.5387 15 83.0805

19. 406 07 SURG
PANCREAS, LIVER &
SHUNT PROCEDURES W
CC 2.8067 55 154.3685
407 07 SURG
PANCREAS, LIVER &
SHUNT PROCEDURES
W/O CC/MCC 1.9472 78 151.8816
TOTALS 148 389.3306
CMI 2.6306
The CMI for this data set is 2.6306. Be sure to carry enough
precision (decimal
points)for the required use.
Data Set Two – CMI Calculation for Top MS-DRGs (Also
available in Excel file
format)
10
MS-DRG MS-DRG Title MDC TYPE RW Volume
Weighted

20. Volume
470
Major joint replacement or reattachment of
lower extremity w/o MCC 8 SURG 2.1137 420
392
Esophagitis, gastroent & misc digest
disorders w/o MCC 6 MED 0.7388 332
194 Simple pneumonia & pleurisy w CC 4 MED 0.9688 295
247
Perc cardiovasc proc w drug-eluting stent w/o
MCC 5 SURG 2.0586 280
293 Heart failure & shock w/o CC/MCC 5 MED 0.6762 246
313 Chest pain 5 MED 0.6138 233
292 Heart failure & shock w CC 5 MED 0.9824 232
690 Kidney & urinary tract infections w/o MCC 11 MED 0.7794
219
192
Chronic obstructive pulmonary disease w/o
CC/MCC 4 MED 0.719 218
871 Septicemia w/o MV 96+ hours w MCC 18 MED 1.8072 213
641
Nutritional & misc metabolic disorders w/o
MCC 10 MED 0.7051 209
291 Heart failure & shock w MCC 5 MED 1.5097 193

21. 885 Psychoses 19 MED 1.0217 188
312 Syncope & collapse 5 MED 0.7423 177
287
Circulatory disorders except AMI, w card cath
w/o MCC 5 MED 1.129 173
195 Simple pneumonia & pleurisy w/o CC/MCC 4 MED 0.7044
172
310
Cardiac arrhythmia & conduction disorders
w/o CC/MCC 5 MED 0.5493 171
603 Cellulitis w/o MCC 9 MED 0.8447 143
379 G.I. hemorrhage w/o CC/MCC 6 MED 0.6776 137
191 Chronic obstructive pulmonary disease w CC 4 MED 0.937
131
65
Intracranial hemorrhage or cerebral infarction w
CC 1 MED 1.0643 128
683 Renal failure w CC 11 MED 0.9512 116
189 Pulmonary edema & respiratory failure 4 MED 1.2136 114
69 Transient ischemia 1 MED 0.6985 110
66
Intracranial hemorrhage or cerebral infarction
w/o CC/MCC 1 MED 0.753 102

22. 4952
CMI
Totals
11
Data Set Three – CMI Calculation for MDC 5 (Also available in
Excel file format)
MS-
DRG MDC TYPE MS-DRG Title
Relative
Weight Volume
Weighted
Volume
001 PRE SURG
HEART TRANSPLANT OR
IMPLANT OF HEART ASSIST
SYSTEM W MCC 25.3920 25
002 PRE SURG
HEART TRANSPLANT OR
IMPLANT OF HEART ASSIST
SYSTEM W/O MCC 15.6820 32

23. 215 05 SURG
OTHER HEART ASSIST SYSTEM
IMPLANT 15.4348 54
216 05 SURG
CARDIAC VALVE & OTH MAJ
CARDIOTHORACIC PROC W
CARD CATH W MCC 9.5238 12
217 05 SURG
CARDIAC VALVE & OTH MAJ
CARDIOTHORACIC PROC W
CARD CATH W CC 6.3291 24
218 05 SURG
CARDIAC VALVE & OTH MAJ
CARDIOTHORACIC PROC W
CARD CATH W/O CC/MCC 5.5693 60
219 05 SURG
CARDIAC VALVE & OTH MAJ
CARDIOTHORACIC PROC W/O
CARD CATH W MCC 7.7067 23
220 05 SURG
CARDIAC VALVE & OTH MAJ
CARDIOTHORACIC PROC W/O
CARD CATH W CC 5.2056 45
221 05 SURG

24. CARDIAC VALVE & OTH MAJ
CARDIOTHORACIC PROC W/O
CARD CATH W/O CC/MCC 4.6347 78
222 05 SURG
CARDIAC DEFIB IMPLANT W
CARDIAC CATH W
AMI/HF/SHOCK W MCC 8.6570 25
223 05 SURG
CARDIAC DEFIB IMPLANT W
CARDIAC CATH W
AMI/HF/SHOCK W/O MCC 6.2924 62
224 05 SURG
CARDIAC DEFIB IMPLANT W
CARDIAC CATH W/O
AMI/HF/SHOCK W MCC 7.6733 44
225 05 SURG
CARDIAC DEFIB IMPLANT W
CARDIAC CATH W/O
AMI/HF/SHOCK W/O MCC 5.8610 98
12
226 05 SURG
CARDIAC DEFIBRILLATOR

25. IMPLANT W/O CARDIAC CATH W
MCC 6.9573 67
227 05 SURG
CARDIAC DEFIBRILLATOR
IMPLANT W/O CARDIAC CATH
W/O MCC 5.4493 85
228 05 SURG
OTHER CARDIOTHORACIC
PROCEDURES W MCC 7.3113 45
229 05 SURG
OTHER CARDIOTHORACIC
PROCEDURES W CC 4.4606 68
230 05 SURG
OTHER CARDIOTHORACIC
PROCEDURES W/O CC/MCC 4.0755 97
231 05 SURG
CORONARY BYPASS W PTCA W
MCC 7.7247 45
232 05 SURG
CORONARY BYPASS W PTCA W/O
MCC 5.5976 72
233 05 SURG
CORONARY BYPASS W CARDIAC
CATH W MCC 7.3493 68
234 05 SURG
CORONARY BYPASS W CARDIAC
CATH W/O MCC 4.8816 105

26. 235 05 SURG
CORONARY BYPASS W/O
CARDIAC CATH W MCC 5.7089 45
236 05 SURG
CORONARY BYPASS W/O
CARDIAC CATH W/O MCC 3.7952 71
237 05 SURG
MAJOR CARDIOVASC
PROCEDURES W MCC 5.0843 32
238 05 SURG
MAJOR CARDIOVASC
PROCEDURES W/O MCC 3.4241 28
239 05 SURG
AMPUTATION FOR CIRC SYS
DISORDERS EXC UPPER LIMB &
TOE W MCC 4.7590 5
240 05 SURG
AMPUTATION FOR CIRC SYS
DISORDERS EXC UPPER LIMB &
TOE W CC 2.7594 6
241 05 SURG
AMPUTATION FOR CIRC SYS
DISORDERS EXC UPPER LIMB &
TOE W/O CC/MCC 1.4111 8
242 05 SURG

27. PERMANENT CARDIAC
PACEMAKER IMPLANT W MCC 3.7242 32
243 05 SURG
PERMANENT CARDIAC
PACEMAKER IMPLANT W CC 2.6695 45
244 05 SURG
PERMANENT CARDIAC
PACEMAKER IMPLANT W/O
CC/MCC 2.1555 89
245 05 SURG AICD GENERATOR PROCEDURES 4.6485 77
13
246 05 SURG
PERC CARDIOVASC PROC W
DRUG-ELUTING STENT W MCC OR
4+ VESSELS/STENTS 3.2368 68
247 05 SURG
PERC CARDIOVASC PROC W
DRUG-ELUTING STENT W/O MCC 2.0586 104
248 05 SURG
PERC CARDIOVASC PROC W NON-
DRUG-ELUTING STENT W MCC OR
4+ VES/STENTS 3.0411 78
249 05 SURG

28. PERC CARDIOVASC PROC W NON-
DRUG-ELUTING STENT W/O MCC 1.8808 125
250 05 SURG
PERC CARDIOVASC PROC W/O
CORONARY ARTERY STENT W
MCC 2.9885 100
251 05 SURG
PERC CARDIOVASC PROC W/O
CORONARY ARTERY STENT W/O
MCC 2.0399 124
252 05 SURG
OTHER VASCULAR PROCEDURES
W MCC 3.2646 52
253 05 SURG
OTHER VASCULAR PROCEDURES
W CC 2.5532 31
254 05 SURG
OTHER VASCULAR PROCEDURES
W/O CC/MCC 1.7304 22
255 05 SURG
UPPER LIMB & TOE AMPUTATION
FOR CIRC SYSTEM DISORDERS W
MCC 2.6051 3
256 05 SURG
UPPER LIMB & TOE AMPUTATION

29. FOR CIRC SYSTEM DISORDERS W
CC 1.6986 2
257 05 SURG
UPPER LIMB & TOE AMPUTATION
FOR CIRC SYSTEM DISORDERS
W/O CC/MCC 1.0558 1
258 05 SURG
CARDIAC PACEMAKER DEVICE
REPLACEMENT W MCC 2.7613 24
259 05 SURG
CARDIAC PACEMAKER DEVICE
REPLACEMENT W/O MCC 1.9924 34
260 05 SURG
CARDIAC PACEMAKER REVISION
EXCEPT DEVICE REPLACEMENT W
MCC 3.7456 66
261 05 SURG
CARDIAC PACEMAKER REVISION
EXCEPT DEVICE REPLACEMENT W
CC 1.8552 78
262 05 SURG
CARDIAC PACEMAKER REVISION
EXCEPT DEVICE REPLACEMENT
W/O CC/MCC 1.3978 81
263 05 SURG VEIN LIGATION & STRIPPING 1.8664 5

30. 14
264 05 SURG
OTHER CIRCULATORY SYSTEM
O.R. PROCEDURES 2.8292 21
265 05 SURG AICD LEAD PROCEDURES 2.8641 25
266 05 SURG
ENDOVASCULAR CARDIAC
VALVE REPLACEMENT W MCC 8.9920 20
267 05 SURG
ENDOVASCULAR CARDIAC
VALVE REPLACEMENT W/O MCC 6.7517 21
280 05 MED
ACUTE MYOCARDIAL
INFARCTION, DISCHARGED
ALIVE W MCC 1.7289 23
281 05 MED
ACUTE MYOCARDIAL
INFARCTION, DISCHARGED
ALIVE W CC 1.0247 10
282 05 MED
ACUTE MYOCARDIAL
INFARCTION, DISCHARGED
ALIVE W/O CC/MCC 0.7562 11

31. 283 05 MED
ACUTE MYOCARDIAL
INFARCTION, EXPIRED W MCC 1.6753 13
284 05 MED
ACUTE MYOCARDIAL
INFARCTION, EXPIRED W CC 0.7703 33
285 05 MED
ACUTE MYOCARDIAL
INFARCTION, EXPIRED W/O
CC/MCC 0.5065 21
286 05 MED
CIRCULATORY DISORDERS
EXCEPT AMI, W CARD CATH W
MCC 2.1240 11
287 05 MED
CIRCULATORY DISORDERS
EXCEPT AMI, W CARD CATH W/O
MCC 1.1290 16
288 05 MED
ACUTE & SUBACUTE
ENDOCARDITIS W MCC 2.7138 24
289 05 MED
ACUTE & SUBACUTE
ENDOCARDITIS W CC 1.6991 60
290 05 MED

32. ACUTE & SUBACUTE
ENDOCARDITIS W/O CC/MCC 1.2476 45
291 05 MED HEART FAILURE & SHOCK W MCC 1.5097 30
292 05 MED HEART FAILURE & SHOCK W CC 0.9824 12
293 05 MED
HEART FAILURE & SHOCK W/O
CC/MCC 0.6762 31
294 05 MED
DEEP VEIN THROMBOPHLEBITIS
W CC/MCC 1.0480 5
295 05 MED
DEEP VEIN THROMBOPHLEBITIS
W/O CC/MCC 0.6926 6
296 05 MED
CARDIAC ARREST, UNEXPLAINED
W MCC 1.2347 7
15
297 05 MED
CARDIAC ARREST, UNEXPLAINED
W CC 0.6475 12
298 05 MED
CARDIAC ARREST, UNEXPLAINED
W/O CC/MCC 0.4227 13
299 05 MED
PERIPHERAL VASCULAR

33. DISORDERS W MCC 1.4094 14
300 05 MED
PERIPHERAL VASCULAR
DISORDERS W CC 0.9770 21
301 05 MED
PERIPHERAL VASCULAR
DISORDERS W/O CC/MCC 0.6776 24
302 05 MED ATHEROSCLEROSIS W MCC 1.0311 44
303 05 MED ATHEROSCLEROSIS W/O MCC 0.6101 51
304 05 MED HYPERTENSION W MCC 1.0016 13
305 05 MED HYPERTENSION W/O MCC 0.6272 23
306 05 MED
CARDIAC CONGENITAL &
VALVULAR DISORDERS W MCC 1.3687 21
307 05 MED
CARDIAC CONGENITAL &
VALVULAR DISORDERS W/O MCC 0.7698 20
308 05 MED
CARDIAC ARRHYTHMIA &
CONDUCTION DISORDERS W
MCC 1.2107 30
309 05 MED
CARDIAC ARRHYTHMIA &
CONDUCTION DISORDERS W CC 0.7865 6
310 05 MED
CARDIAC ARRHYTHMIA &

34. CONDUCTION DISORDERS W/O
CC/MCC 0.5493 1
311 05 MED ANGINA PECTORIS 0.5662 3
312 05 MED SYNCOPE & COLLAPSE 0.7423 2
313 05 MED CHEST PAIN 0.6138 14
314 05 MED
OTHER CIRCULATORY SYSTEM
DIAGNOSES W MCC 1.9195 20
315 05 MED
OTHER CIRCULATORY SYSTEM
DIAGNOSES W CC 0.9613 30
316 05 MED
OTHER CIRCULATORY SYSTEM
DIAGNOSES W/O CC/MCC 0.6210 50
TOTALS 3527
CMI
16
References
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Principles of Healthcare ReimbursementStudent
WorkbookChapter 6ActivitiesTheory into Practice and Real-
World CaseApplication Exercises