TABLE 13A. PROPOSED COMPOSITION OF LOW-VOLUME QUINTILES FOR MS-LTC-DRGs FY 2016,
MS-LTC-DRG,MS-LTC-DRG Description
Proposed Quintile 1,
066,Intracranial hemorrhage or cerebral infarction w/o CC/MCC
069,Transient ischemia
075,Viral meningitis w CC/MCC
086,"Traumatic stupor & coma, coma <1 hr w CC"
087,"Traumatic stupor & coma, coma <1 hr w/o CC/MCC"
096,Bacterial & tuberculous infections of nervous system w/o CC/MCC
101,Seizures w/o MCC
149,Dysequilibrium
153,Otitis media & URI w/o MCC
176,Pulmonary embolism w/o MCC
179,Respiratory infections & inflammations w/o CC/MCC
182,Respiratory neoplasms w/o CC/MCC
187,Pleural effusion w CC
195,Simple pneumonia & pleurisy w/o CC/MCC
284,"Acute myocardial infarction, expired w CC"
294,Deep vein thrombophlebitis w CC/MCC
305,Hypertension w/o MCC
312,Syncope & collapse
316,Other circulatory system diagnoses w/o CC/MCC
378,G.I. hemorrhage w CC
383,Uncomplicated peptic ulcer w MCC
395,Other digestive system diagnoses w/o CC/MCC
408,Biliary tract proc except only cholecyst w or w/o c.d.e. w MCC
418,Laparoscopic cholecystectomy w/o c.d.e. w CC
433,Cirrhosis & alcoholic hepatitis w CC
440,Disorders of pancreas except malignancy w/o CC/MCC
443,"Disorders of liver except malig,cirr,alc hepa w/o CC/MCC"
446,Disorders of the biliary tract w/o CC/MCC
485,Knee procedures w pdx of infection w MCC
552,Medical back problems w/o MCC
562,"Fx, sprn, strn & disl except femur, hip, pelvis & thigh w MCC"
594,Skin ulcers w/o CC/MCC
596,Major skin disorders w/o MCC
598,Malignant breast disorders w CC
644,Endocrine disorders w CC
684,Renal failure w/o CC/MCC
693,Urinary stones w/o esw lithotripsy w MCC
694,Urinary stones w/o esw lithotripsy w/o MCC
722,"Malignancy, male reproductive system w MCC"
730,Other male reproductive system diagnoses w/o CC/MCC
755,"Malignancy, female reproductive system w CC"
760,Menstrual & other female reproductive system disorders w CC/MCC
858,Postoperative or post-traumatic infections w O.R. proc w/o CC/MCC
866,Viral illness w/o MCC
869,Other infectious & parasitic diseases diagnoses w/o CC/MCC
914,Traumatic injury w/o MCC
915,Allergic reactions w MCC
918,Poisoning & toxic effects of drugs w/o MCC
948,Signs & symptoms w/o MCC
977,HIV w or w/o other related condition
Proposed Quintile 2,
054,Nervous system neoplasms w MCC
065,Intracranial hemorrhage or cerebral infarction w CC or tPA in 24 hrs
071,Nonspecific cerebrovascular disorders w CC
074,Cranial & peripheral nerve disorders w/o MCC
083,"Traumatic stupor & coma, coma >1 hr w CC"
093,Other disorders of nervous system w/o CC/MCC
098,Non-bacterial infect of nervous sys exc viral meningitis w CC
100,Seizures w MCC
121,Acute major eye infections w CC/MCC
125,Other disorders of the eye w/o MCC
152,Otitis media & URI w MCC
155,"Other ear, nose, mouth & throat diagnoses w CC"
156,"Other ear, nose, mouth & throat diagnoses w/o CC/MCC"
158,Dental & Oral Diseases w CC
181,Respiratory neoplasms w CC
200,Pneumothorax w CC
290,Acute & subacute endocarditis w/o CC/MCC
293,Heart failure & shock w/o CC/MCC
303,Atherosclerosis w/o MCC
307,Cardiac congenital & valvular disorders w/o MCC
309,Cardiac arrhythmia & conduction disorders w CC
369,Major esophageal disorders w CC
386,Inflammatory bowel disease w CC
436,Malignancy of hepatobiliary system or pancreas w CC
442,"Disorders of liver except malig,cirr,alc hepa w CC"
445,Disorders of the biliary tract w CC
516,Other musculoskelet sys & conn tiss O.R. proc w CC
543,Pathological fractures & musculoskelet & conn tiss malig w CC
546,Connective tissue disorders w CC
550,Septic arthritis w/o CC/MCC
556,Signs & symptoms of musculoskeletal system & conn tissue w/o MCC
561,"Aftercare, musculoskeletal system & connective tissue w/o CC/MCC"
572,Skin debridement w/o CC/MCC
643,Endocrine disorders w MCC
687,Kidney & urinary tract neoplasms w CC
695,Kidney & urinary tract signs & symptoms w MCC
700,Other kidney & urinary tract diagnoses w/o CC/MCC
758,"Infections, female reproductive system w CC"
812,Red blood cell disorders w/o MCC
868,Other infectious & parasitic diseases diagnoses w CC
913,Traumatic injury w MCC
921,Complications of treatment w/o CC/MCC
923,"Other injury, poisoning & toxic effect diag w/o MCC"
933,Extensive burns or full thickness burns w MV 96+ hrs w/o skin graft
934,Full thickness burn w/o skin grft or inhal inj
935,Non-extensive burns
941,O.R. proc w diagnoses of other contact w health services w/o CC/MCC
970,HIV w extensive O.R. procedure w/o MCC
983,Extensive O.R. procedure unrelated to principal diagnosis w/o CC/MCC
989,Non-extensive O.R. proc unrelated to principal diagnosis w/o CC/MCC
Proposed Quintile 3,
041,Periph/cranial nerve & other nerv syst proc w CC or periph neurostim
055,Nervous system neoplasms w/o MCC
072,Nonspecific cerebrovascular disorders w/o CC/MCC
082,"Traumatic stupor & coma, coma >1 hr w MCC"
147,"Ear, nose, mouth & throat malignancy w CC"
168,Other resp system O.R. procedures w/o CC/MCC
188,Pleural effusion w/o CC/MCC
197,Interstitial lung disease w CC
201,Pneumothorax w/o CC/MCC
202,Bronchitis & asthma w CC/MCC
242,Permanent cardiac pacemaker implant w MCC
287,"Circulatory disorders except AMI, w card cath w/o MCC"
301,Peripheral vascular disorders w/o CC/MCC
304,Hypertension w MCC
310,Cardiac arrhythmia & conduction disorders w/o CC/MCC
357,Other digestive system O.R. procedures w CC
373,Major gastrointestinal disorders & peritoneal infections w/o CC/MCC
375,Digestive malignancy w CC
380,Complicated peptic ulcer w MCC
385,Inflammatory bowel disease w MCC
389,G.I. obstruction w CC
415,Cholecystectomy except by laparoscope w/o c.d.e. w CC
475,Amputation for musculoskeletal sys & conn tissue dis w CC
507,Major shoulder or elbow joint procedures w CC/MCC
541,Osteomyelitis w/o CC/MCC
566,Other musculoskeletal sys & connective tissue diagnoses w/o CC/MCC
597,Malignant breast disorders w MCC
605,"Trauma to the skin, subcut tiss & breast w/o MCC"
607,Minor skin disorders w/o MCC
624,"Skin grafts & wound debrid for endoc, nutrit & metab dis w/o CC/MCC"
626,"Thyroid, parathyroid & thyroglossal procedures w CC"
660,Kidney & ureter procedures for non-neoplasm w CC
686,Kidney & urinary tract neoplasms w MCC
709,Penis procedures w CC/MCC
728,Inflammation of the male reproductive system w/o MCC
754,"Malignancy, female reproductive system w MCC"
809,Major hematol/immun diag exc sickle cell crisis & coagul w CC
811,Red blood cell disorders w MCC
813,Coagulation disorders
815,Reticuloendothelial & immunity disorders w CC
829,Myeloprolif disord or poorly diff neopl w other O.R. proc w CC/MCC
834,Acute leukemia w/o major O.R. procedure w MCC
841,Lymphoma & non-acute leukemia w CC
849,Radiotherapy
864,Fever
922,"Other injury, poisoning & toxic effect diag w MCC"
928,Full thickness burn w skin graft or inhal inj w CC/MCC
947,Signs & symptoms w MCC
964,Other multiple significant trauma w CC
975,HIV w major related condition w CC
Proposed Quintile 4,
023,Cranio w major dev impl/acute complex CNS PDX w MCC or chemo implant
037,Extracranial procedures w MCC
038,Extracranial procedures w CC
058,Multiple sclerosis & cerebellar ataxia w MCC
077,Hypertensive encephalopathy w MCC
102,Headaches w MCC
137,Mouth procedures w CC/MCC
146,"Ear, nose, mouth & throat malignancy w MCC"
159,Dental & Oral Diseases w/o CC/MCC
164,Major chest procedures w CC
240,Amputation for circ sys disorders exc upper limb & toe w CC
243,Permanent cardiac pacemaker implant w CC
250,Perc cardiovasc proc w/o coronary artery stent w MCC
253,Other vascular procedures w CC
255,Upper limb & toe amputation for circ system disorders w MCC
260,Cardiac pacemaker revision except device replacement w MCC
273,Percutaneous intracardiac procedures w MCC
282,"Acute myocardial infarction, discharged alive w/o CC/MCC"
347,Anal & stomal procedures w MCC
354,Hernia procedures except inguinal & femoral w CC
368,Major esophageal disorders w MCC
435,Malignancy of hepatobiliary system or pancreas w MCC
498,Local excision & removal int fix devices of hip & femur w CC/MCC
501,Soft tissue procedures w CC
503,Foot procedures w MCC
510,"Shoulder,elbow or forearm proc,exc major joint proc w MCC"
545,Connective tissue disorders w MCC
553,Bone diseases & arthropathies w MCC
555,Signs & symptoms of musculoskeletal system & conn tissue w MCC
574,Skin graft for skin ulcer or cellulitis w CC
580,"Other skin, subcut tiss & breast proc w CC"
584,"Breast biopsy, local excision & other breast procedures w CC/MCC"
595,Major skin disorders w MCC
600,Non-malignant breast disorders w CC/MCC
604,"Trauma to the skin, subcut tiss & breast w MCC"
617,"Amputat of lower limb for endocrine,nutrit,& metabol dis w CC"
659,Kidney & ureter procedures for non-neoplasm w MCC
665,Prostatectomy w MCC
669,Transurethral procedures w CC
717,Other male reproductive system O.R. proc exc malignancy w CC/MCC
781,Other antepartum diagnoses w medical complications
803,Other O.R. proc of the blood & blood forming organs w CC
808,Major hematol/immun diag exc sickle cell crisis & coagul w MCC
814,Reticuloendothelial & immunity disorders w MCC
816,Reticuloendothelial & immunity disorders w/o CC/MCC
842,Lymphoma & non-acute leukemia w/o CC/MCC
843,Other myeloprolif dis or poorly diff neopl diag w MCC
865,Viral illness w MCC
908,Other O.R. procedures for injuries w CC
951,Other factors influencing health status
Proposed Quintile 5,
025,Craniotomy & endovascular intracranial procedures w MCC
028,Spinal procedures w MCC
031,Ventricular shunt procedures w MCC
103,Headaches w/o MCC
133,"Other ear, nose, mouth & throat O.R. procedures w CC/MCC"
157,Dental & Oral Diseases w MCC
216,Cardiac valve & oth maj cardiothoracic proc w card cath w MCC
226,Cardiac defibrillator implant w/o cardiac cath w MCC
227,Cardiac defibrillator implant w/o cardiac cath w/o MCC
256,Upper limb & toe amputation for circ system disorders w CC
270,Other major cardiovascular procedures w MCC
286,"Circulatory disorders except AMI, w card cath w MCC"
326,"Stomach, esophageal & duodenal proc w MCC"
327,"Stomach, esophageal & duodenal proc w CC"
329,Major small & large bowel procedures w MCC
335,Peritoneal adhesiolysis w MCC
336,Peritoneal adhesiolysis w CC
339,Appendectomy w complicated principal diag w CC
381,Complicated peptic ulcer w CC
405,"Pancreas, liver & shunt procedures w MCC"
417,Laparoscopic cholecystectomy w/o c.d.e. w MCC
423,Other hepatobiliary or pancreas O.R. procedures w MCC
466,Revision of hip or knee replacement w MCC
477,Biopsies of musculoskeletal system & connective tissue w MCC
478,Biopsies of musculoskeletal system & connective tissue w CC
480,Hip & femur procedures except major joint w MCC
481,Hip & femur procedures except major joint w CC
486,Knee procedures w pdx of infection w CC
492,"Lower extrem & humer proc except hip,foot,femur w MCC"
493,"Lower extrem & humer proc except hip,foot,femur w CC"
496,Local excision & removal int fix devices exc hip & femur w CC
518,Back & neck proc exc spinal fusion w MCC or disc device/neurostim
542,Pathological fractures & musculoskelet & conn tiss malig w MCC
576,Skin graft exc for skin ulcer or cellulitis w MCC
577,Skin graft exc for skin ulcer or cellulitis w CC
629,"Other endocrine, nutrit & metab O.R. proc w CC"
668,Transurethral procedures w MCC
685,Admit for renal dialysis
711,Testes procedures w CC/MCC
749,Other female reproductive system O.R. procedures w CC/MCC
802,Other O.R. proc of the blood & blood forming organs w MCC
823,Lymphoma & non-acute leukemia w other O.R. proc w MCC
846,Chemotherapy w/o acute leukemia as secondary diagnosis w MCC
847,Chemotherapy w/o acute leukemia as secondary diagnosis w CC
917,Poisoning & toxic effects of drugs w MCC
957,Other O.R. procedures for multiple significant trauma w MCC
963,Other multiple significant trauma w MCC
969,HIV w extensive O.R. procedure w MCC
984,Prostatic O.R. procedure unrelated to principal diagnosis w MCC
985,Prostatic O.R. procedure unrelated to principal diagnosis w CC
