PROPOSED COMPOSITION OF LOW-VOLUME QUINTILES FOR MS-LTC-DRGs FY 2020			
MS-LTC-DRG	MS-LTC-DRG Description		
Quintile 1			
066	Intracranial hemorrhage or cerebral infarction w/o CC/MCC		
069	Transient ischemia w/o thrombolytic		
072	Nonspecific cerebrovascular disorders w/o CC/MCC		
084	"Traumatic stupor & coma, coma >1 hr w/o CC/MCC"		
087	"Traumatic stupor & coma, coma <1 hr w/o CC/MCC"		
093	Other disorders of nervous system w/o CC/MCC		
096	Bacterial & tuberculous infections of nervous system w/o CC/MCC		
102	Headaches w MCC		
103	Headaches w/o MCC		
148	"Ear, nose, mouth & throat malignancy w/o CC/MCC"		
149	Dysequilibrium		
151	Epistaxis w/o MCC		
176	Pulmonary embolism w/o MCC		
182	Respiratory neoplasms w/o CC/MCC		
183	Major chest trauma w MCC		
184	Major chest trauma w CC		
188	Pleural effusion w/o CC/MCC		
195	Simple pneumonia & pleurisy w/o CC/MCC		
200	Pneumothorax w CC		
201	Pneumothorax w/o CC/MCC		
244	Permanent cardiac pacemaker implant w/o CC/MCC		
287	"Circulatory disorders except AMI, w card cath w/o MCC"		
293	Heart failure & shock w/o CC/MCC		
296	"Cardiac arrest, unexplained w MCC"		
310	Cardiac arrhythmia & conduction disorders w/o CC/MCC		
311	Angina pectoris		
373	Major gastrointestinal disorders & peritoneal infections w/o CC/MCC		
376	Digestive malignancy w/o CC/MCC		
379	G.I. hemorrhage w/o CC/MCC		
434	Cirrhosis & alcoholic hepatitis w/o CC/MCC		
440	Disorders of pancreas except malignancy w/o CC/MCC		
483	Major joint/limb reattachment procedure of upper extremities		
550	Septic arthritis w/o CC/MCC		
566	Other musculoskeletal sys & connective tissue diagnoses w/o CC/MCC		
598	Malignant breast disorders w CC		
639	Diabetes w/o CC/MCC		
645	Endocrine disorders w/o CC/MCC		
687	Kidney & urinary tract neoplasms w CC		
694	Urinary stones w/o MCC		
700	Other kidney & urinary tract diagnoses w/o CC/MCC		
722	"Malignancy, male reproductive system w MCC"		
724	"Malignancy, male reproductive system w/o CC/MCC"		
726	Benign prostatic hypertrophy w/o MCC		
755	"Malignancy, female reproductive system w CC"		
759	"Infections, female reproductive system w/o CC/MCC"		
841	Lymphoma & non-acute leukemia w CC		
844	Other myeloprolif dis or poorly diff neopl diag w CC		
855	Infectious & parasitic diseases w O.R. procedure w/o CC/MCC		
914	Traumatic injury w/o MCC		
915	Allergic reactions w MCC		
916	Allergic reactions w/o MCC		
934	Full thickness burn w/o skin graft or inhal inj		
Quintile 2			
042	Periph/cranial nerve & other nerv syst proc w/o CC/MCC		
053	Spinal disorders & injuries w/o CC/MCC		
059	Multiple sclerosis & cerebellar ataxia w CC		
074	Cranial & peripheral nerve disorders w/o MCC		
075	Viral meningitis w CC/MCC		
078	Hypertensive encephalopathy w CC		
098	Non-bacterial infect of nervous sys exc viral meningitis w CC		
124	Other disorders of the eye w MCC		
147	"Ear, nose, mouth & throat malignancy w CC"		
154	"Other ear, nose, mouth & throat diagnoses w MCC"		
155	"Other ear, nose, mouth & throat diagnoses w CC"		
165	Major chest procedures w/o CC/MCC		
192	Chronic obstructive pulmonary disease w/o CC/MCC		
203	Bronchitis & asthma w/o CC/MCC		
204	Respiratory signs & symptoms		
206	Other respiratory system diagnoses w/o MCC		
263	Vein ligation & stripping		
282	"Acute myocardial infarction, discharged alive w/o CC/MCC"		
301	Peripheral vascular disorders w/o CC/MCC		
303	Atherosclerosis w/o MCC		
305	Hypertension w/o MCC		
307	Cardiac congenital & valvular disorders w/o MCC		
316	Other circulatory system diagnoses w/o CC/MCC		
348	Anal & stomal procedures w CC		
390	G.I. obstruction w/o CC/MCC		
418	Laparoscopic cholecystectomy w/o c.d.e. w CC		
493	"Lower extrem & humer proc except hip, foot, femur w CC"		
535	Fractures of hip & pelvis w MCC		
536	Fractures of hip & pelvis w/o MCC		
553	Bone diseases & arthropathies w MCC		
556	Signs & symptoms of musculoskeletal system & conn tissue w/o MCC		
561	"Aftercare, musculoskeletal system & connective tissue w/o CC/MCC"		
562	"Fx, sprn, strn & disl except femur, hip, pelvis & thigh w MCC"		
596	Major skin disorders w/o MCC		
605	"Trauma to the skin, subcut tiss & breast w/o MCC"		
643	Endocrine disorders w MCC		
644	Endocrine disorders w CC		
662	Minor bladder procedures w MCC		
666	Prostatectomy w CC		
668	Transurethral procedures w MCC		
723	"Malignancy, male reproductive system w CC"		
803	Other O.R. proc of the blood & blood forming organs w CC		
812	Red blood cell disorders w/o MCC		
814	Reticuloendothelial & immunity disorders w MCC		
815	Reticuloendothelial & immunity disorders w CC		
834	Acute leukemia w/o major O.R. procedure w MCC		
835	Acute leukemia w/o major O.R. procedure w CC		
846	Chemotherapy w/o acute leukemia as secondary diagnosis w MCC		
866	Viral illness w/o MCC		
921	Complications of treatment w/o CC/MCC		
948	Signs & symptoms w/o MCC		
976	HIV w major related condition w/o CC/MCC		
Quintile 3			
058	Multiple sclerosis & cerebellar ataxia w MCC		
081	Nontraumatic stupor & coma w/o MCC		
085	"Traumatic stupor & coma, coma <1 hr w MCC"		
086	"Traumatic stupor & coma, coma <1 hr w CC"		
121	Acute major eye infections w CC/MCC		
146	"Ear, nose, mouth & throat malignancy w MCC"		
157	Dental & Oral Diseases w MCC		
158	Dental & Oral Diseases w CC		
180	Respiratory neoplasms w MCC		
181	Respiratory neoplasms w CC		
187	Pleural effusion w CC		
228	Other cardiothoracic procedures w MCC		
243	Permanent cardiac pacemaker implant w CC		
283	"Acute myocardial infarction, expired w MCC"		
290	Acute & subacute endocarditis w/o CC/MCC		
312	Syncope & collapse		
369	Major esophageal disorders w CC		
381	Complicated peptic ulcer w CC		
383	Uncomplicated peptic ulcer w MCC		
384	Uncomplicated peptic ulcer w/o MCC		
395	Other digestive system diagnoses w/o CC/MCC		
424	Other hepatobiliary or pancreas O.R. procedures w CC		
435	Malignancy of hepatobiliary system or pancreas w MCC		
436	Malignancy of hepatobiliary system or pancreas w CC		
446	Disorders of the biliary tract w/o CC/MCC		
465	"Wnd debrid & skn grft exc hand, for musculo-conn tiss dis w/o CC/MCC"		
492	"Lower extrem & humer proc except hip, foot, femur w MCC"		
554	Bone diseases & arthropathies w/o MCC		
563	"Fx, sprn, strn & disl except femur, hip, pelvis & thigh w/o MCC"		
594	Skin ulcers w/o CC/MCC		
595	Major skin disorders w MCC		
597	Malignant breast disorders w MCC		
600	Non-malignant breast disorders w CC/MCC		
604	"Trauma to the skin, subcut tiss & breast w MCC"		
660	Kidney & ureter procedures for non-neoplasm w CC		
693	Urinary stones w MCC		
729	Other male reproductive system diagnoses w CC/MCC		
749	Other female reproductive system O.R. procedures w CC/MCC		
758	"Infections, female reproductive system w CC"		
808	Major hematol/immun diag exc sickle cell crisis & coagul w MCC		
809	Major hematol/immun diag exc sickle cell crisis & coagul w CC		
824	Lymphoma & non-acute leukemia w other proc w CC		
840	Lymphoma & non-acute leukemia w MCC		
847	Chemotherapy w/o acute leukemia as secondary diagnosis w CC		
865	Viral illness w MCC		
918	Poisoning & toxic effects of drugs w/o MCC		
923	"Other injury, poisoning & toxic effect diag w/o MCC"		
928	Full thickness burn w skin graft or inhal inj w CC/MCC		
935	Non-extensive burns		
963	Other multiple significant trauma w MCC		
964	Other multiple significant trauma w CC		
983	Extensive O.R. procedure unrelated to principal diagnosis w/o CC/MCC		
Quintile 4			
025	Craniotomy & endovascular intracranial procedures w MCC		
028	Spinal procedures w MCC		
041	Periph/cranial nerve & other nerv syst proc w CC or periph neurostim		
137	Mouth procedures w CC/MCC		
152	Otitis media & URI w MCC		
153	Otitis media & URI w/o MCC		
164	Major chest procedures w CC		
197	Interstitial lung disease w CC		
271	Other major cardiovascular procedures w CC		
273	Percutaneous intracardiac procedures w MCC		
304	Hypertension w MCC		
344	Minor small & large bowel procedures w MCC		
368	Major esophageal disorders w MCC		
375	Digestive malignancy w CC		
385	Inflammatory bowel disease w MCC		
386	Inflammatory bowel disease w CC		
405	"Pancreas, liver & shunt procedures w MCC"		
423	Other hepatobiliary or pancreas O.R. procedures w MCC		
475	Amputation for musculoskeletal sys & conn tissue dis w CC		
480	Hip & femur procedures except major joint w MCC		
495	Local excision & removal int fix devices exc hip & femur w MCC		
498	Local excision & removal int fix devices of hip & femur w CC/MCC		
504	Foot procedures w CC		
510	"Shoulder, elbow or forearm proc, exc major joint proc w MCC"		
511	"Shoulder, elbow or forearm proc, exc major joint proc w CC"		
513	"Hand or wrist proc, except major thumb or joint proc w CC/MCC"		
533	Fractures of femur w MCC		
541	Osteomyelitis w/o CC/MCC		
542	Pathological fractures & musculoskelet & conn tiss malig w MCC		
543	Pathological fractures & musculoskelet & conn tiss malig w CC		
545	Connective tissue disorders w MCC		
546	Connective tissue disorders w CC		
555	Signs & symptoms of musculoskeletal system & conn tissue w MCC		
572	Skin debridement w/o CC/MCC		
575	Skin graft for skin ulcer or cellulitis w/o CC/MCC		
577	Skin graft exc for skin ulcer or cellulitis w CC		
657	Kidney & ureter procedures for neoplasm w CC		
659	Kidney & ureter procedures for non-neoplasm w MCC		
669	Transurethral procedures w CC		
684	Renal failure w/o CC/MCC		
686	Kidney & urinary tract neoplasms w MCC		
695	Kidney & urinary tract signs & symptoms w MCC		
717	Other male reproductive system O.R. proc exc malignancy w CC/MCC		
754	"Malignancy, female reproductive system w MCC"		
813	Coagulation disorders		
843	Other myeloprolif dis or poorly diff neopl diag w MCC		
869	Other infectious & parasitic diseases diagnoses w/o CC/MCC		
904	Skin grafts for injuries w CC/MCC		
917	Poisoning & toxic effects of drugs w MCC		
922	"Other injury, poisoning & toxic effect diag w MCC"		
933	Extensive burns or full thickness burns w MV >96 hrs w/o skin graft		
941	O.R. proc w diagnoses of other contact w health services w/o CC/MCC		
Quintile 5			
023	Craniotomy w major device implant or acute complex CNS PDX w MCC or chemotherapy implant or epilepsy w neurostimulator		
031	Ventricular shunt procedures w MCC		
037	Extracranial procedures w MCC		
054	Nervous system neoplasms w MCC		
055	Nervous system neoplasms w/o MCC		
080	Nontraumatic stupor & coma w MCC		
133	"Other ear, nose, mouth & throat O.R. procedures w CC/MCC"		
179	Respiratory infections & inflammations w/o CC/MCC		
226	Cardiac defibrillator implant w/o cardiac cath w MCC		
240	Amputation for circ sys disorders exc upper limb & toe w CC		
242	Permanent cardiac pacemaker implant w MCC		
245	AICD generator procedures		
253	Other vascular procedures w CC		
255	Upper limb & toe amputation for circ system disorders w MCC		
256	Upper limb & toe amputation for circ system disorders w CC		
258	Cardiac pacemaker device replacement w MCC		
260	Cardiac pacemaker revision except device replacement w MCC		
270	Other major cardiovascular procedures w MCC		
284	"Acute myocardial infarction, expired w CC"		
286	"Circulatory disorders except AMI, w card cath w MCC"		
326	"Stomach, esophageal & duodenal proc w MCC"		
329	Major small & large bowel procedures w MCC		
330	Major small & large bowel procedures w CC		
347	Anal & stomal procedures w MCC		
353	Hernia procedures except inguinal & femoral w MCC		
414	Cholecystectomy except by laparoscope w/o c.d.e. w MCC		
417	Laparoscopic cholecystectomy w/o c.d.e. w MCC		
471	Cervical spinal fusion w MCC		
474	Amputation for musculoskeletal sys & conn tissue dis w MCC		
477	Biopsies of musculoskeletal system & connective tissue w MCC		
478	Biopsies of musculoskeletal system & connective tissue w CC		
486	Knee procedures w pdx of infection w CC		
503	Foot procedures w MCC		
516	Other musculoskelet sys & conn tiss O.R. proc w CC		
518	Back & neck proc exc spinal fusion w MCC or disc device/neurostim		
576	Skin graft exc for skin ulcer or cellulitis w MCC		
581	"Other skin, subcut tiss & breast proc w/o CC/MCC"		
619	O.R. procedures for obesity w MCC		
642	Inborn and other disorders of metabolism		
709	Penis procedures w CC/MCC		
711	Testes procedures w CC/MCC		
713	Transurethral prostatectomy w CC/MCC		
760	Menstrual & other female reproductive system disorders w CC/MCC		
776	Postpartum & post abortion diagnoses w/o O.R. procedure		
811	Red blood cell disorders w MCC		
849	Radiotherapy		
864	Fever and inflammatory conditions		
951	Other factors influencing health status		
957	Other O.R. procedures for multiple significant trauma w MCC		
969	HIV w extensive O.R. procedure w MCC		
977	HIV w or w/o other related condition		
			
			
			
