PHC4 35 Diseases, Procedures, and Medical Conditions for which Laboratory Data... Effective 10/01/2013

PHC4 35 Diseases, Procedures, and Medical Conditions for which Laboratory Data... Effective 10/01/2013

PHC4
35 Diseases, Procedures, and Medical Conditions for which Laboratory Data is Required
Effective 10/01/2013
Laboratory data is to be submitted for discharges in the following conditions:
1. Heart Attack
MS-DRG 280
MS-DRG 281
MS-DRG 282
MS-DRG 283
MS-DRG 284
MS-DRG 285
Acute myocardial infarction, discharged alive with MCC
Acute myocardial infarction, discharged alive with CC
Acute myocardial infarction, discharged alive without CC/MCC
Acute myocardial infarction, expired with MCC
Acute myocardial infarction, expired with CC
Acute myocardial infarction, expired without CC/MCC
2. Heart Failure
MS-DRG 291
MS-DRG 292
MS-DRG 293
Heart failure and shock with MCC
Heart failure and shock with CC
Heart failure and shock without CC/MCC
3. Chest Pain
MS-DRG 313
Chest pain
4. Abnormal Heartbeat
MS-DRG 242
MS-DRG 243
MS-DRG 244
MS-DRG 245
MS-DRG 258
MS-DRG 259
MS-DRG 260
MS-DRG 261
MS-DRG 262
MS-DRG 265
MS-DRG 286
MS-DRG 287
MS-DRG 308
MS-DRG 309
MS-DRG 310
Permanent cardiac pacemaker implant with MCC
Permanent cardiac pacemaker implant with CC
Permanent cardiac pacemaker implant without CC/MCC
AICD generator procedures
Cardiac pacemaker device replacement with MCC
Cardiac pacemaker device replacement without MCC
Cardiac pacemaker revision except device replacement with MCC
Cardiac pacemaker revision except device replacement with CC
Cardiac pacemaker revision except device replacement without CC/MCC
AICD lead procedures
Circulatory disorders except AMI with cardiac cath with MCC
Circulatory disorders except AMI with cardiac cath without MCC
Cardiac arrhythmia and conduction disorders with MCC
Cardiac arrhythmia and conduction disorders with CC
Cardiac arrhythmia and conduction disorders without CC/MCC
5. Coronary Bypass
MS-DRG 001
MS-DRG 002
MS-DRG 215
MS-DRG 222
MS-DRG 223
MS-DRG 224
MS-DRG 225
MS-DRG 226
MS-DRG 227
MS-DRG 228
MS-DRG 229
MS-DRG 230
MS-DRG 231
MS-DRG 232
MS-DRG 233
MS-DRG 234
MS-DRG 235
MS-DRG 236
Heart transplant or implant of heart assist system with MCC
Heart transplant or implant of heart assist system without MCC
Other heart assist system implant
Cardiac defibrillator implant with cardiac cath with AMI, heart failure or shock with MCC
Cardiac defibrillator implant with cardiac cath with AMI, heart failure or shock without MCC
Cardiac defibrillator implant with cardiac cath without AMI, heart failure or shock with MCC
Cardiac defibrillator implant with cardiac cath without AMI, heart failure or shock without MCC
Cardiac defibrillator implant without cardiac cath with MCC
Cardiac defibrillator implant without cardiac cath without MCC
Other cardiothoracic procedures with MCC
Other cardiothoracic procedures with CC
Other cardiothoracic procedures without CC/MCC
Coronary bypass with PTCA with MCC
Coronary bypass with PTCA without MCC
Coronary bypass with cardiac cath with MCC
Coronary bypass with cardiac cath without MCC
Coronary bypass without cardiac cath with MCC
Coronary bypass without cardiac cath without MCC
Page 1
6. Heart Valve Replacement
MS-DRG 216
MS-DRG 217
MS-DRG 218
MS-DRG 219
MS-DRG 220
MS-DRG 221
Cardiac valve and other major cardiothoracic procedure with cardiac cath with MCC
Cardiac valve and other major cardiothoracic procedure with cardiac cath with CC
Cardiac valve and other major cardiothoracic procedure with cardiac cath without CC/MCC
Cardiac valve and other major cardiothoracic procedure without cardiac cath with MCC
Cardiac valve and other major cardiothoracic procedure without cardiac cath with CC
Cardiac valve and other major cardiothoracic procedure without cardiac cath without CC/MCC
7. Percutaneous Transluminal Coronary Angioplasty
MS-DRG 246
MS-DRG 247
MS-DRG 248
MS-DRG 249
MS-DRG 250
MS-DRG 251
Percutaneous cardiovascular procedure with drug-eluting stent with MCC or 4 or more vessels/stents
Percutaneous cardiovascular procedure with drug-eluting stent without MCC
Percutaneous cardiovascular procedure with non-drug-eluting stent with MCC or 4 or more
vessels/stents
Percutaneous cardiovascular procedure with non-drug-eluting stent without MCC
Percutaneous cardiovascular procedure without coronary artery stent with MCC
Percutaneous cardiovascular procedure without coronary artery stent without MCC
8. Pneumonia
MS-DRG 177
MS-DRG 178
MS-DRG 179
MS-DRG 193
MS-DRG 194
MS-DRG 195
Respiratory infections and inflammations with MCC
Respiratory infections and inflammations with CC
Respiratory infections and inflammations without CC/MCC
Simple pneumonia and pleurisy with MCC
Simple pneumonia and pleurisy with CC
Simple pneumonia and pleurisy without CC/MCC
9. Asthma
MS-DRG 190
MS-DRG 191
MS-DRG 192
MS-DRG 202
MS-DRG 203
Chronic obstructive pulmonary disease with MCC
Chronic obstructive pulmonary disease with CC
Chronic obstructive pulmonary disease without CC/MCC
Bronchitis and asthma with CC/MCC
Bronchitis and asthma without CC/MCC
10. Respiratory Failure
MS-DRG 189
Pulmonary edema and respiratory failure
11. Blood Clot in Lung
MS-DRG 175
MS-DRG 176
Pulmonary embolism with MCC
Pulmonary embolism without MCC
12. Lung Repair
MS-DRG 163
MS-DRG 164
MS-DRG 165
MS-DRG 166
MS-DRG 167
MS-DRG 168
Major chest procedures with MCC
Major chest procedures with CC
Major chest procedures without CC/MCC
Other respiratory system O.R. procedures with MCC
Other respiratory system O.R. procedures with CC
Other respiratory system O.R. procedures without CC/MCC
13. Hypotension
MS-DRG 312
Syncope and collapse
Page 2
14. Blood Clot in Extremities
MS-DRG 294
MS-DRG 295
MS-DRG 299
MS-DRG 300
MS-DRG 301
Deep vein thrombophlebitis with CC/MCC
Deep vein thrombophlebitis without CC/MCC
Peripheral vascular disorders with MCC
Peripheral vascular disorders with CC
Peripheral vascular disorders without CC/MCC
15. Vascular Repair
MS-DRG 237
MS-DRG 238
MS-DRG 252
MS-DRG 253
MS-DRG 254
Major cardiovascular procedures with MCC
Major cardiovascular procedures without MCC
Other vascular procedures with MCC
Other vascular procedures with CC
Other vascular procedures without CC/MCC
16. Stroke
MS-DRG 061
MS-DRG 062
MS-DRG 063
MS-DRG 064
MS-DRG 065
MS-DRG 066
MS-DRG 067
MS-DRG 068
Acute ischemic stroke with use of thrombolytic agent with MCC
Acute ischemic stroke with use of thrombolytic agent with CC
Acute ischemic stroke with use of thrombolytic agent without CC/MCC
Intracranial hemorrhage or cerebral infarction with MCC
Intracranial hemorrhage or cerebral infarction with CC or tPA in 24 hours
Intracranial hemorrhage or cerebral infarction without CC/MCC
Nonspecified CVA and precerebral occlusion without infarct with MCC
Nonspecified CVA and precerebral occlusion without infarct without MCC
17. Removal of Blockage in Head and Neck Vessel
MS-DRG 034
MS-DRG 035
MS-DRG 036
MS-DRG 037
MS-DRG 038
MS-DRG 039
Carotid artery stent procedure with MCC
Carotid artery stent procedure with CC
Carotid artery stent procedure without CC/MCC
Extracranial procedures with MCC
Extracranial procedures with CC
Extracranial procedures without CC/MCC
18. Craniotomy
MS-DRG 020
MS-DRG 021
MS-DRG 022
MS-DRG 023
MS-DRG 024
MS-DRG 025
MS-DRG 026
MS-DRG 027
MS-DRG 031
MS-DRG 032
MS-DRG 033
Intracranial vascular procedures with PDX of hemorrhage with MCC
Intracranial vascular procedures with PDX of hemorrhage with CC
Intracranial vascular procedures with PDX of hemorrhage without CC/MCC
Craniotomy with major device implant or acute complex CNS PDX with MCC or chemo implant
Craniotomy with major device implant or acute complex CNS PDX without MCC
Craniotomy and endovascular intracranial procedures with MCC
Craniotomy and endovascular intracranial procedures with CC
Craniotomy and endovascular intracranial procedures without CC/MCC
Ventricular shunt procedures with MCC
Ventricular shunt procedures with CC
Ventricular shunt procedures without CC/MCC
19. Diabetes
Principal diagnosis of:
249.00
249.01
249.10
249.11
249.20
249.21
249.30
249.31
Secondary diabetes mellitus without mention of complication, not stated as uncontrolled, or
unspecified
Secondary diabetes mellitus without mention of complication, uncontrolled
Secondary diabetes mellitus with ketoacidosis, not stated as uncontrolled, or unspecified
Secondary diabetes mellitus with ketoacidosis, uncontrolled
Secondary diabetes mellitus with hyperosmolarity, not stated as uncontrolled, or unspecified
Secondary diabetes mellitus with hyperosmolarity, uncontrolled
Secondary diabetes mellitus with other coma, not stated as uncontrolled, or unspecified
Secondary diabetes mellitus with other coma, uncontrolled
continued
Page 3
249.40
249.41
249.50
249.51
249.60
249.61
249.70
249.71
249.80
249.81
249.90
249.91
250.00
250.01
250.02
250.03
250.10
250.11
250.12
250.13
250.20
250.21
250.22
250.23
250.30
250.31
250.32
250.33
250.40
250.41
250.42
250.43
250.50
250.51
250.52
250.53
250.60
250.61
250.62
250.63
250.70
250.71
250.72
250.73
250.80
250.81
250.82
250.83
250.90
250.91
250.92
250.93
Secondary diabetes mellitus with renal manifestations, not stated as uncontrolled, or unspecified
Secondary diabetes mellitus with renal manifestations, uncontrolled
Secondary diabetes mellitus with ophthalmic manifestations, not stated as uncontrolled, or
unspecified
Secondary diabetes mellitus with ophthalmic manifestations, uncontrolled
Secondary diabetes mellitus with neurological manifestations, not stated as uncontrolled, or
unspecified
Secondary diabetes mellitus with neurological manifestations, uncontrolled
Secondary diabetes mellitus with peripheral circulatory disorders, not stated as uncontrolled, or
unspecified
Secondary diabetes mellitus with peripheral circulatory disorders, uncontrolled
Secondary diabetes mellitus with other specified manifestations, not stated as uncontrolled, or
unspecified
Secondary diabetes mellitus with other specified manifestations, uncontrolled
Secondary diabetes mellitus with unspecified complication, not stated as uncontrolled, or
unspecified
Secondary diabetes mellitus with unspecified complication, uncontrolled
Diabetes mellitus without mention of complication, type II or unspecified type, not stated as
uncontrolled
Diabetes mellitus without mention of complication, type I [juvenile type], not stated as
uncontrolled
Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled
Diabetes mellitus without mention of complication, type I [juvenile type], uncontrolled
Diabetes with ketoacidosis, type II or unspecified type, not stated as uncontrolled
Diabetes with ketoacidosis, type I [juvenile type], not stated as uncontrolled
Diabetes with ketoacidosis, type II or unspecified type, uncontrolled
Diabetes with ketoacidosis, type I [juvenile type], uncontrolled
Diabetes with hyperosmolarity, type II or unspecified type, not stated as uncontrolled
Diabetes with hyperosmolarity, type I [juvenile type], not stated as uncontrolled
Diabetes with hyperosmolarity, type II or unspecified type, uncontrolled
Diabetes with hyperosmolarity, type I [juvenile type], uncontrolled
Diabetes with other coma, type II or unspecified type, not stated as uncontrolled
Diabetes with other coma, type I [juvenile type], not stated as uncontrolled
Diabetes with other coma, type II or unspecified type, uncontrolled
Diabetes with other coma, type I [juvenile type], uncontrolled
Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled
Diabetes with renal manifestations, type I [juvenile type], not stated as uncontrolled
Diabetes with renal manifestations, type II or unspecified type, uncontrolled
Diabetes with renal manifestations, type I [juvenile type], uncontrolled
Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled
Diabetes with ophthalmic manifestations, type I [juvenile type], not stated as uncontrolled
Diabetes with ophthalmic manifestations, type II or unspecified type, uncontrolled
Diabetes with ophthalmic manifestations, type I [juvenile type], uncontrolled
Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled
Diabetes with neurological manifestations, type I [juvenile type], not stated as uncontrolled
Diabetes with neurological manifestations, type II or unspecified type, uncontrolled
Diabetes with neurological manifestations, type I [juvenile type], uncontrolled
Diabetes with peripheral circulatory disorders, type II or unspecified type, not stated as
uncontrolled
Diabetes with peripheral circulatory disorders, type I [juvenile type], not stated as uncontrolled
Diabetes with peripheral circulatory disorders, type II or unspecified type, uncontrolled
Diabetes with peripheral circulatory disorders, type I [juvenile type], uncontrolled
Diabetes with other specified manifestations, type II or unspecified type, not stated as
uncontrolled
Diabetes with other specified manifestations, type I [juvenile type], not stated as uncontrolled
Diabetes with other specified manifestations, type II or unspecified type, uncontrolled
Diabetes with other specified manifestations, type I [juvenile type], uncontrolled
Diabetes with unspecified complication, type II or unspecified type, not stated as uncontrolled
Diabetes with unspecified complication, type I [juvenile type], not stated as uncontrolled
Diabetes with unspecified complication, type II or unspecified type, uncontrolled
Diabetes with unspecified complication, type I [juvenile type], uncontrolled
Page 4
20. Digestive Disease
MS-DRG 368
MS-DRG 369
MS-DRG 370
MS-DRG 371
MS-DRG 372
MS-DRG 373
MS-DRG 377
MS-DRG 378
MS-DRG 379
MS-DRG 388
MS-DRG 389
MS-DRG 390
MS-DRG 391
MS-DRG 392
MS-DRG 393
MS-DRG 394
MS-DRG 395
Major esophageal disorders with MCC
Major esophageal disorders with CC
Major esophageal disorders without CC/MCC
Major gastrointestinal disorders and peritoneal infections with MCC
Major gastrointestinal disorders and peritoneal infections with CC
Major gastrointestinal disorders and peritoneal infections without CC/MCC
GI hemorrhage with MCC
GI hemorrhage with CC
GI hemorrhage without CC/MCC
GI obstruction with MCC
GI obstruction with CC
GI obstruction without CC/MCC
Esophagitis, gastroenteritis and misc digestive disorders with MCC
Esophagitis, gastroenteritis and misc digestive disorders without MCC
Other digestive system diagnoses with MCC
Other digestive system diagnoses with CC
Other digestive system diagnoses without CC/MCC
21. Liver Disease
MS-DRG 432
MS-DRG 433
MS-DRG 434
MS-DRG 435
MS-DRG 436
MS-DRG 437
MS-DRG 438
MS-DRG 439
MS-DRG 440
MS-DRG 441
MS-DRG 442
MS-DRG 443
Cirrhosis and alcoholic hepatitis with MCC
Cirrhosis and alcoholic hepatitis with CC
Cirrhosis and alcoholic hepatitis without CC/MCC
Malignancy of hepatobiliary system or pancreas with MCC
Malignancy of hepatobiliary system or pancreas with CC
Malignancy of hepatobiliary system or pancreas without CC/MCC
Disorders of pancreas except malignancy with MCC
Disorders of pancreas except malignancy with CC
Disorders of pancreas except malignancy without CC/MCC
Disorders of liver except malignancy, cirrhosis, alcoholic hepatitis with MCC
Disorders of liver except malignancy, cirrhosis, alcoholic hepatitis with CC
Disorders of liver except malignancy, cirrhosis, alcoholic hepatitis without CC/MCC
22. Colorectal Repair
MS-DRG 329
MS-DRG 330
MS-DRG 331
MS-DRG 332
MS-DRG 333
MS-DRG 334
Major small and large bowel procedures with MCC
Major small and large bowel procedures with CC
Major small and large bowel procedures without CC/MCC
Rectal resection with MCC
Rectal resection with CC
Rectal resection without CC/MCC
23. Gallbladder Removal
MS-DRG 411
MS-DRG 412
MS-DRG 413
MS-DRG 414
MS-DRG 415
MS-DRG 416
MS-DRG 417
MS-DRG 418
MS-DRG 419
Cholecystectomy with common duct exploration with MCC
Cholecystectomy with common duct exploration with CC
Cholecystectomy with common duct exploration without CC/MCC
Cholecystectomy except by laparoscope without common duct exploration with MCC
Cholecystectomy except by laparoscope without common duct exploration with CC
Cholecystectomy except by laparoscope without common duct exploration without CC/MCC
Laparoscopic cholecystectomy without common duct exploration with MCC
Laparoscopic cholecystectomy without common duct exploration with CC
Laparoscopic cholecystectomy without common duct exploration without CC/MCC
24. Stomach and Small Intestine Repair
MS-DRG 326
MS-DRG 327
MS-DRG 328
MS-DRG 619
MS-DRG 620
MS-DRG 621
Stomach, esophageal and duodenal procedures with MCC
Stomach, esophageal and duodenal procedures with CC
Stomach, esophageal and duodenal procedures without CC/MCC
O.R. procedures for obesity with MCC
O.R. procedures for obesity with CC
O.R. procedures for obesity without CC/MCC
Page 5
25. Kidney Failure
MS-DRG 682
MS-DRG 683
MS-DRG 684
Renal failure with MCC
Renal failure with CC
Renal failure without CC/MCC
26. Kidney and Urinary Tract Infection
MS-DRG 689
MS-DRG 690
Kidney and urinary tract infections with MCC
Kidney and urinary tract infections without MCC
27. Prostatectomy
MS-DRG 665
MS-DRG 666
MS-DRG 667
MS-DRG 707
MS-DRG 708
MS-DRG 713
MS-DRG 714
Prostatectomy with MCC
Prostatectomy with CC
Prostatectomy without CC/MCC
Major male pelvic procedures with CC/MCC
Major male pelvic procedures without CC/MCC
Transurethral prostatectomy with CC/MCC
Transurethral prostatectomy without CC/MCC
28. Medical Back
MS-DRG 551
MS-DRG 552
Medical back problems with MCC
Medical back problems without MCC
29. Major Joint Repair
MS-DRG 461
MS-DRG 462
MS-DRG 466
MS-DRG 467
MS-DRG 468
MS-DRG 469
MS-DRG 470
MS-DRG 480
MS-DRG 481
MS-DRG 482
MS-DRG 485
MS-DRG 486
MS-DRG 487
MS-DRG 488
MS-DRG 489
Bilateral or multiple major joint procedures of lower extremity with MCC
Bilateral or multiple major joint procedures of lower extremity without MCC
Revision of hip or knee replacement with MCC
Revision of hip or knee replacement with CC
Revision of hip or knee replacement without CC/MCC
Major joint replacement or reattachment of lower extremity with MCC
Major joint replacement or reattachment of lower extremity without MCC
Hip and femur procedures except major joint with MCC
Hip and femur procedures except major joint with CC
Hip and femur procedures except major joint without CC/MCC
Knee procedure with principal diagnosis of infection with MCC
Knee procedure with principal diagnosis of infection with CC
Knee procedure with principal diagnosis of infection without CC/MCC
Knee procedure without principal diagnosis of infection with CC/MCC
Knee procedure without principal diagnosis of infection without CC/MCC
30. Neck/Back Repair
MS-DRG 453
MS-DRG 454
MS-DRG 455
MS-DRG 456
MS-DRG 457
MS-DRG 458
MS-DRG 459
MS-DRG 460
MS-DRG 471
MS-DRG 472
MS-DRG 473
MS-DRG 490
MS-DRG 491
Combined anterior/posterior spinal fusion with MCC
Combined anterior/posterior spinal fusion with CC
Combined anterior/posterior spinal fusion without CC/MCC
Spinal fusion except cervical with spinal curvature, malignancy, infection or 9 or more fusions
with MCC
Spinal fusion except cervical with spinal curvature, malignancy, infection or 9 or more fusions
with CC
Spinal fusion except cervical with spinal curvature, malignancy, infection or 9 or more fusions
without CC/MCC
Spinal fusion except cervical with MCC
Spinal fusion except cervical without MCC
Cervical spinal fusion with MCC
Cervical spinal fusion with CC
Cervical spinal fusion without CC/MCC
Back and neck procedure except spinal fusion with CC/MCC or disc device/neurostimulator
Back and neck procedure except spinal fusion without CC/MCC
Page 6
31. Breast Cancer
MS-DRG 576
MS-DRG 577
MS-DRG 578
MS-DRG 579
MS-DRG 580
MS-DRG 581
MS-DRG 582
MS-DRG 583
MS-DRG 584
MS-DRG 585
Skin graft except for skin ulcer or cellulitis with MCC
Skin graft except for skin ulcer or cellulitis with CC
Skin graft except for skin ulcer or cellulitis without CC/MCC
Other skin, subcutaneous tissue and breast procedures with MCC
Other skin, subcutaneous tissue and breast procedures with CC
Other skin, subcutaneous tissue and breast procedures without CC/MCC
Mastectomy for malignancy with CC/MCC
Mastectomy for malignancy without CC/MCC
Breast biopsy, local excision and other breast procedures with CC/MCC
Breast biopsy, local excision and other breast procedures without CC/MCC
32. Hysterectomy
MS-DRG 734
MS-DRG 735
MS-DRG 736
MS-DRG 737
MS-DRG 738
MS-DRG 739
MS-DRG 740
MS-DRG 741
MS-DRG 742
MS-DRG 743
Pelvic evisceration, radical hysterectomy and radical vulvectomy with CC/MCC
Pelvic evisceration, radical hysterectomy and radical vulvectomy without CC/MCC
Uterine and adnexa procedure for ovarian or adnexal malignancy with MCC
Uterine and adnexa procedure for ovarian or adnexal malignancy with CC
Uterine and adnexa procedure for ovarian or adnexal malignancy without CC/MCC
Uterine and adnexa procedure for non-ovarian/adnexal malignancy with MCC
Uterine and adnexa procedure for non-ovarian/adnexal malignancy with CC
Uterine and adnexa procedure for non-ovarian/adnexal malignancy without CC/MCC
Uterine and adnexa procedure for non-malignancy with CC/MCC
Uterine and adnexa procedure for non-malignancy without CC/MCC
33. Infectious Disease
MS-DRG 853
MS-DRG 854
MS-DRG 855
MS-DRG 856
MS-DRG 857
MS-DRG 858
MS-DRG 862
MS-DRG 863
MS-DRG 870
MS-DRG 871
MS-DRG 872
Infectious and parasitic diseases with O.R. procedure with MCC
Infectious and parasitic diseases with O.R. procedure with CC
Infectious and parasitic diseases with O.R. procedure without CC/MCC
Postoperative or post-traumatic infections with O.R. procedure with MCC
Postoperative or post-traumatic infections with O.R. procedure with CC
Postoperative or post-traumatic infections with O.R. procedure without CC/MCC
Postoperative and post-traumatic infections with MCC
Postoperative and post-traumatic infections without MCC
Septicemia or severe sepsis with mechanical ventilation 96+ hrs
Septicemia or severe sepsis without mechanical ventilation 96+ hrs with MCC
Septicemia or severe sepsis without mechanical ventilation 96+ hrs without MCC
34. Ventilation for Respiratory Disease
MS-DRG 207
MS-DRG 208
Respiratory system diagnosis with ventilator support 96+ hrs.
Respiratory system diagnosis with ventilator support <96 hrs.
35. Tracheostomy
MS-DRG 003
MS-DRG 004
ECMO or tracheostomy with mechanical ventilation 96+ hrs or PDX except face, mouth, and
neck with major O.R. procedure
Tracheostomy with mechanical ventilation 96+ hrs or PDX except face, mouth, and neck
without major O.R. procedure
Page 7