Table 6A.--New Diagnosis Codes
----------------------------------------------------------------------------------------------------------------
Diagnosis
code Description CC MDC DRG
----------------------------------------------------------------------------------------------------------------
337.3....... Autonomic dysreflexia....... N 1 18, 19
438.53...... Other paralytic syndrome, N 1 12
bilateral.
482.40...... Pneumonia due to Y 4 79, 80, 81
Staphyloccus, unspecified. 5 121 \1\
15 387, 389 \2\
25 489 \3\
482.41...... Pneumonia due to Y 4 79, 80, 81
Staphylococcus aureus. 5 121 \1\
15 387, 389 \2\
25 489 \3\
482.49...... Other Staphylococcus Y 4 79, 80, 81
pneumonia. 5 121 \1\
15 387, 389 \2\
25 489 \3\
518.83...... Chronic respiratory failure. Y 4 87
5 121 \1\
518.84...... Acute and chronic Y 4 87
respiratory failure. 5 121 \1\
22 506, 507
519.00...... Unspecified tracheostomy Y Pre 482
complication. 4 101, 102
519.01...... Infection of tracheostomy... Y Pre 482
4 101, 102
519.02...... Mechanical complication of Y Pre 482
tracheostomy. 4 101, 102
519.09...... Other tracheostomy Y Pre 482
complication. 4 101, 102
536.40...... Unspecified gastrostomy Y 6 188, 189, 190
complication.
536.41...... Infection of gastrostomy.... Y 6 188, 189, 190
536.42...... Mechanical complication of Y 6 188, 189, 190
gastrostomy.
536.49...... Other gastrostomy Y 6 188, 189, 190
complication.
564.81...... Neurogenic bowel............ N 6 182, 183, 184
564.89...... Other functional disorders N 6 182, 183, 184
of intestine.
569.62...... Mechanical complication of Y 6 188, 189, 190
colostomy and enterostomy.
659.70...... Abnormality in fetal heart N 14 370, 371, 372, 373, 374, 375
rate/rhythm, unspecified as
to episode of care or not
applicable.
659.71...... Abnormality in fetal heart N 14 370, 371, 372, 373, 374, 375
rate/rhythm, delivered,
with or without mention of
antepartum condition.
659.73...... Abnormality in fetal heart N 14 383, 384
rate/rhythm, antepartum
condition or complication.
763.81...... Abnormality in fetal heart N 15 390
rate or rhythm before the
onset of labor.
763.82...... Abnormality in fetal heart N 15 390
rate or rhythm during labor.
763.83...... Abnormality in fetal heart N 15 390
rate or rhythm, unspecified
as to time of onset.
763.89...... Other specified N 15 390
complications of labor and
delivery affecting fetus
and newborn.
780.71...... Chronic fatigue syndrome.... N 23 463, 464
25 490
780.79...... Other malaise and fatigue... N 23 463, 464
25 490
786.03...... Apnea....................... Y 4 99, 100
25 490
786.04...... Cheyne-Stokes respiration... Y 4 99, 100
25 490
786.05...... Shortness of breath......... N 4 99, 100
25 490
786.06...... Tachypnea................... N 4 99, 100
25 490
786.07...... Wheezing.................... N 4 99, 100
25 490
965.61...... Poisoning by propionic acid N 21 449, 450, 451
derivatives.
965.69...... Poisoning by other N 21 449, 450, 451
antirheumatics.
995.86...... Malignant hyperthermia...... Y 21 454,455
996.55...... Mechanical complications due Y 21 452, 453
to artificial skin graft
and decellularized
allodermis.
996.56...... Mechanical complications due Y 21 452, 453
to peritoneal dialysis
catheter.
996.68...... Infection and inflammatory Y 21 452, 453
reaction due to peritoneal
dialysis catheter.
V02.51...... Carrier or suspected carrier N 23 467
of Group B streptococcus.
V02.52...... Carrier or suspected carrier N 23 467
of other streptococcus.
V02.59...... Carrier or suspected carrier N 23 467
of other specified
bacterial diseases.
V10.48...... Personal history of N 17 411, 412
malignant neoplasm of
epididymis.
V13.61...... Personal history of N 23 467
hypospadias.
V13.69...... Personal history other N 23 467
congenital malformation.
[[Page 41079]]
V16.51...... Family history of malignant N 23 467
neoplasm of kidney.
V16.59...... Family history of malignant N 23 467
neoplasm of other urinary
organs.
V18.61...... Family history of polycystic N 23 467
kidney.
V18.69...... Family history of other N 23 467
kidney diseases.
V23.81...... Supervision of high-risk Y 14 469
pregnancy of elderly
primigravida.
V23.82...... Supervision of high-risk Y 14 469
pregnancy of elderly
multigravida.
V23.83...... Supervision of high-risk Y 14 469
pregnancy of young
primigravida.
V23.84...... Supervision of high-risk Y 14 469
pregnancy of young
multigravida.
V23.89...... Supervision of other high- Y 14 469
risk pregnancy.
V26.51...... Tubal ligation status....... N 23 467
V26.52...... Vasectomy status............ N 23 467
V29.3....... Observation for suspected N 23 467
genetic or metabolic
condition.
V43.83...... Organ or tissue replaced by N 23 467
artificial skin.
V44.50...... Unspecified cystostomy N 23 467
status.
V44.51...... Cutaneous-vesicostomy status N 23 467
V44.52...... Appendico-vesicostomy status N 23 467
V44.59...... Other cystostomy status..... N 23 467
V56.2....... Fitting and adjustment of N 11 317
peritoneal dialysis
catheter.
V58.62...... Encounter for aftercare for N 23 465, 466
long- term (current) use of
antibiotics.
V76.44...... Special screening for N 23 467
malignant neoplasm of
prostate.
V76.45...... Special screening for N 23 467
malignant neoplasm of
testis.
----------------------------------------------------------------------------------------------------------------
\1\ Classified as a "major complication" in this DRG.
\2\ Classified as a "major problem" in these DRGs.
\3\ HIV major related condition in this DRG.
Table 6B.--New Procedure Codes
----------------------------------------------------------------------------------------------------------------
Procedure
code Description OR MDC DRG
----------------------------------------------------------------------------------------------------------------
36.31....... Open chest transmyocardial Y 5 108
revascularization.
36.32....... Other transmyocardial Y 5 108
revascularization.
36.39....... Other heart revascularization. Y 5 108
37.67....... Implantation of Y 5 110, 111
cardiomyostimulation system.
75.37....... Amnioinfusion................. N
86.67....... Dermal regenerative graft..... Y 1 7, 8
3 63
5 120
6 170, 171
8 217
9 263, 264, 265, 266
10 287
21 439
22 504, 506, 507
24 486
92.30....... Stereotactic radiosurgery, not N \1\ 1 7, 8
otherwise specified. 10 292, 293
17 401, 402, 408
92.31....... Single source photon N \1\ 1 7, 8
radiosurgery. 10 292, 293
17 401, 402, 408
92.32....... Multi-source photon N \1\ 1 7, 8
radiosurgery. 10 292, 293
17 401, 402, 408
92.33....... Particulate radiosurgery...... N \1\ 1 7, 8
10 292, 293
17 401, 402, 408
92.39....... Stereotactic radiosurgery, not N \1\ 1 7, 8
elsewhere classified. 10 292, 293
17 401, 402, 408
96.29....... Reduction of intussusception N
of alimentary tract.
99.10....... Injection or infusion of N
thrombolytic agent.
99.20....... Injection or infusion of N
platelet inhibitor.
----------------------------------------------------------------------------------------------------------------
\1\ Non-operating room procedure that affects DRG assignment.
[[Page 41080]]
Table 6C.--Invalid Diagnosis Codes
----------------------------------------------------------------------------------------------------------------
Diagnosis
code Description CC MDC DRG
----------------------------------------------------------------------------------------------------------------
482.4....... Pneumonia due to Y 4 79, 80, 81
Staphylococcus. 5 121 \1\1
15 387, 389 \2\
25 489 \3\
519.0....... Tracheostomy complication... Y PRE 482
4 101, 102
564.8....... Other specified functional N 6 182, 183, 184
disorders of intestine.
763.8....... Other specified N 15 390
complications of labor and
delivery affecting fetus
and newborn.
780.7....... Malaise and fatigue......... N 23 463, 464
25 490
965.6....... Poisoning by antirheumatics N 21 449, 450, 451
[antiphlogistics].
V02.5....... Carrier or suspected carrier N 23 467
of other specified
bacterial diseases.
V13.6....... Personal history of N 23 467
congenital malformations.
V16.5....... Family history of malignant N 23 467
neoplasm of urinary organs.
V18.6....... Family history of kidney N 23 467
diseases.
V23.8....... Supervision of other high- Y 14 469
risk pregnancy.
V44.5....... Cystostomy status........... N 23 467
----------------------------------------------------------------------------------------------------------------
\1\ Classified as a "major complication" in this DRG.
\2\ Classified as a "major problem" in these DRGs.
\3\ HIV major related condition in this DRG.
Table 6D.--Invalid Procedure Codes
----------------------------------------------------------------------------------------------------------------
Procedure
code Description OR MDC DRG
----------------------------------------------------------------------------------------------------------------
36.3........ Other heart Y 5 108
revascularization.
92.3........ Stereotactic radiosurgery... N \1\ 1 7,8
10 292, 293
17 401, 402, 408
----------------------------------------------------------------------------------------------------------------
\1\ Non-operating room procedure that affects DRG assignment.
Table 6E.--Revised Diagnosis Code Titles
----------------------------------------------------------------------------------------------------------------
Diagnosis
code Description CC MDC DRG
----------------------------------------------------------------------------------------------------------------
518.81...... Acute respiratory failure... Y 4 87
5 121 \1\
22 506, 507
659.60...... Elderly multigravida N 14 370, 371, 372, 373, 374, 375
unspecified as to episode
of care or not applicable.
659.61...... Elderly multigravida N 14 370, 371, 372, 373, 374, 375
delivered, with mention of
antepartum condition.
659.63...... Elderly multigravida with N 14 383, 384
antepartum condition or
complication.
V56.1....... Fitting and adjustment of N 11 317
extracorporeal dialysis
catheter.
V82.4....... Maternal postnatal screening N 23 467
for chromosomal anomalies.
----------------------------------------------------------------------------------------------------------------
\1\ Classified as a "major complication" in this DRG.
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