Attachment O_Provider Discount Data_clean.xlsx
XLSX spreadsheet 214 KB Posted
- Attached to
- RFP for Medical & Pharmacy Benefits
- Solicitation number
- S-44300-00014758
- Issued by
- Marion County, Oregon
About this file
Summary: Attachment O - Provider Discount Data
This Excel workbook contains provider pricing and discount data compiled by Oregon's Public Employees' Benefit Board (PEBB) for its Medical and Pharmacy Benefit Request for Proposal. The attachment captures PEBB's historical utilization data organized by Diagnosis-Related Groups (DRGs) for inpatient hospital admissions and Current Procedural Terminology (CPT) codes for outpatient procedures. The data is stratified across multiple dimensions: facility type (those subject to and exempt from Oregon's Senate Bill 1067), plan type (Coordinated Care and Statewide plans), and plan tier (Regional and Statewide). For each DRG and CPT code, the workbook presents 2024 utilization counts, DRG weights, average allowed amounts per admission or claim, and average Medicare allowed amounts, enabling proposers to submit competitive pricing bids reflective of PEBB's actual claims experience. The file comprises six primary tabs: DRG data for Coordinated Care plans both subject to and exempt from SB 1067; DRG data for Statewide plans under the same SB 1067 classifications; and CPT procedure code data for Regional and Statewide plans similarly segmented by SB 1067 applicability.
Proposers are instructed to complete highlighted cells within each tab to establish their provider discount arrangements aligned with PEBB's 2024 claims profile. The DRG-based admissions data reflects complex, high-acuity procedures such as organ transplants, craniotomy procedures, spinal fusion, and septicemia cases, with admission counts ranging from single cases to over 800 ventilator-dependent admissions. CPT procedure code data encompasses thousands of outpatient services, from high-volume codes such as office visits (99214, 99213) and lab work (80053, 85025) to specialized procedures and injections. Senate Bill 1067 classifications indicate differing reimbursement frameworks or regulatory environments for affected versus non-affected facilities. The structured data presentation facilitates transparent comparison of historical utilization patterns and allows PEBB to evaluate proposers' pricing strategies against documented claims history, supporting competitive procurement processes and cost containment objectives across its employee health benefit programs.
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Workbook Overview
Oregon PEBB Medical and Pharmacy RFP
This spreadsheet is intended to capture your provider pricing arrangements as it applies to PEBB's recent utilization. Pricing requests are split out between DRGs (Admits) and CPTs (Procedures). These are further split by plan type (Coordinated Care and Statewide Plans) and applicability of Senate Bill 1067.
Please fill out the highlighted cells on each tab, as indicated by the headers.
PEBB Medical & Pharmacy Benefit RFP OregonBuys Bid No. S-44300-00014758 Attachment O Provider Discount Data
Not Peer Reviewed
DRG - Coordinated Care SB1067
Proposers, this tab is a summary of the DRGs and the number of admins in 2024 in PEBB's coordinated care plans at facilities subject to Senate Bill 1067.
| PEBB 2024 Data | Proposers, please fill out these columns. | ||||
| DRG Description | DRG | Coordinated Care Counts | DRG Weight v42.0 CN | Average Allowed Amount Per Admit | Medicare Allowed Amount per Admit |
| ECMO or trach w MV >96 hrs or PDX exc face, mouth & neck w maj O.R. | 3 | 4 | 21.432 | ||
| Trach w MV >96 hrs or PDX exc face, mouth & neck w/o maj O.R. | 4 | 1 | 14.130 | ||
| Liver transplant w MCC or intestinal transplant | 5 | 2 | 10.649 | ||
| Tracheostomy for face, mouth & neck dx or laryngectomy w/o CC/MCC | 13 | 1 | 2.650 | ||
| Allogeneic bone marrow transplant | 14 | 2 | 13.102 | ||
| Autologous bone marrow transplant w CC/MCC | 16 | 3 | 6.036 | ||
| Intracranial vascular procedures w PDX hemorrhage w CC | 21 | 1 | 5.527 | ||
| Cranio w major dev impl/acute CNS PDX w MCC/chemo impl/epilep w stim | 23 | 2 | 5.705 | ||
| Cranio w major dev impl/acute complex CNS PDX w/o MCC | 24 | 2 | 3.802 | ||
| Craniotomy & endovascular intracranial procedures w MCC | 25 | 15 | 4.472 | ||
| Craniotomy & endovascular intracranial procedures w CC | 26 | 7 | 3.059 | ||
| Craniotomy & endovascular intracranial procedures w/o CC/MCC | 27 | 10 | 2.468 | ||
| Spinal procedures w CC or spinal neurostimulators | 29 | 7 | 3.357 | ||
| Spinal procedures w/o CC/MCC | 30 | 2 | 2.225 | ||
| Ventricular shunt procedures w MCC | 31 | 2 | 4.191 | ||
| Ventricular shunt procedures w CC | 32 | 2 | 2.136 | ||
| Periph/cranial nerve & other nerv syst proc w MCC | 40 | 1 | 3.772 | ||
| Periph/cranial nerve & other nerv syst proc w/o CC/MCC | 42 | 2 | 1.758 | ||
| Spinal disorders & injuries w/o CC/MCC | 53 | 1 | 0.921 | ||
| Nervous system neoplasms w MCC | 54 | 3 | 1.499 | ||
| Nervous system neoplasms w/o MCC | 55 | 1 | 1.091 | ||
| Degenerative nervous system disorders w MCC | 56 | 5 | 2.504 | ||
| Degenerative nervous system disorders w/o MCC | 57 | 12 | 1.334 | ||
| Multiple sclerosis & cerebellar ataxia w/o CC/MCC | 60 | 4 | 0.892 | ||
| Ischemic stroke/precereb occl/trans isch w thrombolytic agent w CC | 62 | 4 | 1.781 | ||
| Intracranial hemorrhage or cerebral infarction w MCC | 64 | 9 | 1.989 | ||
| Intracranial hemorrhage or cerebral infarction w CC or tPA in 24 hrs | 65 | 16 | 1.017 | ||
| Intracranial hemorrhage or cerebral infarction w/o CC/MCC | 66 | 6 | 0.688 | ||
| Transient ischemia w/o thrombolytic | 69 | 1 | 0.800 | ||
| Nonspecific cerebrovascular disorders w CC | 71 | 1 | 1.054 | ||
| Nonspecific cerebrovascular disorders w/o CC/MCC | 72 | 1 | 0.750 | ||
| Cranial & peripheral nerve disorders w MCC | 73 | 1 | 1.546 | ||
| Cranial & peripheral nerve disorders w/o MCC | 74 | 1 | 1.042 | ||
| Viral meningitis w/o CC/MCC | 76 | 1 | 0.917 | ||
| Hypertensive encephalopathy w CC | 78 | 1 | 0.998 | ||
| Traumatic stupor & coma, coma >1 hr w MCC | 82 | 2 | 2.320 | ||
| Traumatic stupor & coma, coma >1 hr w/o CC/MCC | 84 | 2 | 0.956 | ||
| Traumatic stupor & coma, coma <1 hr w/o CC/MCC | 87 | 1 | 0.884 | ||
| Concussion w MCC | 88 | 1 | 1.411 | ||
| Other disorders of nervous system w MCC | 91 | 4 | 1.823 | ||
| Other disorders of nervous system w CC | 92 | 5 | 1.059 | ||
| Other disorders of nervous system w/o CC/MCC | 93 | 3 | 0.789 | ||
| Bacterial & tuberculous infections of nervous system w CC | 95 | 4 | 2.397 | ||
| Non-bacterial infect of nervous sys exc viral meningitis w CC | 98 | 2 | 2.169 | ||
| Seizures w MCC | 100 | 4 | 1.985 | ||
| Seizures w/o MCC | 101 | 20 | 0.922 | ||
| Headaches w MCC | 102 | 1 | 1.160 | ||
| Headaches w/o MCC | 103 | 2 | 0.850 | ||
| Orbital procedures w CC/MCC | 113 | 1 | 2.257 | ||
| Other disorders of the eye w MCC | 124 | 1 | 1.304 | ||
| Other disorders of the eye w/o MCC | 125 | 1 | 0.826 | ||
| Sinus & mastoid procedures w CC/MCC | 135 | 1 | 2.411 | ||
| Major head & neck procedures w MCC | 140 | 2 | 4.229 | ||
| Major head & neck procedures w CC | 141 | 1 | 2.149 | ||
| Other ear, nose, mouth & throat O.R. procedures w CC | 144 | 1 | 1.757 | ||
| Other ear, nose, mouth & throat O.R. procedures w/o CC/MCC | 145 | 4 | 1.185 | ||
| Dysequilibrium | 149 | 2 | 0.748 | ||
| Otitis media & URI w/o MCC | 153 | 5 | 0.712 | ||
| Other ear, nose, mouth & throat diagnoses w MCC | 154 | 1 | 1.626 | ||
| Other ear, nose, mouth & throat diagnoses w CC | 155 | 1 | 0.934 | ||
| Dental & Oral Diseases w CC | 158 | 2 | 0.941 | ||
| Major chest procedures w MCC | 163 | 5 | 4.609 | ||
| Major chest procedures w CC | 164 | 5 | 2.517 | ||
| Major chest procedures w/o CC/MCC | 165 | 8 | 1.864 | ||
| Other resp system O.R. procedures w MCC | 166 | 2 | 3.850 | ||
| Other resp system O.R. procedures w CC | 167 | 3 | 1.827 | ||
| Pulmonary embolism w MCC or acute cor pulmonale | 175 | 10 | 1.409 | ||
| Pulmonary embolism w/o MCC | 176 | 9 | 0.815 | ||
| Respiratory infections & inflammations w MCC | 177 | 6 | 1.617 | ||
| Respiratory infections & inflammations w/o CC/MCC | 179 | 2 | 0.770 | ||
| Respiratory neoplasms w MCC | 180 | 2 | 1.748 | ||
| Respiratory neoplasms w CC | 181 | 1 | 1.110 | ||
| Respiratory neoplasms w/o CC/MCC | 182 | 1 | 0.838 | ||
| Major chest trauma w MCC | 183 | 1 | 1.587 | ||
| Major chest trauma w CC | 184 | 3 | 1.068 | ||
| Major chest trauma w/o CC/MCC | 185 | 1 | 0.778 | ||
| Pleural effusion w MCC | 186 | 2 | 1.580 | ||
| Pleural effusion w CC | 187 | 1 | 1.004 | ||
| Pulmonary edema & respiratory failure | 189 | 10 | 1.237 | ||
| Chronic obstructive pulmonary disease w MCC | 190 | 1 | 1.123 | ||
| Simple pneumonia & pleurisy w MCC | 193 | 20 | 1.318 | ||
| Simple pneumonia & pleurisy w CC | 194 | 11 | 0.820 | ||
| Simple pneumonia & pleurisy w/o CC/MCC | 195 | 6 | 0.623 | ||
| Pneumothorax w CC | 200 | 1 | 1.108 | ||
| Pneumothorax w/o CC/MCC | 201 | 3 | 0.677 | ||
| Bronchitis & asthma w CC/MCC | 202 | 11 | 0.967 | ||
| Bronchitis & asthma w/o CC/MCC | 203 | 8 | 0.697 | ||
| Other respiratory system diagnoses w MCC | 205 | 1 | 1.888 | ||
| Other respiratory system diagnoses w/o MCC | 206 | 2 | 0.906 | ||
| Respiratory system diagnosis w ventilator support >96 hours | 207 | 4 | 6.467 | ||
| Respiratory system diagnosis w ventilator support <=96 hours | 208 | 5 | 2.684 | ||
| Cardiac valve & oth maj cardiothoracic proc w card cath w CC | 217 | 1 | 6.458 | ||
| Cardiac valve & oth maj cardiothoracic proc w/o card cath w MCC | 219 | 9 | 7.738 | ||
| Cardiac valve & oth maj cardiothoracic proc w/o card cath w CC | 220 | 6 | 5.297 | ||
| Cardiac valve & oth maj cardiothoracic proc w/o card cath w/o CC/MCC | 221 | 4 | 4.593 | ||
| Cardiac defib implant w cardiac cath w/o AMI/HF/shock w MCC | 224 | 3 | N/A | ||
| Other cardiothoracic procedures w MCC | 228 | 1 | 4.983 | ||
| Other cardiothoracic procedures w/o MCC | 229 | 2 | 3.106 | ||
| Coronary bypass w cardiac cath w MCC | 233 | 2 | 7.816 | ||
| Coronary bypass w cardiac cath w/o MCC | 234 | 5 | 5.320 | ||
| Coronary bypass w/o cardiac cath w MCC | 235 | 3 | 5.884 | ||
| Coronary bypass w/o cardiac cath w/o MCC | 236 | 8 | 4.112 | ||
| Amputation for circ sys disorders exc upper limb & toe w CC | 240 | 2 | 2.912 | ||
| Permanent cardiac pacemaker implant w CC | 243 | 1 | 2.253 | ||
| Permanent cardiac pacemaker implant w/o CC/MCC | 244 | 2 | 1.805 | ||
| AICD generator procedures | 245 | 1 | 4.887 | ||
| Perc cardiovasc proc w drug-eluting stent w MCC or 4+ art/stents | 246 | 10 | N/A | ||
| Perc cardiovasc proc w drug-eluting stent w/o MCC | 247 | 25 | N/A | ||
| Perc cardiovasc proc w non-drug-eluting stent w/o MCC | 249 | 1 | N/A | ||
| Perc cardiovasc proc w/o coronary artery stent w/o MCC | 251 | 1 | 1.563 | ||
| Other vascular procedures w MCC | 252 | 1 | 3.430 | ||
| Other vascular procedures w CC | 253 | 6 | 2.553 | ||
| Other vascular procedures w/o CC/MCC | 254 | 2 | 1.749 | ||
| Upper limb & toe amputation for circ system disorders w CC | 256 | 1 | 1.694 | ||
| Cardiac pacemaker device replacement w/o MCC | 259 | 1 | 1.758 | ||
| Cardiac pacemaker revision except device replacement w CC | 261 | 1 | 1.898 | ||
| AICD lead procedures | 265 | 1 | 3.567 | ||
| Endovascular cardiac valve replacement & supplement procedures w MCC | 266 | 2 | 5.991 | ||
| Aortic and heart assist procedures except pulsation balloon w/o MCC | 269 | 3 | 4.161 | ||
| Other major cardiovascular procedures w MCC | 270 | 3 | 5.133 | ||
| Other major cardiovascular procedures w CC | 271 | 1 | 3.444 | ||
| Percutaneous and other intracardiac procedures w MCC | 273 | 2 | 3.910 | ||
| Percutaneous and other intracardiac procedures w/o MCC | 274 | 3 | 3.121 | ||
| Acute myocardial infarction, discharged alive w MCC | 280 | 12 | 1.641 | ||
| Acute myocardial infarction, discharged alive w CC | 281 | 8 | 0.922 | ||
| Acute myocardial infarction, discharged alive w/o CC/MCC | 282 | 6 | 0.725 | ||
| Circulatory disorders except AMI, w card cath w MCC | 286 | 5 | 2.213 | ||
| Circulatory disorders except AMI, w card cath w/o MCC | 287 | 2 | 1.090 | ||
| Heart failure & shock w MCC | 291 | 11 | 1.305 | ||
| Heart failure & shock w CC | 292 | 3 | 0.861 | ||
| Heart failure & shock w/o CC/MCC | 293 | 1 | 0.549 | ||
| Peripheral vascular disorders w MCC | 299 | 3 | 1.618 | ||
| Peripheral vascular disorders w CC | 300 | 1 | 1.071 | ||
| Peripheral vascular disorders w/o CC/MCC | 301 | 2 | 0.713 | ||
| Hypertension w/o MCC | 305 | 2 | 0.751 | ||
| Cardiac congenital & valvular disorders w/o MCC | 307 | 1 | 0.926 | ||
| Cardiac arrhythmia & conduction disorders w MCC | 308 | 5 | 1.206 | ||
| Cardiac arrhythmia & conduction disorders w CC | 309 | 3 | 0.739 | ||
| Cardiac arrhythmia & conduction disorders w/o CC/MCC | 310 | 8 | 0.560 | ||
| Syncope & collapse | 312 | 1 | 0.871 | ||
| Chest pain | 313 | 1 | 0.713 | ||
| Other circulatory system diagnoses w MCC | 314 | 3 | 2.154 | ||
| Other circulatory system diagnoses w CC | 315 | 4 | 0.962 | ||
| Stomach, esophageal & duodenal proc w MCC | 326 | 3 | 5.079 | ||
| Stomach, esophageal & duodenal proc w CC | 327 | 8 | 2.428 | ||
| Stomach, esophageal & duodenal proc w/o CC/MCC | 328 | 15 | 1.594 | ||
| Major small & large bowel procedures w MCC | 329 | 11 | 4.592 | ||
| Major small & large bowel procedures w CC | 330 | 17 | 2.364 | ||
| Major small & large bowel procedures w/o CC/MCC | 331 | 16 | 1.651 | ||
| Peritoneal adhesiolysis w CC | 336 | 1 | 2.112 | ||
| Peritoneal adhesiolysis w/o CC/MCC | 337 | 1 | 1.535 | ||
| Appendectomy w complicated principal diag w MCC | 338 | 1 | N/A | ||
| Appendectomy w complicated principal diag w CC | 339 | 2 | N/A | ||
| Appendectomy w complicated principal diag w/o CC/MCC | 340 | 8 | N/A | ||
| Appendectomy w/o complicated principal diag w CC | 342 | 2 | N/A | ||
| Appendectomy w/o complicated principal diag w/o CC/MCC | 343 | 4 | N/A | ||
| Minor small & large bowel procedures w CC | 345 | 1 | 1.489 | ||
| Anal & stomal procedures w MCC | 347 | 1 | 2.367 | ||
| Anal & stomal procedures w CC | 348 | 1 | 1.259 | ||
| Anal & stomal procedures w/o CC/MCC | 349 | 1 | 0.881 | ||
| Hernia procedures except inguinal & femoral w MCC | 353 | 1 | 2.933 | ||
| Hernia procedures except inguinal & femoral w CC | 354 | 6 | 1.701 | ||
| Hernia procedures except inguinal & femoral w/o CC/MCC | 355 | 4 | 1.333 | ||
| Other digestive system O.R. procedures w MCC | 356 | 1 | 4.266 | ||
| Other digestive system O.R. procedures w/o CC/MCC | 358 | 3 | 1.355 | ||
| Major esophageal disorders w MCC | 368 | 3 | 1.670 | ||
| Major esophageal disorders w CC | 369 | 2 | 1.018 | ||
| Major gastrointestinal disorders & peritoneal infections w MCC | 371 | 3 | 1.748 | ||
| Major gastrointestinal disorders & peritoneal infections w CC | 372 | 1 | 1.029 | ||
| Major gastrointestinal disorders & peritoneal infections w/o CC/MCC | 373 | 5 | 0.725 | ||
| Digestive malignancy w MCC | 374 | 1 | 2.111 | ||
| Digestive malignancy w CC | 375 | 1 | 1.229 | ||
| Digestive malignancy w/o CC/MCC | 376 | 1 | 0.883 | ||
| G.I. hemorrhage w MCC | 377 | 6 | 1.818 | ||
| G.I. hemorrhage w CC | 378 | 15 | 0.986 | ||
| G.I. hemorrhage w/o CC/MCC | 379 | 5 | 0.637 | ||
| Complicated peptic ulcer w MCC | 380 | 3 | 1.924 | ||
| Complicated peptic ulcer w/o CC/MCC | 382 | 1 | 0.749 | ||
| Uncomplicated peptic ulcer w/o MCC | 384 | 1 | 0.870 | ||
| Inflammatory bowel disease w MCC | 385 | 2 | 1.625 | ||
| Inflammatory bowel disease w CC | 386 | 9 | 0.993 | ||
| Inflammatory bowel disease w/o CC/MCC | 387 | 2 | 0.670 | ||
| G.I. obstruction w MCC | 388 | 3 | 1.470 | ||
| G.I. obstruction w CC | 389 | 6 | 0.802 | ||
| G.I. obstruction w/o CC/MCC | 390 | 11 | 0.547 | ||
| Esophagitis, gastroent & misc digest disorders w MCC | 391 | 12 | 1.285 | ||
| Esophagitis, gastroent & misc digest disorders w/o MCC | 392 | 33 | 0.780 | ||
| Other digestive system diagnoses w MCC | 393 | 2 | 1.656 | ||
| Other digestive system diagnoses w CC | 394 | 15 | 0.941 | ||
| Other digestive system diagnoses w/o CC/MCC | 395 | 1 | 0.636 | ||
| Pancreas, liver & shunt procedures w MCC | 405 | 2 | 5.429 | ||
| Pancreas, liver & shunt procedures w CC | 406 | 1 | 2.808 | ||
| Pancreas, liver & shunt procedures w/o CC/MCC | 407 | 1 | 2.136 | ||
| Cholecystectomy except by laparoscope w/o c.d.e. w/o CC/MCC | 416 | 1 | 1.370 | ||
| Laparoscopic cholecystectomy w/o c.d.e. w MCC | 417 | 13 | 2.377 | ||
| Laparoscopic cholecystectomy w/o c.d.e. w CC | 418 | 13 | 1.658 | ||
| Laparoscopic cholecystectomy w/o c.d.e. w/o CC/MCC | 419 | 9 | 1.318 | ||
| Cirrhosis & alcoholic hepatitis w MCC | 432 | 13 | 1.959 | ||
| Malignancy of hepatobiliary system or pancreas w MCC | 435 | 6 | 1.825 | ||
| Malignancy of hepatobiliary system or pancreas w CC | 436 | 5 | 1.128 | ||
| Disorders of pancreas except malignancy w MCC | 438 | 10 | 1.664 | ||
| Disorders of pancreas except malignancy w CC | 439 | 14 | 0.860 | ||
| Disorders of pancreas except malignancy w/o CC/MCC | 440 | 10 | 0.615 | ||
| Disorders of liver except malig, cirr, alc hepa w MCC | 441 | 7 | 1.890 | ||
| Disorders of liver except malig, cirr, alc hepa w CC | 442 | 5 | 0.966 | ||
| Disorders of liver except malig, cirr, alc hepa w/o CC/MCC | 443 | 1 | 0.703 | ||
| Disorders of the biliary tract w MCC | 444 | 2 | 1.684 | ||
| Disorders of the biliary tract w CC | 445 | 3 | 1.085 | ||
| Disorders of the biliary tract w/o CC/MCC | 446 | 3 | 0.797 | ||
| Combined anterior/posterior spinal fusion w MCC | 453 | 2 | N/A | ||
| Combined anterior/posterior spinal fusion w/o CC/MCC | 455 | 5 | N/A | ||
| Spinal fus exc cerv w spinal curv/malig/infec or ext fus w MCC | 456 | 1 | 8.469 | ||
| Spinal fus exc cerv w spinal curv/malig/infec or ext fus w CC | 457 | 1 | 5.739 | ||
| Spinal fus exc cerv w spinal curv/malig/infec or ext fus w/o CC/MCC | 458 | 3 | 4.318 | ||
| Spinal fusion except cervical w MCC | 459 | 1 | N/A | ||
| Spinal fusion except cervical w/o MCC | 460 | 17 | N/A | ||
| Bilateral or multiple major joint procs of lower extremity w/o MCC | 462 | 2 | 2.864 | ||
| Wnd debrid & skn grft exc hand, for musculo-conn tiss dis w CC | 464 | 3 | 2.949 | ||
| Wnd debrid & skn grft exc hand, for musculo-conn tiss dis w/o CC/MCC | 465 | 1 | 1.736 | ||
| Revision of hip or knee replacement w/o CC/MCC | 468 | 2 | 2.623 | ||
| Major hip & knee repl or reattach lower extremity w MCC or TAR | 469 | 3 | 3.269 | ||
| Major hip & knee replacement or reattach lower extremity w/o MCC | 470 | 9 | 1.886 | ||
| Cervical spinal fusion w MCC | 471 | 3 | 4.857 | ||
| Cervical spinal fusion w CC | 472 | 4 | 2.897 | ||
| Cervical spinal fusion w/o CC/MCC | 473 | 3 | 2.367 | ||
| Amputation for musculoskeletal sys & conn tissue dis w MCC | 474 | 1 | 4.485 | ||
| Amputation for musculoskeletal sys & conn tissue dis w/o CC/MCC | 476 | 1 | 1.163 | ||
| Biopsies of musculoskeletal system & connective tissue w MCC | 477 | 1 | 3.439 | ||
| Biopsies of musculoskeletal system & connective tissue w CC | 478 | 2 | 2.339 | ||
| Hip & femur procedures except major joint w MCC | 480 | 2 | 2.941 | ||
| Hip & femur procedures except major joint w CC | 481 | 6 | 2.075 | ||
| Hip & femur procedures except major joint w/o CC/MCC | 482 | 3 | 1.586 | ||
| Major joint/limb reattachment procedure of upper extremities | 483 | 3 | 2.548 | ||
| Knee procedures w pdx of infection w CC | 486 | 1 | 2.121 | ||
| Lower extrem & humer proc except hip, foot, femur w CC | 493 | 4 | 2.401 | ||
| Lower extrem & humer proc except hip, foot, femur w/o CC/MCC | 494 | 9 | 1.885 | ||
| Local excision & removal int fix devices of hip & femur w CC/MCC | 498 | 1 | 2.525 | ||
| Soft tissue procedures w MCC | 500 | 1 | 3.169 | ||
| Soft tissue procedures w CC | 501 | 3 | 1.785 | ||
| Soft tissue procedures w/o CC/MCC | 502 | 4 | 1.397 | ||
| Foot procedures w CC | 504 | 1 | 1.755 | ||
| Foot procedures w/o CC/MCC | 505 | 1 | 1.755 | ||
| Shoulder, elbow or forearm proc, exc major joint proc w/o CC/MCC | 512 | 1 | 1.608 | ||
| Hand or wrist proc, except major thumb or joint proc w/o CC/MCC | 514 | 2 | 1.020 | ||
| Other musculoskelet sys & conn tiss O.R. proc w MCC | 515 | 1 | 3.092 | ||
| Other musculoskelet sys & conn tiss O.R. proc w CC | 516 | 4 | 2.012 | ||
| Other musculoskelet sys & conn tiss O.R. proc w/o CC/MCC | 517 | 3 | 1.493 | ||
| Back & neck proc exc spinal fusion w MCC or disc device/neurostim | 518 | 1 | 3.584 | ||
| Back & neck proc exc spinal fusion w CC | 519 | 5 | 1.972 | ||
| Back & neck proc exc spinal fusion w/o CC/MCC | 520 | 11 | 1.433 | ||
| Hip replacement w principal diagnosis of hip fracture w/o MCC | 522 | 1 | 2.108 | ||
| Fractures of femur w/o MCC | 534 | 1 | 0.814 | ||
| Sprains, strains, & dislocations of hip, pelvis & thigh w CC/MCC | 537 | 1 | 0.919 | ||
| Osteomyelitis w CC | 540 | 1 | 1.294 | ||
| Pathological fractures & musculoskelet & conn tiss malig w MCC | 542 | 2 | 1.865 | ||
| Pathological fractures & musculoskelet & conn tiss malig w CC | 543 | 2 | 1.061 | ||
| Connective tissue disorders w MCC | 545 | 3 | 2.527 | ||
| Connective tissue disorders w CC | 546 | 1 | 1.158 | ||
| Connective tissue disorders w/o CC/MCC | 547 | 1 | 0.746 | ||
| Medical back problems w/o MCC | 552 | 5 | 0.964 | ||
| Signs & symptoms of musculoskeletal system & conn tissue w/o MCC | 556 | 1 | 0.817 | ||
| Tendonitis, myositis & bursitis w/o MCC | 558 | 1 | 0.864 | ||
| Aftercare, musculoskeletal system & connective tissue w MCC | 559 | 1 | 1.856 | ||
| Fx, sprn, strn & disl except femur, hip, pelvis & thigh w MCC | 562 | 1 | 1.464 | ||
| Fx, sprn, strn & disl except femur, hip, pelvis & thigh w/o MCC | 563 | 4 | 0.894 | ||
| Other musculoskeletal sys & connective tissue diagnoses w MCC | 564 | 1 | 1.569 | ||
| Other musculoskeletal sys & connective tissue diagnoses w CC | 565 | 2 | 1.020 | ||
| Skin debridement w MCC | 570 | 2 | 3.010 | ||
| Skin debridement w/o CC/MCC | 572 | 1 | 1.142 | ||
| Skin graft for skin ulcer or cellulitis w CC | 574 | 1 | 3.465 | ||
| Skin graft exc for skin ulcer or cellulitis w CC | 577 | 1 | 2.663 | ||
| Other skin, subcut tiss & breast proc w MCC | 579 | 2 | 3.259 | ||
| Other skin, subcut tiss & breast proc w CC | 580 | 6 | 1.773 | ||
| Other skin, subcut tiss & breast proc w/o CC/MCC | 581 | 4 | 1.439 | ||
| Mastectomy for malignancy w/o CC/MCC | 583 | 1 | 1.643 | ||
| Breast biopsy, local excision & other breast procedures w/o CC/MCC | 585 | 1 | 1.985 | ||
| Malignant breast disorders w MCC | 597 | 1 | 1.757 | ||
| Cellulitis w MCC | 602 | 9 | 1.469 | ||
| Cellulitis w/o MCC | 603 | 15 | 0.881 | ||
| Minor skin disorders w MCC | 606 | 1 | 1.610 | ||
| Minor skin disorders w/o MCC | 607 | 2 | 0.864 | ||
| Adrenal & pituitary procedures w CC/MCC | 614 | 4 | 2.279 | ||
| Adrenal & pituitary procedures w/o CC/MCC | 615 | 1 | 1.433 | ||
| Amputat of lower limb for endocrine, nutrit, & metabol dis w MCC | 616 | 2 | 3.865 | ||
| Amputat of lower limb for endocrine, nutrit, & metabol dis w CC | 617 | 8 | 1.932 | ||
| O.R. procedures for obesity w MCC | 619 | 3 | 2.727 | ||
| O.R. procedures for obesity w CC | 620 | 13 | 1.597 | ||
| O.R. procedures for obesity w/o CC/MCC | 621 | 83 | 1.462 | ||
| Skin grafts & wound debrid for endoc, nutrit & metab dis w MCC | 622 | 1 | 3.742 | ||
| Skin grafts & wound debrid for endoc, nutrit & metab dis w CC | 623 | 1 | 1.913 | ||
| Thyroid, parathyroid & thyroglossal procedures w CC | 626 | 2 | 1.509 | ||
| Other endocrine, nutrit & metab O.R. proc w CC | 629 | 1 | 2.249 | ||
| Diabetes w MCC | 637 | 9 | 1.456 | ||
| Diabetes w CC | 638 | 13 | 0.917 | ||
| Diabetes w/o CC/MCC | 639 | 7 | 0.627 | ||
| Misc disorders of nutrition, metabolism, fluids/electrolytes w MCC | 640 | 2 | 1.328 | ||
| Misc disorders of nutrition, metabolism, fluids/electrolytes w/o MCC | 641 | 23 | 0.781 | ||
| Inborn and other disorders of metabolism | 642 | 1 | 1.241 | ||
| Endocrine disorders w MCC | 643 | 3 | 1.657 | ||
| Endocrine disorders w CC | 644 | 2 | 1.033 | ||
| Endocrine disorders w/o CC/MCC | 645 | 1 | 0.779 | ||
| Kidney transplant w hemodialysis w MCC | 650 | 1 | 4.607 | ||
| Major bladder procedures w CC | 654 | 2 | 2.822 | ||
| Kidney & ureter procedures for neoplasm w CC | 657 | 1 | 1.828 | ||
| Kidney & ureter procedures for neoplasm w/o CC/MCC | 658 | 5 | 1.504 | ||
| Kidney & ureter procedures for non-neoplasm w MCC | 659 | 3 | 2.584 | ||
| Kidney & ureter procedures for non-neoplasm w CC | 660 | 16 | 1.340 | ||
| Kidney & ureter procedures for non-neoplasm w/o CC/MCC | 661 | 5 | 1.027 | ||
| Other kidney & urinary tract procedures w MCC | 673 | 2 | 4.190 | ||
| Other kidney & urinary tract procedures w CC | 674 | 2 | 2.308 | ||
| Renal failure w MCC | 682 | 5 | 1.502 | ||
| Renal failure w CC | 683 | 7 | 0.889 | ||
| Kidney & urinary tract neoplasms w CC | 687 | 1 | 1.053 | ||
| Kidney & urinary tract infections w MCC | 689 | 2 | 1.170 | ||
| Kidney & urinary tract infections w/o MCC | 690 | 6 | 0.803 | ||
| Urinary stones w/o MCC | 694 | 3 | 0.781 | ||
| Other kidney & urinary tract diagnoses w MCC | 698 | 6 | 1.681 | ||
| Other kidney & urinary tract diagnoses w CC | 699 | 9 | 1.020 | ||
| Other kidney & urinary tract diagnoses w/o CC/MCC | 700 | 6 | 0.694 | ||
| Major male pelvic procedures w CC/MCC | 707 | 1 | 1.941 | ||
| Major male pelvic procedures w/o CC/MCC | 708 | 3 | 1.483 | ||
| Transurethral prostatectomy w CC/MCC | 713 | 2 | 1.446 | ||
| Other male reproductive system O.R. proc exc malignancy w CC/MCC | 717 | 2 | 1.856 | ||
| Inflammation of the male reproductive system w/o MCC | 728 | 3 | 0.817 | ||
| Uterine & adnexa proc for ovarian or adnexal malignancy w CC | 737 | 1 | 1.998 | ||
| Uterine & adnexa proc for ovarian or adnexal malignancy w/o CC/MCC | 738 | 1 | 1.517 | ||
| Uterine, adnexa proc for non-ovarian/adnexal malig w CC | 740 | 1 | 1.818 | ||
| Uterine, adnexa proc for non-ovarian/adnexal malig w/o CC/MCC | 741 | 1 | 1.374 | ||
| Uterine & adnexa proc for non-malignancy w CC/MCC | 742 | 1 | 1.827 | ||
| Uterine & adnexa proc for non-malignancy w/o CC/MCC | 743 | 17 | 1.199 | ||
| D&C, conization, laparoscopy & tubal interruption w CC/MCC | 744 | 1 | 1.954 | ||
| Other female reproductive system O.R. procedures w CC/MCC | 749 | 2 | 2.589 | ||
| Malignancy, female reproductive system w MCC | 754 | 1 | 1.809 | ||
| Infections, female reproductive system w CC | 758 | 2 | 1.019 | ||
| Infections, female reproductive system w/o CC/MCC | 759 | 1 | 0.640 | ||
| Menstrual & other female reproductive system disorders w/o CC/MCC | 761 | 1 | 0.634 | ||
| Vaginal delivery w O.R. proc except steril &/or D&C | 768 | 15 | 1.096 | ||
| Postpartum & post abortion diagnoses w O.R. procedure | 769 | 4 | 1.390 | ||
| Abortion w D&C, aspiration curettage or hysterotomy | 770 | 2 | 1.076 | ||
| Postpartum & post abortion diagnoses w/o O.R. procedure | 776 | 14 | 0.714 | ||
| Abortion w/o D&C | 779 | 2 | 0.935 | ||
| Cesarean section w sterilization w MCC | 783 | 2 | 1.842 | ||
| Cesarean section w sterilization w CC | 784 | 4 | 1.083 | ||
| Cesarean section w sterilization w/o CC/MCC | 785 | 18 | 0.874 | ||
| Cesarean section w/o sterilization w MCC | 786 | 30 | 1.616 | ||
| Cesarean section w/o sterilization w CC | 787 | 65 | 1.062 | ||
| Cesarean section w/o sterilization w/o CC/MCC | 788 | 151 | 0.905 | ||
| Neonates, died or transferred to another acute care facility | 789 | 13 | 1.803 | ||
| Extreme immaturity or respiratory distress syndrome, neonate | 790 | 27 | 5.945 | ||
| Prematurity w major problems | 791 | 24 | 4.060 | ||
| Prematurity w/o major problems | 792 | 22 | 2.450 | ||
| Full term neonate w major problems | 793 | 51 | 4.171 | ||
| Neonate w other significant problems | 794 | 232 | 1.476 | ||
| Normal newborn | 795 | 272 | 0.200 | ||
| Vaginal delivery w sterilization/D&C w/o CC/MCC | 798 | 4 | 0.968 | ||
| Other O.R. proc of the blood & blood forming organs w CC | 803 | 1 | 1.780 | ||
| Vaginal delivery w/o sterilization/D&C w MCC | 805 | 30 | 0.998 | ||
| Vaginal delivery w/o sterilization/D&C w CC | 806 | 86 | 0.724 | ||
| Vaginal delivery w/o sterilization/D&C w/o CC/MCC | 807 | 325 | 0.637 | ||
| Major hematol/immun diag exc sickle cell crisis & coagul w MCC | 808 | 2 | 2.290 | ||
| Major hematol/immun diag exc sickle cell crisis & coagul w CC | 809 | 10 | 1.239 | ||
| Major hematol/immun diag exc sickle cell crisis & coagul w/o CC/MCC | 810 | 1 | 0.952 | ||
| Red blood cell disorders w MCC | 811 | 2 | 1.407 | ||
| Red blood cell disorders w/o MCC | 812 | 5 | 0.923 | ||
| Coagulation disorders | 813 | 8 | 1.548 | ||
| Reticuloendothelial & immunity disorders w MCC | 814 | 1 | 2.091 | ||
| Reticuloendothelial & immunity disorders w CC | 815 | 2 | 1.016 | ||
| Reticuloendothelial & immunity disorders w/o CC/MCC | 816 | 1 | 0.659 | ||
| Other antepartum diagnoses w O.R. procedure w MCC | 817 | 1 | 2.535 | ||
| Other antepartum diagnoses w O.R. procedure w CC | 818 | 3 | 1.288 | ||
| Other antepartum diagnoses w O.R. procedure w/o CC/MCC | 819 | 6 | 0.817 | ||
| Lymphoma & leukemia w major O.R. procedure w MCC | 820 | 2 | 5.822 | ||
| Lymphoma & leukemia w major O.R. procedure w/o CC/MCC | 822 | 1 | 1.144 | ||
| Lymphoma & non-acute leukemia w other proc w CC | 824 | 2 | 2.199 | ||
| Lymphoma & non-acute leukemia w other proc w/o CC/MCC | 825 | 1 | 1.231 | ||
| Myeloprolif disord or poorly diff neopl w maj O.R. proc w CC | 827 | 3 | 2.360 | ||
| Myeloprolif disord or poorly diff neopl w other procedure w CC/MCC | 829 | 2 | 3.084 | ||
| Other antepartum diagnoses w/o O.R. procedure w MCC | 831 | 9 | 1.151 | ||
| Other antepartum diagnoses w/o O.R. procedure w CC | 832 | 18 | 0.747 | ||
| Other antepartum diagnoses w/o O.R. procedure w/o CC/MCC | 833 | 24 | 0.520 | ||
| Acute leukemia w/o major O.R. procedure w MCC | 834 | 2 | 5.527 | ||
| Acute leukemia w/o major O.R. procedure w CC | 835 | 3 | 2.136 | ||
| Chemo w acute leukemia as sdx or w high dose chemo agent w MCC | 837 | 2 | 5.007 | ||
| Chemo w acute leukemia as sdx w CC or high dose chemo agent | 838 | 4 | 2.028 | ||
| Chemo w acute leukemia as sdx w/o CC/MCC | 839 | 5 | 1.370 | ||
| Lymphoma & non-acute leukemia w MCC | 840 | 3 | 3.189 | ||
| Lymphoma & non-acute leukemia w CC | 841 | 1 | 1.568 | ||
| Other myeloprolif dis or poorly diff neopl diag w MCC | 843 | 1 | 1.893 | ||
| Chemotherapy w/o acute leukemia as secondary diagnosis w MCC | 846 | 3 | 2.554 | ||
| Chemotherapy w/o acute leukemia as secondary diagnosis w CC | 847 | 27 | 1.271 | ||
| Chemotherapy w/o acute leukemia as secondary diagnosis w/o CC/MCC | 848 | 1 | 0.819 | ||
| Infectious & parasitic diseases w O.R. procedure w MCC | 853 | 29 | 5.001 | ||
| Infectious & parasitic diseases w O.R. procedure w CC | 854 | 11 | 1.998 | ||
| Infectious & parasitic diseases w O.R. procedure w/o CC/MCC | 855 | 1 | 1.626 | ||
| Postoperative or post-traumatic infections w O.R. proc w MCC | 856 | 4 | 4.512 | ||
| Postoperative or post-traumatic infections w O.R. proc w CC | 857 | 7 | 2.179 | ||
| Postoperative or post-traumatic infections w O.R. proc w/o CC/MCC | 858 | 1 | 1.288 | ||
| Postoperative & post-traumatic infections w/o MCC | 863 | 2 | 1.000 | ||
| Fever and inflammatory conditions | 864 | 1 | 0.898 | ||
| Viral illness w MCC | 865 | 1 | 1.476 | ||
| Viral illness w/o MCC | 866 | 4 | 0.885 | ||
| Septicemia or severe sepsis w MV >96 hours | 870 | 3 | 6.957 | ||
| Septicemia or severe sepsis w/o MV >96 hours w MCC | 871 | 59 | 1.962 | ||
| Septicemia or severe sepsis w/o MV >96 hours w/o MCC | 872 | 40 | 1.031 | ||
| O.R. procedure w principal diagnoses of mental illness | 876 | 5 | 3.930 | ||
| Acute adjustment reaction & psychosocial dysfunction | 880 | 3 | 0.959 | ||
| Depressive neuroses | 881 | 8 | 0.914 | ||
| Neuroses except depressive | 882 | 2 | 0.962 | ||
| Disorders of personality & impulse control | 883 | 4 | 1.854 | ||
| Psychoses | 885 | 32 | 1.410 | ||
| Alcohol/drug abuse or dependence w/o rehabilitation therapy w MCC | 896 | 9 | 1.781 | ||
| Alcohol/drug abuse or dependence w/o rehabilitation therapy w/o MCC | 897 | 5 | 0.882 | ||
| Wound debridements for injuries w CC | 902 | 1 | 1.898 | ||
| Skin grafts for injuries w/o CC/MCC | 905 | 1 | 1.648 | ||
| Other O.R. procedures for injuries w MCC | 907 | 2 | 3.984 | ||
| Other O.R. procedures for injuries w CC | 908 | 2 | 2.017 | ||
| Other O.R. procedures for injuries w/o CC/MCC | 909 | 4 | 1.268 | ||
| Allergic reactions w MCC | 915 | 1 | 1.738 | ||
| Allergic reactions w/o MCC | 916 | 3 | 0.664 | ||
| Poisoning & toxic effects of drugs w MCC | 917 | 8 | 1.640 | ||
| Poisoning & toxic effects of drugs w/o MCC | 918 | 13 | 0.885 | ||
| Complications of treatment w MCC | 919 | 7 | 1.824 | ||
| Complications of treatment w CC | 920 | 5 | 1.016 | ||
| O.R. proc w diagnoses of other contact w health services w CC | 940 | 4 | 2.111 | ||
| Signs & symptoms w MCC | 947 | 1 | 1.286 | ||
| Signs & symptoms w/o MCC | 948 | 8 | 0.795 | ||
| Aftercare w CC/MCC | 949 | 1 | 1.079 | ||
| Other factors influencing health status | 951 | 1 | 0.567 | ||
| Craniotomy for multiple significant trauma | 955 | 1 | 6.828 | ||
| Other O.R. procedures for multiple significant trauma w MCC | 957 | 1 | 7.464 | ||
| Other O.R. procedures for multiple significant trauma w/o CC/MCC | 959 | 2 | 2.644 | ||
| Other multiple significant trauma w CC | 964 | 1 | 1.500 | ||
| Extensive O.R. procedure unrelated to principal diagnosis w MCC | 981 | 3 | 4.754 | ||
| Extensive O.R. procedure unrelated to principal diagnosis w CC | 982 | 8 | 2.448 | ||
| Extensive O.R. procedure unrelated to principal diagnosis w/o CC/MCC | 983 | 3 | 1.668 | ||
| Non-extensive O.R. proc unrelated to principal diagnosis w MCC | 987 | 4 | 3.503 | ||
| Non-extensive O.R. proc unrelated to principal diagnosis w CC | 988 | 1 | 1.716 | ||
| Non-extensive O.R. proc unrelated to principal diagnosis w/o CC/MCC | 989 | 1 | 1.156 | ||
| Principal diagnosis invalid as discharge diagnosis | 998 | 27 | - 0 |
Not Peer Reviewed
DRG - Coordinated Care nonSB106
Proposers, this tab is a summary of the DRGs and the number of admins in 2024 in PEBB's coordinated care plans at facilities not subject to Senate Bill 1067.
| PEBB 2024 Data | Proposers, please fill out these columns. | ||||
| DRG Description | DRG | Coordinated Care Counts | DRG Weight v42.0 CN | Average Allowed Amount Per Admit | Average Medicare Allowed Amount Per Admit |
| Liver transplant w MCC or intestinal transplant | 5 | 1 | 10.649 | ||
| Lung transplant | 7 | 1 | 13.069 | ||
| Cranio w major dev impl/acute CNS PDX w MCC/chemo impl/epilep w stim | 23 | 2 | 5.705 | ||
| Craniotomy & endovascular intracranial procedures w MCC | 25 | 2 | 4.472 | ||
| Craniotomy & endovascular intracranial procedures w CC | 26 | 1 | 3.059 | ||
| Craniotomy & endovascular intracranial procedures w/o CC/MCC | 27 | 2 | 2.468 | ||
| Spinal procedures w CC or spinal neurostimulators | 29 | 1 | 3.357 | ||
| Spinal procedures w/o CC/MCC | 30 | 1 | 2.225 | ||
| Extracranial procedures w/o CC/MCC | 39 | 1 | 1.138 | ||
| Spinal disorders & injuries w CC/MCC | 52 | 1 | 2.013 | ||
| Degenerative nervous system disorders w MCC | 56 | 4 | 2.504 | ||
| Degenerative nervous system disorders w/o MCC | 57 | 5 | 1.334 | ||
| Ischemic stroke/precereb occl/trans isch w thrombolytic agent w MCC | 61 | 1 | 2.703 | ||
| Intracranial hemorrhage or cerebral infarction w MCC | 64 | 6 | 1.989 | ||
| Intracranial hemorrhage or cerebral infarction w CC or tPA in 24 hrs | 65 | 3 | 1.017 | ||
| Intracranial hemorrhage or cerebral infarction w/o CC/MCC | 66 | 2 | 0.688 | ||
| Concussion w CC | 89 | 1 | 1.072 | ||
| Other disorders of nervous system w MCC | 91 | 2 | 1.823 | ||
| Other disorders of nervous system w CC | 92 | 2 | 1.059 | ||
| Bacterial & tuberculous infections of nervous system w/o CC/MCC | 96 | 1 | 2.397 | ||
| Non-bacterial infect of nervous sys exc viral meningitis w CC | 98 | 1 | 2.169 | ||
| Seizures w/o MCC | 101 | 3 | 0.922 | ||
| Mouth procedures w CC/MCC | 137 | 2 | 1.399 | ||
| Other ear, nose, mouth & throat O.R. procedures w CC | 144 | 1 | 1.757 | ||
| Otitis media & URI w/o MCC | 153 | 1 | 0.712 | ||
| Other ear, nose, mouth & throat diagnoses w CC | 155 | 1 | 0.934 | ||
| Dental & Oral Diseases w MCC | 157 | 1 | 1.638 | ||
| Dental & Oral Diseases w CC | 158 | 3 | 0.941 | ||
| Major chest procedures w MCC | 163 | 2 | 4.609 | ||
| Major chest procedures w/o CC/MCC | 165 | 2 | 1.864 | ||
| Pulmonary embolism w MCC or acute cor pulmonale | 175 | 2 | 1.409 | ||
| Pulmonary embolism w/o MCC | 176 | 4 | 0.815 | ||
| Respiratory infections & inflammations w MCC | 177 | 1 | 1.617 | ||
| Respiratory infections & inflammations w/o CC/MCC | 179 | 1 | 0.770 | ||
| Major chest trauma w CC | 184 | 1 | 1.068 | ||
| Pulmonary edema & respiratory failure | 189 | 3 | 1.237 | ||
| Chronic obstructive pulmonary disease w MCC | 190 | 1 | 1.123 | ||
| Simple pneumonia & pleurisy w MCC | 193 | 8 | 1.318 | ||
| Simple pneumonia & pleurisy w CC | 194 | 2 | 0.820 | ||
| Simple pneumonia & pleurisy w/o CC/MCC | 195 | 1 | 0.623 | ||
| Bronchitis & asthma w CC/MCC | 202 | 3 | 0.967 | ||
| Respiratory signs & symptoms | 204 | 2 | 0.811 | ||
| Other respiratory system diagnoses w/o MCC | 206 | 1 | 0.906 | ||
| Respiratory system diagnosis w ventilator support <=96 hours | 208 | 2 | 2.684 | ||
| Amputation for circ sys disorders exc upper limb & toe w MCC | 239 | 1 | 5.037 | ||
| Perc cardiovasc proc w drug-eluting stent w MCC or 4+ art/stents | 246 | 2 | N/A | ||
| Perc cardiovasc proc w drug-eluting stent w/o MCC | 247 | 3 | N/A | ||
| Other circulatory system O.R. procedures | 264 | 2 | 3.495 | ||
| Other major cardiovascular procedures w MCC | 270 | 2 | 5.133 | ||
| Percutaneous and other intracardiac procedures w/o MCC | 274 | 1 | 3.121 | ||
| Acute myocardial infarction, discharged alive w MCC | 280 | 4 | 1.641 | ||
| Acute myocardial infarction, discharged alive w CC | 281 | 2 | 0.922 | ||
| Acute myocardial infarction, discharged alive w/o CC/MCC | 282 | 5 | 0.725 | ||
| Circulatory disorders except AMI, w card cath w MCC | 286 | 1 | 2.213 | ||
| Circulatory disorders except AMI, w card cath w/o MCC | 287 | 1 | 1.090 | ||
| Heart failure & shock w MCC | 291 | 5 | 1.305 | ||
| Heart failure & shock w CC | 292 | 1 | 0.861 | ||
| Peripheral vascular disorders w CC | 300 | 1 | 1.071 | ||
| Hypertension w/o MCC | 305 | 1 | 0.751 | ||
| Cardiac arrhythmia & conduction disorders w CC | 309 | 1 | 0.739 | ||
| Cardiac arrhythmia & conduction disorders w/o CC/MCC | 310 | 1 | 0.560 | ||
| Syncope & collapse | 312 | 1 | 0.871 | ||
| Other circulatory system diagnoses w MCC | 314 | 1 | 2.154 | ||
| Stomach, esophageal & duodenal proc w MCC | 326 | 1 | 5.079 | ||
| Stomach, esophageal & duodenal proc w CC | 327 | 1 | 2.428 | ||
| Stomach, esophageal & duodenal proc w/o CC/MCC | 328 | 3 | 1.594 | ||
| Major small & large bowel procedures w MCC | 329 | 2 | 4.592 | ||
| Major small & large bowel procedures w CC | 330 | 2 | 2.364 | ||
| Major small & large bowel procedures w/o CC/MCC | 331 | 4 | 1.651 | ||
| Peritoneal adhesiolysis w/o CC/MCC | 337 | 1 | 1.535 | ||
| Appendectomy w complicated principal diag w CC | 339 | 1 | N/A | ||
| Appendectomy w complicated principal diag w/o CC/MCC | 340 | 3 | N/A | ||
| Appendectomy w/o complicated principal diag w CC | 342 | 1 | N/A | ||
| Appendectomy w/o complicated principal diag w/o CC/MCC | 343 | 1 | N/A | ||
| Hernia procedures except inguinal & femoral w/o CC/MCC | 355 | 1 | 1.333 | ||
| Major gastrointestinal disorders & peritoneal infections w MCC | 371 | 1 | 1.748 | ||
| Major gastrointestinal disorders & peritoneal infections w CC | 372 | 2 | 1.029 | ||
| Major gastrointestinal disorders & peritoneal infections w/o CC/MCC | 373 | 1 | 0.725 | ||
| Digestive malignancy w CC | 375 | 1 | 1.229 | ||
| G.I. hemorrhage w CC | 378 | 2 | 0.986 | ||
| Inflammatory bowel disease w CC | 386 | 1 | 0.993 | ||
| G.I. obstruction w CC | 389 | 4 | 0.802 | ||
| G.I. obstruction w/o CC/MCC | 390 | 5 | 0.547 | ||
| Esophagitis, gastroent & misc digest disorders w MCC | 391 | 2 | 1.285 | ||
| Esophagitis, gastroent & misc digest disorders w/o MCC | 392 | 6 | 0.780 | ||
| Laparoscopic cholecystectomy w/o c.d.e. w MCC | 417 | 3 | 2.377 | ||
| Laparoscopic cholecystectomy w/o c.d.e. w CC | 418 | 2 | 1.658 | ||
| Laparoscopic cholecystectomy w/o c.d.e. w/o CC/MCC | 419 | 2 | 1.318 | ||
| Disorders of pancreas except malignancy w MCC | 438 | 2 | 1.664 | ||
| Disorders of pancreas except malignancy w CC | 439 | 6 | 0.860 | ||
| Disorders of pancreas except malignancy w/o CC/MCC | 440 | 2 | 0.615 | ||
| Disorders of liver except malig, cirr, alc hepa w MCC | 441 | 1 | 1.890 | ||
| Disorders of the biliary tract w MCC | 444 | 1 | 1.684 | ||
| Disorders of the biliary tract w CC | 445 | 2 | 1.085 | ||
| Disorders of the biliary tract w/o CC/MCC | 446 | 2 | 0.797 | ||
| Spinal fus exc cerv w spinal curv/malig/infec or ext fus w CC | 457 | 1 | 5.739 | ||
| Spinal fus exc cerv w spinal curv/malig/infec or ext fus w/o CC/MCC | 458 | 1 | 4.318 | ||
| Spinal fusion except cervical w/o MCC | 460 | 3 | N/A | ||
| Wnd debrid & skn grft exc hand, for musculo-conn tiss dis w CC | 464 | 1 | 2.949 | ||
| Wnd debrid & skn grft exc hand, for musculo-conn tiss dis w/o CC/MCC | 465 | 1 | 1.736 | ||
| Major hip & knee replacement or reattach lower extremity w/o MCC | 470 | 2 | 1.886 | ||
| Cervical spinal fusion w/o CC/MCC | 473 | 2 | 2.367 | ||
| Amputation for musculoskeletal sys & conn tissue dis w/o CC/MCC | 476 | 1 | 1.163 | ||
| Hip & femur procedures except major joint w CC | 481 | 1 | 2.075 | ||
| Local excision & removal int fix devices exc hip & femur w MCC | 495 | 1 | 3.521 | ||
| Local excision & removal int fix devices exc hip & femur w CC | 496 | 1 | 1.973 | ||
| Soft tissue procedures w/o CC/MCC | 502 | 1 | 1.397 | ||
| Foot procedures w CC | 504 | 1 | 1.755 | ||
| Other musculoskelet sys & conn tiss O.R. proc w CC | 516 | 1 | 2.012 | ||
| Back & neck proc exc spinal fusion w/o CC/MCC | 520 | 1 | 1.433 | ||
| Hip replacement w principal diagnosis of hip fracture w/o MCC | 522 | 2 | 2.108 | ||
| Medical back problems w/o MCC | 552 | 1 | 0.964 | ||
| Aftercare, musculoskeletal system & connective tissue w/o CC/MCC | 561 | 1 | 0.818 | ||
| Skin debridement w CC | 571 | 1 | 1.674 | ||
| Other skin, subcut tiss & breast proc w/o CC/MCC | 581 | 2 | 1.439 | ||
| Mastectomy for malignancy w/o CC/MCC | 583 | 1 | 1.643 | ||
| Cellulitis w/o MCC | 603 | 2 | 0.881 | ||
| Amputat of lower limb for endocrine, nutrit, & metabol dis w CC | 617 | 2 | 1.932 | ||
| O.R. procedures for obesity w/o CC/MCC | 621 | 10 | 1.462 | ||
| Diabetes w MCC | 637 | 3 | 1.456 | ||
| Diabetes w CC | 638 | 4 | 0.917 | ||
| Diabetes w/o CC/MCC | 639 | 2 | 0.627 | ||
| Misc disorders of nutrition, metabolism, fluids/electrolytes w MCC | 640 | 2 | 1.328 | ||
| Misc disorders of nutrition, metabolism, fluids/electrolytes w/o MCC | 641 | 3 | 0.781 | ||
| Inborn and other disorders of metabolism | 642 | 1 | 1.241 | ||
| Endocrine disorders w/o CC/MCC | 645 | 1 | 0.779 | ||
| Kidney transplant | 652 | 1 | 3.071 | ||
| Kidney & ureter procedures for non-neoplasm w CC | 660 | 3 | 1.340 | ||
| Renal failure w MCC | 682 | 1 | 1.502 | ||
| Renal failure w CC | 683 | 2 | 0.889 | ||
| Renal failure w/o CC/MCC | 684 | 3 | 0.607 | ||
| Kidney & urinary tract infections w/o MCC | 690 | 1 | 0.803 | ||
| Other kidney & urinary tract diagnoses w MCC | 698 | 2 | 1.681 | ||
| Inflammation of the male reproductive system w/o MCC | 728 | 1 | 0.817 | ||
| Uterine & adnexa proc for non-malignancy w CC/MCC | 742 | 1 | 1.827 | ||
| Uterine & adnexa proc for non-malignancy w/o CC/MCC | 743 | 3 | 1.199 | ||
| Infections, female reproductive system w CC | 758 | 1 | 1.019 | ||
| Menstrual & other female reproductive system disorders w CC/MCC | 760 | 1 | 0.986 | ||
| Vaginal delivery w O.R. proc except steril &/or D&C | 768 | 3 | 1.096 | ||
| Postpartum & post abortion diagnoses w/o O.R. procedure | 776 | 5 | 0.714 | ||
| Abortion w/o D&C | 779 | 1 | 0.935 | ||
| Cesarean section w sterilization w CC | 784 | 1 | 1.083 | ||
| Cesarean section w sterilization w/o CC/MCC | 785 | 2 | 0.874 | ||
| Cesarean section w/o sterilization w MCC | 786 | 7 | 1.616 | ||
| Cesarean section w/o sterilization w CC | 787 | 9 | 1.062 | ||
| Cesarean section w/o sterilization w/o CC/MCC | 788 | 27 | 0.905 | ||
| Neonates, died or transferred to another acute care facility | 789 | 4 | 1.803 | ||
| Extreme immaturity or respiratory distress syndrome, neonate | 790 | 5 | 5.945 | ||
| Prematurity w/o major problems | 792 | 5 | 2.450 | ||
| Full term neonate w major problems | 793 | 6 | 4.171 | ||
| Neonate w other significant problems | 794 | 39 | 1.476 | ||
| Normal newborn | 795 | 91 | 0.200 | ||
| Vaginal delivery w/o sterilization/D&C w MCC | 805 | 4 | 0.998 | ||
| Vaginal delivery w/o sterilization/D&C w CC | 806 | 26 | 0.724 | ||
| Vaginal delivery w/o sterilization/D&C w/o CC/MCC | 807 | 90 | 0.637 | ||
| Major hematol/immun diag exc sickle cell crisis & coagul w MCC | 808 | 1 | 2.290 | ||
| Reticuloendothelial & immunity disorders w MCC | 814 | 1 | 2.091 | ||
| Reticuloendothelial & immunity disorders w CC | 815 | 1 | 1.016 | ||
| Reticuloendothelial & immunity disorders w/o CC/MCC | 816 | 1 | 0.659 | ||
| Other antepartum diagnoses w O.R. procedure w MCC | 817 | 2 | 2.535 | ||
| Other antepartum diagnoses w O.R. procedure w CC | 818 | 3 | 1.288 | ||
| Other antepartum diagnoses w O.R. procedure w/o CC/MCC | 819 | 6 | 0.817 | ||
| Other antepartum diagnoses w/o O.R. procedure w MCC | 831 | 2 | 1.151 | ||
| Other antepartum diagnoses w/o O.R. procedure w CC | 832 | 2 | 0.747 | ||
| Other antepartum diagnoses w/o O.R. procedure w/o CC/MCC | 833 | 15 | 0.520 | ||
| Acute leukemia w/o major O.R. procedure w MCC | 834 | 1 | 5.527 | ||
| Infectious & parasitic diseases w O.R. procedure w MCC | 853 | 1 | 5.001 | ||
| Infectious & parasitic diseases w O.R. procedure w CC | 854 | 1 | 1.998 | ||
| Postoperative & post-traumatic infections w/o MCC | 863 | 1 | 1.000 | ||
| Other infectious & parasitic diseases diagnoses w/o CC/MCC | 869 | 1 | 0.720 | ||
| Septicemia or severe sepsis w/o MV >96 hours w MCC | 871 | 14 | 1.962 | ||
| Septicemia or severe sepsis w/o MV >96 hours w/o MCC | 872 | 10 | 1.031 | ||
| O.R. procedure w principal diagnoses of mental illness | 876 | 14 | 3.930 | ||
| Acute adjustment reaction & psychosocial dysfunction | 880 | 9 | 0.959 | ||
| Depressive neuroses | 881 | 13 | 0.914 | ||
| Neuroses except depressive | 882 | 18 | 0.962 | ||
| Disorders of personality & impulse control | 883 | 4 | 1.854 | ||
| Organic disturbances & intellectual disability | 884 | 1 | 1.670 | ||
| Psychoses | 885 | 91 | 1.410 | ||
| Behavioral & developmental disorders | 886 | 3 | 1.797 | ||
| Other mental disorder diagnoses | 887 | 3 | 1.189 | ||
| Alcohol/drug abuse or dependence, left ama | 894 | 5 | 0.624 | ||
| Alcohol/drug abuse or dependence w rehabilitation therapy | 895 | 1 | 1.448 | ||
| Alcohol/drug abuse or dependence w/o rehabilitation therapy w/o MCC | 897 | 148 | 0.882 | ||
| Other O.R. procedures for injuries w MCC | 907 | 2 | 3.984 | ||
| Other O.R. procedures for injuries w CC | 908 | 1 | 2.017 | ||
| Other O.R. procedures for injuries w/o CC/MCC | 909 | 1 | 1.268 | ||
| Traumatic injury w/o MCC | 914 | 1 | 0.916 | ||
| Allergic reactions w/o MCC | 916 | 2 | 0.664 | ||
| Poisoning & toxic effects of drugs w/o MCC | 918 | 2 | 0.885 | ||
| Complications of treatment w/o CC/MCC | 921 | 1 | 0.688 | ||
| Other injury, poisoning & toxic effect diag w/o MCC | 923 | 1 | 1.020 | ||
| O.R. proc w diagnoses of other contact w health services w/o CC/MCC | 941 | 2 | 1.954 | ||
| Rehabilitation w CC/MCC | 945 | 2 | 1.527 | ||
| Signs & symptoms w MCC | 947 | 1 | 1.286 | ||
| Signs & symptoms w/o MCC | 948 | 4 | 0.795 | ||
| Aftercare w CC/MCC | 949 | 1 | 1.079 | ||
| Other O.R. procedures for multiple significant trauma w/o CC/MCC | 959 | 1 | 2.644 | ||
| Other multiple significant trauma w CC | 964 | 1 | 1.500 | ||
| Extensive O.R. procedure unrelated to principal diagnosis w MCC | 981 | 4 | 4.754 | ||
| Extensive O.R. procedure unrelated to principal diagnosis w CC | 982 | 5 | 2.448 | ||
| Extensive O.R. procedure unrelated to principal diagnosis w/o CC/MCC | 983 | 17 | 1.668 | ||
| Non-extensive O.R. proc unrelated to principal diagnosis w CC | 988 | 4 | 1.716 | ||
| Non-extensive O.R. proc unrelated to principal diagnosis w/o CC/MCC | 989 | 9 | 1.156 | ||
| Principal diagnosis invalid as discharge diagnosis | 998 | 10 | 0.000 |
Not Peer Reviewed
DRG - Statewide SB1067
Proposers, this tab is a summary of the DRGs and the number of admins in 2024 in PEBB's statewide plans at facilities subject to Senate Bill 1067.
| PEBB 2024 Data | Proposers, please fill out these columns. | ||||
| DRG Description | DRG | Statewide Counts | DRG Weight v42.0 CN | Average Allowed Amount Per Admit | Average Medicare Allowed Amount Per Admit |
| Heart transplant or implant of heart assist system w MCC | 1 | 1 | 28.168 | ||
| ECMO or trach w MV >96 hrs or PDX exc face, mouth & neck w maj O.R. | 3 | 1 | 21.432 | ||
| Liver transplant w MCC or intestinal transplant | 5 | 1 | 10.649 | ||
| Tracheostomy for face, mouth & neck dx or laryngectomy w/o CC/MCC | 13 | 1 | 2.650 | ||
| Allogeneic bone marrow transplant | 14 | 1 | 13.102 | ||
| Autologous bone marrow transplant w CC/MCC | 16 | 2 | 6.036 | ||
| Intracranial vascular procedures w PDX hemorrhage w MCC | 20 | 3 | 8.061 | ||
| Cranio w major dev impl/acute CNS PDX w MCC/chemo impl/epilep w stim | 23 | 3 | 5.705 | ||
| Cranio w major dev impl/acute complex CNS PDX w/o MCC | 24 | 2 | 3.802 | ||
| Craniotomy & endovascular intracranial procedures w MCC | 25 | 5 | 4.472 | ||
| Craniotomy & endovascular intracranial procedures w CC | 26 | 4 | 3.059 | ||
| Craniotomy & endovascular intracranial procedures w/o CC/MCC | 27 | 10 | 2.468 | ||
| Spinal procedures w MCC | 28 | 1 | 6.080 | ||
| Spinal procedures w CC or spinal neurostimulators | 29 | 3 | 3.357 | ||
| Carotid artery stent procedure w/o CC/MCC | 36 | 1 | 1.833 | ||
| Periph/cranial nerve & other nerv syst proc w MCC | 40 | 1 | 3.772 | ||
| Nervous system neoplasms w MCC | 54 | 3 | 1.499 | ||
| Degenerative nervous system disorders w MCC | 56 | 4 | 2.504 | ||
| Degenerative nervous system disorders w/o MCC | 57 | 4 | 1.334 | ||
| Multiple sclerosis & cerebellar ataxia w CC | 59 | 1 | 1.224 | ||
| Ischemic stroke/precereb occl/trans isch w thrombolytic w/o CC/MCC | 63 | 1 | 1.405 | ||
| Intracranial hemorrhage or cerebral infarction w MCC | 64 | 5 | 1.989 | ||
| Intracranial hemorrhage or cerebral infarction w CC or tPA in 24 hrs | 65 | 5 | 1.017 | ||
| Cranial & peripheral nerve disorders w MCC | 73 | 1 | 1.546 | ||
| Cranial & peripheral nerve disorders w/o MCC | 74 | 1 | 1.042 | ||
| Hypertensive encephalopathy w CC | 78 | 1 | 0.998 | ||
| Traumatic stupor & coma, coma >1 hr w CC | 83 | 1 | 1.390 | ||
| Traumatic stupor & coma, coma >1 hr w/o CC/MCC | 84 | 1 | 0.956 | ||
| Traumatic stupor & coma, coma <1 hr w/o CC/MCC | 87 | 1 | 0.884 | ||
| Other disorders of nervous system w CC | 92 | 1 | 1.059 | ||
| Other disorders of nervous system w/o CC/MCC | 93 | 1 | 0.789 | ||
| Non-bacterial infect of nervous sys exc viral meningitis w CC | 98 | 1 | 2.169 | ||
| Non-bacterial infect of nervous sys exc viral meningitis w/o CC/MCC | 99 | 1 | 1.393 | ||
| Seizures w/o MCC | 101 | 6 | 0.922 | ||
| Headaches w MCC | 102 | 2 | 1.160 | ||
| Headaches w/o MCC | 103 | 2 | 0.850 | ||
| Mouth procedures w CC/MCC | 137 | 1 | 1.399 | ||
| Mouth procedures w/o CC/MCC | 138 | 1 | 0.814 | ||
| Major head & neck procedures w MCC | 140 | 1 | 4.229 | ||
| Major head & neck procedures w/o CC/MCC | 142 | 2 | 1.572 | ||
| Other ear, nose, mouth & throat O.R. procedures w/o CC/MCC | 145 | 1 | 1.185 | ||
| Ear, nose, mouth & throat malignancy w MCC | 146 | 1 | 2.294 | ||
| Otitis media & URI w MCC | 152 | 2 | 1.135 | ||
| Otitis media & URI w/o MCC | 153 | 1 | 0.712 | ||
| Other ear, nose, mouth & throat diagnoses w MCC | 154 | 1 | 1.626 | ||
| Other ear, nose, mouth & throat diagnoses w CC | 155 | 1 | 0.934 | ||
| Major chest procedures w MCC | 163 | 2 | 4.609 | ||
| Major chest procedures w CC | 164 | 4 | 2.517 | ||
| Major chest procedures w/o CC/MCC | 165 | 3 | 1.864 | ||
| Other resp system O.R. procedures w CC | 167 | 1 | 1.827 | ||
| Pulmonary embolism w MCC or acute cor pulmonale | 175 | 6 | 1.409 | ||
| Pulmonary embolism w/o MCC | 176 | 1 | 0.815 | ||
| Respiratory infections & inflammations w MCC | 177 | 9 | 1.617 | ||
| Respiratory infections & inflammations w CC | 178 | 1 | 0.992 | ||
| Respiratory infections & inflammations w/o CC/MCC | 179 | 3 | 0.770 | ||
| Major chest trauma w MCC | 183 | 1 | 1.587 | ||
| Major chest trauma w CC | 184 | 1 | 1.068 | ||
| Pulmonary edema & respiratory failure | 189 | 5 | 1.237 | ||
| Chronic obstructive pulmonary disease w MCC | 190 | 1 | 1.123 | ||
| Chronic obstructive pulmonary disease w CC | 191 | 1 | 0.859 | ||
| Simple pneumonia & pleurisy w MCC | 193 | 2 | 1.318 | ||
| Simple pneumonia & pleurisy w CC | 194 | 3 | 0.820 | ||
| Simple pneumonia & pleurisy w/o CC/MCC | 195 | 4 | 0.623 | ||
| Pneumothorax w CC | 200 | 2 | 1.108 | ||
| Bronchitis & asthma w CC/MCC | 202 | 4 | 0.967 | ||
| Respiratory signs & symptoms | 204 | 1 | 0.811 | ||
| Respiratory system diagnosis w ventilator support >96 hours | 207 | 3 | 6.467 | ||
| Respiratory system diagnosis w ventilator support <=96 hours | 208 | 2 | 2.684 | ||
| Cardiac valve & oth maj cardiothoracic proc w card cath w CC | 217 | 1 | 6.458 | ||
| Cardiac valve & oth maj cardiothoracic proc w/o card cath w MCC | 219 | 3 | 7.738 | ||
| Cardiac valve & oth maj cardiothoracic proc w/o card cath w CC | 220 | 3 | 5.297 | ||
| Cardiac valve & oth maj cardiothoracic proc w/o card cath w/o CC/MCC | 221 | 2 | 4.593 | ||
| Cardiac defib implant w cardiac cath w/o AMI/HF/shock w MCC | 224 | 1 | N/A | ||
| Other cardiothoracic procedures w MCC | 228 | 3 | 4.983 | ||
| Other cardiothoracic procedures w/o MCC | 229 | 1 | 3.106 | ||
| Coronary bypass w PTCA w/o MCC | 232 | 1 | 6.109 | ||
| Coronary bypass w cardiac cath w/o MCC | 234 | 1 | 5.320 | ||
| Coronary bypass w/o cardiac cath w MCC | 235 | 2 | 5.884 | ||
| Permanent cardiac pacemaker implant w/o CC/MCC | 244 | 1 | 1.805 | ||
| Perc cardiovasc proc w drug-eluting stent w MCC or 4+ art/stents | 246 | 6 | N/A | ||
| Perc cardiovasc proc w drug-eluting stent w/o MCC | 247 | 8 | N/A | ||
| Perc cardiovasc proc w non-drug-eluting stent w/o MCC | 249 | 1 | N/A | ||
| Other vascular procedures w CC | 253 | 1 | 2.553 | ||
| Other vascular procedures w/o CC/MCC | 254 | 2 | 1.749 | ||
| Other circulatory system O.R. procedures | 264 | 1 | 3.495 | ||
| Endovascular cardiac valve replacement & supplement procedures w MCC | 266 | 1 | 5.991 | ||
| Endovascular cardiac valve replacement & supplement procedures s MCC | 267 | 4 | 4.705 | ||
| Other major cardiovascular procedures w MCC | 270 | 2 | 5.133 | ||
| Other major cardiovascular procedures w/o CC/MCC | 272 | 1 | 2.502 | ||
| Percutaneous and other intracardiac procedures w MCC | 273 | 2 | 3.910 | ||
| Percutaneous and other intracardiac procedures w/o MCC | 274 | 3 | 3.121 | ||
| Acute myocardial infarction, discharged alive w MCC | 280 | 6 | 1.641 | ||
| Acute myocardial infarction, discharged alive w CC | 281 | 6 | 0.922 | ||
| Acute myocardial infarction, discharged alive w/o CC/MCC | 282 | 3 | 0.725 | ||
| Circulatory disorders except AMI, w card cath w MCC | 286 | 1 | 2.213 | ||
| Circulatory disorders except AMI, w card cath w/o MCC | 287 | 3 | 1.090 | ||
| Heart failure & shock w MCC | 291 | 6 | 1.305 | ||
| Heart failure & shock w CC | 292 | 3 | 0.861 | ||
| Heart failure & shock w/o CC/MCC | 293 | 1 | 0.549 | ||
| Peripheral vascular disorders w MCC | 299 | 2 | 1.618 | ||
| Peripheral vascular disorders w CC | 300 | 2 | 1.071 | ||
| Atherosclerosis w/o MCC | 303 | 1 | 0.672 | ||
| Hypertension w/o MCC | 305 | 2 | 0.751 | ||
| Cardiac arrhythmia & conduction disorders w CC | 309 | 2 | 0.739 | ||
| Cardiac arrhythmia & conduction disorders w/o CC/MCC | 310 | 3 | 0.560 | ||
| Syncope & collapse | 312 | 1 | 0.871 | ||
| Chest pain | 313 | 1 | 0.713 | ||
| Other circulatory system diagnoses w CC | 315 | 2 | 0.962 | ||
| Other circulatory system diagnoses w/o CC/MCC | 316 | 1 | 0.683 | ||
| Stomach, esophageal & duodenal proc w MCC | 326 | 1 | 5.079 | ||
| Stomach, esophageal & duodenal proc w CC | 327 | 6 | 2.428 | ||
| Stomach, esophageal & duodenal proc w/o CC/MCC | 328 | 5 | 1.594 | ||
| Major small & large bowel procedures w MCC | 329 | 4 | 4.592 | ||
| Major small & large bowel procedures w CC | 330 | 8 | 2.364 | ||
| Major small & large bowel procedures w/o CC/MCC | 331 | 10 | 1.651 | ||
| Peritoneal adhesiolysis w CC | 336 | 1 | 2.112 | ||
| Peritoneal adhesiolysis w/o CC/MCC | 337 | 1 | 1.535 | ||
| Appendectomy w complicated principal diag w/o CC/MCC | 340 | 1 | N/A | ||
| Appendectomy w/o complicated principal diag w/o CC/MCC | 343 | 2 | N/A | ||
| Minor small & large bowel procedures w/o CC/MCC | 346 | 1 | 1.245 | ||
| Inguinal & femoral hernia procedures w CC | 351 | 1 | 1.505 | ||
| Hernia procedures except inguinal & femoral w MCC | 353 | 1 | 2.933 | ||
| Hernia procedures except inguinal & femoral w CC | 354 | 1 | 1.701 | ||
| Hernia procedures except inguinal & femoral w/o CC/MCC | 355 | 1 | 1.333 | ||
| Other digestive system O.R. procedures w MCC | 356 | 3 | 4.266 | ||
| Other digestive system O.R. procedures w CC | 357 | 3 | 2.252 | ||
| Major gastrointestinal disorders & peritoneal infections w CC | 372 | 1 | 1.029 | ||
| Digestive malignancy w MCC | 374 | 2 | 2.111 | ||
| Digestive malignancy w CC | 375 | 2 | 1.229 | ||
| G.I. hemorrhage w MCC | 377 | 5 | 1.818 | ||
| G.I. hemorrhage w CC | 378 | 5 | 0.986 | ||
| Complicated peptic ulcer w MCC | 380 | 2 | 1.924 | ||
| Complicated peptic ulcer w CC | 381 | 3 | 1.089 | ||
| Complicated peptic ulcer w/o CC/MCC | 382 | 2 | 0.749 | ||
| Inflammatory bowel disease w CC | 386 | 3 | 0.993 | ||
| Inflammatory bowel disease w/o CC/MCC | 387 | 1 | 0.670 | ||
| G.I. obstruction w MCC | 388 | 1 | 1.470 | ||
| G.I. obstruction w CC | 389 | 8 | 0.802 | ||
| G.I. obstruction w/o CC/MCC | 390 | 5 | 0.547 | ||
| Esophagitis, gastroent & misc digest disorders w MCC | 391 | 8 | 1.285 | ||
| Esophagitis, gastroent & misc digest disorders w/o MCC | 392 | 7 | 0.780 | ||
| Other digestive system diagnoses w MCC | 393 | 1 | 1.656 | ||
| Other digestive system diagnoses w CC | 394 | 2 | 0.941 | ||
| Other digestive system diagnoses w/o CC/MCC | 395 | 1 | 0.636 | ||
| Pancreas, liver & shunt procedures w/o CC/MCC | 407 | 2 | 2.136 | ||
| Laparoscopic cholecystectomy w/o c.d.e. w MCC | 417 | 3 | 2.377 | ||
| Laparoscopic cholecystectomy w/o c.d.e. w CC | 418 | 5 | 1.658 | ||
| Laparoscopic cholecystectomy w/o c.d.e. w/o CC/MCC | 419 | 2 | 1.318 | ||
| Hepatobiliary diagnostic procedures w MCC | 420 | 1 | 3.530 | ||
| Hepatobiliary diagnostic procedures w/o CC/MCC | 422 | 1 | 1.469 | ||
| Other hepatobiliary or pancreas O.R. procedures w MCC | 423 | 2 | 4.067 | ||
| Cirrhosis & alcoholic hepatitis w MCC | 432 | 2 | 1.959 | ||
| Cirrhosis & alcoholic hepatitis w CC | 433 | 2 | 1.070 | ||
| Malignancy of hepatobiliary system or pancreas w MCC | 435 | 3 | 1.825 | ||
| Disorders of pancreas except malignancy w MCC | 438 | 4 | 1.664 | ||
| Disorders of pancreas except malignancy w CC | 439 | 5 | 0.860 | ||
| Disorders of pancreas except malignancy w/o CC/MCC | 440 | 4 | 0.615 | ||
| Disorders of liver except malig, cirr, alc hepa w MCC | 441 | 7 | 1.890 | ||
| Disorders of liver except malig, cirr, alc hepa w CC | 442 | 9 | 0.966 | ||
| Disorders of liver except malig, cirr, alc hepa w/o CC/MCC | 443 | 1 | 0.703 | ||
| Disorders of the biliary tract w CC | 445 | 1 | 1.085 | ||
| Disorders of the biliary tract w/o CC/MCC | 446 | 1 | 0.797 | ||
| Combined anterior/posterior spinal fusion w CC | 454 | 1 | N/A | ||
| Combined anterior/posterior spinal fusion w/o CC/MCC | 455 | 5 | N/A | ||
| Spinal fus exc cerv w spinal curv/malig/infec or ext fus w MCC | 456 | 1 | 8.469 | ||
| Spinal fus exc cerv w spinal curv/malig/infec or ext fus w/o CC/MCC | 458 | 2 | 4.318 | ||
| Spinal fusion except cervical w MCC | 459 | 2 | N/A | ||
| Spinal fusion except cervical w/o MCC | 460 | 6 | N/A | ||
| Bilateral or multiple major joint procs of lower extremity w/o MCC | 462 | 3 | 2.864 | ||
| Wnd debrid & skn grft exc hand, for musculo-conn tiss dis w CC | 464 | 1 | 2.949 | ||
| Revision of hip or knee replacement w/o CC/MCC | 468 | 9 | 2.623 | ||
| Cervical spinal fusion w CC | 472 | 1 | 2.897 | ||
| Cervical spinal fusion w/o CC/MCC | 473 | 2 | 2.367 | ||
| Hip & femur procedures except major joint w CC | 481 | 2 | 2.075 | ||
| Hip & femur procedures except major joint w/o CC/MCC | 482 | 1 | 1.586 | ||
| Knee procedures w pdx of infection w/o CC/MCC | 487 | 2 | 1.580 | ||
| Knee procedures w/o pdx of infection w/o CC/MCC | 489 | 2 | 1.238 | ||
| Lower extrem & humer proc except hip, foot, femur w MCC | 492 | 2 | 3.551 | ||
| Lower extrem & humer proc except hip, foot, femur w CC | 493 | 2 | 2.401 | ||
| Lower extrem & humer proc except hip, foot, femur w/o CC/MCC | 494 | 5 | 1.885 | ||
| Local excision & removal int fix devices exc hip & femur w/o CC/MCC | 497 | 1 | 1.343 | ||
| Local excision & removal int fix devices of hip & femur w/o CC/MCC | 499 | 1 | 1.161 | ||
| Soft tissue procedures w CC | 501 | 1 | 1.785 | ||
| Other musculoskelet sys & conn tiss O.R. proc w MCC | 515 | 1 | 3.092 | ||
| Other musculoskelet sys & conn tiss O.R. proc w CC | 516 | 1 | 2.012 | ||
| Other musculoskelet sys & conn tiss O.R. proc w/o CC/MCC | 517 | 2 | 1.493 | ||
| Back & neck proc exc spinal fusion w/o CC/MCC | 520 | 1 | 1.433 | ||
| Hip replacement w principal diagnosis of hip fracture w/o MCC | 522 | 1 | 2.108 | ||
| Fractures of hip & pelvis w MCC | 535 | 1 | 1.330 | ||
| Fractures of hip & pelvis w/o MCC | 536 | 1 | 0.811 | ||
| Medical back problems w/o MCC | 552 | 1 | 0.964 | ||
| Bone diseases & arthropathies w/o MCC | 554 | 1 | 0.835 | ||
| Signs & symptoms of musculoskeletal system & conn tissue w/o MCC | 556 | 2 | 0.817 | ||
| Tendonitis, myositis & bursitis w/o MCC | 558 | 1 | 0.864 | ||
| Aftercare, musculoskeletal system & connective tissue w MCC | 559 | 1 | 1.856 | ||
| Fx, sprn, strn & disl except femur, hip, pelvis & thigh w/o MCC | 563 | 2 | 0.894 |
This is the start of the file's text. The full file is on GovTribe.
File details come from the government source that posted it. Updated .