Maryland Department of Health and Mental Hygiene 30-06.pdf · PT 30-06 STATE DHMH OF MARYLAND Maryland Department of Health and Mental Hygiene 201 w. Preston Street. ... 122 CIRCULATORY

PT 30-06STATE OF MARYLAND

DHMHMaryland Department of Health and Mental Hygiene201 w. Preston Street. Baltimore, Maryland 21201Robert L. Ehrlich, Jr., Governor -Michael S. Steele, Lt. Governor -S. Anthony McCann, Secretary

MARYLAND MEDICAL ASSISTANCE PROGRAMHospital Transmittal #193

June 14, 2006

TO: Hospital Providers ()'\ ~ 'j!'JJ!"{\":1

FROM: Paul Gurny, Deputy secret~~'Health Care Financing .(~

Brian Hepburn, MD, Director ~ tJfbt~~Mental Hygiene Administration

RE: Fee-for-Service Hospital Day Limits

The purpose of this transmittal is to inform you of changes in the hospital day limits. Foradmissions on or after Julyl, 2006, the day limits will be adjusted from 105% of theaverage length of stay to 120% of the average length of stay by diagnosis related groups.See Attachment A for the new day limits.

The Health Services Cost Review Commission assisted the Department in establishingthe new day limits, which are based on the Centers for Medicare and Medicaid DRGGrouper Version 23. Thee Department has submitted proposed regulations that reflect thenew day limits (COMAR 10.09.06.04 ) to the Administrative, Executive and LegislativeReview Committee. The new regulations establish an effective date of July1, 2006.

The procedure of how day limits will be processed by Medical Assistance will notchange. The only change is that the day limits will be higher for some diagnosis relatedgroups.

Any questions regarding this transmittal for non-psychiatric acute care services should bedirected to Stephanie Oliver, Division Chief, at 410767 -1722. For psychiatric services,please direct questions to Susan Steinberg, Mental Hygiene Administration,410-767-8451.

If you have specific questions for Delmarva Foundation for Medical Care, please call PegBarnaba at 410-712-7405 (email: barmabapdfmc.org). If you have questions for MAPS,please call Nancy Calvert at 410-277-0513.

Attachment

Toll Free 1-877 -4MD-DHMH .TTY for Disabled -Maryland Relay Service 1-800-735-2258Web Site: www.dhmh.state.rnd.us

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ATTACHMENT A DAY LIMITS BY DIAGNOSIS RELATED GROUP(based on 120% of the average length of stay)

DIAGNOSISRELATEDGROUP DIAGNOSIS RELATED GROUP DESCRIPTIONS DAY LIMIT

1 ~~~I_<?~9_~X_~~~-~-~?_~-~-~ -13

? ~~~I_<?~9_~X_~~~~-~?- ~~9- f~ 66 CARPAL TUNNEL RELEASE 27 PERI PH & CRANIAL NERVE & OTHER NERV SYST PROC W CC 1-1

8 PERI PH & CRANIAL NERVE & OTHER NERV SYST PROC WIO CC 4

9 SPINAL DISORDERS & INJURIES 8

10 NERVOUS SYSTEM NEOPLASMS W CC 7

~ 1 ~~_f3~9_~~_~'!_~T_~~ -~~9-,=,~-~~-~_-? -~~9- f~ 512 DEGENERATIVE NERVOUS SYSTEM DISORDERS 8

~~ ~~~TJ~~~_~~-~~_f3~~l~_~_~~~~~-~~-~_f3_~~~I.A: 6

~1 7~? ~ 4~? ~9-~-~~_~~lfl_~_~_~~~_~~_9~r:._-?~~-~~_f3_'?l~_9_f3~~_f3~_'!!_f~ 1-6

~? ~9-~-~~_~~lfl_~_~_~~~_~~_9~r:._~~~-~_f3 -'?l~_9_f3~~_f3~_'!!!~ -c:;-~ 4

~ ~ ~~~I.A:~- ~- ~~_f3~,=,~~-~~-~-~~Y~_£?~~-9~I?_~~~-~ -~c:; ~ ~ ~ -~ ~~~-- ~~-- 5

~~ ~~~I.A:~- ~- ~~_f3~,=,~~-~~-~-~~Y~_£?!~-9~I?_~~~- ~!~-~~ 320 NERVOUS SYSTEM INFECTION EXCEPT VIRAL MENINGITIS 1-1

21 vIRAC-M-ENI-NGiTis 5

22 HY-PE-RTENSivE-E-NCEPH-ALOPATHY 7

23 NONTMU-MATIC-STUPOR-&- COM-A 4

24 sEizURE-&-HEADACHE-AGE ;17-W-CC- 5

~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~

~? ~~~-~.A: Tl~ _~T_l!~- 9_f3- ~ -~9_~.A:'- f~~~ -~~~r:._~~_f3 -T~r:.- ~ _1_1:i_<? _l!~ ?

~~ T_~~~_~.A:Tl~_~T_l!~_9_f3- ~- ~9_~.A::.f~~~- ~~~~-~ti_~~-~_I:I~~F3~_::= -T~~_~- ~?- ~ -~c:; ?29 TRAUMATIC STUPOR & COMA, COMA LESS THAN 1 HOUR, > THAN 17 WIO CC 3

~~:~~~~~~~~~~~1 :::::::::::::::~32 CONCUSSION AGE >17 WIO CC 2

34 OTHER DISORDERS OF NERVOUS SYSTEM W CC 5

35 OTHER DISORDERS OF NERVOUS SYSTEM WIO CC 3

36 RETINAL PROCEDURES 2

37 ORBITAL PROCEDURES 4

38 PRIMARY IRIS PROCEDURES 4

39 LENS PROCEDURES WITH OR WITHOUT VITRECTOMY 5

40 EXTRAOCULAR PROCEDURES EXCEPT ORBIT AGE >17 5

42 INTRAOCULAR PROCEDURES EXCEPT RETINA 2

43 HYPHEMA 5

44 ACUTE MAJOR EYE INFECTIONS 6

45 NEUROLOGICAL EYE DISORDERS 4

46 OTHER DISORDERS OF THE EYE AGE >17 W CC 4

47 OTHER DISORDERS OF THE EYE AGE >17 WIO CC 4

49 MAJOR HEAD & NECK PROCEDURES 9

50 SIALOADENECTOMY 2

51 SALIVARY GLAND PROCEDURES EXCEPT SIALOADENECTOMY 2

52 CLEFT LIP"& -PALATERE-PAIR 1

53 855 MisCE-CLAN-EOU-S -EAR 6

56 RH-INOPLASiY 357 T&APRO-C 5

6/2/2006 1 I



59 TONSILLECTOMY &IOR ADENOIDECTOMY ONLY 2

61 MYRINGOTOMY W TUBE INSERTION AGE >17 8

63 OTHER EAR '-5

:::::::::::: :~~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~

66 EPISTAXIS ' '6

~~~~~~~~~~~~~? 368 OTITIS MEDIA & URI AGE >17 W CC ' 3

69 OTITIS MEDIA & URI AGE >17 W/O CC '-2

~? ~~~I:'-_~-~~!-!~~_.&_R~~9.F3_~!TX 473 OTHER EAR 4

~? ~1:'-.~9.F3- .c.1:I_~?_~ .I:'~<?_<;:-~~-~~~.~ 1-376 OTHER RESP SYSTEM O.R. PROCEDURES W CC '1-3

77 6~~~~~~~~~~~~~~~ ~~~ 7

79 RESPIRATORY INFECTIONS & INFLAMMATIONS AGE >17 W CC 9

80 6

82 REspjRATORY-NEOPLASM-S 783 MAjoR-cHESTTMUMA-W-CC ' ' 3

84 MAjoR- CHEST TMUMA-wio -cc 2

85 PLEUML-EF-FusioN.W -CC- 7

86 PLEURAL EFFUSION W/O CC 3--' 87 '-6

88 CHRONIC OBSTRUCTIVE PULMONARY DISEASE 4

89 SIMPLE PNEUMONIA & PLEURISY AGE >17 W CC 5

90 SIMPLE PNEUMONIA & PLEURISY AGE >17 W/O CC 3

92 INTERSTITIAL LUNG DISEASE W CC 6

93 INTERSTITIAL LUNG DISEASE W/O CC 4

94 PNEUMOTHORAX W CC 6

95 PNEUMOTHORAX W/O CC 4

96 BRONCHITIS & ASTHMA AGE >17 W CC 3

97 BRONCHITIS & ASTHMA AGE >17 W/O CC 3

99 RESPIRATORY SIGNS & SYMPTOMS W CC 4

100 RESPIRATORY SIGNS & SYMPTOMS W/O CC 2

101 OTHER RESPIRATORY SYSTEM DIAGNOSES W CC 4

102 OTHER RESPIRATORY SYSTEM DIAGNOSES W/O CC 2

103 HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM 33

104 CARDIAC VALVE & OTHER MAJOR CARDIOTHORACIC PROC W CARDIAC CATH 21

105 CARDIAC VALVE & OTHER MAJOR CARDIOTHORACIC PROC W 10 CARDIAC CA TH 18

106 CORONARY BYPASS W PTCA 13

108 OTHER CARDIOTHORACIC PROCEDURES 10

110 MAJOR CARDIOVASCULAR PROCEDURES W CC 11

111 MAJOR CARDIOVASCULAR PROCEDURES W/O CC 6"-- 113 AMPUTATION FOR CIRC SYSTEM DISORDERS EXCEPT UPPER LIMB & TOE 14

' '--114 1-0

1.17 1-2

118 CARDIAC PACEMAKER DEVICE REPLACEMENT 7

1-1-9 vEiN- LIGATiO.N -&- STRIPP-ING 1-3

6/2/2006 2

-



120 OTHER CIRCULATORY SYSTEM O.R. PROCEDURES 13

1_~~ fl_l3f~_~_~<?'3X_9!?_<?~~-~~?- Y'f- .A.~_I_~_~~~<?- '3- <;::'<?_~p' ~ ~ 7122 CIRCULATORY DISORDERS W AMI WIO MAJOR COMP 3

123 CIRCULATORY DISORDERS W AMI 8

1_~~ 5125 CIRCULATORY DISORDERS EXCEPT AMI, W CARDIAC CATH & WIO COMP-OIAGNOSI 3

1_~? .A.~_~T_~ -~- ?_~.B.~f~_"!"~_~t:'J.9~f~_F3~I~I_~ 1-1

1_~? ~~~~"!"_~.A.I_L.Y_F3~-~-~~<?_<?~-- ~ ~ 5128 DEEP VEIN THROMBOPHLEBITIS 6

~~~~~~~~~~~)~~~ 6130 PERIPHERAL VASCULAR DISORDERS W cc 6

;-31 4

;-32 ATHE -ROS-CL-ERO-sis -w -cc 3

;-33 ATHEROSCLERO-sis-wiocc-- 2

;-34 HY-PE-RTENSioN 3

;-35 6

~~~~~~~~~~~~1~~~ ~~~~~~~~~~~~~~~$138 CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC 4

139 CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WIO CC 2

140 ANGINA PECTORIS 2

1_~~ :<3.y~<;::.<??~- ~ -~~~.L_~.P.-?~_~_<?f_- ~142 SYNCOPE & COLLAPSE W 10 CC 2

143 CHEST PAIN 2

144 OTHER CIRCULATORY SYSTEM DIAGNOSES W CC 7

145 OTHER CIRCULATORY SYSTEM DIAGNOSES WIO CC 3

146 RECTAL RESECTION W CC 13

147 RECTAL RESECTION WIO CC 6

148 MAJOR SMALL & LARGE BOWEL PROCEDURES W CC 15

149 MAJOR SMALL & LARGE BOWEL PROCEDURES WIO CC 7

150 PERITONEAL ADHESIOL YSIS W CC 11

151 PERITONEAL ADHESIOL YSIS WIO CC 6

152 MINOR SMALL & LARGE BOWEL PROCEDURES W CC 11

153 MINOR SMALL & LARGE BOWEL PROCEDURES WIO CC 5

154 STOMACH W CC 17

155 STOMACH WIO CC 8

157 ANAL & STOMAL PROCEDURES W CC 5

158 ANAL & STOMAL PROCEDURES WIO CC 2

159 HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL AGE >17 W CC 5

160 HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL AGE >17 WIO CC 3

161 INGUINAL & FEMORAL HERNIA PROCEDURES AGE >17 W CC 5

162 INGUINAL & FEMORAL HERNIA PROCEDURES AGE >17 WIO CC 3

164 APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W CC 7

165 APPENDECTOMY W COMPLICATED PRINCIPAL DIAG WIO CC 4

166 APPENDECTOMY WIO COMPLICATED PRINCIPAL DIAG W CC 4

;-67 2

1-68 MoUTH PROCEDURES-W-CC- 51-69 MOU-TH P ROC E- DuREswi6-cc 3

~ ~ ~: ~ ~ ~ ~ ~ ~ ~ )~~g ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~~?

6/2/2006 3



1_~~ ~T_~~_I3_~}~~-?~I~~_~!,~"!"~Iy1_9-~I3:_~_F3~~-~~l}_f3~-?_~!~-q~ 6

1_~? ~1_<?_~~-~I_\[~--~~~!<.3_~~~-qX ~ ~~ ~-- --~ ~ ---~- 9

1_~~ ~~<?_~~~I_\[~-~~~!<.3_~~~-qX'!Y!_C?_~-~ 3

~~~~~~~~~~~~~~; ~~~~~~~~~~~~~~~~

1_~? ~<?Iy1-~~J~~~~-q-~~~~I_q-l}.~~-~~ 6

1_~? ~~-~9-~~-~I_~~"!"~I?_~-~.P."!"!~-~~~~_F3 -~ -~-q ~~ ---~ ~ 4178 UNCOMPLICATED PEPTIC ULCER WIO cc 4

1-79 iN-FLAMMATO-RYBOWE-C-ois-EASE 51-80 G~I: -O-BSTRUC;-ioN- w- CC 6

1-81 G~I:-O-BSTRUC;--ION. wio-cc--. 4

~~~~~~~~~~~)~~? ~~~~~~~~~~~~~~~~183 ESOPHAGITIS WIO CC 3

~~~~~~~~~~~~1~~~ ~~~ 3187 DENTAL EXTRACTIONS & RESTORATIONS 4

1-88 6

1-89 3

1-91 PANCREA-S -W -CC 1- 3

192 PANCREAS WIO CC 12

1_~~ ~I_L.I-.A:~!' -"!"~-~!. .P.13_C?~ -~~~.~~_~_9_~~.'( -~~~~~-~.'(~~-~_C?F3_~~9_~._q~~.:_~-~-q ~ 9194 BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR WIO C.D.E. WIO CC 5

195 CHOLECYSTECTOMY W C.D.E. W CC 15

196 CHOLECYSTECTOMY W C.D.E. WIO CC 9

197 CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WIO C.D.E. W CC 10

198 CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WIO C.D.E. WIO CC 4

1_~~ t"!~?~~~~l~l,:-.f3X _q!~~~9_-?~I~_~~9_~.~I?_~.F3~- F_9_F3_Iy1_.A:!-_I~~_.A:~~!' ~ '7200 HEPATOBILIARY DIAGNOSTIC PROCEDURE FOR NON-MALIGNANCY 14

201 OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES 20

202 CIRRHOSIS & ALCOHOLIC HEPATITIS 7

203 MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS 8

204 DISORDERS OF PANCREAS EXCEPT MALIGNANCY 5

205 DISORDERS OF LIVER EXCEPT MALIG W CC 7

206 DISORDERS OF LIVER EXCEPT MALIG WIO CC 4

207 DISORDERS OF THE BILIARY TRACT W CC 5

208 DISORDERS OF THE BILIARY TRACT WIO CC 3

210 HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT AGE >17 W CC 8

211 HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT AGE >17 WIO CC 5

213 AMPUTATION FOR MUSCULOSKELETAL SYSTEM & CONN TISSUE DISORDERS 13

216 BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE 10

217 WND DEBRID & SKN GRFT EXCEPT HAND 14

218 LOWER EXTREM & HUMER PROC EXCEPT HIP 5

219 LOWER EXTREM & HUMER PROC EXCEPT HIP 3

223 MAJOR SHOULDER/ELBOW PROC 5

224 SH-OULDE-R 2225 Fo-oTPRocEDuREs 5226 SOF;--;--ISSUE-PROCE-OUR-ES w- cc' 1- 0

227 3228 5

6/2/2006 4



2_~~ t"!~-~~_<?~_~~I.S:T_~_F3~~ 3.,

2_~9 ~_<?f~~ -~~~!?_I~~- ~ _F3~r:'!<?_\[~~_<?~ J~T_~!~_~~-\[~<;:-~?_~~_tJ.I?_~ -~~r:'!~_F3 ~~~-- 7

2_~? ~13~1:-I_F3~?_<;:.C?~_'! 6233 OTHER MUSCULOSKELET SYS & CONN TISS OoR. PROC W CC 8

234 5235 FRACTURES-OF-F-EMU-R 4236 FRACTURES OF HIP & PELVIS 5

237 SPRAINS 5

238 OSTEOMYELITIS 8

239 8240 9241 4242 sEPTic ARTH- RiTis 5243 MEDicAL BACK PR-OBLEMS 5

~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~$

245 BONE DISEASES & SPECIFIC ARTHROPATHIES W/O CC 4

246 4~~~~~~~~~~~~~? ~~~~~~~~~~~~~~~?

2_~~ T_~~I?_<?_~~~~~ '72_~~ ~~T- ~~~-~~~ '7

2- ~9 f_~ -~~~~~~- ~.?_I:-I.A:~_I? -~~ -q -~~9.~ -~ -~-~. ~

2_~~ f_~ -~.C?~~~~-~.?_I:-I.A:~_I?- ~~~-~~9.~_~~<?_f~ ?

2_~~ f_~_~~~-~~ -~~fy1-~~I?- ~~~-~~.L_~~~~~-~~~~~<?_<?~yy--~~--- '7

2_~~ f_~_~~~-~~-~~fy1-~~_1? -~~~ _~~_L_~~~~~~~-~~~<?_<?~YY!_<?_~.~- ~256 OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES 5

257 TOTAL MASTECTOMY FOR MALIGNANCYW CC 3

258 TOTAL MASTECTOMY FOR MALIGNANCYW/O CC 2

259 SUBTOTAL MASTECTOMY FOR MALIGNANCYW CC 5

260 SUBTOTAL MASTECTOMY FOR MALIGNANCYW/O CC 4

261 BREAST PROC FOR NON-MALIGNANCY EXCEPT BIOPSY & LOCAL EXCISION 2

262 BREAST BIOPSY & LOCAL EXCISION FOR NON-MALIGNANCY 4

263 SKIN GRAFT &IOR DEBRID FOR SKN ULCER OR CELLULITIS W CC 9

264 SKIN GRAFT &lOR DEBRID FOR SKN ULCER OR CELLULITIS W/O CC 5

265 SKIN GRAFT &lOR DEBRID EXCEPT FOR SKIN ULCER OR CELLULITIS W CC 11

266 SKIN GRAFT &IOR DEBRID EXCEPT FOR SKIN ULCER OR CELLULITIS W/O CC 5

267 PERIANAL & PILONIDAL PROCEDURES 7

268 SKIN 5

269 OTHER SKIN W CC 7

270 OTHER SKIN W/O CC 3

271 SKIN ULCERS 6

272 MAJOR SKIN DISORDERS W CC 6

273 MAJOR SKIN DISORDERS W/O CC 3

274 MALIGNANT BREAST DISORDERS W CC 6

275 MALIGNANT BREAST DISORDERS W/O CC 4

276 NON-MALIGNANT BREAST DISORDERS 4

271 5

278 3~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~~9 ~ ~ ~ ~ ~ ~~~ ~ ~ ~ ~ ~ ~ ~?

6/2/2006 5

..oJ .8.



f.~~ !.~~.~~ .~~ .~tI.~.?~~~ -~!~.~~ 2f.~? ~~~ .<?~ -~~I_~ .I?l.s. <?F3~~ .F3.s. Y'l. f~ ..~ ~ ~ ~ ~ ~ ~ ~. 5284 MINOR SKIN DISORDERS WIO CC 3285 AMPUTAT OF LOWER LIMB FOR ENDOCRINE ' 1.2

286 1- 6287 SKIN GRAFTS & WOUND DEBRID FOR ENDOC 9288 O~R~. PROC.EOURES. FOR .OBESI;:Y 4289 PARATHYROID PROCEDURES 6290 THYR-OiOPROCEDURES 4291 THYR.OGLOSSAL. P-ROCEOU. REs 1

~~~~~~~~~~~~~? 1.6293 OTHER ENDOCRINE WIO CC 3294 OiABETESAGE.;35 4f_~? ~1~~~!.~.s.~~~.9:~.5 4;f_~? ~~_~~I~I.<?~~.~ -~. ~.I.s.~. ~~.~ ~.~~~!~. ~~~~~_I?~~.~. ~.C?~.>.!? ~. ~~- ?297 NUTRITIONAL & MISC METABOLIC DISORDERS AGE >17 WIO CC 3299 INBORN ERRORS OF METABOLISM 4300 ENDOCRINE DISORDERS W CC 5301 ENDOCRINE DISORDERS WIO CC 3302 KIDNEY TRANSPLANT 19303 KIDNEY 8304 KIDNEY W CC 8305 KIDNEY WIO CC 4306 PROSTATECTOMY W CC 120 0 307 PROSTATECTOMY W 10 CC 2

308 MINOR BLADDER PROCEDURES W CC 5309 MINOR BLADDER PROCEDURES WIO CC 30 310 TRANSURETHRAL PROCEDURES W CC 5

311 TRANSURETHRAL PROCEDURES WIO CC 3312 URETHRAL PROCEDURES W CC 6313 URETHRAL PROCEDURES WIO CC 40 315 OTHER KIDNEY & URINARY TRACT PROCEDURES 14

316 RENAL FAILURE 70 317 ADMIT FOR RENAL DIALYSIS 8

318 KIDNEY & URINARY TRACT NEOPLASMS W CC 6319 KIDNEY & URINARY TRACT NEOPLASMS WIO CC 2320 KIDNEY & URINARY TRACT INFECTIONS AGE >17 W CC 5321 3323 URINARY STONES W CC 3324 2325 5326 4328 ' 3

331 5332 3334 4335 3336 30 6/2/2006 6

IIIl

ATTACHMENT A DAY LIMITS BY DIAGNOSIS RELATED GROUP

(based on 120% of the average length of stay)


337 TRANSURETHRAL PROSTATECTOMY WIO CC 2

3_~~ !.~~T~_-?_~_I3~~~~~_I3~?!_~~~ ~~~!~-ty~~-~X- 28339 TESTES PROCEDURES, FOR NON-MALIGNANCYAGE-GREATE-R-THAN-17 1-1

3_~ ~ ~~~!-?_~_I3~~-~.o.~_I3~? 8344 OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR-MALiGNANCY 1-0

345 OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXCEPT FO-R MALIGNANCY 1-1

346 MALIGNANCY MALE REPRODUCTIVE SYSTEM WITH CC 6

347 MALIGNANCY MALE REPRODUCTIVE SYSTEM WITHOUT CC 3

348 BENIGN PROSTATIC HYPERTROPHY W CC 4

349 BENIGN PROSTATIC HYPERTROPHY WIO cc 1

350 INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM 5

352 OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES 7

353 PELVIC EVISCERATION 8

354 UTERINE W CC 5

355 UTERINE WIO CC 3

356 FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES 2

357 UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY 10

358 UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W CC 3

359 UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WIO CC 3

360 VAGINA 6

3_~~ ~~-~~<?-?~<?~X_~.I_~~I_~!<?_~~~ _T~I?~~_I_ty!.~~~_~~T!<?ty ~~ ---~~~~ -~ ~~~--- 3

3_~? ~~-q~?_~~~.I~-~~_I?~~_I_~!_~~~_~~T!<?_ty ~ :2363 D&C, CONIZATION AND RADIO-IMPLANT, FOR MALIGNANCY 5

~~~~~~~~~~~~~~ ~ 3

3_~? ~!_~~_13- f_~~p:-_~~ -~~'p:~_<?_q~_~11.\(~_~'(.s.T~~ _<?;~_._~_13~~-~~~_13~?_- ~ ~ ---~ 6

3_~? ~~~~~-~~~-~XY:!_~~ 6367 MALIGNANCYW/O CC 4

368 INFECTIONS 4

369 3370 CESAREAN-sEcii6-N-w-cC- 5

3-71 cEsAREAN-sEcTi6-N-wiocc 4372 3

~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~~~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~374 VAGINAL DELIVERY W STERILIZATION &lOR D&C 3

375 VAGINAL DELIVERY W O.R. PROC EXCEPT STERIL &lOR D&C 4

376 POSTPARTUM & POST ABORTION DIAGNOSES WIO O.R. PROCEDURE 3

377 POSTPARTUM & POST ABORTION DIAGNOSES W O.R. PROCEDURE 5

378 ECTOPIC PREGNANCY 3

379 THREATENED ABORTION 4

380 ABORTION WIO D&C 3

381 ABORTION W D&C 2

382 FALSE LABOR 3

383 OTHER ANTEPARTUM DIAGNOSES W MEDICAL COMPLICATIONS 4

384 OTHER ANTEPARTUM DIAGNOSES WIO MEDICAL COMPLICATIONS 3

392 SPLENECTOMY AGE >17 9

394 OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS 8

395 RED BLOOD CELL DISORDERS AGE >17 5

397 COAGULATION DISORDERS 6

I6/2/2006 7

,1__-



398 RETICULOENDOTHELIAL & IMMUNITY DISORDERS W CC 5399 RETICULOENDOTHELIAL & IMMUNITY DISORDERS W/O CC ' '---'4

401 LYMPHOMA & NON-ACUTE LEUKEMIA W OTHER O.R. PROC W CC '---1-2

402 LYMPHOMA & NON-ACUTE LEUKEMIA W OTHER O.R. PROC W/O CC--- '---1-0

403 LYMPHOMA & NON-ACUTE LEUKEMIAW CC 9

404 LYMPHOMA & NON-ACUTE LEUKEMIA W/O CC 7406 MYELOPROLIF DISORD OR POORLY DIFF NEOPL W MAJ O.R.PROC W CC -' 1-4

407 MYELOPROLIF DISORD OR POORLY DIFF NEOPL W MAJ O.R.PROC W/O CC '4

408 MYELOPROLIF DISORD OR POORLY DIFF NEOPL W OTHER O.R.PROC 1-0409 RADIOTHERAPY ' 8

410 CHEMOTHERAPY W/O ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS '4413 OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W CC -.-' ' 7

414 OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W/O CC ' 4

415 O.R. PROCEDURE FOR INFECTIOUS & PARASITIC DISEASES ' 1-5

416 SEPTICEMIA AGE >17 -' ' 9

418 POSTOPERATIVE & POST-TRAUMATIC INFECTIONS ---' 6

419 FEVER OF UNKNOWN ORIGIN AGE >17 W CC ' '-4

420 FEVER OF UNKNOWN ORIGIN AGE >17 W/O cc ' 4

421 VIRAL ILLNESS AGE >17 ' 4

423 OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES ' 8

424 1- 9

~~~~~~~~~~~~~~~ ~~-' 4426 DEPRESSIVE NEUROSES ' 5

427 NE-UROSES-EXCEP-j--OEPR-ES-sivE 4' 4-28 ' 7

'-429 ---' ' 1-3430 PSYC-HOSES ' ' 7

'---432 ' 9

433 ALCO-HOUORUGABUSE-ORDE-PENDE- NCE' 2

~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~~~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~~?

440 WOUND DEBRIDEMENTS FOR INJURIES 12

441 HAND PROCEDURES FOR INJURIES 5

442 OTHER O.R. PROCEDURES FOR INJURIES W CC 9

443 OTHER O.R. PROCEDURES FOR INJURIES W/O CC 3

444 TRAUMATIC INJURY AGE >17 W CC 3

445 TRAUMATIC INJURY AGE >17 W/O CC 2

447 ALLERGIC REACTIONS AGE >17 3

449 POISONING & TOXIC EFFECTS OF DRUGS AGE >17 W CC 4

450 POISONING & TOXIC EFFECTS OF DRUGS AGE >17 W/O CC 2

452 COMPLICATIONS OF TREATMENT W CC 6

453 COMPLICATIONS OF TREATMENT W/O CC 3

454 OTHER INJURY W CC 4

455 OTHER INJURY W/OCC 2

461 O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES 15

462 REHABILITATION 13

463 SIGNS & SYMPTOMS W CC 4

464 SIGNS & SYMPTOMS W/O CC 3

465 AFTERCARE W HISTORY OF MALIGNANCY AS SECONDARY DIAGNOSIS 1

6/2/2006 8

--


DIAGNOSISRELATED

GROUP DIAGNOSIS RELATED GROUP DESCRIPTIONS DAY LIMIT

466 AFTERCARE W/O HISTORY OF MALIGNANCY AS SECONDARY DIAGNOSIS 4

4.~? .QT.~~. F3- ~~~~.Q~~ .1.f':I~_~~-~~~J~~..~~.ft:~~I:J. .s.T.A.~~~ ~~~.~ 3468 EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOS-IS-' ' ..'--;:80;;-'.-

'.--"..' '--' " '-' 4_~~ .B-I_~J:~~.~ .<?~. ~.~~_~I.I:'~.~.~.ft:~.<?~.J. <?J~T.~.I3.Q~~.9.~.~.Q~~F3. ~>.<J:REMITY ' 9

4.~~ .A.~-~!. ~ -~~. ~~~.~lt:.. ,!!!.Q. ~.ft:~.<?~ .<?':~'. ~.I3.Q~~~~. F3.~ .ft:~~.:-. ~? ~ '.24475 RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT' ' 1.2

4.~? .p.F3.<?s.T.A. ~!~. .Q:.F3.: .~~9.~.~~. ~ -~~. ~~.13~~ T~I? -!.<? ~.13!~.~!~~~. ~J.A.<;3.~.<?s.I.~ TBD**

4_~? ~9.~:-~~~~~)~~ -9.._~:. f.~<?~~1? .l:!~~ -~- ~~~. ~.~~.I:?~.Q _I:'~I. f':If~~.A.~ .I?lt:.- C? .f':I.Q~l.s.. ~ ;:80;; 479 OTHER VASCULAR PROCEDURES W/O CC ' 4

480 LIVER TRANSPLANT ANDIOR INTESTINAL TRANSPLANT " 22

481 BONE MARROW TRANSPLANT 31

482 TRACHEOSTOMY FOR FACE 1-5~~~~~~~~~~~~~~ ' 1.]

485 LIMB REATTACHMENT " 1-5

' 486 '..'-.1.5

'..'487 ' '..9

488 24489 ""--.8

"...' 490 HIV W OR W/O OTHER RELATED CONDITION 6

4- ~~ ~.A.~<?13 -~.Q~~~.~. ~~~.~. F3.~t:..~ .A.~.I:I~~~~ ?~<?_~~I?~~~-~. <?f. ~.p.~ .~~ ~~J:F3.~~~~- ?

492 CHEMO W ACUTE LEUKEMIA AS SDX OR W USE OF HIGH DOSE CHEMO AGENT 20' ' "-' 493 LAPAROSCOPIC CHOLECYSTECTOMYW/O C.D.E. W CC 6

494 LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W/O CC 3

495 LUNG TRANSPLANT 34'.".-"-' ' 496 COMBINED ANTERIOR/POSTERIOR SPINAL FUSION 16

497 SPINAL FUSION EXCEPT CERVICAL W CC 7

498 SPINAL FUSION EXCEPT CERVICAL W/O CC 3

499 BACK & NECK PROCEDURES EXCEPT SPINAL FUSION W CC 4

500 BACK & NECK PROCEDURES EXCEPT SPINAL FUSION W/O CC 2

501 KNEE PROCEDURES W PDX OF INFECTION W CC 10

502 KNEE PROCEDURES W PDX OF INFECTION W/O CC 8

503 KNEE PROCEDURES W/O PDX OF INFECTION 5

504 EXTENSIVE BURNS OR FULL THICKNESS BURNS W MV 96+ HRS W SKIN GRAFT 46,--- 505 EXTENSIVE BURNS OR FULL THICKNESS BURNS W MV 96+ HRS W/O SKIN GRAFT 12

506 FULL THICKNESS BURN W SKIN GRAFT OR INHAL INJ W CC OR SIG TRAUMA 18

507 FULL THICKNESS BURN W SKIN GRFT OR INHAL INJ W/O CC OR SIG TRAUMA 14

508 FULL THICKNESS BURN W/O SKIN GRFT OR INHAL INJ W CC OR SIG TRAUMA 5,.- 509 FULL THICKNESS BURN W/O SKIN GRFT OR INH INJ W/O CC OR SIG TRAUMA 6

510 NON-EXTENSIVE BURNS W CC OR SIGNIFICANT TRAUMA 11

511 NON-EXTENSIVE BURNS W/O CC OR SIGNIFICANT TRAUMA 4

512 SIMULTANEOUS PANCREASE/KIDNEY TRANSPLANT 10

515 6518 PERCUTANEOUS CARDIOV ASC PROC W 10 CORONARY ARTERY STENT OR AMI 4' 519 '--.6

520 CERVICAL SPINAL FUSION W/O CC 3

521 ALCOHOUDRUG ABUSE OR DEPENDENCE W CC 4

522 '--'4'-"".523 "-" ' 4

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ATTACHMENT A DAY LIMITS BY DIAGNOSIS RELATED GROUP '¥

(based on 120% of the average length of stay)

DIAGNOSIS

RELATEDGROUP DIAGNOSIS RELATED GROUP DESCRIPTIONS DAY LIMIT

5_~~ !_~~_~~~~T_~~~ti_~~~.: -35_~9 .C?T_f:!~_I3- ti- ~~'3_~-~.s.~!?~ -~!:~!_~~.I_~.P.':.A.~~-- 24528 INTRACRANIAL VASCULAR PROCEDURES W POX HEMORRHAGE 21

529 VENTRICULAR SHUNT PROCEDURES W CC 9

530 VENTRICULAR SHUNT PROCEDURES W/O CC 6

531 spiNAL PR-OCE- OURES W CC 1- 3

532 spiNAL PR-OCE-OURES W/O- C-G 4

:::::::::::~~~ 4534 EXTRACRANIAL PROCEDURES W/O CC 5

535 1-3

::::::::::: ~~~ ::::::::::::::~ 9537 LOCAL EXCISION & REMOVAL OF INT FIX DEVICES EXCEPT HIP & FEMUR W CC 9

538 LOCAL EXCISION & REMOVAL OF INT FIX DEVICES EXCEPT HIP & FEMUR W/O C 4

5- ~~ ~-,(~~_f:!.C?~~- ~ _L.~~t<_r;~~~- ~ -t:-1..:-.~ _C?~ -C?:~.- ~13.C?~~ _E?~'3_~ -~ -C;;~ ~ ~540 LYMPHOMA & LEUKEMIA W MAJOR O.R. PROCEDURE W/O CC 4

541 ECMO OR TRACH W MV 96+ HRS OR POX EXC FACE 45

542 TRACH W MV 96+ HRS OR POX EXC FACE 36

543 CRANIOTOMY W IMPLANT OF CHEMO AGENT OR ACUTE COMPLEX CNS POX 16

544 MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY 5

545 REVISION OF HIP OR KNEE REPLACEMENT 6

546 SPINAL FUSION EXC CERV WITH CURVATURE OF THE SPINE OR MALIG 15

547 CORONARY BYPASS W CARDIAC CATH W MAJOR CV OX 14

548 CORONARY BYPASS W CARDIAC CATH W/O MAJOR CV OX 10

549 CORONARY BYPASS W/O CARDIAC CATH W MAJOR CV OX 12

550 CORONARY BYPASS W/O CARDIAC CATH W/O MAJOR CV OX 7

551 PERMANENT CARDIAC PACEMAKER IMPL W MAJ CV OX OR AICD LEAD OR GNRTR 7

552 OTHER PERMANENT CARDIAC PACEMAKER IMPLANT W/O MAJOR CV OX 5

553 OTHER VASCULAR PROCEDURES W CC W MAJOR CV OX 11

554 OTHER VASCULAR PROCEDURES W CC W/O MAJOR CV OX 7' 555 PERCUTANEOUS CARDIOVASCULAR PROC W MAJOR CV OX 5

556 PERCUTANEOUS CARDIOVASC PROC W NON-DRUG-ELUTING STENT W/O MAJ CV 2

557 PERCUTANEOUS CARDIOVASCULAR PROC W DRUG-ELUTING STENT W MAJOR CV 4

558 PERCUTANEOUS CARDIOVASCULAR PROC W DRUG-ELUTING STENT W/O MAJ CV 2

559 9

** The combined medical and surgical DRG day limits will form the day limit for DRGs 468, 476, and 477.

Note: DRGs specific to children have been excluded. Day limit only applies to adults.

The day limits are based on version 23 of the CMS-DRGs.

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Maryland Department of Health and Mental Hygiene 30-06.pdf · PT 30-06 STATE DHMH OF MARYLAND Maryland Department of Health and Mental Hygiene 201 w. Preston Street. ... 122 CIRCULATORY