Colorectal Resection(COLON) ECR Summary Description

Version: 5.4.005

Services and costs associated with a procedure of Colon Resection (COLON) are grouped together to include the index stay during which the procedure was performed, a 30-day look back period to capture pre-operative diagnostic workup leading to the surgery and a 90-day post-discharge period to capture post-operative care. Patients are identified as those with a primary procedure code of colon resection on an inpatient stay service or a colon resection procedure code in any position on an outpatient facility/professional service, along with a qualifying diagnosis code.

As part of the Colon Resection episode, we evaluate services that are 1) typical or routine and considered part of expected care for colon resection; and 2) those that are related to complications associated with colon resection.

In addition, the Colon Resection episode is related back to the underlying Colon Cancer, Rectal Cancer or Diverticulitis episode (if one exists) as part of typical care for these conditions at the patient level, and is compared to similar episodes as part of the risk adjustment methodology.

Episode Components

Trigger CodesCodes that, when meeting the trigger criteria, indicate an episode exists (See Table A)
SubTypesEpisodes often have sub-types or variants, which are useful to adjust for the severity of that episode, and reduce the need to have multiple episodes of the same type.
Relevant DiagnosesThese are diagnosis codes that could serve as a proxy to the trigger diagnosis codes in order to steer services to an episode. There are two types of relevant diagnosis: 1) those that are for routine and typical care for an episode and include codes that represent signs and symptoms related to the episode, diagnosis codes for similar conditions, status codes, family history codes or for aftercare (See Table B); and 2) those that indicate the occurrence of a PAC (potentially avoidable complication) during the episode time window (See Table C)
Relevant ProceduresThese include all services that are relevant to a given episode but would only be included in the episode if they have a relevant diagnosis code on the claim (See Tables D and E)
Relevant PharmacyThese include all pharmacy codes that are relevant to a given episode. Pharmacy codes are grouped into Prometheus Drug Groups for inclusion in the episode (See Table H). All relevant pharmacy codes in this episode are classified as typical.

SubTypes

SubType GroupsAbdominoperineal Resection, Allergic, Dietetic, Eosinophilic Gastroenteritis, Angiodysplasia of intestine, Cancer in situ, Anorectal, Cancer in situ, Colon, Cancer of colon, Cancer of other GI organs; peritoneum, Cancer of rectum and anus, Cancer; other and unspecified primary, Colectomy with proctectomy, Colonoscopy w biopsy, polypectomy, Congenital GI Problems in NB, Crohn's Disease, Crohn's Disease w Abscess, Crohn's Disease w Fistula, Crohn's disease w other complications, Crohn's disease w rectal bleeding, Digestive congenital anomalies, Disseminated Metastatic Cancer, Diverticulitis w Perf, Abscess, Diverticulitis with hemorrhage, Diverticulitis, colitis, Diverticulosis, Meckel's diverticulum, Angiodyspalsia, Esophageal Reflux and Other Esophagitis, GI inflammation from chemotherapy, Hx of colon polyps, family Hx of colon cancer, Intestinal Obstruction, Laparoscopic colectomy with proctectomy, Laparoscopic partial colectomy, Laparoscopic total intra-abd colectomy, Morbid Obesity, Neoplasms of unspecified nature or uncertain behavior, Neoplsm - histiocytosis - lymph nodes - head / face / neck, Neoplsm - mast cell tumor - lymph nodes - head / face / neck, Nonspecific Gastroenteritis, Obesity, Obstructive sleep apnea, Orthostatic Hypotension / Dizziness, Overweight, Partial Colectomy , Pelvic Exenteration, Personal history of cancer, Personal history of GI cancer, Previous bowel surgery, ostomy status, Pseudopolyposis of colon, Rectal Resection, Secondary malignancies, Severe Morbid Obesity, Sleep Apnea, Total intra-Abdominal colectomy , Toxic Effects of Radiation, Toxic Gastroenteritis, Ulc Colitis w Abscess, Ulc Colitis w Fistula, Ulc Colitis w Obstruction, Ulceration of Intestine, Ulcerative Colitis, Ulcerative colitis w other complications, Ulcerative colitis w rectal bleeding, Vascular Insufficiency of intestine

Code Tables

Table A: Trigger Codes

Trigger TypeCodes
ICD-9-PCS (PX) Triggers1731, 1732, 1733, 1734, 1735, 1736, 1739, 4571, 4572, 4573, 4574, 4575, 4576, 4579, 458, 4581, 4582, 4583, 4840, 4841, 4842, 4843, 4849, 485, 4850, 4851, 4852, 4859, 4861, 4862, 4863, 4864, 4865, 4866, 4869
ICD-9-CM (DX) Qualifying Diagnosis1530, 1531, 1532, 1533, 1534, 1535, 1536, 1537, 1538, 1539, 1540, 1541, 1542, 1543, 1548, 1580, 1588, 1589, 1590, 1598, 1599, 1763, 1765, 1768, 1769, 1948, 1949, 1952, 1953, 1958, 1962, 1966, 1968, 1969, 1975, 1976, 1977, 1978, 19889, 1990, 1991, 20230, 20233, 20236, 20238, 20250, 20253, 20256, 20258, 20260, 20263, 20266, 20268, 20917, 20920, 20926, 20927, 20929, 20930, 20970, 20971, 20972, 20974, 20979, 2303, 2304, 2305, 2306, 2307, 2309, 2348, 2349, 2352, 2354, 2355, 2374, 2377, 23770, 23771, 23772, 23773, 23779, 2379, 2388, 2389, 2390, 2398, 23989, 2399, 538, 5550, 5551, 5552, 5559, 556, 5560, 5561, 5562, 5563, 5564, 5565, 5566, 5568, 5569, 5570, 5571, 5579, 5581, 5582, 5583, 55841, 55842, 5589, 5600, 5602, 56200, 56202, 56210, 56211, 56212, 56213, 56881, 56889, 5689, 5693, 56982, 56983, 56984, 56985, 56986, 56987, 56989, 5699, 5781, 5789, 5790, 5791, 5792, 5798, 5799, 7510, 7512, 7513, 7514, 7515, 7518, 7519, 7876, 78760, 7890, 78900, 78902, 78904, 78905, 78907, 78909, 7893, 78930, 78932, 78934, 78935, 78937, 78939, 78951, 78960, 78962, 78964, 78965, 78966, 78967, 78969, 7899, 7934, 7936, 79670, 79671, 79672, 79673, 79674, 79676, 936, 937, 938, V1000, V1005, V1006, V1009, V1089, V109 , V1090, V1091, V1272, V1367, V160, V1851, V443, V453, V711
ICD-10-PCS (PX) Triggers0D1N0Z4, 0D1N4Z4, 0DBE0ZZ, 0DBE3ZZ, 0DBE4ZZ, 0DBE7ZZ, 0DBF0ZZ, 0DBF3ZZ, 0DBF4ZZ, 0DBF7ZZ, 0DBG0ZZ, 0DBG3ZZ, 0DBG4ZZ, 0DBG7ZZ, 0DBH0ZZ, 0DBH3ZZ, 0DBH4ZZ, 0DBH7ZZ, 0DBK0ZZ, 0DBK3ZZ, 0DBK4ZZ, 0DBK7ZZ, 0DBL0ZZ, 0DBL3ZZ, 0DBL4ZZ, 0DBL7ZZ, 0DBM0ZZ, 0DBM3ZZ, 0DBM4ZZ, 0DBM7ZZ, 0DBN0ZZ, 0DBN3ZZ, 0DBN4ZZ, 0DBN7ZZ, 0DBP0ZZ, 0DBP4ZZ, 0DTE0ZZ, 0DTE4ZZ, 0DTE7ZZ, 0DTE8ZZ, 0DTF0ZZ, 0DTF4ZZ, 0DTF7ZZ, 0DTF8ZZ, 0DTG0ZZ, 0DTG4ZZ, 0DTG7ZZ, 0DTG8ZZ, 0DTH0ZZ, 0DTH4ZZ, 0DTH7ZZ, 0DTH8ZZ, 0DTK0ZZ, 0DTK4ZZ, 0DTK7ZZ, 0DTK8ZZ, 0DTL0ZZ, 0DTL4ZZ, 0DTL7ZZ, 0DTL8ZZ, 0DTM0ZZ, 0DTM4ZZ, 0DTM7ZZ, 0DTM8ZZ, 0DTN0ZZ, 0DTN4ZZ, 0DTN7ZZ, 0DTN8ZZ, 0DTP0ZZ, 0DTP4ZZ, 0DTP7ZZ, 0DTP8ZZ
ICD-10-CM (DX) Qualifying DiagnosisC180, C181, C182, C183, C184, C185, C186, C187, C188, C189, C19, C20, C210, C211, C212, C218, C260, C269, C451, C457, C459, C463, C464, C467, C469, C480, C481, C482, C488, C758, C759, C762, C763, C768, C772, C775, C778, C779, C785, C786, C7880, C7889, C7989, C799, C7A00, C7A026, C7A095, C7A096, C7A098, C7A1, C7A8, C7B00, C7B01, C7B04, C7B09, C7B8, C800, C801, C960, C962, C96A, D010, D011, D012, D013, D0140, D0149, D017, D019, D093, D098, D099, D372, D373, D374, D375, D378, D379, D438, D439, D440, D442, D449, D483, D484, D487, D489, D490, D4989, D499, K5000, K50011, K50012, K50013, K50014, K50018, K50019, K5010, K50111, K50112, K50113, K50114, K50118, K50119, K5080, K50811, K50812, K50813, K50814, K50818, K50819, K5090, K50911, K50912, K50913, K50914, K50918, K50919, K5100, K51011, K51012, K51013, K51014, K51018, K51019, K5120, K51211, K51212, K51213, K51214, K51218, K51219, K5130, K51311, K51312, K51313, K51314, K51318, K51319, K5140, K51411, K51412, K51413, K51414, K51418, K51419, K5150, K51511, K51512, K51513, K51514, K51518, K51519, K5180, K51811, K51812, K51813, K51814, K51818, K51819, K5190, K51911, K51912, K51913, K51914, K51918, K51919, K520, K521, K522, K5221, K5222, K5229, K523, K5281, K5282, K52831, K52832, K52838, K52839, K5289, K529, K550, K55011, K55012, K55019, K55021, K55022, K55029, K55031, K55032, K55039, K55041, K55042, K55049, K55051, K55052, K55059, K55061, K55062, K55069, K551, K5520, K5521, K5530, K5531, K5532, K5533, K558, K559, K561, K562, K5710, K5711, K5720, K5721, K5730, K5731, K5732, K5733, K5740, K5741, K5750, K5751, K5752, K5753, K5780, K5781, K5790, K5791, K5792, K5793, K5931, K5939, K625, K631, K633, K634, K6381, K6389, K639, K661, K668, K669, K689, K900, K901, K902, K904, K9041, K9049, K9089, K909, K921, K922, K9281, K9289, K929, Q420, Q421, Q422, Q423, Q428, Q429, Q430, Q431, Q432, Q433, Q434, Q435, Q436, Q437, Q438, Q439, Q458, Q459, Q8500, Q8501, Q8502, Q8503, Q8509, R100, R1010, R1012, R102, R1030, R1032, R1033, R10812, R10814, R10815, R10816, R10817, R10819, R10822, R10824, R10825, R10826, R10827, R10829, R1084, R109, R1113, R150, R159, R180, R1900, R1902, R1904, R1905, R1907, R1909, R194, R198, R85610, R85611, R85612, R85613, R85614, R85619, R933, R935, T183XXA, T184XXA, T185XXA, T188XXA, T189XXA, Z800, Z8371, Z8500, Z85020, Z85030, Z85038, Z85040, Z85048, Z85060, Z85068, Z8507, Z8509, Z85110, Z85230, Z85520, Z85821, Z85831, Z8589, Z859, Z86010, Z87738, Z933, Z980
CPT / HCPCS Triggers44140, 44141, 44143, 44144, 44145, 44146, 44147, 44150, 44151, 44155, 44156, 44157, 44158, 44160, 44204, 44205, 44206, 44207, 44208, 44210, 44211, 44212, 45110, 45111, 45112, 45113, 45114, 45116, 45119, 45123, 45126, 45160, 45170, 45171, 45172, 45395, 45397

Trigger Codes will be used to identify patients with this episode.

Table B: ICD-9 Relevant Typical Diagnosis Codes:

Group IDGroup NameICD-9-CM (DX)
DX05345Orthostatic Hypotension / Dizziness4580, 7804
DX06162GI - diarrhea78791
DX06173GI - peritoneal ds - nec / nos56889 - 5689
DX06187GI - hemorrhoids - internal4550 - 4552
DX06188GI - hemorrhoids - external4553 - 4555
DX06189GI - hemorrhoids - nos4556 - 4558
DX06190GI - hemorrhoids - residual tags4559
DX06204GI - constipation78761
DX06206GI - abdominal pain78902, 78904
DX06207GI - flatulence / gas pain7873
DX06208GI - symptoms - nec / nos7879, 78799, V473
DX06211GI - abnormal bowel sounds7875
DX06212GI - visible peristalsis7874
DX06213GI - abnormal feces7877
DX06214GI - abdominal tenderness78962
DX06216GI - abdominal mass78932, 78934
DX06217GI - ascites78959
DX06218GI - abnormal abdominal imaging study7936
DX06219GI - abnormal gi imaging study7934
DX06220GI - abnormal stool exam7921
DX06221GI - personal hx of GI diseaseV127 - V1270, V1279
DX06256Inj - anus / rectum - other937
DX06260Inj - gi tract - foreign body936, 938
DX06267Nausea, vomiting78701 - 78703
DX06276Anal and rectal conditions5646, 7876, 78762 - 78763
DX06281Diverticulitis, colitis5583 - 55842, 56211
DX06283Intestinal Malabsorption, Celiac Disease5790 - 5792, 5798 - 5799
DX06285Previous bowel surgery, ostomy statusV441 - V444 , V453 , V535 - V5359, V551 - V554
DX06286Personal history of GI cancerV1000, V1005 - V1006, V1009
DX06287Hx of colon polyps, family Hx of colon cancerV1272, V160, V1851
DX06288Cancer of colon1530 - 1539, 1590, 20910 - 20916
DX06290Cancer of other GI organs; peritoneum1580 - 1589, 1598 - 1599, 2307, 2309
DX06291Cancer of rectum and anus1540 - 1548, 20917, 79670 - 79674, 79676
DX06295Digestive congenital anomalies7515, 7518 - 7519, V1367
DX06297Cancer in situ, Colon2303
DX06298Cancer in situ, Anorectal2304 - 2306
DX06306GI Bleed5693, 5781 - 5789
DX06307Intestinal Obstruction56987
DX06311Vascular Insufficiency of intestine5570 - 5579
DX06312Injury to GI Tract86320, 86329 - 86330, 86339 - 86380, 86389 - 86390, 86399, 86800, 86802 - 86810, 86812 - 8691
DX06324Cancer small bowel20926
DX06326Diverticulosis, Meckel's diverticulum, Angiodyspalsia56200, 56210, 7510
DX06336Diverticulitis with hemorrhage56202, 56212 - 56213
DX06337Toxic Gastroenteritis5582
DX06340GI inflammation from chemotherapy538
DX06341Crohn's Disease5550 - 5559
DX06342Ulcerative Colitis556 - 5563, 5565 - 5569
DX06348Ulceration of Intestine56982
DX06349Angiodysplasia of intestine56984 - 56986
DX06351Pseudopolyposis of colon5564
DX06354Perianal disease5690
DX06356Nonspecific Gastroenteritis5589
DX06363Irritable Bowel and other functional GI disor5640 - 5641, 5645, 5648, 56489 - 5649, 56989 - 5699
DX06364Heartburn7871
DX06365Abdominal pain7890 - 78901, 78903, 78905, 78907 - 78909, 7899
DX06366Abdominal mass7893 - 78931, 78933, 78935 - 78939
DX06367Abdominal tenderness78960 - 78961, 78963 - 78969
DX06368Benign Carcinoid Tumor of the GI tract2113 - 2114
DX1092Inj - adrenal86801, 86811
DX1583Congenital GI Problems in NB7511 - 7514
DX16242Blood - other anemia2850
DX16293Iron deficiency and other anemias2800 - 2819, 2858 - 2859
DX16295Acute post-hemorrhagic anemia2851
DX1767Cancer; other and unspecified primary1763, 1765 - 1769, 1948 - 1949, 1952 - 1953, 1958, 1991, 20230, 20233, 20236, 20238, 20250, 20253, 20256, 20258 - 20260, 20263, 20266, 20268, 20920, 20927 - 20930, 20970, 20979, V1089 - V1091, V711
DX1768Secondary malignancies1962, 1966 - 1969, 1975 - 1978, 19889, 20971 - 20972, 20974, 78951
DX1772Neoplasms of unspecified nature or uncertain behavior2348 - 2349, 2352, 2354 - 2355, 2374, 2377 - 2379, 2388 - 2390, 2398, 23989 - 2399
DX1773Disseminated Metastatic Cancer1990
DX1963Anxiety Disorders29384
DX2104NS - acute pain - post op33818
DX2159Toxic Effects of Radiation5581
DX2340Prvn - pre-op examV7281, V7283 - V7284
DX2350Othr - post-surgical states necV4589

 

Table B: ICD-10 Relevant Typical Diagnosis Codes:

Group IDGroup NameICD-10-CM (DX)
DXX05345Orthostatic Hypotension / DizzinessI951, R42
DXX0608ID - other viral - nec / nosR1111
DXX06162GI - diarrheaR197
DXX06173GI - peritoneal ds - nec / nosK668 - K669
DXX06187GI - hemorrhoids - internalK640 - K643
DXX06189GI - hemorrhoids - nosK645 - K649
DXX06190GI - hemorrhoids - residual tagsK644
DXX06204GI - constipationR150
DXX06206GI - abdominal painR1012, R1032
DXX06207GI - flatulence / gas painR140 - R143
DXX06208GI - symptoms - nec / nosR194, R198
DXX06213GI - abnormal fecesR195
DXX06214GI - abdominal tendernessR10812, R10822
DXX06216GI - abdominal massR1902, R1904
DXX06218GI - abnormal abdominal imaging studyR935
DXX06219GI - abnormal gi imaging studyR933
DXX06221GI - personal hx of GI diseaseZ8719
DXX06256Inj - anus / rectum - otherT185XXA
DXX06260Inj - gi tract - foreign bodyT183XXA, T184XXA, T188XXA, T189XXA
DXX06267Nausea, vomitingR110, R1110, R1112, R112
DXX06276Anal and rectal conditionsK594, R151 - R152
DXX06277Irritable Bowel and other functional GI disorK580 - K589, K5900 - K5902, K591, K598 - K599, K634, K6389 - K639, K9289 - K929
DXX06281Diverticulitis, colitisK5282, K5732, K5752, K5792
DXX06283Intestinal Malabsorption, Celiac DiseaseK900 - K902, K904, K9089 - K909
DXX06285Previous bowel surgery, ostomy statusZ431 - Z434, Z4651 - Z4659, Z931 - Z934, Z980
DXX06286Personal history of GI cancerZ8500, Z85038, Z85048, Z85068 - Z8509
DXX06287Hx of colon polyps, family Hx of colon cancerZ800, Z8371, Z86010
DXX06288Cancer of colonC180 - C189, C260, C7A020 - C7A025, C7A029
DXX06290Cancer of other GI organs; peritoneumC269, C451, C480 - C488, D0140 - D0149, D017 - D019
DXX06291Cancer of rectum and anusC19 - C20, C210 - C218, C7A026, R85610 - R85614, R85619
DXX06295Digestive congenital anomaliesQ434 - Q439, Q458 - Q459, Z87738
DXX06297Cancer in situ, ColonD010
DXX06298Cancer in situ, AnorectalD011 - D013
DXX063Not Named, Requires UpdateK5711, K5731, K5751, K5791
DXX06306GI BleedK625, K921 - K922
DXX06307Intestinal ObstructionR1113
DXX06311Vascular Insufficiency of intestineK550 - K551, K558 - K559
DXX06312Injury to GI TractS36122A, S36123A, S36128A, S36129A, S3613XA
DXX06324Cancer small bowelC7A095
DXX06326Diverticulosis, Meckel's diverticulum, AngiodyspalsiaK5710, K5730, K5750, K5790, Q430
DXX06335Retroperitoneal AbscessK689
DXX06336Diverticulitis with hemorrhageK5721, K5733, K5741, K5753, K5781, K5793
DXX06337Toxic GastroenteritisK521
DXX06340GI inflammation from chemotherapyK9281
DXX06341Crohn's DiseaseK5000, K5010, K5080, K5090
DXX06342Ulcerative ColitisK5100, K5120, K5130, K5150, K5180, K5190
DXX06348Ulceration of IntestineK633
DXX06349Angiodysplasia of intestineK5520 - K5521, K6381
DXX06351Pseudopolyposis of colonK5140, K51411, K51418 - K51419
DXX06353Perforation, Peritonitis, Abd AbscessR188
DXX06354Perianal diseaseK620 - K621
DXX06356Nonspecific GastroenteritisK529
DXX06364HeartburnR12
DXX06365Abdominal painR100, R1010 - R1011, R102, R1030 - R1031, R1033, R1084 - R109
DXX06366Abdominal massR1900 - R1901, R1903, R1905 - R1909
DXX06367Abdominal tendernessR10811, R10813 - R10819, R10821, R10823 - R10829
DXX06368Benign Carcinoid Tumor of the GI tractD120 - D129, K635
DXX06369Esophageal Reflux and Other EsophagitisK50012, K50112, K50812, K50912
DXX06370Crohn's Disease w FistulaK50013, K50113, K50813, K50913
DXX06371Crohn's Disease w AbscessK50014, K50114, K50814, K50914
DXX06372Ulc Colitis w ObstructionK51012, K51212, K51312, K51412, K51512, K51812, K51912
DXX06373Ulc Colitis w FistulaK51013, K51213, K51313, K51413, K51513, K51813, K51913
DXX06374Ulc Colitis w AbscessK51014, K51214, K51314, K51414, K51514, K51814, K51914
DXX06375Allergic, Dietetic, Eosinophilic GastroenteritisK522, K5281, K5289
DXX06376Diverticulitis w Perf, AbscessK5720, K5740, K5780
DXX06381Ulcerative colitis w rectal bleedingK51011, K51211, K51311, K51511, K51811, K51911
DXX06382Ulcerative colitis w other complicationsK51018 - K51019, K51218 - K51219, K51318 - K51319, K51518 - K51519, K51818 - K51819, K51918 - K51919
DXX06383Crohn's disease w rectal bleedingK50011, K50111, K50811, K50911
DXX06384Crohn's disease w other complicationsK50018 - K50019, K50118 - K50119, K50818 - K50819, K50918 - K50919
DXX1092Inj - adrenalS37812A, S37813A, S37818A, S37819A
DXX1583Congenital GI Problems in NBQ420 - Q429, Q431 - Q433
DXX1605Neoplsm - mast cell tumor - lymph nodes - head / face / neckC962
DXX1614Neoplsm - histiocytosis - lymph nodes - head / face / neckC960, C96A
DXX16242Blood - other anemiaD640 - D643
DXX16293Iron deficiency and other anemiasD500 - D509, D510 - D519, D520 - D529, D530 - D539, D644, D6489 - D649
DXX16295Acute post-hemorrhagic anemiaD62
DXX1767Cancer; other and unspecified primaryC457 - C459, C463 - C464, C467 - C469, C758 - C759, C762 - C763, C768, C7A00, C7A096 - C7A8, C7B00, C7B09, C7B8, C801, Z85020, Z85030, Z85040, Z85060, Z85110, Z85230, Z85520, Z85821, Z8589 - Z859
DXX1768Secondary malignanciesC772, C775 - C779, C785 - C786, C7880 - C7889, C7989 - C799, C7B01, C7B04, R180
DXX1772Neoplasms of unspecified nature or uncertain behaviorD093 - D099, D372 - D375, D378 - D379, D438 - D439, D440, D442, D449, D483 - D484, D487 - D489, D490, D4989 - D499, Q8500 - Q8509
DXX1773Disseminated Metastatic CancerC800
DXX1963Anxiety DisordersF064
DXX2104NS - acute pain - post opG8918
DXX2159Toxic Effects of RadiationK520
DXX2340Prvn - pre-op examZ01810, Z01812 - Z01818
DXX2350Othr - post-surgical states necZ9621 - Z9622, Z974, Z978, Z983, Z9862
DXX2370Fever & ChillsR5081, R509, R6883
DXX2385Personal history of cancerZ85831
DXX2387Post-surgical statesZ9889

 

Diagnosis Codes which will be used in combination with Procedure codes to identify relevant typical services.

Table C: ICD-9 Relevant Potentially Avoidable Complication Codes:

Group IDGroup NameICD-9-CM (DX)
DX01390Coma, persistent vegetative state3481, 3484 - 3485, 78001, 78003
DX01391Meningitis / Encephalitis3237 - 32372
DX01392Delirium, Encephalopathy7800
DX01395Other cerebral complications99701 - 99702
DX04126other lung complications5110 - 5118, 51189, 5121, 9973, 99739
DX04130Aspiration Pneumonia5070 - 5078, 99732
DX04131legionnaire's disease48284
DX04138Viral Pneumonia0521, 4800, 4802, 4808 - 4809
DX04142Respiratory Failure5187 - 51884, 7991
DX04154Respiratory Insufficiency78603 - 78604, 78609, 7990 - 79902, E8763 - E8764, V4612 - V462
DX04160Tracheostomy Complications5190
DX04164Chronic Fungal and Other Pneumonias0730, 11505, 11515, 11595, 483, 4846 - 4848
DX04170Ventilator Associated Pnuemonia99731
DX04172Gram Negative Pneumonia48282 - 48283
DX04173MRSA Pneumonia48242
DX04174Other Staph Pneumonia4824 - 48241, 48249
DX04176Resp Failure following trauma / surgery5185
DX04177Ventilator DependenceV461 - V4611
DX04187Other lung problems5119, 5180
DX04188Other Bacterial Pneumonia4828, 48289 - 4829
DX04189Debilitating Viral Pneumonia48881
DX04190Influenza with Pneumonia4870
DX05272dic, coagulation, hemorrhagic disorders2866, 2874, 28984
DX05274transfusion, infusion related complications27661, 28741, 78066, 99934 - 99941, 99949 - 99951, 99959 - 9996, 9997 - 99980, 99982 - 99989, E8701, E8703, E8708 - E8709, E8711, E8713, E8721, E8723, E8730 - E8731, E8735 - E8739, E8741, E8750 - E8761
DX05275phlebitis, deep vein thrombosis (dvt)4510 - 45181, 45189 - 4519, 4531, 45340 - 4536, 4538, 45389 - 4539, 4591 - 45919, 9972
DX05281STEMI 41001, 41011, 41021, 41031, 41041, 41051, 41061, 41081, 41091
DX05289Subendocardial infarct41071
DX05297Hypotension / Syncope4582, 45829 - 4589, 7802
DX05298Fluid Electrolyte Acid Base Problems2760 - 2766, 27669 - 2769
DX05299Shock / Cardiac Arrest42741 - 4275, 78550 - 78551, 78559, 9950, 9954, 9971, 9980 - 99809
DX05303Acute CHF / pulm edema42821, 42823, 42831, 42833, 42841, 42843, 514 , 5184 , 78602
DX05308Pulmonary Embolism4151 - 41519, 4162
DX05309IVC & other intra-abd venous thrombosis452 - 4530, 4532 - 4533
DX05311Other Phlebitis, Lymphangitis, varices45182 - 45184, 45379, 45381 - 45384
DX05320Atrial Flutter / Fibrillation42731 - 42732
DX05335Sinus Node Dysfunction42789
DX05336Supraventricular Tachyarrhythmias4270
DX05339Ventricular Arrhythmias4271
DX05340Other cardiac arrhythmias4272, 4278, 4279, 7850
DX05342Acute cor pulmonale4150
DX06267Nausea, vomiting78704
DX06272Splenic Hematoma / Rupture86500 - 86509
DX06274Intestinal infection00800 - 00809, 00841 - 00842, 00846 - 00849, 00867 - 00869
DX06275Abdominal hernia5511 - 55129, 5518 - 5519, 5521 - 55229, 5528 - 5529, 5531 - 55329, 5538 - 5539
DX06276Anal and rectal conditions78760
DX06301Marginal Ulcer53400 - 53491
DX06305C-Difficile Infection00845
DX06306GI Bleed53082, 53501, 53511, 53521, 53541, 53551, 53561, 53571, 5780
DX06307Intestinal Obstruction5372 - 5373, 5600 - 5602 , 56081 - 5609
DX06314Digestive system complications5647, 56481, 99749
DX06315Fistula GI tract56981, 5961, 6191
DX06317Acute esophagitis, acute gastritis, duodenitis53012, 5350 - 53500, 5354 - 53540, 5355 - 53550, 5356 - 53560
DX06335Retroperitoneal Abscess56731 - 56739
DX06338Complications of colostomy, enterostomy56960 - 56961, 56969
DX06352Hemoperitoneum56881
DX06353Perforation, Peritonitis, Abd Abscess5670 - 56729, 5678, 56782 - 5679, 56882, 5695, 56983, 6145, 7894 - 78949
DX07110Hepatorenal Syndrome5724
DX09187wound infections04042, 9985 - 9986
DX09190Wound Dehiscence9983, 99831 - 99833
DX09191Decubitus Ulcer7070 - 70709, 70720 - 70722, 70725
DX09192Dermatitis, Urticaria99521
DX09194Chronic Skin Ulcer70710 - 70719
DX10110Severe Protein Calorie Malnutrition260 - 262, 7994
DX1030Diabetes, poor control24901, 24930 - 24931, 24941, 24951, 24961, 24971, 24981, 24991, 25002 - 25003, 25030 - 25033, 25042 - 25043, 25052 - 25053, 25062 - 25063, 25072 - 25073, 25082 - 25083, 25092 - 25093, 2511 - 2512
DX11137rhabdomyolysis72888
DX11142Acute Renal Failure5845 - 5849, 586, 7885
DX11143Urinary Tract Infection59000 - 5909, 5950 - 5954, 59589 - 5959, 5970 - 59801, 7881
DX11145Urinary Complications9975
DX11147Complication of genitourinary device99631, 99665, 99676
DX13112Fistula of Female Urogenital Tract6190, 6192 - 6199
DX16296Hemorrhage4590, 79001
DX1846Opportunistic Infections11284, 118
DX1849Other bacterial infections0400, 04089 - 04111, 0412 - 0413, 0415 - 04189, 449, 79539
DX1850MRSA, Drug Resistant Infections04112, V090 - V0991
DX1851Sepsis0031, 0362, 0380 - 03811, 03819 - 0389, 0545, 99591
DX1852Severe Sepsis03812, 04082, 78552, 99592, 99594
DX1853Bacteremia, SIRS, no organ dysfunction7907, 99590, 99593
DX1855E. Coli Infection0414
DX2011Substance-induced disorders96509
DX2164Accidental FallsE8809, E8842 - E8849, E888 - E8889
DX2169Poisoning by Psychostimulants9773, 9779
DX2171Adverse effects of drugs3393, 52802, 9952 - 99520, 99522 - 99523, 99527 - 9953, E9300 - E9310, E9319 - E9321, E9326 - E9349, E9352 - E9447, E9451 - E9479, E9499
DX2172Overdose, Poisonings9090, 9095, 9600 - 9649, 9651 - 9695, 9698 - 9708, 9709 - 9772, 9774 - 9778, E8502 - E8589, E8690, E8698 - E8699, E972, E9800 - E9802, E9804 - E9805, E9828 - E9829
DX2360Complication of Implanted device, graft99652, 99655, 99660, 99669, 99679
DX2361complications of surgical procedures5643 - 5644, 5696, 56962, 56971 - 56979, 5793, 78062, 99524, 99586, 9974, 99771 - 9979, 9981 - 9982, 9988 - 99881, 99883, 9989, E8700, E8704, E8707, E8710, E8714 - E8715, E8717 - E8720, E8724 - E8725, E8728 - E8729, E8740, E8743 - E8744, E8748 - E8749, E8762, E8765 - E8766, E8781, E8783, E8788 - E8789, E8795, E8798 - E8799
DX2362complications of medical care56030, 56032 - 56039, 78065, 9093, 99791 - 99799, 99889, 9990, 9992 - 9993, 9999, E8733, E8768 - E8769, E8794, E8796 - E8797
DX2366Postop adhesions5680
DX2370Fever & Chills7806 - 78061, 78064
DX9909HAC: Foreign Body Retained After Surgery9984, 9987
DX9910HAC 02: Air Embolism9991
DX9911HAC: Blood Incompatibility99960 - 99969
DX9912HAC 04: Stage III and IV Pressure Ulcers70723 - 70724
DX9914HAC 09: Manifestations of Poor Glycemic Control24910 - 24921, 25010 - 25023, 2510
DX9915HAC: Catheter Associated UTIs99664
DX9916HAC: Infection due to central venous catheter99931

Table C: ICD-10 Relevant Potentially Avoidable Complication Codes:

Group IDGroup NameICD-10-CM (DX)
DXX01390Coma, persistent vegetative stateE035, G931, G935 - G936, R4020, R402110 - R402114, R402120 - R402124, R402210 - R402214, R402220 - R402224, R402310 - R402314, R402320 - R402324, R402340 - R402344, R403
DXX01392Delirium, EncephalopathyG92
DXX01395Other cerebral complicationsG972, I97810 - I97811, I97820 - I97821
DXX01403Complication of nervous system deviceT85191A, T85199A
DXX02147Complications after eye surgeryH59313, H59811 - H5989
DXX04126other lung complicationsJ90, J940 - J942, J949, J954 - J955, J95811, J95859 - J9588, R091
DXX04127empyema, lung abscessJ869
DXX04130Aspiration PneumoniaJ690, J698
DXX04138Viral PneumoniaB012, J120, J122 - J123, J1289 - J129
DXX04142Respiratory FailureJ80, J9584, J9600 - J9602, J9610 - J9612, J9620 - J9622, J9690 - J9692, R092, J9600
DXX04154Respiratory InsufficiencyR063, R0681, R0901 - R0902, Y653 - Y654, Z9912, Z9981
DXX04164Chronic Fungal and Other PneumoniasA70, B390 - B392, B440, B7781, J17
DXX04170Ventilator Associated PnuemoniaJ95851
DXX04172Gram Negative PneumoniaJ155 - J156
DXX04173MRSA PneumoniaJ15212
DXX04174Other Staph PneumoniaJ1520, J15211, J1529
DXX04177Ventilator DependenceZ9911
DXX04187Other lung problemsJ182, J918, J9811 - J9819
DXX04188Other Bacterial PneumoniaJ158 - J159
DXX04189Debilitating Viral PneumoniaJ09X1
DXX04190Influenza with PneumoniaJ1000 - J1008, J1100 - J1108, J1000, J1100
DXX05272dic, coagulation, hemorrhagic disordersD65, D7582
DXX05274transfusion, infusion related complicationsD6951, E8771, R5084, T8022XA, T8029XA, T8040XA, T80410A, T80411A, T80419A, T8049XA, T8051XA, T8059XA, T8061XA, T8069XA, T80818A, T8089XA, T8090XA, T80910A, T80911A, T80919A, T8092XA, T80A0XA, T80A10A, T80A11A, T80A19A, T80A9XA, T880XXA, Y621, Y623, Y630 - Y631, Y635 - Y639, Y640 - Y649, Y650 - Y651
DXX05275phlebitis, deep vein thrombosis (dvt)I8000 - I8003, I8010 - I8013, I80201 - I80209, I80211 - I80219, I80221 - I80229, I80231 - I80239, I80291 - I803, I809, I821, I82401 - I82409, I82411 - I82419, I82421 - I82429, I82431 - I82439, I82441 - I82449, I82491 - I82499, I824Y1 - I824Y9, I824Z1 - I824Z9, I82501 - I82509, I82511 - I82519, I82521 - I82529, I82531 - I82539, I82541 - I82549, I82591 - I82599, I825Y1 - I825Y9, I825Z1 - I825Z9, I82811 - I82819, I82890, I8290, I87001 - I87009, I87011 - I87019, I87021 - I87029, I87031 - I87039, I87091 - I87099
DXX05281STEMI I2101 - I2109, I2111 - I2119, I2121 - I213
DXX05289Subendocardial infarctI214
DXX05291Recent AMII220 - I229
DXX05297Hypotension / SyncopeI952, I9581, I959, R55
DXX05298Fluid Electrolyte Acid Base ProblemsE860 - E869, E870 - E876, E8770, E8779 - E878
DXX05299Shock / Cardiac ArrestI462 - I469, I4901 - I4902, I97120 - I97121, I97710 - I97711, I97790 - I97791, I9788, R570 - R579, T782XXA, T8110XA, T8111XA, T8112XA, T8119XA, T882XXA, T886XXA
DXX05303Acute CHF / pulm edemaI5021, I5023, I5031, I5033, I5041, I5043, J810 - J811, R0601
DXX05308Pulmonary EmbolismI2690 - I2699, I2782
DXX05309IVC & other intra-abd venous thrombosisI81, I820, I82220 - I82221, I823
DXX05311Other Phlebitis, Lymphangitis, varicesI808, I82601 - I82609, I82611 - I82619, I82621 - I82629, I82A11 - I82A19
DXX05317Complications after heart proceduresI97110 - I97111, I97130, I97190
DXX05320Atrial Flutter / FibrillationI480 - I484, I4891 - I4892
DXX05335Sinus Node DysfunctionI498, R001
DXX05336Supraventricular TachyarrhythmiasI471, I492
DXX05339Ventricular ArrhythmiasI470, I472
DXX05340Other cardiac arrhythmiasI479, I499, R000
DXX05342Acute cor pulmonaleI2601 - I2609
DXX05355PVD w UlcerI70231 - I70239, I70241 - I70249, I70331 - I70339, I70341 - I70349, I70431 - I70439, I70441 - I70449, I70531 - I70539, I70541 - I70549, I70631 - I70639, I70641 - I70649, I70731 - I70739, I70741 - I70749
DXX06274Intestinal infectionA040 - A044, A048, A0839
DXX06276Anal and rectal conditionsR159
DXX06301Marginal UlcerK280 - K287
DXX06305C-Difficile InfectionA047
DXX06306GI BleedK2901, K2931, K2961, K2971, K2981, K2991, K920
DXX06307Intestinal ObstructionK315, K560 - K562, K565, K5660 - K567
DXX06314Digestive system complicationsK592 - K593, K913, K9181 - K9183
DXX06315Fistula GI tractN321, N822 - N824
DXX06317Acute esophagitis, acute gastritis, duodenitisK2900, K2970, K2980, K2990
DXX06335Retroperitoneal AbscessK6812 - K6819
DXX06338Complications of colostomy, enterostomyK9400 - K9402, K9409, K9410 - K9412, K9419
DXX06352HemoperitoneumK661
DXX06353Perforation, Peritonitis, Abd AbscessK630 - K631, K650 - K651, K658 - K659, N733, R1930 - R1937
DXX06369Esophageal Reflux and Other EsophagitisK209
DXX06379Abdominal Hernia w Gangrene/ObstructionK420 - K421, K430 - K431, K433 - K434, K436 - K437, K450 - K451, K460
DXX06380Abdominal Hernia w/out Gangrene/ObstructionK429, K432, K435, K439, K458, K461 - K469
DXX07110Hepatorenal SyndromeK767
DXX081072Pyogenic ArthritisM0000, M00011 - M00019, M00051 - M00059, M00061 - M00069, M0008 - M0009, M0010, M00111 - M00119, M00151 - M00159, M00161 - M00169, M0018 - M0019, M0020, M00211 - M00219, M00251 - M00259, M00261 - M00269, M0028 - M0029, M0080, M00811 - M00819, M00851 - M00859, M00861 - M00869, M0088 - M0089
DXX09187wound infectionsA4852, K6811, T814XXA, T8183XA
DXX09190Wound DehiscenceT8131XA, T8132XA, T8133XA
DXX09191Decubitus UlcerL89000 - L89002, L89009, L89010 - L89012, L89019, L89020 - L89022, L89029, L89100 - L89102, L89109, L89110 - L89112, L89119, L89120 - L89122, L89129, L89130 - L89132, L89139, L89140 - L89142, L89149, L89150 - L89152, L89159, L89200 - L89202, L89209, L89210 - L89212, L89219, L89220 - L89222, L89229, L89300 - L89302, L89309, L89310 - L89312, L89319, L89320 - L89322, L89329, L8940 - L8942, L8945, L89500 - L89502, L89509, L89510 - L89512, L89519, L89520 - L89522, L89529, L89600 - L89602, L89609, L89610 - L89612, L89619, L89620 - L89622, L89629, L89810 - L89812, L89819, L89890 - L89892, L89899, L8990 - L8992, L8995
DXX09192Dermatitis, UrticariaT7841XA
DXX09194Chronic Skin UlcerL97101 - L97109, L97111 - L97119, L97121 - L97129, L97201 - L97209, L97211 - L97219, L97221 - L97229, L97301 - L97309, L97311 - L97319, L97321 - L97329, L97401 - L97409, L97411 - L97419, L97421 - L97429, L97501 - L97509, L97511 - L97519, L97521 - L97529, L97801 - L97809, L97811 - L97819, L97821 - L97829, L97901 - L97909, L97911 - L97919, L97921 - L97929
DXX10102diabetes mellitus with ophthalmic manifestationsE11311
DXX10111Diabetes, other manifestationE0965
DXX1030Diabetes, poor controlE0811, E08641 - E0865, E0911, E09641, E1011, E10641, E1065, E11641, E1165, E1311, E13641, E160 - E162, E0911, E1011
DXX11137rhabdomyolysisM6282
DXX11142Acute Renal FailureN170 - N179, N19, R34
DXX11143Urinary Tract InfectionA5601, N10, N110 - N111, N136, N151, N2884 - N2886, N3000 - N3001, N3010 - N3011, N3020 - N3021, N3030 - N3031, N3080 - N3081, N3090 - N3091, N340 - N342, N35111 - N3512, R300, R309
DXX11145Urinary ComplicationsN990, N99520 - N99528, N99530 - N99538, N9981, N9989
DXX11147Complication of genitourinary deviceT8381XA, T8382XA, T8383XA, T8384XA, T8385XA, T8386XA, T8389XA, T839XXA
DXX13112Fistula of Female Urogenital TractN820 - N821, N825 - N829
DXX16296HemorrhageR58, R710
DXX1846Opportunistic InfectionsB3781, B395 - B399, B488
DXX1849Other bacterial infectionsA480, A482, A484, A488, A4901, A491 - A498, B950 - B955, B9561, B958, B960 - B961, B963 - B967, B9681 - B9689, I76, J200 - J202, M00021 - M00029, M00031 - M00039, M00041 - M00049, M00071 - M00079, M00121 - M00129, M00131 - M00139, M00141 - M00149, M00171 - M00179, M00221 - M00229, M00231 - M00239, M00241 - M00249, M00271 - M00279, M00821 - M00829, M00831 - M00839, M00841 - M00849, M00871 - M00879, R899
DXX1850MRSA, Drug Resistant InfectionsA4902, B9562, Z1610 - Z1619, Z1620 - Z1629, Z1630 - Z1633, Z16341 - Z1639
DXX1851SepsisA021, A227, A267, A327, A392 - A394, A400 - A409, A4101 - A414, A4150 - A4159, A4181 - A419, A427, A5486, B007, B377
DXX1852Severe SepsisA483, R6511, R6520 - R6521
DXX1853Bacteremia, SIRS, no organ dysfunctionR6510, R7881
DXX1948Suicide or Self-inflicted InjuryT400X5A, T403X5A, T410X2A, T411X2A, T41202A, T41292A, T413X2A, T4142XA, T415X2A, T420X2A, T421X2A, T422X2A, T423X2A, T424X2A, T425X2A, T426X2A, T4272XA, T428X2A, T43012A, T43022A, T431X2A, T43202A, T43212A, T43222A, T43292A, T433X2A, T434X2A, T43502A, T43592A, T438X2A, T4392XA, T440X2A, T441X2A, T442X2A, T443X2A, T444X2A, T445X2A, T446X2A, T447X2A, T448X2A, T44902A, T44992A, T450X2A, T451X2A, T452X2A, T453X2A, T454X2A, T45512A, T45522A, T45602A, T45612A, T45622A, T45692A, T457X2A, T458X2A, T4592XA, T460X2A, T461X2A, T462X2A, T463X2A, T464X2A, T465X2A, T466X2A, T467X2A, T468X2A, T46902A, T46992A, T470X2A, T471X2A, T472X2A, T473X2A, T474X2A, T475X2A, T476X2A, T477X2A, T478X2A, T4792XA, T480X2A, T481X2A, T48202A, T48292A, T483X2A, T484X2A, T485X2A, T486X2A, T48902A, T48992A, T490X2A, T491X2A, T492X2A, T493X2A, T494X2A, T495X2A, T496X2A, T497X2A, T498X2A, T4992XA, T500X2A, T501X2A, T502X2A, T503X2A, T504X2A, T505X2A, T506X2A, T507X2A, T508X2A, T50902A, T50Z12A
DXX2156adverse effects of drugs, correct useG4440 - G4441, K1232, R502, T360X5A, T361X5A, T362X5A, T363X5A, T364X5A, T365X5A, T366X5A, T367X5A, T368X5A, T3695XA, T370X5A, T371X5A, T372X5A, T373X5A, T374X5A, T375X5A, T378X5A, T3795XA, T380X5A, T381X5A, T382X5A, T383X5A, T384X5A, T385X5A, T386X5A, T387X5A, T38805A, T38815A, T38895A, T38905A, T38995A, T39015A, T39095A, T391X5A, T392X5A, T39315A, T39395A, T394X5A, T398X5A, T3995XA, T40605A, T40695A, T407X5A, T40905A, T40995A, T410X5A, T411X5A, T41205A, T41295A, T413X5A, T4145XA, T415X5A, T420X5A, T421X5A, T422X5A, T423X5A, T424X5A, T425X5A, T426X5A, T4275XA, T428X5A, T43015A, T43025A, T431X5A, T43205A, T43215A, T43225A, T43295A, T433X5A, T434X5A, T43505A, T43595A, T43605A, T43615A, T43625A, T43635A, T43695A, T438X5A, T4395XA, T440X5A, T441X5A, T442X5A, T443X5A, T444X5A, T445X5A, T446X5A, T447X5A, T448X5A, T44905A, T44995A, T450X5A, T451X5A, T452X5A, T453X5A, T454X5A, T45515A, T45525A, T45605A, T45615A, T45625A, T45695A, T457X5A, T458X5A, T4595XA, T460X5A, T461X5A, T462X5A, T463X5A, T464X5A, T465X5A, T466X5A, T467X5A, T468X5A, T46905A, T46995A, T470X5A, T471X5A, T472X5A, T473X5A, T474X5A, T475X5A, T476X5A, T477X5A, T478X5A, T4795XA, T480X5A, T481X5A, T48205A, T48295A, T483X5A, T484X5A, T485X5A, T486X5A, T48905A, T48995A, T490X5A, T491X5A, T492X5A, T493X5A, T494X5A, T495X5A, T496X5A, T497X5A, T498X5A, T4995XA, T500X5A, T501X5A, T502X5A, T503X5A, T504X5A, T505X5A, T506X5A, T507X5A, T508X5A, T50905A, T50995A, T50A15A, T50A25A, T50A95A, T50B15A, T50B95A, T50Z15A, T50Z95A, T8859XA
DXX2164Accidental FallsV00811A - V00811D, V00812A - V00812D, V00818A - V00818D, V00831A - V00831D, W050XXA - W050XXD, W051XXA - W051XXD, W052XXA - W052XXD, W06XXXA - W06XXXD, W07XXXA - W07XXXD, W08XXXA - W08XXXD, W102XXA - W102XXD, W108XXA - W108XXD, W109XXA - W109XXD, W1811XA - W1811XD, W1812XA - W1812XD
DXX2171Adverse effects of drugsT402X5A, T404X5A
DXX2360Complication of Implanted device, graftT85613A, T85623A, T85693A, T8572XA, T8579XA, T86820 - T86829, T86842 - T86849
DXX2361complications of surgical proceduresD7801 - D7802, D7811 - D7812, D7821 - D7822, E3601 - E3602, E3611 - E3612, E89810 - E89811, G9731 - G9732, G9748 - G9749, G9751 - G9752, G9781 - G9782, H9521 - H9522, H9531 - H9532, H9541 - H9542, I97131, I97191, I97410 - I9742, I9751 - I9752, I97610 - I9762, I9789, J9561 - J9562, J9571 - J9572, J95830 - J95831, J9589, K910, K912, K9161 - K9162, K9171 - K9172, K91840 - K91841, K91850 - K91858, K9189, K9403, K9413, L7601 - L7602, L7611 - L7612, L7621 - L7622, M96810 - M96811, M96820 - M96821, M96830 - M96831, N9961 - N9962, N9971 - N9972, N99820 - N99821, R5082, T81710A, T81711A, T81718A, T81719A, T8172XA, T8182XA, T8189XA, T819XXA, T883XXA, T8852XA, T888XXA, Y620, Y624, Y626 - Y629, Y652, Y6551 - Y6552, Y700 - Y708, Y710 - Y718, Y720 - Y728, Y730 - Y738, Y740 - Y748, Y750 - Y758, Y760 - Y768, Y770 - Y778, Y780 - Y788, Y790 - Y798, Y800 - Y808, Y810 - Y818, Y828 - Y829, Y848
DXX2362complications of medical careD7881 - D7889, E368, E8989, H95811 - H9589, I973, J95850, L7681 - L7682, M9689, R680, T800XXS, T801XXA, T801XXS, T80211S, T80212S, T80218S, T80219S, T8022XS, T8029XS, T8030XS, T80310S, T80311S, T80319S, T8039XS, T8040XS, T80410S, T80411S, T80419S, T8049XS, T8051XS, T8052XS, T8059XS, T8061XS, T8062XS, T8069XS, T80810S, T80818S, T8089XS, T8090XS, T80910S, T80911S, T80919S, T8092XS, T80A0XS, T80A10S, T80A11S, T80A19S, T80A9XS, T8110XS, T8111XS, T8112XS, T8119XS, T8130XS, T8131XS, T8132XS, T8133XS, T814XXS, T81500S, T81501S, T81502S, T81503S, T81504S, T81505S, T81506S, T81507S, T81508S, T81509S, T81510S, T81511S, T81512S, T81513S, T81514S, T81515S, T81516S, T81517S, T81518S, T81519S, T81520S, T81521S, T81522S, T81523S, T81524S, T81525S, T81526S, T81527S, T81528S, T81529S, T81530S, T81531S, T81532S, T81533S, T81534S, T81535S, T81536S, T81537S, T81538S, T81539S, T81590S, T81591S, T81592S, T81593S, T81594S, T81595S, T81596S, T81597S, T81598S, T81599S, T8160XS, T8161XS, T8169XS, T81710S, T81711S, T81718S, T81719S, T8172XS, T8181XA, T8181XS, T8182XS, T8183XS, T8189XS, T819XXS, T8201XS, T8202XS, T8203XS, T8209XS, T82110S, T82111S, T82118S, T82119S, T82120S, T82121S, T82128S, T82129S, T82190S, T82191S, T82198S, T82199S, T82211S, T82212S, T82213S, T82218S, T82221S, T82222S, T82223S, T82228S, T82310S, T82311S, T82312S, T82318S, T82319S, T82320S, T82321S, T82322S, T82328S, T82329S, T82330S, T82331S, T82332S, T82338S, T82339S, T82390S, T82391S, T82392S, T82398S, T82399S, T8241XS, T8242XS, T8243XS, T8249XS, T82510S, T82511S, T82513S, T82514S, T82515S, T82518S, T82519S, T82520S, T82521S, T82523S, T82524S, T82525S, T82528S, T82529S, T82530S, T82531S, T82533S, T82534S, T82535S, T82538S, T82539S, T82590S, T82591S, T82593S, T82594S, T82595S, T82598S, T82599S, T826XXS, T827XXS, T82817S, T82818S, T82827S, T82828S, T82837S, T82838S, T82847S, T82848S, T82857S, T82858S, T82867S, T82868S, T82897S, T82898S, T829XXS, T83010S, T83018S, T83020S, T83028S, T83030S, T83038S, T83090S, T83098S, T83110S, T83111S, T83112S, T83118S, T83120S, T83121S, T83122S, T83128S, T83190S, T83191S, T83192S, T83198S, T8321XS, T8322XS, T8323XS, T8329XS, T8331XS, T8332XS, T8339XS, T83410S, T83418S, T83420S, T83428S, T83490S, T83498S, T83711S, T83718S, T83721S, T83728S, T8381XS, T8382XS, T8383XS, T8384XS, T8385XS, T8386XS, T8389XS, T839XXS, T84010S, T84011S, T84012S, T84013S, T84018S, T84019S, T84020S, T84021S, T84022S, T84023S, T84028S, T84029S, T84030S, T84031S, T84032S, T84033S, T84038S, T84039S, T84050S, T84051S, T84052S, T84053S, T84058S, T84059S, T84060S, T84061S, T84062S, T84063S, T84068S, T84069S, T84090S, T84091S, T84092S, T84093S, T84098S, T84099S, T84110S, T84111S, T84112S, T84113S, T84114S, T84115S, T84116S, T84117S, T84119S, T84120S, T84121S, T84122S, T84123S, T84124S, T84125S, T84126S, T84127S, T84129S, T84190S, T84191S, T84192S, T84193S, T84194S, T84195S, T84196S, T84197S, T84199S, T84210S, T84213S, T84216S, T84218S, T84220S, T84223S, T84226S, T84228S, T84290S, T84293S, T84296S, T84298S, T84310S, T84318S, T84320S, T84328S, T84390S, T84398S, T84410S, T84418S, T84420S, T84428S, T84490S, T84498S, T8450XS, T8451XS, T8452XS, T8453XS, T8454XS, T8459XS, T8460XS, T84610S, T84611S, T84612S, T84613S, T84614S, T84615S, T84619S, T84620S, T84621S, T84622S, T84623S, T84624S, T84625S, T84629S, T8463XS, T8469XS, T847XXS, T8481XS, T8482XS, T8483XS, T8484XS, T8485XS, T8486XS, T8489XS, T849XXS, T8501XS, T8502XS, T8503XS, T8509XS, T85110S, T85111S, T85112S, T85118S, T85120S, T85121S, T85122S, T85128S, T85190S, T85191S, T85192S, T85199S, T8521XS, T8522XS, T8529XS, T85310S, T85311S, T85318S, T85320S, T85321S, T85328S, T85390S, T85391S, T85398S, T8541XS, T8542XS, T8543XS, T8544XS, T8549XS, T85510S, T85511S, T85518S, T85520S, T85521S, T85528S, T85590S, T85591S, T85598S, T85610S, T85611S, T85612S, T85613S, T85614S, T85618S, T85620S, T85621S, T85622S, T85623S, T85624S, T85628S, T85630S, T85631S, T85633S, T85638S, T85690S, T85691S, T85692S, T85693S, T85694S, T85698S, T8571XS, T8572XS, T8579XS, T859XXS, T880XXS, T881XXA, T881XXS, T882XXS, T883XXS, T884XXA, T884XXS, T8851XS, T8852XS, T8859XS, T887XXA, T888XXS, T889XXA, T889XXS, Y633, Y658 - Y69, Y844, Y846 - Y847
DXX2366Postop adhesionsK660, N994
DXX2367Malfunction / Complication of Heart Device, HT82817A, T82818A
DXX9909HAC: Foreign Body Retained After SurgeryT81500A, T81501A, T81502A, T81503A, T81504A, T81505A, T81506A, T81507A, T81508A, T81509A, T81510A, T81511A, T81512A, T81513A, T81514A, T81515A, T81516A, T81517A, T81518A, T81519A, T81520A, T81521A, T81522A, T81523A, T81524A, T81525A, T81526A, T81527A, T81528A, T81529A, T81530A, T81531A, T81532A, T81533A, T81534A, T81535A, T81536A, T81537A, T81538A, T81539A, T81590A, T81591A, T81592A, T81593A, T81594A, T81595A, T81596A, T81597A, T81598A, T81599A, T8160XA, T8161XA, T8169XA
DXX9910HAC 02: Air EmbolismT800XXA
DXX9911HAC: Blood IncompatibilityT8030XA, T80310A, T80311A, T80319A, T8039XA
DXX9912HAC 04: Stage III and IV Pressure UlcersL89003 - L89004, L89013 - L89014, L89023 - L89024, L89103 - L89104, L89113 - L89114, L89123 - L89124, L89133 - L89134, L89143 - L89144, L89153 - L89154, L89203 - L89204, L89213 - L89214, L89223 - L89224, L89303 - L89304, L89313 - L89314, L89323 - L89324, L8943 - L8944, L89503 - L89504, L89513 - L89514, L89523 - L89524, L89603 - L89604, L89613 - L89614, L89623 - L89624, L89813 - L89814, L89893 - L89894, L8993 - L8994
DXX9914HAC 09: Manifestations of Poor Glycemic ControlE0800 - E0801, E0810, E0900 - E0901, E0910, E1010, E1100 - E1101, E1300 - E1301, E1310, E15, E0900 - E0910, E1010, E1100, E1300 - E1310
DXX9916HAC: Infection due to central venous catheterT80218A, T80219A
XX0000Ungrouped CodesT8351XA, T8351XS, T8359XA, T8359XS, T836XXA, T836XXS, T84040S, T84041S, T84042S, T84043S, T84048S, T84049S, T8581XA, T8581XS, T8582XA, T8582XS, T8583XA, T8583XS, T8584XA, T8584XS, T8585XA, T8585XS, T8586XA, T8586XS, T8589XA, T8589XS

PAC Codes which will be used in combination with Procedure codes to identify relevant PAC services.

Table D: ICD-9 Relevant Procedure Codes

Group IDGroup NameICD-9-PCS (PX)
PX01206Microscopic examination (bacterial smear, culture, toxicology) - 2069052, 9132, 9139, 9192
PX03231Other therapeutic procedures - 2319659
PX06179CT scan abdomen - 1798801
PX06185Upper gastrointestinal X-ray - 1858761 - 8762
PX06186Lower gastrointestinal X-ray - 1868764
PX06194Diagnostic ultrasound of gastrointestinal tract - 1948874
PX06196Diagnostic ultrasound of abdomen or retroperitoneum - 1968876
PX06240Colectomy with proctectomy4595, 4840 - 4841, 4843 - 4849
PX06243Laparoscopic colectomy with proctectomy4842, 4851
PX06244Laparoscopic partial colectomy1731 - 1739
PX06245Laparoscopic total intra-abd colectomy4581
PX06246Partial Colectomy 4571 - 4579, 4590, 4593 - 4594
PX06247Total intra-Abdominal colectomy 458, 4582 - 4583, 4592
PX06248Abdominoperineal Resection485 - 4850, 4852 - 4861
PX06249Rectal Resection4862 - 4869
PX0672Colostomy, temporary and permanent - 0724610 - 4611, 4613 - 4614
PX0673Ileostomy and other enterostomy - 0734620 - 4624
PX0677Proctoscopy and anorectal biopsy - 0774823 - 4824, 4826, 4921 - 4923
PX0681Hemorrhoid procedures - 0814941 - 4949
PX0690Excision, lysis peritoneal adhesions - 0905451 - 5459
PX0692Other bowel diagnostic procedures - 0924511 - 4512, 4515, 4519 - 4522, 4526, 4528 - 4529, 4821 - 4822, 4825, 4829, 4929
PX0693Other non-OR upper GI therapeutic procedures - 0939701 - 9702 , 9751
PX0695Other non-OR lower GI therapeutic procedures - 0954543, 4685 - 4687, 4695 - 4696, 4831 - 4834, 4903, 4931, 9609, 9619, 9622 - 9623, 9626, 9629, 9637 - 9639, 9703 - 9704, 9752 - 9753, 9993
PX0696Other OR lower GI therapeutic procedures - 0964601 - 4604, 4650 - 4664
PX0697Other gastrointestinal diagnostic procedures - 0975423 - 5429
PX0698Other non-OR gastrointestinal therapeutic procedures - 0985496 - 5497, 5499, 9608, 9624, 9628, 9636, 9643 , 9759 , 9782 , 9786
PX0799Other OR gastrointestinal therapeutic procedures - 0995461 - 5464
PX08214Traction, splints, and other wound care - 2149356 - 9357, 9359
PX09169Debridement of wound, infection or burn - 1698622, 8628

Table D: ICD-10 Relevant Procedure Codes

Group IDGroup NameICD-10-PCS (PX)
PXX0219Other therapeutic procedures on eyelids, conjunctiva, cornea - 0190JBL0ZZ, 0JBM0ZZ
PXX03231Other therapeutic procedures - 231069Y3ZZ, 069Y4ZZ, 0HD0XZZ - 0HD1XZZ, 0HD4XZZ - 0HDNXZZ, 0WQFXZZ, 3E0G33Z, 3E0H33Z, 3E0M33Z, 3E0P33Z, 3E1038X, 3E10X8X - 3E10X8Z, 3E1N38X - 3E1N88Z, 3E1U38X - 3E1U38Z, 5A05121
PXX0326Other therapeutic ear procedures - 0260JB10ZZ
PXX0329Oral and Dental Services - 0292W31XYZ
PXX0333Other OR therapeutic procedures on nose, mouth and pharynx - 0330JB40ZZ
PXX04178CT scan chest - 178BW2400Z - BW24ZZZ
PXX0441Other non-OR therapeutic procedures on respiratory system - 0413E0M3SF
PXX0442Other OR therapeutic procedures on respiratory system - 0420DQ80ZZ, 0DQE0ZZ, 0DQW0ZZ - 0DQW4ZZ
PXX05226Other diagnostic radiology and related techniques - 226BD14ZZZ
PXX0561Other OR procedures on vessels other than head and neck - 061069Y0ZZ, 3E033TZ
PXX06179CT scan abdomen - 179B52F00Z - B52FYZZ, B52FZZZ - B52GYZZ, B52GZZZ - B52HYZZ, B52HZZZ, BD2400Z - BD24ZZZ, BF2500Z - BF2CZZZ, BW2000Z - BW20ZZZ, BW2G00Z - BW2GZZZ
PXX06185Upper gastrointestinal X-ray - 185BD11YZZ, BD15YZZ - BD15ZZZ
PXX06186Lower gastrointestinal X-ray - 186BD14YZZ
PXX06194Diagnostic ultrasound of gastrointestinal tract - 194BD41ZZZ - BD4CZZZ, BF40ZZZ - BF4CZZZ
PXX06196Diagnostic ultrasound of abdomen or retroperitoneum - 196BW40ZZZ
PXX06223Enteral and parenteral nutrition - 2233E0G36Z
PXX06240Colectomy with proctectomy0D1A07Q, 0D1A0JQ, 0D1A0KQ, 0D1A0ZQ, 0D1A47Q, 0D1A4JQ, 0D1A4KQ, 0D1A4ZQ, 0D1A87Q, 0D1A8JQ, 0D1A8KQ, 0D1A8ZQ, 0D1B07Q, 0D1B0JQ, 0D1B0KQ, 0D1B0ZQ, 0D1B47Q, 0D1B4JQ, 0D1B4KQ, 0D1B4ZQ, 0D1B87Q, 0D1B8JQ, 0D1B8KQ, 0D1B8ZQ
PXX06243Laparoscopic colectomy with proctectomy0DTP4ZZ
PXX06244Laparoscopic partial colectomy0DBE4ZZ, 0DBF4ZZ, 0DBG4ZZ, 0DBH4ZZ, 0DBK4ZZ, 0DBL4ZZ, 0DBM4ZZ, 0DBN4ZZ, 0DTF4ZZ, 0DTG4ZZ, 0DTH4ZZ, 0DTK4ZZ, 0DTL4ZZ, 0DTM4ZZ, 0DTN4ZZ
PXX06245Laparoscopic total intra-abd colectomy0DTE4ZZ
PXX06246Partial Colectomy 0D1907L, 0D190JL, 0D190KL, 0D190Z9 - 0D190ZL, 0D1947L, 0D194JL, 0D194KL, 0D194Z9 - 0D194ZL, 0D1987L, 0D198JL, 0D198KL, 0D198Z9 - 0D198ZL, 0D1A07H - 0D1A07N, 0D1A0JH - 0D1A0JN, 0D1A0KH - 0D1A0KN, 0D1A0ZA - 0D1A0ZP, 0D1A47H - 0D1A47N, 0D1A4JH - 0D1A4JN, 0D1A4KH - 0D1A4KN, 0D1A4ZA - 0D1A4ZP, 0D1A87H - 0D1A87N, 0D1A8JH - 0D1A8JN, 0D1A8KH - 0D1A8KN, 0D1A8ZA - 0D1A8ZP, 0D1B07H - 0D1B07N, 0D1B0JH - 0D1B0JN, 0D1B0KH - 0D1B0KN, 0D1B0ZB - 0D1B0ZP, 0D1B47H - 0D1B47N, 0D1B4JH - 0D1B4JN, 0D1B4KH - 0D1B4KN, 0D1B4ZB - 0D1B4ZP, 0D1B87H - 0D1B87N, 0D1B8JH - 0D1B8JN, 0D1B8KH - 0D1B8KN, 0D1B8ZB - 0D1B8ZP, 0D1H07H - 0D1H07P, 0D1H0JH - 0D1H0JP, 0D1H0KH - 0D1H0KP, 0D1H0ZH - 0D1H0ZP, 0D1H47H - 0D1H47P, 0D1H4JH - 0D1H4JP, 0D1H4KH - 0D1H4KP, 0D1H4ZH - 0D1H4ZP, 0D1H87H - 0D1H87N, 0D1H8JH - 0D1H8JN, 0D1H8KH - 0D1H8KN, 0D1H8ZH - 0D1H8ZP, 0D1K07K - 0D1K07P, 0D1K0JK - 0D1K0JP, 0D1K0KK - 0D1K0KP, 0D1K0ZK - 0D1K0ZP, 0D1K47K - 0D1K47P, 0D1K4JK - 0D1K4JP, 0D1K4KK - 0D1K4KP, 0D1K4ZK - 0D1K4ZP, 0D1K87K - 0D1K87P, 0D1K8JK - 0D1K8JP, 0D1K8KK - 0D1K8KP, 0D1K8ZK - 0D1K8ZP, 0D1L07L - 0D1L07P, 0D1L0JL - 0D1L0JP, 0D1L0KL - 0D1L0ZP, 0D1L47L - 0D1L47P, 0D1L4JL - 0D1L4JP, 0D1L4KL - 0D1L4ZP, 0D1L87L - 0D1L87P, 0D1L8JL - 0D1L8JP, 0D1L8KL - 0D1L8KP, 0D1L8ZL - 0D1L8ZP, 0D1M07M - 0D1M07P, 0D1M0JM - 0D1M0JP, 0D1M0KM - 0D1M0ZP, 0D1M47M - 0D1M47P, 0D1M4JM - 0D1M4JP, 0D1M4KM - 0D1M4ZP, 0D1M87M - 0D1M87P, 0D1M8JM - 0D1M8JP, 0D1M8KM - 0D1M8KP, 0D1M8ZM - 0D1M8ZP, 0D1N07N - 0D1N07P, 0D1N0JN - 0D1N0JP, 0D1N0KN - 0D1N0KP, 0D1N0ZN - 0D1N0ZP, 0D1N47N - 0D1N47P, 0D1N4JN - 0D1N4JP, 0D1N4KN - 0D1N4KP, 0D1N4ZN - 0D1N4ZP, 0D1N87N - 0D1N87P, 0D1N8JN - 0D1N8JP, 0D1N8KN - 0D1N8KP, 0D1N8ZN - 0D1N8ZP, 0DBE0ZZ, 0DBE3ZZ, 0DBE7ZZ, 0DBF0ZZ, 0DBF3ZZ, 0DBF7ZZ, 0DBG0ZZ, 0DBG3ZZ, 0DBG7ZZ, 0DBH0ZZ, 0DBH3ZZ, 0DBH7ZZ, 0DBK0ZZ, 0DBK3ZZ, 0DBK7ZZ, 0DBL0ZZ, 0DBL3ZZ, 0DBL7ZZ, 0DBM0ZZ, 0DBM3ZZ, 0DBM7ZZ, 0DBN0ZZ, 0DBN3ZZ, 0DBN7ZZ, 0DTF0ZZ, 0DTF7ZZ - 0DTG0ZZ, 0DTG7ZZ - 0DTH0ZZ, 0DTH7ZZ - 0DTH8ZZ, 0DTK0ZZ, 0DTK7ZZ - 0DTL0ZZ, 0DTL7ZZ - 0DTM0ZZ, 0DTM7ZZ - 0DTN0ZZ, 0DTN7ZZ - 0DTN8ZZ
PXX06247Total intra-Abdominal colectomy 0D1A07P, 0D1A0JP, 0D1A0KP, 0D1A47P, 0D1A4JP, 0D1A4KP, 0D1A87P, 0D1A8JP, 0D1A8KP, 0D1B07P, 0D1B0JP, 0D1B0KP, 0D1B47P, 0D1B4JP, 0D1B4KP, 0D1B87P, 0D1B8JP, 0D1B8KP, 0D1H87P, 0D1H8JP, 0D1H8KP, 0DTE0ZZ, 0DTE7ZZ - 0DTE8ZZ
PXX06249Rectal Resection0D1N0Z4, 0D1N4Z4, 0DBP0ZZ, 0DBP4ZZ, 0DTP0ZZ, 0DTP7ZZ - 0DTP8ZZ
PXX0672Colostomy, temporary and permanent - 0720D1H074, 0D1H0J4, 0D1H0K4, 0D1H0Z4, 0D1H3J4 - 0D1H474, 0D1H4J4, 0D1H4K4, 0D1H4Z4, 0D1H874, 0D1H8J4, 0D1H8K4, 0D1H8Z4, 0D1K074, 0D1K0J4, 0D1K0K4, 0D1K0Z4, 0D1K3J4 - 0D1K474, 0D1K4J4, 0D1K4K4, 0D1K4Z4, 0D1K874, 0D1K8J4, 0D1K8K4, 0D1K8Z4, 0D1L074, 0D1L0J4, 0D1L0K4, 0D1L3J4 - 0D1L474, 0D1L4J4, 0D1L4K4, 0D1L874, 0D1L8J4, 0D1L8K4, 0D1L8Z4, 0D1M074, 0D1M0J4, 0D1M0K4, 0D1M3J4 - 0D1M474, 0D1M4J4, 0D1M4K4, 0D1M874, 0D1M8J4, 0D1M8K4, 0D1M8Z4, 0D1N074, 0D1N0J4, 0D1N0K4, 0D1N3J4 - 0D1N474, 0D1N4J4, 0D1N4K4, 0D1N874, 0D1N8J4, 0D1N8K4, 0D1N8Z4, 0H87XZZ
PXX0673Ileostomy and other enterostomy - 0730D1B074, 0D1B0J4, 0D1B0K4, 0D1B0Z4, 0D1B3J4 - 0D1B474, 0D1B4J4, 0D1B4K4, 0D1B4Z4, 0D1B874, 0D1B8J4, 0D1B8K4, 0D1B8Z4
PXX0675Small bowel resection - 0750DB87ZZ, 0DBA7ZZ, 0DBB7ZZ
PXX0677Proctoscopy and anorectal biopsy - 0770D9P3ZX, 0D9P4ZX, 0D9P7ZX, 0D9P8ZX, 0D9Q0ZX, 0D9Q3ZX, 0D9Q4ZX, 0D9Q7ZX, 0D9Q8ZX, 0D9QXZX, 0D9R0ZX, 0D9R3ZX, 0D9R4ZX, 0DBP0ZX, 0DBP3ZX, 0DBP4ZX, 0DBP7ZX, 0DBP8ZX, 0DBQ0ZX, 0DBQ3ZX, 0DBQ4ZX, 0DBQ7ZX, 0DBQ8ZX, 0DBQXZX, 0DBR0ZX, 0DBR3ZX, 0DBR4ZX
PXX0681Hemorrhoid procedures - 081065Y0ZC, 065Y3ZC, 065Y4ZC, 06BY0ZC, 06BY3ZC, 06BY4ZC, 06LY0CC, 06LY0DC, 06LY0ZC, 06LY3CC, 06LY3DC, 06LY3ZC, 06LY4CC, 06LY4DC, 06LY4ZC, 0D5Q7ZZ, 0D7Q7ZZ, 0D7Q8ZZ, 0DSQ7ZZ
PXX0686Other hernia repair - 0860DQS0ZZ - 0DQT4ZZ, 0WQF0ZZ - 0WQF4ZZ
PXX0690Excision, lysis peritoneal adhesions - 0900DN80ZZ - 0DN84ZZ, 0DN90ZZ - 0DN94ZZ, 0DNA0ZZ - 0DNA4ZZ, 0DNB0ZZ - 0DNB4ZZ, 0DNC0ZZ - 0DNC4ZZ, 0DNE0ZZ - 0DNE4ZZ, 0DNF0ZZ - 0DNF4ZZ, 0DNG0ZZ - 0DNG4ZZ, 0DNH0ZZ - 0DNH4ZZ, 0DNJ0ZZ - 0DNJ4ZZ, 0DNK0ZZ - 0DNK4ZZ, 0DNL0ZZ - 0DNL4ZZ, 0DNM0ZZ - 0DNM4ZZ, 0DNN0ZZ - 0DNN4ZZ, 0DNS0ZZ - 0DNW4ZZ, 0FN00ZZ - 0FNG4ZZ
PXX0692Other bowel diagnostic procedures - 0920D980ZX, 0D990ZX, 0D9A0ZX, 0D9B0ZX, 0D9C0ZX, 0D9E0ZX, 0D9F0ZX, 0D9G0ZX, 0D9H0ZX, 0D9K0ZX, 0D9L0ZX, 0D9M0ZX, 0D9N0ZX, 0D9P0ZX, 0DB80ZX, 0DB90ZX, 0DBA0ZX, 0DBB0ZX, 0DBC0ZX, 0DBE0ZX, 0DBF0ZX, 0DBG0ZX, 0DBH0ZX, 0DBK0ZX, 0DBL0ZX, 0DBM0ZX, 0DBN0ZX, 0DJD3ZZ - 0DJD4ZZ
PXX0693Other non-OR upper GI therapeutic procedures - 0930D20X0Z - 0D20XYZ, 0DP6X0Z, 0DP6XUZ, 0WQFXZ2, 3E0G76Z, 3E0G7GC, 3E0G86Z, 3E0G8GC, 3E1G78X - 3E1G78Z
PXX0694Other OR upper GI therapeutic procedures - 0940DQA0ZZ
PXX0695Other non-OR lower GI therapeutic procedures - 0950D2DX0Z - 0D2DXYZ, 0D5E4ZZ, 0D5E8ZZ, 0D5F4ZZ, 0D5F8ZZ, 0D5G4ZZ, 0D5G8ZZ, 0D5H4ZZ, 0D5H8ZZ, 0D5K4ZZ, 0D5K8ZZ, 0D5L4ZZ, 0D5L8ZZ, 0D5M4ZZ, 0D5M8ZZ, 0D5N4ZZ, 0D5N8ZZ - 0D5P8ZZ, 0D5Q4ZZ, 0D5Q8ZZ, 0D5R4ZZ, 0D780DZ, 0D783DZ, 0D784DZ, 0D787DZ - 0D790DZ, 0D793DZ, 0D794DZ, 0D797DZ - 0D7A0DZ, 0D7A3DZ, 0D7A4DZ, 0D7A7DZ - 0D7B0DZ, 0D7B3DZ, 0D7B4DZ, 0D7B7DZ - 0D7C0DZ, 0D7C3DZ, 0D7C4DZ, 0D7C7DZ - 0D7E0DZ, 0D7E3DZ, 0D7E4DZ, 0D7E7DZ - 0D7F0DZ, 0D7F3DZ, 0D7F4DZ, 0D7F7DZ - 0D7G0DZ, 0D7G3DZ, 0D7G4DZ, 0D7G7DZ - 0D7H0DZ, 0D7H3DZ, 0D7H4DZ, 0D7H7DZ - 0D7K0DZ, 0D7K3DZ, 0D7K4DZ, 0D7K7DZ - 0D7L0DZ, 0D7L3DZ, 0D7L4DZ, 0D7L7DZ - 0D7M0DZ, 0D7M3DZ, 0D7M4DZ, 0D7M7DZ - 0D7N0DZ, 0D7N3DZ, 0D7N4DZ, 0D7N7DZ - 0D7N8ZZ, 0D7P7DZ - 0D7P8ZZ, 0D7Q7DZ, 0D7Q8DZ, 0D9P70Z, 0D9P80Z, 0DH80DZ, 0DH83DZ, 0DH84DZ, 0DH87DZ, 0DH88DZ, 0DH90DZ, 0DH93DZ, 0DH94DZ, 0DH97DZ, 0DH98DZ, 0DHA0DZ, 0DHA3DZ, 0DHA4DZ, 0DHA7DZ, 0DHA8DZ, 0DHB0DZ, 0DHB3DZ, 0DHB4DZ, 0DHB7DZ, 0DHB8DZ, 0DHE0DZ - 0DHE8DZ, 0DHP0DZ, 0DHP3DZ, 0DHP4DZ, 0DHP7DZ, 0DHP8DZ, 0DP0X0Z, 0DP0XUZ, 0DPDX0Z, 0DPDXUZ, 0DS97ZZ - 0DS98ZZ, 0DSA7ZZ - 0DSA8ZZ, 0DSB7ZZ - 0DSB8ZZ, 0DSK7ZZ - 0DSK8ZZ, 0DSL7ZZ - 0DSL8ZZ, 0DSM7ZZ - 0DSM8ZZ, 0DSN7ZZ - 0DSN8ZZ, 0DSPXZZ, 0HB9XZZ, 2Y43X5Z, 3E0G37Z, 3E0G73Z, 3E0G77Z, 3E0G83Z, 3E0G87Z, 3E0H36Z - 3E0H37Z, 3E0H73Z - 3E0H77Z, 3E0H7GC, 3E0H83Z - 3E0H87Z, 3E0H8GC, 3E1H78Z, 8E0VX1D
PXX0696Other OR lower GI therapeutic procedures - 0960D19074, 0D190J4, 0D190K4, 0D190Z4, 0D193J4 - 0D19474, 0D194J4, 0D194K4, 0D194Z4, 0D19874, 0D198J4, 0D198K4, 0D198Z4, 0D1A074, 0D1A0J4, 0D1A0K4, 0D1A0Z4, 0D1A3J4 - 0D1A474, 0D1A4J4, 0D1A4K4, 0D1A4Z4, 0D1A874, 0D1A8J4, 0D1A8K4, 0D1A8Z4, 0D9870Z, 0D9880Z, 0D9E70Z, 0D9E80Z, 0DB97ZZ, 0DNP7ZZ - 0DNP8ZZ, 0DQB0ZZ, 0DQF0ZZ, 0DQG0ZZ, 0DQH0ZZ, 0DQK0ZZ, 0DQL0ZZ, 0DQM0ZZ, 0DQN0ZZ, 0DS90ZZ - 0DS94ZZ, 0DSA0ZZ - 0DSA4ZZ, 0DSB0ZZ - 0DSB4ZZ, 0DSH0ZZ - 0DSH8ZZ, 0DSK0ZZ - 0DSK4ZZ, 0DSL0ZZ - 0DSL4ZZ, 0DSM0ZZ - 0DSM4ZZ, 0DSN0ZZ - 0DSN4ZZ
PXX0697Other gastrointestinal diagnostic procedures - 0970D9S0ZX, 0D9S3ZX, 0D9S4ZX, 0D9T0ZX, 0D9T3ZX, 0D9T4ZX, 0D9V0ZX, 0D9V3ZX, 0D9V4ZX, 0D9W0ZX, 0D9W3ZX, 0D9W4ZX, 0DBS0ZX, 0DBS3ZX, 0DBS4ZX, 0DBT0ZX, 0DBT3ZX, 0DBT4ZX, 0DBV0ZX, 0DBV3ZX, 0DBV4ZX, 0DBW0ZX, 0DBW3ZX, 0DBW4ZX, 0DJU3ZZ, 0DJV3ZZ, 0DJW3ZZ, 0W9G0ZX, 0W9G3ZX, 0W9G4ZX, 0W9H0ZX, 0W9H3ZX, 0W9H4ZX, 0W9J0ZX, 0W9J3ZX, 0W9J4ZX, 0WBH0ZX, 0WBH3ZX, 0WBH4ZX, 0WJF3ZZ, 0WJG3ZZ, 0WJH3ZZ - 0WJH4ZZ, 0WJJ3ZZ, 0WJP3ZZ, 0WJP7ZZ - 0WJP8ZZ, 0WJR3ZZ, 0WJR7ZZ - 0WJR8ZZ, 0Y950ZX, 0Y953ZX, 0Y954ZX, 0Y960ZX, 0Y963ZX, 0Y964ZX, 0YB50ZX, 0YB53ZX, 0YB54ZX, 0YB60ZX, 0YB63ZX, 0YB64ZX, 0YB70ZX, 0YB73ZX, 0YB74ZX, 0YB80ZX, 0YB83ZX, 0YB84ZX, 0YJ53ZZ - 0YJ54ZZ, 0YJ63ZZ - 0YJ64ZZ, 0YJ73ZZ - 0YJ74ZZ, 0YJ83ZZ - 0YJ84ZZ, 0YJA3ZZ - 0YJA4ZZ, 0YJE3ZZ - 0YJE4ZZ, 3E1M38X - 3E1M38Z
PXX0698Other non-OR gastrointestinal therapeutic procedures - 09807PPX0Z - 07PPX3Z, 0D9970Z, 0D9980Z, 0D9A70Z, 0D9A80Z, 0D9B70Z, 0D9B80Z, 0D9F70Z, 0D9F80Z, 0D9G70Z, 0D9G80Z, 0D9H70Z, 0D9H80Z, 0D9K70Z, 0D9K80Z, 0D9L70Z, 0D9L80Z, 0D9M70Z, 0D9M80Z, 0D9N70Z, 0D9N80Z, 0DN87ZZ - 0DN88ZZ, 0DN97ZZ - 0DN98ZZ, 0DNA7ZZ - 0DNA8ZZ, 0DNB7ZZ - 0DNB8ZZ, 0DNE7ZZ - 0DNE8ZZ, 0DNF7ZZ - 0DNF8ZZ, 0DNG7ZZ - 0DNG8ZZ, 0DNH7ZZ - 0DNH8ZZ, 0DNK7ZZ - 0DNK8ZZ, 0DNL7ZZ - 0DNL8ZZ, 0DNM7ZZ - 0DNM8ZZ, 0DNN7ZZ - 0DNN8ZZ, 0DP0X2Z - 0DP0XDZ, 0DP571Z, 0DP581Z, 0DP5X1Z - 0DP5X3Z, 0DP5XUZ, 0DP6X2Z - 0DP6XDZ, 0DPDX2Z - 0DPDXDZ, 0DPP71Z - 0DPPX1Z, 0DQV0ZZ - 0DQV4ZZ, 0DS9XZZ, 0DSAXZZ, 0DSBXZZ, 0DSHXZZ, 0DSKXZZ, 0DSLXZZ, 0DSMXZZ, 0DSNXZZ, 0DWU00Z, 0DWU30Z, 0DWU40Z, 0DWV00Z, 0DWV30Z, 0DWV40Z, 0DWW00Z, 0DWW30Z, 0DWW40Z, 0FP0X2Z - 0FP0X3Z, 0FP4X2Z - 0FP4XDZ, 0FPBX1Z - 0FPBX3Z, 0FPDX1Z - 0FPDXDZ, 0FPGX2Z - 0FPGX3Z, 0W1G0J9 - 0W1G0JJ, 0W1G4J9 - 0W1G4JJ, 0W1J0J4, 0W1J0JY - 0W1J4J4, 0W1J4JY, 0WCP7ZZ - 0WCP8ZZ, 0WFJ0ZZ - 0WFJ4ZZ, 0WFP0ZZ - 0WFP8ZZ, 0WHP0YZ, 0WHP33Z - 0WHP3YZ, 0WHP43Z - 0WHP4YZ, 0WHP73Z - 0WHP7YZ, 0WHP83Z - 0WHP8YZ, 0WPFX0Z - 0WPFXYZ, 0WPGX0Z - 0WPGX3Z, 0WPJ00Z - 0WPJ4YZ, 0WPP31Z - 0WPPXYZ, 0WWP31Z - 0WWP8YZ, 2W53X0Z, 2W53X4Z - 2W53XYZ, 2Y53X5Z, 3E0M36Z - 3E0M3KZ, 3E0M3TZ, 3E0M7SF, 3E0P36Z - 3E0P3BZ, 3E0P3HZ - 3E0P3KZ, 3E0P3TZ, 3E0P7BZ, 3E0P7HZ - 3E0P7KZ, 3E0P7TZ, 3E0P8BZ, 3E0P8HZ - 3E0P8KZ, 3E0P8TZ, 3E1H78X, 3E1J78X - 3E1J88Z
PXX08160Other therapeutic procedures on muscles and tendons - 1600JB00ZZ, 0JB50ZZ, 0JB60ZZ, 0JB70ZZ, 0JB80ZZ, 0JB90ZZ, 0JBB0ZZ, 0JBC0ZZ, 0JBD0ZZ, 0JBF0ZZ, 0JBG0ZZ, 0JBH0ZZ, 0JBN0ZZ, 0JBP0ZZ, 0JBQ0ZZ, 0JBR0ZZ, 0JD00ZZ, 0JD10ZZ, 0JD40ZZ, 0JD50ZZ, 0JD60ZZ, 0JD70ZZ, 0JD80ZZ, 0JD90ZZ, 0JDB0ZZ, 0JDC0ZZ, 0JDD0ZZ, 0JDF0ZZ, 0JDG0ZZ, 0JDH0ZZ, 0JDJ0ZZ, 0JDK0ZZ, 0JDL0ZZ, 0JDM0ZZ, 0JDN0ZZ, 0JDP0ZZ, 0JDQ0ZZ, 0JDR0ZZ
PXX08214Traction, splints, and other wound care - 2140NH005Z, 0NH035Z, 0NH045Z, 2W10X6Z - 2W1VX7Z, 2W20X4Z - 2W2VX4Z, 2W30X3Z - 2W30XYZ, 2W31X3Z, 2W33X3Z - 2W33XYZ, 2W34X3Z - 2W34XYZ, 2W35X3Z - 2W35XYZ, 2W36X3Z - 2W36XYZ, 2W37X3Z - 2W37XYZ, 2W38X3Z - 2W38XYZ, 2W39X3Z - 2W39XYZ, 2W3AX3Z - 2W3AXYZ, 2W3BX3Z - 2W3BXYZ, 2W3CX3Z - 2W3CXYZ, 2W3DX3Z - 2W3DXYZ, 2W3EX3Z - 2W3EXYZ, 2W3FX3Z - 2W3FXYZ, 2W3GX3Z - 2W3GXYZ, 2W3HX3Z - 2W3HXYZ, 2W3JX3Z - 2W3JXYZ, 2W3KX3Z - 2W3KXYZ, 2W3LX3Z - 2W3LXYZ, 2W3MX3Z - 2W3MXYZ, 2W3NX3Z - 2W3NXYZ, 2W3PX3Z - 2W3PXYZ, 2W3QX3Z - 2W3QXYZ, 2W3RX3Z - 2W3RXYZ, 2W3SX3Z - 2W3SXYZ, 2W3TX3Z - 2W3TXYZ, 2W3UX3Z - 2W3UXYZ, 2W3VX3Z - 2W3VXYZ, 2W40X5Z - 2W4VX5Z, 2Y40X5Z, 2Y45X5Z
PXX09169Debridement of wound, infection or burn - 1690HB0XZZ, 0HB1XZZ, 0HB4XZZ, 0HB5XZZ, 0HB6XZZ, 0HB7XZZ, 0HB8XZZ, 0HBAXZZ, 0HBBXZZ, 0HBCXZZ, 0HBDXZZ, 0HBEXZZ, 0HBFXZZ, 0HBGXZZ, 0HBHXZZ, 0HBJXZZ, 0HBKXZZ, 0HBLXZZ, 0HBMXZZ, 0HBNXZZ, 3E1038Z

Procedure Codes which will be used in combination with diagnosis codes to identify relevant services.

Table E: Relevant Procedure Codes CPT/HCPCS

Group IDGroup NameCPT / HCPCS
CT0025Preventive Medicine, Care Coordination98960 - 98962, 99361 - 99362, 99366 - 99373, 99383 - 99387, 99393 - 99397, 99401 - 99404, 99411 - 99412, 99429, 99441 - 99449, 99499
CT0027Colonoscopy - therapeutic45382 - 45383, 45386 - 45392
CT0071Drainage of Abdominal Abscess49020 - 49061
CT0072Image guided drainage of abdominal abscess49405 - 49407
CT0080Imaging Abdomen74000 - 74185, 74261 - 74280, 76700 - 76705, 76975, 76999
CT0083Blood Type, Coomb's test86900 - 86901
CT0089Metabolic Renal Hepatic Chemistry Panel80050 - 80051, 80053, 80069 - 80076, 82247 - 82248
CT0090Physical Therapy / Rehab97036, 97755
CT0091Physician Services - Outpatient 99201 - 99215, 99241 - 99245, 99354 - 99355, 99358 - 99359
CT0092Physician Services - Inpatient99221 - 99223, 99238 - 99239, 99252 - 99255
CT0112Procedure - spinal canal - injection into spinal canal62310 - 62319
CT0113Procedure - spinal canal - other62350, 62355
CT0125Procedure - neuro - other or rx62360 - 62368
CT0126Procedure - neuro - other non - or rx62273
CT0131Procedure - anesthesia01991 - 01992
CT04281Blood Gases, Pulse Oximetry82800 - 82810
CT0433Other care - respiratory - ventillator management99504
CT05116Procedure - artery - extremity - injection of thrombin36002
CT05176Procedure - peripheral venous catheter36000
CT05177Procedure - catheter - venous - other - vena cava or selective branch catheter36010 - 36012
CT05178Procedure - catheter - venous - other - other36481 - 36510
CT05179Procedure - catheter - arterial - arterial line for monitoring36620 - 36625
CT05181Procedure - catheter - arterial - selective branch catheter36215 - 36218
CT05182Procedure - catheter - arterial - pulmonary artery catheter36014 - 36015
CT05183Procedure - catheter - arterial - other36100 - 36140, 36640 - 36660
CT05184Procedure - vascular access - port / pump - insertion36260
CT05185Procedure - vascular access - port / pump - revision36261
CT05186Procedure - vascular access - port / pump - removal36262
CT05190Procedure - anesthesia00880 - 00882
CT05217Imaging - nuclear - venous thrombosis - scan78456 - 78458
CT05221Imaging - venography - extremities36005
CT05230Tests - cardiac stress tests - cardiac stress tests - other78491 - 78492
CT05308Cardiac Stress Test78451 - 78454, 78460 - 78465, 78472 - 78473, 78481 - 78483, 93015 - 93018
CT0608Procedure - ugi endoscopy - small bowel endoscopy44360 - 44365, 44369 - 44372, 44376 - 44382
CT0609Procedure - ugi endoscopy - other44383 - 44386
CT06104Imaging - nuclear - shilling test78270 - 78272
CT06106Imaging - nuclear - gi blood loss78278
CT06107Imaging - nuclear - other gi78290
CT06109Imaging - x-ray - abdomen74190
CT06112Imaging - x-ray - upper gi - small bowel - contrast74250 - 74251, 74355
CT06113Imaging - x-ray - upper gi - duodenogram74260
CT06114Imaging - x-ray - upper gi - other74340
CT06115Imaging - x-ray - lower gi - large bowel - contrast74283
CT06121Tests - gi - other dx91120 - 91122, 91132 - 91299
CT06128Colectomy with proctectomy44155 - 44158
CT06134Laparoscopic colectomy with proctectomy44211 - 44212, 45395 - 45397
CT06136Laparoscopic partial colectomy44204 - 44208
CT06138Laparoscopic total intra-abd colectomy44210
CT06139Partial Colectomy 44140 - 44147, 44160
CT06140Total intra-Abdominal colectomy 44150 - 44151
CT0619Procedure - gastrostomy43653, 43750, 43760, 43830 - 43832, 44373, 74350
CT0627Procedure - other procedures - stomach43761, 43870, 44615
CT06305Abdominoperineal Resection45110, 45112, 45119
CT06306Rectal Resection45111, 45113 - 45116, 45123
CT06307Pelvic Exenteration45126
CT06312Colonoscopy through Stoma44390 - 44391, 44393, 44397, 45355
CT0636Procedure - colorectal resection - partial w / ostomy44188
CT0640Procedure - colorectal resection - other44139, 44213, 45130 - 45136, 45160, 45550
CT0641Procedure - colostomy44320 - 44346, 44605, 45563, 45805, 45825
CT0642Procedure - small bowel resection44120 - 44128, 44202 - 44203, 44661
CT0643Procedure - ileostomy / other enterostomy44015, 44130, 44187, 44300 - 44316
CT0647Procedure - appendectomy / related - appendectomy44950 - 44960
CT0648Procedure - appendectomy / related - drainage of appendiceal abscess44900 - 44901
CT0649Procedure - laparotomy / related49000 - 49010, 49220
CT0651Procedure - laparoscopy - abdomen - dx49320
CT0652Procedure - laparoscopy - abdomen - biopsy49321
CT0653Procedure - laparoscopy - gi - other44238, 49324 - 49326, 49329
CT0654Procedure - lysis of adhesions44005, 44180
CT0655Procedure - paracentesis49080 - 49081
CT0656Procedure - other lower gi procedures - closure of enterostomy44227, 44620 - 44626
CT0657Procedure - other lower gi procedures - other bowel dx44010, 44020, 44025, 44100
CT0658Procedure - other lower gi procedures - other or rx44021, 44050 - 44055, 44111, 44500 - 44604, 44640 - 44660, 44700 - 44701, 44799 - 44899
CT0659Procedure - other lower gi procedures - other non - or rx45520, 91100
CT0664Procedure - hemorrhoidectomy46250 - 46262
CT0665Procedure - hemorrhoid destruction / ligation46221, 46930 - 46936, 46945 - 46946
CT0666Procedure - other hemorrhoid procedures46083, 46230, 46320 - 46500, 46947
CT0667Procedure - other anal / rectal procedures - other procedures - rectum / anus45150, 45170 - 45190, 45540 - 45541, 45562, 45800, 45820, 45900 - 45915, 45999 - 46030, 46070, 46220, 46900 - 46924, 46937 - 46942, 46999, 91123
CT0672Procedure - proctosigmoidoscopy - dx 45300, 45305
CT0673Procedure - proctosigmoidoscopy - rx 45303, 45308 - 45327
CT0674Procedure - proctoscopy - screeningS0601
CT0675Procedure - anoscopy46600 - 46606, 46610 - 46615
CT0676Procedure - proctoscopy / anoscopy - other45100
CT0686Procedure - other or gi rx - excision of lesion - abdomen / retroperitoneum49200 - 49205
CT0687Procedure - other or gi rx - other procedure - abdomen49215, 49250 - 49255, 49422 - 49423, 49425 - 49426, 49428 - 49429, 49900, 49905 - 49999
CT0688Procedure - other gi dx45990, 49180, 49400, 49424, 49427
CT0689Procedure - other or rx - drainage / excision of pilonidal cyst10080 - 10081
CT0690Procedure - anesthesia00700, 00730, 00740, 00790, 00800, 00810, 00820, 00840, 00902
CT0691Therapy - nasogastric tube43752
CT0728Procedure - other procedures - pancreas48400
CT0803Procedure - laminectomy / related62351
CT0835Procedure - injection - tendons / joints / etc.20500
CT0840Procedure - other dx on musculoskeletal system20501
CT0841Procedure - other rx on muscles and tendons22900
CT0844Procedure - other or rx on musculoskeletal system22901 - 22999
CT0849Procedure - anesthesia01905
CT0924Procedure - i&d - skin - drainage - post - op infection10180
CT0925Procedure - debridement - wound / infection / burn - debridement11000 - 11001, 11041 - 11044
CT0959Procedure - other non - or rx - other non - or skin procedures15850 - 15852, 97602
CT0965Other care - wound care97597 - 97598, 97605 - 97606, E0181 - E0190
CT0966Other care - wound care - hyperbaric oxygenA4575
CT0969Other care - chronic edema - surgical stockingsA4490 - A4510
CT1036Other care - nutrition - assessment97802 - 97803
CT1137Procedure - anesthesia00860
CT1146Therapy - dialysis - suppliesA4932
CT1151Imaging - nuclear - bladder / ureter78730 - 78740
CT1166Lab - urinalysis81007 - 81020, 81050 - 81099
CT1316Procedure - repair - cystocele / rectocele45560
CT1602Procedure - lymphadenectomy38562 - 38564, 38747 - 38780
CT1613Procedure - heme / lymph - other rx36680, 49062, 49323
CT1615Therapy - transfusion - administration36430 - 36455
CT1620Therapy - phlebotomy99195
CT16296Lipid Level Monitoring80061
CT16299Bleeding Status99363 - 99364
CT1638Rx - administration - injection99506
CT1639Rx - administration - infusion99601 - 99602
CT1645Lab - blood gases82820
CT1652Lab - transfusion medicine86890 - 86891, 86903 - 86911, 86985 - 86999
CT17104RADIATION TREATMENTS49411
CT1824Lab - microbiology - other87015
CT1825Lab - microbiology - c & s87040 - 87088
CT19381Smoking / Tobacco Cessation99406 - 99407
CT2009Alcohol / Drug Use Screening99408 - 99409
CT2101Lab - therapeutic drug assay80154
CT2304Therapy - pt - exercises / activities97542
CT2324Other care - ostomy - nursing care99505
CT2325Other care - ostomy - suppliesA4394 - A4427, A5051 - A5063, A5093
CT2328Other care - bladder / bowel care - drainage bagA5102
CT2329Other care - bladder / bowel care - other supplies - diaper / relatedA4520, A4554
CT2330Other care - bladder / bowel care - other supplies - skin barrierA5120 - A5200
CT23308Other therapeutic Sigmoidoscopy45334, 45337, 45339 - 45345
CT2331Other care - observationG0379
CT9903E & M - hospital99217 - 99220, 99231 - 99236, 99291 - 99292, 99481 - 99482, G0378
CT9904E & M - emergency care99281 - 99285, G0380 - G0384
CT9905E & M - home visit99224 - 99226, 99341 - 99350
CT9906E & M - nursing home99304 - 99339
CT9907E & M - prevention99420
CT9908E & M - other99288, 99340, 99360, 99374 - 99380, 99450 - 99456, 99485 - 99489, 99607
CT9910Procedure - anesthesia01922, 01996 - 01999, 99140
CT99103Imaging - ct - follow - up76380
CT99104Imaging - ct - other76497
CT99107Imaging - mri - other75559, 75563, 76498
CT99111Imaging - us - retroperitoneum76770 - 76775
CT99113Imaging - us - guide - biopsy76942
CT99114Imaging - us - guide - other76998
CT99115Imaging - us - other76970
CT99125Imaging - nuclear - localization of inflammation78805 - 78807
CT99128Imaging - nuclear - other78799
CT99136Imaging - other imaging76010 - 76080 , 76499
CT99137Imaging - therapeutic procedure - abscess drainage75989
CT99138Imaging - therapeutic procedure - other therapeutic procedure75984
CT99142Lab - pathology consultation80500 - 80502
CT99143Lab - chemistry82270 - 82272, 82705 - 82715, 82926 - 82928
CT99148Lab - surgical pathology88302 - 88309, 88312 - 88342, 88346 - 88349, 88358 - 88362, 88365 - 88399
CT99173Lab - specimen collection - specimen handling99000
CT99183Transportation - other transportationA0021 - A0998
CT99185DME - bath / toilet aidsE0160 - E0175, E0240 - E0249
CT99186DME - beds / accessoriesE0250 - E0326, E0350 - E0352
CT99191SuppliesA4450 - A4455, A4458 - A4465, A4470 - A4480, A4550, A4649, A6000 - A6407, A6413 - A6457, A6550
CT9928Therapy - accupuncture97810 - 97814
CT99309Physician Services99251
CT99311Urine Protein81000 - 81005, 82042 - 82044
CT99316Physician Services - Inpatient99356 - 99357
CT9932Therapy - nonoperative removal of foreign body45307, 46608
CT99392Other diagnostic procedures (interview, evaluation, consultation)99605 - 99606, G0438 - G0439
CT9940Therapy - other36299
CT9964Other care - home care - specialized visit99507 - 99511, 99600
CT9965Other care - home care - physician supervisionG0372
CT9990Other care - other - ancillary services97804, 99001, 99199
XX0000Ungrouped Codes37191 - 37193, 37619, 6030F, 7010F, 97610, C9735, G0299 - G0300, G8152 - G8157, G8193 - G8196, G8204 - G8221, G8696 - G8698, G8702 - G8707, G8968 - G8969, G9199 - G9201, G9235, G9237, G9298 - G9299, G9307 - G9312

CPT / HCPCS / ICD-9-PCS (PX) Codes which will be used in combination with ICD-9 diagnosis codes to identify relevant services.

Table H: Relevant Typical Drug Groups

Group IDGroup Name
RX001contrast media
RX002diagnostic agents
RX0111parasympathomimetics
RX017hypnotics and sedatives
RX0320cough and cold preparations
RX0321decongestants and other nasal preparations for topical use
RX0322other otologicals
RX0324throat preparations
RX0425antihistamines for systemic use
RX0426Bronchodilators: adrenergics for systemic use
RX0427drugs for obstructive airway diseases - inhalants
RX0429other systemic drugs for obstructive airway diseases
RX0530agents acting on the renin-angiotensin system
RX0531Agents for hypertensive emergencies
RX0535beta blocking agents
RX0536calcium channel blockers
RX0538diuretics
RX0539i.v. solutions & additives
RX0540Nitrates and other antianginals
RX0541other antihypertensives
RX0546Antiplatelet Agents Thrombin Inhibitors
RX0645antacids
RX0646antidiarrheals intestinal adsorbents
RX0647antiemetics and antinauseants
RX0648digestives incl. enzymes
RX0649drugs for constipation
RX0650drugs for functional gastrointestinal disorders
RX0651drugs for peptic ulcer and gerd
RX0652intestinal antiinfectives
RX0653intestinal antiinflammatory agents
RX0654stomatological preparations
RX0857antiinflammatory and antirheumatic products
RX0860muscle relaxants
RX0861opioids
RX0862other analgesics and antipyretics
RX0864topical products for joint and muscular pain
RX0965agents for treatment of hemorrhoids and anal fissures for topical use
RX0968antibiotics and chemotherapeutics for dermatological use
RX0969antifungals for dermatological use
RX0970antipruritics incl. antihistamines anesthetics etc.
RX0971antiseptics and disinfectants
RX0973corticosteroids dermatological preparations
RX0976irrigating solutions
RX0977medicated dressings
RX0978other dermatological preparations
RX0979preparations for treatment of wounds and ulcers
RX0980Moisturizers and skin protective agents
RX1086corticosteroids for systemic use
RX1087drugs affecting bone structure and mineralization
RX1088drugs for inborn errors of metabolism
RX1089drugs used in diabetes
RX1091glucagon: pancreatic hormones
RX1093Insulin
RX1194urinary antiinfectives and antiseptics
RX13104GYNECOLOGICAL ANTIINFECTIVES AND ANTISEPTICS
RX16106iron preparations
RX16108other hematological agents
RX16109vitamin b12 and folic acid
RX16112Blood Stimulating Agents Erythropoietin
RX17112Chemoprotective agents in Cancer Treatment
RX18117antibacterials for systemic use
RX18119antiinfectives
RX19123antidepressants
RX19125anxiolytics
RX23129immune sera and immunoglobulins
RX23131mineral supplements
RX23133other nutrients
RX23134vaccines
RX23135vitamins
RX99136anesthetics general
RX99137anesthetics local
RX99138medical gas