Transcription
Hospital Industry Data InstituteWest Virginia Hospital AssociationReports Reference ManualIntroductionThis reference manual contains information to assist users in the interpretation of data available from thereports. For additional assistance, please contact the West Virginia Hospital Association staff using the linkon HIDI Analytic Advantage .Reporting PeriodCYCalendar Year, January 1 – December 31West Virginia hospital discharge data are reported based on Calendar YearFFYFederal Fiscal Year, October 1 – September 30Reports based on Federal Fiscal Year are indicated as FFYExample: FFY2019 includes data from October 1, 2018 – September 30, 2019Report DataHospital Inpatient Reports: Comprehensive information about utilization patterns and market sharecharacteristics. Inpatient reports contain data for all discharges submitted.Acute Category: Represents discharges for acute care patients selected by “Place of Service 1, 2, 3, 5, 6,and 7”. See page 4 for definitions and caveats.Non-acute Category: Represents discharges for non-acute patients selected by “Place of Service 4”. Seepage 4 for definitions and caveats.Hospital Outpatient Reports: Submission of outpatient data from WV hospitals started with January 1, 2020visits. “Classified” services are revenue codes that have been identified and grouped within categories suchas Emergency, Surgical, Observation, and Clinical Services as reported in the standard outpatientreports. “Unclassified” visits include those revenue codes that fall outside of the “Classified” definition.“Classified” visits can include “Unclassified” revenue codes, but “Unclassified” visits cannot include“Classified” revenue codes. Refer to the “Outpatient Data” section for revenue codes included in the service categories.Out of State Data: Not yet available. WV residents receiving care from hospitals in other states will beincluded as data becomes available.1May 26, 2020
Hospital Industry Data InstituteWest Virginia Hospital AssociationReports Reference ManualReport TypesRegion Reports: Data are compiled based on patient origin – patient residence (county or ZIP code) reportedon inpatient discharge records.Service Area Reports: Data are compiled based on patient destination – where patient received treatment(Including WV Region, see page 48).Diagnosis Groups: Many of the reports have been grouped based on diagnosis groups - MDC and DRG. Major Diagnostic Category (MDC): MDC’s are formed by dividing all possible principal diagnoses into25 mutually exclusive diagnosis areas. MDC codes, like DRG codes, are primarily a claims andadministrative data element unique to the United States medical care reimbursement system. DRGcodes are mapped (or grouped) into MDC codes.The diagnoses in each MDC correspond to a single organ system or etiology and, in general, areassociated with a particular medical specialty. MDC 1 – MDC 23 are grouped according to principaldiagnoses. Patients are assigned to MDC 24 (Multiple Significant Trauma) with at least twosignificant trauma diagnosis codes (either as principal or secondary) from different body sitecategories. Patients assigned to MDC 25 (HIV Infections) must have a principal diagnosis of an HIVInfection or a principal diagnosis of a significant HIV related condition and a secondary diagnosis ofan HIV Infection. MDC Descriptions are in the Reference List beginning on page 10. Diagnosis Related Group (DRG): DRG code assignments are based upon criteria established forMedicare’s hospital reimbursement system. HIDI uses the 3M Core Grouping Software to processdischarges. DRG Descriptions are in the Reference List beginning on page 11.Clinical Classification Software: Clinical Classifications Software (CCS) provides a method to classifydiagnoses and procedures into a limited number of categories by aggregating individual ICD codes into broaddiagnosis and procedure groups to facilitate statistical analysis and reporting1. In February of 2020, HCUPreleased an updated version of the CCS software and includes a method to identify the primary classificationsystem for each diagnoses code, which is being used in the HIDI reporting tool to replace the previous CCSDx classifications. CCS PX classifications are not affected at this time. For additional information, please referto the CCSR User Guide, available on the HCUP web site via the above link. A listing of CCSR Body Systemsand CCS PX Level 1 and 2 are included in this manual.For outpatient data, CCS Services and Procedures provides a method for classifying Current ProceduralTerminology (CPT ) codes and Healthcare Common Procedure Coding System (HCPCS) codes into clinicallymeaningful procedure categories. NOTE: Categories are applied to principal CPT/HCPCS codes. A listing ofCCS Services and Procedures are included in this manual.Age Definition: Age may be reported for all ages, displayed as age ranges, or by age categories based onreported data. Any age reported as less than 0 or greater than 124 will be displayed as “Invalid AgeReported.” 2016 and 2017 data include Age Groups only. All Ages provide aggregated data within age ranges ofo 0-17; 18-44; 45-64; 65-74; and 75 2May 26, 2020
Hospital Industry Data InstituteWest Virginia Hospital AssociationReports Reference ManualNewborn Indicator: Available as a filter selection in some of the Analytic Advantage PLUS reports. Newborno Any record with a principal diagnosis code beginning with Z38 Non-Newborno Any record with a principal diagnosis code that does not begin with Z38 Value Not Assignedo Diagnosis code not assignedSwing-Bed: Available as a filter selection in some of the Analytic Advantage PLUS reports. As defined inthe regulations, a swing-bed hospital is a hospital or critical access hospital (CAH) participating in Medicarethat has CMS approval to provide post-hospital SNF care and meets certain requirements. Swing-bed countsare identified by bill type 18x, as reported by hospitals submitting data.3May 26, 2020
Hospital Industry Data InstituteWest Virginia Hospital AssociationReports Reference ManualReference ListsAll DataCodeDescriptionPlace of Service (Inpatient Only): Identifies the area where the patient received treatment.Inpatient1Acute medical/surgical unit (non-PPS exempt)2Psychiatric unit or facility [*Not available in 2016 or 2017 data. Included in Acute category]3Medical rehabilitation unit or facility [*Not available in 2016 or 2017 data. Included in Acute category]4Alternate level of care (SNF/ICF/Other LTC/Hospice/Subacute/Swing-bed)5Alcohol rehabilitation unit or facility6Drug rehabilitation unit or facility7Other inpatientPatient Type (Outpatient Only): Identifies the primary area where the patient received treatment.Outpatient1Emergency room2Outpatient surgery3Observation only4Other outpatientEthnicity1Hispanic or Latino2Neither Hispanic or Latino9No Ethnicity ReportedRace1White2Black or African American3American Indian/Alaskan Native4Asian5Native Hawaiian/Pacific Islander6Other7Multi-Racial (two or more races)9Unknown or Patient Refused4May 26, 2020
Hospital Industry Data InstituteWest Virginia Hospital AssociationReports Reference ManualPayer: The following general payment categories are the preferred method for reporting the source ofpayment for West Virginia. For reporting purposes, HIDI displays Primary Payer or Primary Payer Category.West Virginia Payers (Summarized)*Primary payer will display as submitted within these summarized categories,most summarized categories represent multiple individual payers.Payer CategoriesAARPAccess West VirginiaAcordiaAdvantageAetnaBlue Cross of VirginiaCHAMPUSCharityCommercial NECDOL-Black LungEmployer/ERISA/UnionFederal Bureau of CorrectionsFederal NECHealth Plan of the Upper Ohio ValleyMedicareMountain State Blue CrossNational Association of Letter CarriersNECNon-Profit NECOther BluesOther States’ GovernmentOther States’ MedicaidOther States’ Workers’ CompPrudentialRailroad WorkerSelf-PayTeamsterUMWAUMWA TrustsUnknownUnknown H990 NEC NONEVeterans AdministrationWest Virginia Children’s Health InsuranceWest Virginia County/Local CorrectionsWest Virginia Department of CorrectionsWest Virginia GovernmentWest Virginia Maternal & Child HealthWest Virginia MedicaidWest Virginia PEIAWest Virginia Small Business PlanWest Virginia Voc RehabWest Virginia Workers’ ercial5May 26, 2020
Hospital Industry Data InstituteWest Virginia Hospital AssociationReports Reference ManualPoint of Origin: The number of discharges is reported by point of origin. Valid UB-04 codes indicatingthe source of admission for adults, pediatrics and newborns follows.Adults and Pediatrics1Non-Health Care Facility Point of Origin2Clinic or Physicians’ Office4Transfer from Hospital5Transfer from Skilled Nursing Facility (SNF), Intermediate Care Facility (ICF), or AssistedLiving Facility (ALF)6Transfer from Another Health Care Facility8Court/Law Enforcement9Information not availableDTransfer from One Distinct Unit of the Hospital to another Distinct Unit of the SameHospital Resulting in a Separate Claim to the PayerETransfer from Ambulatory Surgery Center (ASC)FTransfer from a Hospice FacilityNewborns5Born inside this Hospital5NHIDI Code6Born outside this Hospital6NHIDI CodeHIDI Codes 5N and 6N arecalculated using Point of Origin5 or 6 and Type of Admission 4Type of Admission or Visit1EmergencyRequires immediate medical intervention2UrgentRequires immediate attention for care and treatment3ElectiveCondition permits adequate time to schedule services4NewbornCode necessitates the use of Point of Origin Codes5TraumaTrauma center/hospital, as licensed or designated by state or localgovernment authority, involving a trauma activation9UnknownInformation not available, reported, or hospital unable to classify typeof admission6May 26, 2020
Hospital Industry Data InstituteWest Virginia Hospital AssociationReports Reference ManualDischarge DispositionDischarge Disposition categories are added for a higher-level roll-up for potential report geDispositionDescription3OtherHospital00Not Reported1Home01Home/Self CareDischarged to Home or Self Care – RoutineDischarge3OtherHospital02To an Acute CareFacilityDischarged/Transferred to a Short-Term GeneralHospital for Inpatient Care5Post-Acute03To Skilled NursingFacility (SNF)Discharged/Transferred to Skilled Nursing Facility(SNF) with Medicare Certification in Anticipation ofSkilled Care9CustodialCare04To IntermediateCare Facility (ICF)Discharged/Transferred to a Facility that ProvidesCustodial or Supportive Care3OtherHospital05To DesignatedCancer Center orChildren’s HospitalDischarged/Transferred to a Designated CancerCenter or Children’s Hospital10Home Health06Home Health CareDischarged/Transferred to Home Under Care of anOrganized Home Health Service Organization inAnticipation of Covered Skilled Care7AgainstMedicalAdvice (AMA)07Against MedicalAdvice (AMA)Left Against Medical Advice (AMA) or DiscontinuedCare6Admitted IP09Admitted to thishospitalAdmitted as an Inpatient to this Hospital (For useonly on Medicare Outpatient ement21To a LawEnforcement AgencyDischarged/Transferred to Court/Law Enforcement8OtherDisposition30Still a PatientStill a Patient8OtherDisposition40Expired at Home(Hospice)Expired at Home (Medicare and TRICARE claims forHospice Care)8OtherDisposition41Expired in a MedicalFacility (Hospice)Expired in a Medical Facility – Hospital, SNF, ICF orfree standing hospice (For use only on Medicareand TRICARE claims for Hospice Care)8OtherDisposition42Expired – PlaceUnknown (Hospice)Expired - Place Unknown (For use only on Medicareand TRICARE claims for Hospice Care)3OtherHospital43To a Federal HealthCare FacilityDischarged/Transferred to a Federal Health CareFacility8OtherDisposition50Hospice – HomeHospice – Home8OtherDisposition51Hospice – MedicalFacilityHospice – Medical Facility (Certified) ProvidingHospice Level of Care7May 26, 2020
Hospital Industry Data InstituteWest Virginia Hospital AssociationReports Reference ManualDischarge eDispositionDescription8OtherDisposition61To Hospital-BasedSwing-BedDischarged/Transferred to a Hospital-BasedMedicare Approved Swing-Bed5Post-Acute62To d to an InpatientRehabilitation Facility (IRF) including RehabilitationDistinct Part Units of a Hospital5Post-Acute63To a Long-TermCare HospitalDischarged/Transferred to a Medicare CertifiedLong-Term Care Hospital (LTCH)5Post-Acute64To a Nursing FacilityDischarged/Transferred to a Nursing FacilityCertified under Medicaid but not Certified underMedicare2PsychHospital65To a PsychiatricHospitalDischarged/Transferred to a Psychiatric Hospital orPsychiatric Distinct Part Unit of a Hospital3OtherHospital66To a Critical AccessHospital (CAH)Discharged/Transferred to a Critical Access Hospital(CAH)8OtherDisposition69To a DesignatedDisaster AlternativeCare SiteDischarged/Transferred to a Designated DisasterAlternative Care Site5Post-Acute70To Another Type ofInstitutionDischarged/Transferred to another Type of HealthCare Institution not Defined Elsewhere in this CodeList1Home81Home/Self Care withPlanned Acute CareReadmissionDischarged to Home or Self Care with a PlannedAcute Care Hospital Inpatient Readmission3OtherHospital82To an Acute CareFacility with PlannedAcute CareReadmissionDischarged/Transferred to a Short-Term GeneralHospital for Inpatient Care with a Planned AcuteCare Hospital Inpatient Readmission83To Skilled NursingFacility (SNF) withPlanned Acute CareReadmissionDischarged/Transferred to a Skilled Nursing Facility(SNF) with Medicare Certification with a PlannedAcute Care Hospital Inpatient Readmission84To IntermediateCare Facility (ICF)with planned AcuteCare ReadmissionDischarged/Transferred to a Facility that ProvidesCustodial or Supportive Care with a Planned AcuteCare Hospital Inpatient Readmission85To a DesignatedCancer Center orChildren’s Hospitalwith Planned AcuteCare ReadmissionDischarged/Transferred to a Designated CancerCenter or Children’s Hospital with a Planned AcuteCare Hospital Inpatient 8May 26, 2020
Hospital Industry Data InstituteWest Virginia Hospital AssociationReports Reference ManualDischarge DispositionCategoryCategoryDescriptionCode10Home Health86Home Health Carewith Planned AcuteCare ReadmissionDischarged/Transferred to Home Under Care of anOrganized Home Health Service Organization with aPlanned Acute Care Hospital Inpatient Readmission7LawEnforcement87To a LawEnforcement Agencywith Planned AcuteCare ReadmissionDischarged/Transferred to Court/Law Enforcementwith a Planned Acute Care Hospital InpatientReadmission3OtherHospital88To a Federal CareFacility with PlannedAcute CareReadmissionDischarged/Transferred to a Federal Health CareFacility with a Planned Acute Care HospitalInpatient Readmission8OtherDisposition89To Hospital-BasedSwing-Bed withPlanned Acute CareReadmissionDischarged/Transferred to a Hospital-BasedMedicare Approved Swing-Bed with a PlannedAcute Care Hospital Inpatient Readmission8OtherDisposition90To an InpatientRehab Facility(IRF)with Planned AcuteCare ReadmissionDischarged/Transferred to an InpatientRehabilitation Facility (IRF) including RehabilitationDistinct Part Units of a Hospital with a PlannedAcute Care Hospital Inpatient Readmission91To a Long-TermCare hospital withPlanned Acute CareReadmissionDischarged/Transferred to a Medicare CertifiedLong-Term Care Hospital (LTCH) with a PlannedAcute Care Hospital Inpatient Readmission92To a Nursing Facilitywith Planned AcuteCare ReadmissionDischarged/Transferred to a Nursing FacilityCertified under Medicaid but not Certified underMedicare with a Planned Acute Care HospitalInpatient Readmission93To a PsychiatricFacility with PlannedAcute CareReadmissionDischarged/Transferred to a Psychiatric Hospital orPsychiatric Distinct Part Unit of a Hospital with aPlanned Acute Care Hospital Inpatient Readmission94To a Critical AccessHospital (CAH) withPlanned Acute CareReadmissionDischarged/Transferred to a Critical Access Hospital(CAH) with a Planned Acute Care Hospital InpatientReadmissionDischarged/Transferred to another Type of HealthCare Institution not Defined Elsewhere in this CodeList with a Planned Acute Care Hospital InpatientReadmissionInvalid Code 2PsychHospital3OtherHospital8OtherDisposition95To another type ofInstitution withPlanned Acute CareReadmission8OtherDisposition99Invalid CodeDescriptionReadmission – defined as “An intentional readmission after discharge from an acute care hospital that is ascheduled part of the patient’s plan of care.”9May 26, 2020
Hospital Industry Data InstituteWest Virginia Hospital AssociationReports Reference ManualMajor Diagnostic CategoryMDCMDC DescriptionMDC Definition01Nervous SystemDiseases & Disorders of the Nervous System02Eye DiseasesDiseases & Disorders of the Eye03Ear, Nose, Mouth & ThroatDiseases & Disorders of the Ear, Nose, Mouth & Throat04Respiratory SystemDiseases & Disorders of the Respiratory System05Circulatory SystemDiseases & Disorders of the Circulatory System06Digestive SystemDiseases & Disorders of the Digestive System07Liver/PancreasDiseases & Disorders of the Hepatobiliary System &Pancreas08Musculoskeletal/Connective TissueDiseases & Disorders of the Musculoskeletal System &Connective Tissue09Skin/Subcu Tissue/BreastDiseases & Disorders of the Skin, Subcutaneous Tissue& Breast10Endocrine/Nutritional/MetabolicEndocrine, Nutritional & Metabolic Diseases & Disorders11Kidney/Urinary TractDiseases & Disorders of the Kidney & Urinary Tract12Male ReproductiveDiseases & Disorders of the Male Reproductive System13Female ReproductiveDiseases & Disorders of the Female mPregnancy, Childbirth & the Puerperium15Newborn & Other NeonatesNewborns & Other Neonates with Conditions Originatingin the Perinatal Period16Blood/RelatedDiseases & Disorders of Blood, Blood Forming Organs,Immunological Disorders17Neoplasms/RelatedMyeloproliferative Diseases & Disorders, PoorlyDifferentiated Neoplasm18Infection/ParasitesInfectious & Parasitic Diseases, Systemic or UnspecifiedSites19Mental DisordersMental Diseases & Disorders20Substance AbuseAlcohol/Drug Use & Alcohol/Drug Induced OrganicMental Disorders21Injury/PoisoningInjuries, Poisonings & Toxic Effects of Drugs22BurnsBurns23Other FactorsFactors Influencing Health Status & Other ContactsWith Health Services24Multiple TraumaMultiple Significant Trauma25HIV InfectionsHuman Immunodeficiency Virus Infections26UnknownUnknown – blank10May 26, 2020
Hospital Industry Data InstituteWest Virginia Hospital AssociationReports Reference ManualMDC Listing – FFY2020Reference: MS-DRGs V37.0 Definitions Manual, 3M Health Information Systems, Oct. 1, 2019TYPEPRE MDCDRGs 001 - 017NOTE:DRGs 001 - 017 can be assigned to any of the Major Diagnostic CategoriesDRG 001DRG 002DRG 003DRG 004DRG 005DRG 006DRG 007DRG 008DRG 010DRG 011DRG 012DRG GHEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM W MCCHEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM W/O MCCECMO OR TRACH W MV 96 HRS OR PDX EXC FACE, MOUTH & NECK W MAJ O.R.TRACH W MV 96 HRS OR PDX EXC FACE, MOUTH & NECK W/O MAJ O.R.LIVER TRANSPLANT W MCC OR INTESTINAL TRANSPLANTLIVER TRANSPLANT W/O MCCLUNG TRANSPLANTSIMULTANEOUS PANCREAS/KIDNEY TRANSPLANTPANCREAS TRANSPLANTTRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY W MCCTRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY W CCTRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY W/OCC/MCCDRG 014DRG 016DRG 017SURGSURGSURGALLOGENEIC BONE MARROW TRANSPLANTAUTOLOGOUS BONE MARROW TRANSPLANT W CC/MCC OR T-CELL IMMUNOTHERAPYAUTOLOGOUS BONE MARROW TRANSPLANT W/O CC/MCCMDC 01TYPENERVOUS SYSTEMDRGs 020 - 103DRG 020DRG 021DRG 022DRG 023SURGSURGSURGSURGINTRACRANIAL VASCULAR PROCEDURES W PDX HEMORRHAGE W MCCINTRACRANIAL VASCULAR PROCEDURES W PDX HEMORRHAGE W CCINTRACRANIAL VASCULAR PROCEDURES W PDX HEMORRHAGE W/O CC/MCCCRANIOTOMY W MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PDX W MCC ORCHEMOTHERAPY IMPLANT OR EPILEPSY W NEUROSTIMULATORDRG 024DRG 025DRG 026DRG 027DRG 028DRG 029DRG 030DRG 031DRG 032DRG 033DRG 034DRG 035DRG GSURGCRANIO W MAJOR DEV IMPL/ACUTE COMPLEX CNS PDX W/O MCCCRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES W MCCCRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES W CCCRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES W/O CC/MCCSPINAL PROCEDURES W MCCSPINAL PROCEDURES W CC OR SPINAL NEUROSTIMULATORSSPINAL PROCEDURES W/O CC/MCCVENTRICULAR SHUNT PROCEDURES W MCCVENTRICULAR SHUNT PROCEDURES W CCVENTRICULAR SHUNT PROCEDURES W/O CC/MCCCAROTID ARTERY STENT PROCEDURE W MCCCAROTID ARTERY STENT PROCEDURE W CCCAROTID ARTERY STENT PROCEDURE W/O CC/MCC11May 26, 2020
Hospital Industry Data InstituteWest Virginia Hospital AssociationReports Reference ManualMDC Listing – FFY2020MDC 01TYPENERVOUS SYSTEMDRGs 020 - 103DRG 037DRG 038DRG 039DRG 040DRG 041DRG 042DRG 052DRG 053DRG 054DRG 055DRG 056DRG 057DRG 058DRG 059DRG 060DRG DMEDMEDEXTRACRANIAL PROCEDURES W MCCEXTRACRANIAL PROCEDURES W CCEXTRACRANIAL PROCEDURES W/O CC/MCCPERIPH, CRANIAL NERVE & OTHER NERV SYST PROC W MCCPERIPH, CRANIAL NERVE & OTHER NERV SYST PROC W CC OR PERIPH NEUROSTIMPERIPH, CRANIAL NERVE & OTHER NERV SYST PROC W/O CC/MCCSPINAL DISORDERS & INJURIES W CC/MCCSPINAL DISORDERS & INJURIES W/O CC/MCCNERVOUS SYSTEM NEOPLASMS W MCCNERVOUS SYSTEM NEOPLASMS W/O MCCDEGENERATIVE NERVOUS SYSTEM DISORDERS W MCCDEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCCMULTIPLE SCLEROSIS & CEREBELLAR ATAXIA W MCCMULTIPLE SCLEROSIS & CEREBELLAR ATAXIA W CCMULTIPLE SCLEROSIS & CEREBELLAR ATAXIA W/O CC/MCCISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WTHROMBOLYTIC AGENT W MCCDRG 062MEDISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WTHROMBOLYTIC AGENT W CCDRG 063MEDISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WTHROMBOLYTIC AGENT W/O CC/MCCDRG 064DRG 065DRG 066DRG 067DRG 068DRG 069DRG 070DRG 071DRG 072DRG 073DRG 074DRG 075DRG 076DRG 077DRG 078DRG 079DRG 080DRG 081DRG DMEDMEDMEDINTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W MCCINTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC OR TPA IN 24 HRSINTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W/O CC/MCCNONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT W MCCNONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT W/O MCCTRANSIENT ISCHEMIA W/O THROMBOLYTICNONSPECIFIC CEREBROVASCULAR DISORDERS W MCCNONSPECIFIC CEREBROVASCULAR DISORDERS W CCNONSPECIFIC CEREBROVASCULAR DISORDERS W/O CC/MCCCRANIAL & PERIPHERAL NERVE DISORDERS W MCCCRANIAL & PERIPHERAL NERVE DISORDERS W/O MCCVIRAL MENINGITIS W CC/MCCVIRAL MENINGITIS W/O CC/MCCHYPERTENSIVE ENCEPHALOPATHY W MCCHYPERTENSIVE ENCEPHALOPATHY W CCHYPERTENSIVE ENCEPHALOPATHY W/O CC/MCCNONTRAUMATIC STUPOR & COMA W MCCNONTRAUMATIC STUPOR & COMA W/O MCCTRAUMATIC STUPOR & COMA, COMA 1 HR W MCC12May 26, 2020
Hospital Industry Data InstituteWest Virginia Hospital AssociationReports Reference ManualMDC Listing – FFY2020MDC 01DRG 083DRG 084DRG 085DRG 086DRG 087DRG 088DRG 089DRG 090DRG 091DRG 092DRG 093DRG 094DRG 095DRG 096DRG 097DRG 098DRG 099DRG 100DRG 101DRG 102DRG 103MDC 02DRG 113DRG 114DRG 115DRG 116DRG 117DRG 121DRG 122DRG 123DRG 124DRG 125MDC 03DRG 129DRG 130DRG MEDMEDMEDTYPESURGSURGSURGNERVOUS SYSTEMDRGs 020 - 103TRAUMATIC STUPOR & COMA, COMA 1 HR W CCTRAUMATIC STUPOR & COMA, COMA 1 HR W/O CC/MCCTRAUMATIC STUPOR & COMA, COMA 1 HR W MCCTRAUMATIC STUPOR & COMA, COMA 1 HR W CCTRAUMATIC STUPOR & COMA, COMA 1 HR W/O CC/MCCCONCUSSION W MCCCONCUSSION W CCCONCUSSION W/O CC/MCCOTHER DISORDERS OF NERVOUS SYSTEM W MCCOTHER DISORDERS OF NERVOUS SYSTEM W CCOTHER DISORDERS OF NERVOUS SYSTEM W/O CC/MCCBACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM W MCCBACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM W CCBACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM W/O CC/MCCNON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS W MCCNON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS W CCNON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS W/O CC/MCCSEIZURES W MCCSEIZURES W/O MCCHEADACHES W MCCHEADACHES W/O MCCEYE DISEASESDRGs 113 - 125ORBITAL PROCEDURES W CC/MCCORBITAL PROCEDURES W/O CC/MCCEXTRAOCULAR PROCEDURES EXCEPT ORBITINTRAOCULAR PROCEDURES W CC/MCCINTRAOCULAR PROCEDURES W/O CC/MCCACUTE MAJOR EYE INFECTIONS W CC/MCCACUTE MAJOR EYE INFECTIONS W/O CC/MCCNEUROLOGICAL EYE DISORDERSOTHER DISORDERS OF THE EYE W MCCOTHER DISORDERS OF THE EYE W/O MCCEAR, NOSE, MOUTH & THROATDRGs 129 - 159MAJOR HEAD & NECK PROCEDURES W CC/MCC OR MAJOR DEVICEMAJOR HEAD & NECK PROCEDURES W/O CC/MCCCRANIAL/FACIAL PROCEDURES W CC/MCC13May 26, 2020
Hospital Industry Data InstituteWest Virginia Hospital AssociationReports Reference ManualMDC Listing – FFY2020MDC 03DRG 132DRG 133DRG 134DRG 135DRG 136DRG 137DRG 138DRG 139DRG 146DRG 147DRG 148DRG 149DRG 150DRG 151DRG 152DRG 153DRG 154DRG 155DRG 156DRG 157DRG 158DRG 159MDC 04DRG 163DRG 164DRG 165DRG 166DRG 167DRG 168DRG 175DRG 176DRG 177DRG 178DRG 179DRG 180DRG 181DRG 182DRG GSURGSURGMEDMEDMEDMEDMEDMEDMEDMEDMEDEAR, NOSE, MOUTH & THROATDRGs 129 - 159CRANIAL/FACIAL PROCEDURES W/O CC/MCCOTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES W CC/MCCOTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES W/O CC/MCCSINUS & MASTOID PROCEDURES W CC/MCCSINUS & MASTOID PROCEDURES W/O CC/MCCMOUTH PROCEDURES W CC/MCCMOUTH PROCEDURES W/O CC/MCCSALIVARY GLAND PROCEDURESEAR, NOSE, MOUTH & THROAT MALIGNANCY W MCCEAR, NOSE, MOUTH & THROAT MALIGNANCY W CCEAR, NOSE, MOUTH & THROAT MALIGNANCY W/O CC/MCCDYSEQUILIBRIUMEPISTAXIS W MCCEPISTAXIS W/O MCCOTITIS MEDIA & URI W MCCOTITIS MEDIA & URI W/O MCCOTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES W MCCOTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES W CCOTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES W/O CC/MCCDENTAL & ORAL DISEASES W MCCDENTAL & ORAL DISEASES W CCDENTAL & ORAL DISEASES W/O CC/MCCRESPIRATORY SYSTEMDRGs 163 - 208MAJOR CHEST PROCEDURES W MCCMAJOR CHEST PROCEDURES W CCMAJOR CHEST PROCEDURES W/O CC/MCCOTHER RESP SYSTEM O.R. PROCEDURES W MCCOTHER RESP SYSTEM O.R. PROCEDURES W CCOTHER RESP SYSTEM O.R. PROCEDURES W/O CC/MCCPULMONARY EMBOLISM W MCCPULMONARY EMBOLISM W/O MCCRESPIRATORY INFECTIONS & INFLAMMATIONS W MCCRESPIRATORY INFECTIONS & INFLAMMATIONS W CCRESPIRATORY INFECTIONS & INFLAMMATIONS W/O CC/MCCRESPIRATORY NEOPLASMS W MCCRESPIRATORY NEOPLASMS W CCRESPIRATORY NEOPLASMS W/O CC/MCCMAJOR CHEST TRAUMA W MCC14May 26, 2020
Hospital Industry Data InstituteWest Virginia Hospital AssociationReports Reference ManualMDC Listing – FFY2020MDC 04TYPERESPIRATORY SYSTEMDRGs 163 - 208DRG 184DRG 185DRG 186DRG 187DRG 188DRG 189DRG 190DRG 191DRG 192DRG 193DRG 194DRG 195DRG 196DRG 197DRG 198DRG 199DRG 200DRG 201DRG 202DRG 203DRG 204DRG 205DRG 206DRG DMEDMEDMEDMEDMEDMEDMEDMEDMAJOR CHEST TRAUMA W CCMAJOR CHEST TRAUMA W/O CC/MCCPLEURAL EFFUSION W MCCPLEURAL EFFUSION W CCPLEURAL EFFUSION W/O CC/MCCPULMONARY EDEMA & RESPIRATORY FAILURECHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCCCHRONIC OBSTRUCTIVE PULMONARY DISEASE W CCCHRONIC OBSTRUCTIVE PULMONARY DISEASE W/O CC/MCCSIMPLE PNEUMONIA & PLEURISY W MCCSIMPLE PNEUMONIA & PLEURISY W CCSIMPLE PNEUMONIA & PLEURISY W/O CC/MCCINTERSTITIAL LUNG DISEASE W MCCINTERSTITIAL LUNG DISEASE W CCINTERSTITIAL LUNG DISEASE W/O CC/MCCPNEUMOTHORAX W MCCPNEUMOTHORAX W CCPNEUMOTHORAX W/O CC/MCCBRONCHITIS & ASTHMA W CC/MCCBRONCHITIS & ASTHMA W/O CC/MCCRESPIRATORY SIGNS & SYMPTOMSOTHER RESPIRATORY SYSTEM DIAGNOSES W MCCOTHER RESPIRATORY SYSTEM DIAGNOSES W/O MCCRESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96 HOURSDRG 208MEDRESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96 HOURSMDC 05DRG 215DRG 216DRG 217DRG 218DRG 219DRG 220DRG 221DRG 222DRG 223DRG 224DRG GCIRCULATORY SYSTEMDRGs 215 - 320OTHER HEART ASSIST SYSTEM IMPLANTCARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W CARD CATH W MCCCARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W CARD CATH W CCCARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W CARD CATH W/O CC/MCCCARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W/O CARD CATH W MCCCARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W/O CARD CATH W CCCARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W/O CARD CATH W/O CC/MCCCARDIAC DEFIB IMPLANT W CARDIAC CATH W AMI/HF/SHOCK W MCCCARDIAC DEFIB IMPLANT W CARDIAC CATH W AMI/HF/SHOCK W/O MCCCARDIAC DEFIB IMPLANT W CARDIAC CATH W/O AMI/HF/SHOCK W MCCCARDIAC DEFIB IMPLANT W CARDIAC CATH W/O AMI/HF/SHOCK W/O MCC15May 26, 2020
Hospital Industry Data InstituteWest Virginia Hospital AssociationReports Reference ManualMDC Listing – FFY2020MDC 05TYPECIRCULATORY SYSTEMDRGs 215 – 320DRG 226DRG 227DRG 228DRG 229DRG 231DRG 232DRG 233DRG 234DRG 235DRG 236DRG 239DRG 240DRG 241DRG 242DRG 243DRG 244DRG 245DRG GSURGSURGSURGSURGSURGSURGCARDIAC DEFIBRILLATOR IMPLANT W/O CARDIAC CATH W MCCCARDIAC DEFIBRILLATOR IMPLANT W/O CARDIAC CATH W/O MCCOTHER CARDIOTHORACIC PROCEDURES W MCCOTHER CARDIOTHORACIC PROCEDURES W/
associated with a particular medical specialty. MDC 1 - MDC 23 are grouped according to principal diagnoses. Patients are assigned to MDC 24 (Multiple Significant Trauma) with at least two . 5 Native Hawaiian/Pacific Islander 6 Other 7 Multi-Racial (two or more races) . West Virginia Voc Rehab Government West Virginia Workers' Comp .
