| Diagnostic Conditions Subject to a Payment Reduction
If Present on Admission,
FY 2009 |
| |
Condition |
ICD-9-CM Codes |
CC/MCC |
Description |
Guidelines |
| |
Serious Preventable
Event— |
|
|
1. |
Object left in surgery |
998.4
998.7* |
CC |
Foreign body accidentally
left during a procedure |
NQF
serious reportable preventable events
NQF’s Safe Practices for Better
Healthcare |
2. |
Air embolism |
999.1 |
MCC |
Complications of medical
care, NOS, air embolism |
NQF
serious reportable preventable events
NQF’s Safe Practices for Better
Healthcare |
3. |
Blood incompatibility |
999.6 |
CC |
Complications of medical
care, NOS, ABO incompatibility reaction) |
NQF
serious reportable preventable events
NQF’s Safe Practices for Better
Healthcare |
4. |
Vascular
Catheter-Associated Infection |
999.31 |
CC |
Infection due to central
venous catheter |
Guidelines for the Prevention of Intravascular
Catheter-Related Infections, 2002
|
5. |
Surgical Site
Infection—Mediastinitis after Coronary Artery Bypass Graft (CABG) surgery |
519.2 |
MCC |
Mediastinitis |
Guideline for the Prevention of Surgical Site
Infection, 1999
|
With procedure codes |
36.10 –36.19 |
CABG |
6. |
Catheter-Associated
Urinary Tract Infections |
996.64 |
CC |
Infection and inflammatory
reaction due to indwelling urinary catheter) and on the same claim |
Guideline for Prevention of Catheter-associated
Urinary Tract Infections
|
If on the same claim,
then not POA |
112.2 |
CC |
Candidiasis of other
urogenital sites |
590.10 |
CC |
Acute pyelonephritis,
without lesion of renal medullary necrosis |
590.11 |
MCC |
Acute pyelonephritis,
with lesion of renal medullary necrosis |
590.2 |
MCC |
Renal and perinephric
abscess |
590.3 |
CC |
Pyeloureteritis cystica |
590.80 |
CC |
Pyelonephritis,
unspecified |
590.81 |
CC |
Pyelitis or
pyelonephritis in diseases classified elsewhere |
595.0 |
CC |
Acute cystitis |
597.0 |
CC |
Urethral abscess |
599.0 |
CC |
Urinary tract infection,
site not specified |
7. |
Pressure Ulcers (Decubitus
Ulcers) |
707.23* |
MCC |
Pressure ulcer, stage
III |
— |
707.24* |
MCC |
Pressure ulcer, stage IV |
8. |
Falls and Trauma |
CC/MCC codes in ICD-9-CM
code ranges: |
|
NQF
serious reportable preventable events
NQF’s Safe Practices for Better
Healthcare |
Fractures |
800 – 829 |
Dislocations |
830 – 839 |
Intracranial injury |
850 – 854 |
Crushing injury |
925 – 929 |
Burns |
940 – 949 |
Electric Shock |
991 – 994 |
| 9. |
Manifestations of Poor Glycemic Control |
|
|
| |
Diabetic ketoacidosis
Nonketotic hyperosmolar coma |
250.10 – 250.13
250.20 – 250.23 |
MCC
MCC
CC
CC |
|
Inpatient Diabetes
and Glycemic Control:
Conference
Recommendations: Position Statement
Feb. 1, 2006 |
| |
Hypoglycemic coma
Secondary diabetes with ketoacidosis
Secondary diabetes with hyperosmolarity |
251.0
249.10 or 249.11
249.20 or 249.21 |
CC
MCC
MCC
MCC
MCC |
|
Society of Hospital
Medicine, Glycemic Control Resource Room
|
| 10. |
Surgical Site Infections Following |
|
|
| |
Certain Orthopedic Procedures |
996.67
or
998.59 |
CC
CC |
Surgical site infection |
Guideline
for the Prevention of Surgical Site Infection, 1999
Guideline for Isolation Precautions:
Preventing Transmission of Infectious Agents in Healthcare
Settings 2007 |
| |
|
And one of following procedure codes |
| |
|
81.01–81.08, 81.23–81.24, 81.31–81.38, 81.83, 81.85 |
|
| |
Bariatric Surgery for Obesity
|
Principle Dx-278.01
And |
|
Obesity |
| |
|
998.59
And |
CC |
Surgical site infection |
| |
|
44.38, or 44.39, or 44.95 |
|
Bariatric surgery |
| 11. |
Deep Vein Thrombosis (DVT)
and Pulmonary Embolism (PE) Following Orthopedic Procedures |
453.40–453.42 Or
415.11 or 415.19 |
MCC
MCC
MCC |
|
The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy: Evidence-Based
Guidelines, 2004
|
| |
|
And one of the following procedure codes
00.85-00.87, 81.51-81.52, or |
Hip replacement |
| |
|
81.54
|
Total knee replacement
|
Source: 72 Fed. Reg.
47200-219; Table 1: Hospital-Acquired Conditions, 72 Fed. Reg. 47218 (Aug.
22, 2007);
* New codes for FY 2009; Final Rule FY 2009, 73 Fed. Reg. 48490–91 (Aug. 19, 2008) |
