Prospective Payment System Points: A Pullout Guide
August 1, 2000
Prospective Payment System Points: A Pullout Guide
The following lists provide the top three point earners for prospective payment system (PPS) diagnoses.
PPS 10-point HHRG Diagnoses Orthopedic (ICD-9 Prefixes)
170 Malignant neoplasm of bone and articular cartilage
171 Malignant neoplasm of connective and other soft tissue
213 Benign neoplasm of bone and articular cartilage
274 Gout
710 Diffuse diseases of connective tissue
711 Arthropathy associated with infections
712 Crystal arthropathies
713 Arthropathy associated with other disorders classified elsewhere
714 Rheumatoid arthritis and other inflammatory polyarthropathies
716 Other and unspecified arthropathies
717 Internal derangement of knee
718 Other derangement of joint
720 Ankylosing spondylitis and other inflammatory spondylopathies
721 Spondylosis and allied disorders
722 Intervertebral disc disorders
723 Other disorders of cervical region
724 Other and unspecified disorders of back
725 Polymyalgia rheumatica
728 Disorders of muscle, ligament, and fascia
730 Osteomyelitis, periostitis, and other infections involving bone
731 Osteitis deformans and osteopathies associated with other disorders classified elsewhere
732 Osteochondropathies
781 Symptoms involving nervous and musculoskeletal systems
800 Fracture of vault of skull
801 Fracture of base of skull
802 Fracture of face bones
803 Other and unqualified skull fractures
804 Multiple fractures involving skull or face with other bones
805 Fracture of vertebral column without mention of spinal cord injury
806 Fracture of vertebral column with spinal cord injury
807 Fracture of rib(s), sternum, larynx, and trachea
808 Fracture of pelvis
809 Ill-defined fractures of bones of trunk
810 Fracture of clavicle
811 Fracture of scapula
812 Fracture of humerus
813 Fracture of radius and ulna
814 Fracture of carpal bone(s)
815 Fracture of metacarpal bone(s)
816 Fracture of one or more phalanges of hand
817 Multiple fractures of hand bones
818 Ill-defined fractures of upper limb
819 Multiple fractures involving both upper limbs, and upper limb with rib(s) and sternum
820 Fracture of neck of femur
821 Fracture of other and unspecified parts of femur
822 Fracture of patella
823 Fracture of tibia and fibula
824 Fracture of ankle
825 Fracture of one or more tarsal and metatarsal bones
827 Other, multiple, and ill-defined fractures of lower limb
828 Multiple fractures involving both lower limbs, lower with upper limb, and lower limb(s) with rib(s) and sternum
831 Dislocation of shoulder
832 Dislocation of elbow
833 Dislocation of wrist
835 Dislocation of hip
836 Dislocation of knee
837 Dislocation of ankle
846 Sprains and strains of sacroiliac region
847 Sprains and strains of other and unspecified parts of back
887 Traumatic amputation of arm and hand (complete) (partial)
896 Traumatic amputation of foot (complete) (partial)
897 Traumatic amputation of leg(s) (complete) (partial)
927 Crushing injury of upper limb
928 Crushing injury of lower limb
PPS 16-point HHRG Diagnoses Endocrine/Diabetes Mellitus (ICD-9 Prefix 250)
Diseases of Other Endocrine Glands (250-259)
250 Diabetes mellitus [Excludes: gestational diabetes (648.8)/hyperglycemia NOS (790.6)/neonatal diabetes mellitus (775.1)/nonclinical diabetes (790.2)]
The following fifth-digit subclassification is for use with category 250:
• 0 — type II [noninsulin dependent type] [NIDDM type] [adult-onset type] or unspecified type, not stated as uncontrolled
• Fifth-digit 0 — is for use for type II, adult-onset diabetic patients, even if the patient requires insulin
• 1 — type I [insulin dependent type] [IDDM] [juvenile type], not stated as uncontrolled
• 2 — type II [noninsulin dependent type] [NIDDM type] [adult-onset type] or unspecified type, uncontrolled
• Fifth-digit II — is for use for type II, adult-onset diabetic patients, even if the patient requires insulin
• 3 — type I [insulin dependent type] [IDDM] [juvenile type], uncontrolled
250.0 Diabetes mellitus without mention of complication
• Diabetes mellitus without mention of complication or manifestation classifiable to 250.1-250.9
• Diabetes (mellitus) NOS
250.1 Diabetes with ketoacidosis
• Diabetic:
— acidosis without mention of coma
— ketosis without mention of coma
250.2 Diabetes with hyperosmolarity
— Hyperosmolar (nonketotic) coma
250.3 Diabetes with other coma
— Diabetic coma (with ketoacidosis)
— Diabetic hypoglycemic coma
— Insulin coma NOS
[Excludes: diabetes with hyperosmolar coma (250.2)]
250.4 Diabetes with renal manifestations. Use additional code to identify manifestation, as:
• Diabetic:
— nephropathy NOS (583.81)
— nephrosis (581.81)
• Intercapillary glomerulosclerosis (581.81)
• Kimmelstiel-Wilson syndrome (581.81)
250.5 Diabetes with ophthalmic manifestations. Use additional code to identify manifestation, as:
• Diabetic:
— blindness (369.00-369.9)
— cataract (366.41)
— glaucoma (365.44)
— retinal edema (362.83)
— retinopathy (362.01-362.02)
250.6 Diabetes with neurological manifestations. Use additional code to identify manifestation, as:
• Diabetic:
— amyotrophy (358.1)
— mononeuropathy (354.0-355.9)
— neurogenic arthropathy (713.5)
— peripheral autonomic neuropathy (337.1)
— polyneuropathy (357.2)
250.7 Diabetes with peripheral circulatory disorders. Use additional code to identify manifestation, as:
• Diabetic:
— gangrene (785.4)
— peripheral angiopathy (443.81)
250.8 Diabetes with other specified manifestations
— Diabetic hypoglycemia
— Hypoglycemic shock
Use additional code to identify manifestation, as:
— diabetic bone changes (731.8)
Use additional E code to identify cause, if drug-induced.
250.9 Diabetes with unspecified complication
PPS 19-point HHRG Diagnoses Neurologic (ICD-9 Code Prefixes)
013 Tuberculosis of meninges and central nervous system
045 Acute poliomyelitis
046 Slow virus infection of central nervous system
047 Meningitis due to enterovirus
048 Other enterovirus diseases of central nervous system
049 Other nonarthropod-borne viral diseases of central nervous system
191 Malignant neoplasm of brain
192 Malignant neoplasm of other and unspecified parts of nervous system
225 Benign neoplasm of brain and other parts of nervous system
320 Bacterial meningitis
321 Meningitis due to other organisms
322 Meningitis of unspecified cause
323 Encephalitis, myelitis, and encephalomyelitis
324 Intracranial and intraspinal abscess
325 Phlebitis and thrombophlebitis of intracranial venous sinuses
326 Late effects of intracranial abscess or pyogenic infection
330 Cerebral degenerations usually manifest in childhood
331 Other cerebral degenerations
332 Parkinson's disease
333 Other extrapyramidal disease and abnormal movement disorders
334 Spinocerebellar disease (like Friedreich's ataxia)
335 Spinocerebellar disease (like Werdnig-Hoffmann disease)
336 Other diseases of spinal cord
337 Disorders of the autonomic nervous system
340 Multiple sclerosis
341 Other demyelinating diseases of central nervous system
342 Hemiplegia and hemiparesis
343 Infantile cerebral palsy
344 Other paralytic syndromes
347 Cataplexy and narcolepsy
348 Other conditions of brain
349 Other and unspecified disorders of the nervous system
352 Disorders of other cranial nerves
356 Hereditary and idiopathic peripheral neuropathy
357 Inflammatory and toxic neuropathy
358 Myoneural disorders
392 Rheumatic chorea
430 Subarachnoid hemorrhage
431 Intracerebral hemorrhage
432 Other and unspecified intracranial hemorrhage
433 Occlusion and stenosis of precerebral arteries
434 Occlusion of cerebral arteries
435 Transient cerebral ischemia
436 Acute, but ill-defined, cerebrovascular disease
437 Other and ill-defined cerebrovascular disease
741 Spina bifida
742 Other congenital anomalies of nervous system
851 Cerebral laceration and contusion
852 Subarachnoid, subdural, and extradural hemorrhage, following injury
853 Other and unspecified intracranial hemorrhage following injury
854 Intracranial injury of other and unspecified nature
907 Late effects of injuries to the nervous system
950 Injury to optic nerve and pathways
951 Injury to other cranial nerve(s)
952 Spinal cord injury without evidence of spinal bone injury
953 Injury to nerve roots and spinal plexus
954 Injury to other nerve(s) of trunk, excluding shoulder and pelvic girdles
955 Injury to peripheral nerve(s) of shoulder girdle and upper limb
956 Injury to peripheral nerve(s) of pelvic girdle and lower limb
Source: www.PPS4dummies.homepage.com.