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Issue Name Claim Types States
Acute Respiratory Failure: MS-DRG 189 Inpatient IL, IN, KY, MI, MN, OH, WI
Blood Transfusions Outpatient Hospital, Physician IL, IN, KY, MI, MN, OH, WI
Bronchoscopy Services Outpatient Hospital, Physician IL, IN, KY, MI, MN, OH, WI
Cardiac arrhythmia & conduction disorders w MCC or w CC DRG 138, MSDRG 308, 309 Inpatient IL, IN, KY, MI, MN, OH, WI
Cardiac Defib Implant W Cardiac Cath W/O AMI/HF/Shock W MCC Inpatient IL, IN, KY, MI, MN, OH, WI
Cardiac Valve & Oth Maj Cardiothoracic Procedures w CC or MCC Inpatient IL, IN, KY, MI, MN, OH, WI
Carotid Artery Stent & Extracranial Procedures w CC or MCC Inpatient IL, IN, KY, MI, MN, OH, WI
Chronic Obstructive Pulmonary Disease DRG 88 MSDRG 190, 191 Inpatient IL, IN, KY, MI, MN, OH, WI
Coronary Bypass W PTCA/Cardiac Cath w MCC Inpatient IL, IN, KY, MI, MN, OH, WI
Cranial/Facial Procedures w CC or MCC Inpatient IL, IN, KY, MI, MN, OH, WI
Craniotomy, Endovascular and Intracranial Vascular Procedures w CC or MCC Inpatient IL, IN, KY, MI, MN, OH, WI
CSW during Inpatient Hospital CSW Providers IL, IN, KY, MI, MN, OH, WI
Diseases and Disorders of the Respiratory System DRG 076,079 MSDRG166,167,177,178,179 Inpatient IL, IN, KY, MI, MN, OH, WI
Disorders Of The Eye, Infections And Procedures (Orbital And Interocular) w CC or MCC Inpatient IL, IN, KY, MI, MN, OH, WI
Esophagitis gastroenteritis and misc digest disorder w/MCC DRG 182 MSDRG 391 Inpatient IL, IN, KY, MI, MN, OH, WI
Excisional Debridement MSDRG 463, 464, 465, 573, 574, 575, 901, 902, 903 (ICD9 86.22) Inpatient IL, IN, KY, MI, MN, OH, WI
Extensive OR procedure unrelated to Principal Diagnosis DRG 468 MSDRG 981,982,983 Inpatient IL, IN, KY, MI, MN, OH, WI
Gastroenteritis Hemorrhage w/MCC wCC DRG 174,MS DRG 377,378,379 Inpatient IL, IN, KY, MI, MN, OH, WI
Heart Failure & Shock w/MCC, w CC, w/o CC/MCC DRG 127 MS-DRG 291, 292, 293 Inpatient IL, IN, KY, MI, MN, OH, WI
Hospital to Hospital Transfer Inpatient Hospital IL, IN, KY, MI, MN, OH, WI
Intracaranial Hemorrhage or Cerebral Infarction DRG 014, MS-DRG 064, 065, 066 Inpatient IL, IN, KY, MI, MN, OH, WI
Intravenous Infusion Chemotherapy and Non-chemotherapy - Excessive Units Reported Outpatient Hospital / Professional IL, IN, KY, MI, MN, OH, WI
IV-Hydration Outpatient Hospital, Physician IL, IN, KY, MI, MN, OH, WI
Kidney & Urinary Tract Infections w/MCC DRG 320, MS-DRG 689 Inpatient IL, IN, KY, MI, MN, OH, WI
Major Cardiovasc Thoracic Aortic Aneurysm Repair Procedures w CC or MCC Inpatient IL, IN, KY, MI, MN, OH, WI
Major Chest Procedures w CC or MCC Inpatient IL, IN, KY, MI, MN, OH, WI
Major Head & Neck Procedures w CC or MCC Inpatient IL, IN, KY, MI, MN, OH, WI
Major joint replacement or reattachment w/MCC DRG 544 MS-DRG 469 Inpatient IL, IN, KY, MI, MN, OH, WI
Neulasta Outpatient Hospital, Physician IL, IN, KY, MI, MN, OH, WI
Nutritional & Metabolic Disorders w/MCC DRG 296, MS-DRG 640 Inpatient IL, IN, KY, MI, MN, OH, WI
Once in a Lifetime Procedures Outpatient Hospital, Physician IL, IN, KY, MI, MN, OH, WI
Other Cardiothoracic Procedures w CC or MCC Inpatient IL, IN, KY, MI, MN, OH, WI
Other Ear, Nose, Mouth & Throat O.R.Procedures w CC or MCC Inpatient IL, IN, KY, MI, MN, OH, WI
Oxaliplatin Outpatient Hospital IL, IN, KY, MI, MN, OH, WI
Perc Cardiovasc Proc W Drug-Eluting Or Non Drug Eluting Stent w MCC or 4+ Vessels/Stents Inpatient IL, IN, KY, MI, MN, OH, WI
Periph/Cranial Nerve & Other Nerv Syst Proc w CC or MCC Inpatient IL, IN, KY, MI, MN, OH, WI
PreAdmission Testing Outpatient Hospital IL, IN, KY, MI, MN, OH, WI
Renal Failure DRG 316, MS-DRG 682, 683, 684 Inpatient IL, IN, KY, MI, MN, OH, WI
Respiratory system diagnosis w ventilator support DRG 475, 565,566 MS - DRG 207, 208 Inpatient IL, IN, KY, MI, MN, OH, WI
Separately Paid Ambulance Service during Inpatient Hospitalization Outpatient / Professional IL, IN, KY, MI, MN, OH, WI
Septicemia DRG 416, 576 MS-DRG 870, 871, 872 Inpatient IL, IN, KY, MI, MN, OH, WI
Simple Pneumonia DRG 089, MSDRG 193, 194, 195 Inpatient IL, IN, KY, MI, MN, OH, WI
Spinal Procedures Neurostimulators W CC or MCC Inpatient IL, IN, KY, MI, MN, OH, WI
Tracheostomy MS-DRG Validation - Overpayment Inpatient IL, IN, KY, MI, MN, OH, WI
Tracheostomy MS-DRG Validation - Underpayment Inpatient IL, IN, KY, MI, MN, OH, WI
Untimed Codes Outpatient Hospital, Physician IL, IN, KY, MI, MN, OH, WI
Ventricular Shunt Procedures W CC or MCC Inpatient IL, IN, KY, MI, MN, OH, WI
Wheelchair Bundling DME IL, IN, KY, MI, MN, OH, WI

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