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Triggering and Grouping Codes			Table of Contents			
HIP REPLACEMENT/REVISION						
Code	Code Type	Used in Trigger Rule	Code Description			
00.70	ICD-9 Procedure	Y	"Revision of hip replacement, both acetabular and femoral components"	 		
00.71	ICD-9 Procedure	Y	"Revision of hip replacement, acetabular component"	 		
00.72	ICD-9 Procedure	Y	"Revision of hip replacement, femoral component"	 		
00.73	ICD-9 Procedure	Y	"Revision of hip replacement, acetabular liner and/or femoral head only"	 		
00.74	ICD-9 Procedure	Y	"Hip bearing surface, metal-on-polyethylene"	 		
00.75	ICD-9 Procedure	Y	"Hip bearing surface, metal-on-metal"	 		
00.76	ICD-9 Procedure	Y	"Hip bearing surface, ceramic-on-ceramic"			
00.77	ICD-9 Procedure	Y	"Hip bearing surface, ceramic-on-polyethylene"			
00.85	ICD-9 Procedure	Y	"Resurfacing hip, total, acetabulum and femoral head"			
00.86	ICD-9 Procedure	Y	"Resurfacing hip, partial, femoral head"			
00.87	ICD-9 Procedure	Y	"Resurfacing hip, partial, acetabulum"			
81.51	ICD-9 Procedure	Y	Total hip replacement	 		
81.52	ICD-9 Procedure	Y	Partial hip replacement	 		
81.53	ICD-9 Procedure	Y	"Revision of hip replacement, not otherwise specified"	 		
466	MS-DRG	Y	Revision Of Hip Or Knee Replacement W Mcc	 		 
467	MS-DRG	Y	Revision Of Hip Or Knee Replacement W Cc	 		
468	MS-DRG	Y	Revision Of Hip Or Knee Replacement W/O Cc/Mcc	 		
469	MS-DRG	Y	Major Joint Replacement Or Reattachment Of Lower Extremity W Mcc	 		
470	MS-DRG	Y	Major Joint Replacement Or Reattachment Of Lower Extremity W/O Mcc	 		
27125	CPT-4	Y	"Hemiarthroplasty, Hip, Partial (Eg, Femoral Stem Prosthesis, Bipolar Arthroplasty)"	 		
27130	CPT-4	Y	"Arthroplasty, Acetabular And Proximal Femoral Prosthetic Replacement (Total Hip Arthroplasty), With Or Without Autograft Or Allograft"	 		
27132	CPT-4	Y	"Conversion Of Previous Hip Surgery To Total Hip Arthroplasty, With Or Without Autograft Or Allograft"	 		
27134	CPT-4	Y	"Revision Of Total Hip Arthroplasty; Both Components, With Or Without Autograft Or Allograft"	 		
27137	CPT-4	Y	"Revision Of Total Hip Arthroplasty; Acetabular Component Only, With Or Without Autograft Or Allograft"	 		
27138	CPT-4	Y	"Revision Of Total Hip Arthroplasty; Femoral Component Only, With Or Without Allograft"	 		
0007	APC	No data	Level II Incision & Drainage	 		
0016	APC	No data	Level IV Debridement & Destruction	 		
0064	APC	No data	Level III Treatment Fracture/Dislocation	 		
0260	APC	No data	Level I Plain Film Except Teeth	 		
0266	APC	No data	Level II Diagnostic and Screening Ultrasound	 		
0267	APC	No data	Level III Diagnostic and Screening Ultrasound	 		
0283	APC	No data	Computed Tomography with Contrast	 		
0332	APC	No data	Computed Tomography without Contrast	 		
0334	APC	No data	Combined Abdomen and Pelvis CT with Contrast	 		
0336	APC	No data	Magnetic Resonance Imaging and Magnetic Resonance Angiography without Contrast	 		
0337	APC	No data	Magnetic Resonance Imaging and Magnetic Resonance Angiography without Contrast followed by Contrast	 		
0437	APC	No data	Level II Drug Administration	 		
0439	APC	No data	Level IV Drug Administration	 		
0440	APC	No data	Level V Drug Administration	 		
0604	APC	No data	Level 1 Hospital Clinic Visits	 		
0605	APC	No data	Level 2 Hospital Clinic Visits	 		
0606	APC	No data	Level 3 Hospital Clinic Visits	 		
0607	APC	No data	Level 4 Hospital Clinic Visits	 		
0608	APC	No data	Level 5 Hospital Clinic Visits	 		
146	CCS	No data	"Treatment, fracture or dislocation of hip and femur"	 		
153	CCS	No data	"Hip replacement, total and partial"	 		
162	CCS	No data	Other OR therapeutic procedures on joints	 		
180	CCS	No data	Other CT scan	 		
197	CCS	No data	Other diagnostic ultrasound	 		
198	CCS	No data	Magnetic resonance imaging	 		
206	CCS	No data	"Microscopic examination (bacterial smear, culture, toxicology)"	 		
209	CCS	No data	Radioisotope scan and function studies	 		
211	CCS	No data	Therapeutic radiology	 		
212	CCS	No data	Diagnostic physical therapy	 		
213	CCS	No data	"Physical therapy exercises, manipulation, and other procedures"	 		
215	CCS	No data	Other physical therapy and rehabilitation	 		
222	CCS	No data	Blood transfusion	 		
226	CCS	No data	Other diagnostic radiology and related techniques	 		
227	CCS	No data	"Other diagnostic procedures (interview, evaluation, consultation)"	 		
231	CCS	No data	Other therapeutic procedures	 		
232	CCS	No data	Anesthesia	 		
233	CCS	No data	Laboratory - Chemistry and Hematology	 		
240	CCS	No data	"Medications (Injections, infusions and other forms)"	 		
E0100	HCPCS	No data	"Cane, Includes Canes Of All Materials, Adjustable Or Fixed, With Tip"	 		
E0135	HCPCS	No data	"Walker, Folding (Pickup), Adjustable Or Fixed Height"	 		
E0143	HCPCS	No data	"Walker, Folding, Wheeled, Adjustable Or Fixed Height"	 		
E0149	HCPCS	No data	"Walker, Heavy Duty, Wheeled, Rigid Or Folding, Any Type"	 		
E0971	HCPCS	No data	"Manual Wheelchair Accessory, Anti-Tipping Device, Each"	 		
E0973	HCPCS	No data	"Wheelchair Accessory, Adjustable Height, Detachable Armrest, Complete Assembly, Each"	 		
E2402	HCPCS	No data	"Negative Pressure Wound Therapy Electrical Pump, Stationary Or Portable"	 		
E2601	HCPCS	No data	"General Use Wheelchair Seat Cushion, Width Less Than 22 Inches, Any Depth"	 		
E2611	HCPCS	No data	"General Use Wheelchair Back Cushion, Width Less Than 22 Inches, Any Height, Including Any Type Mounting Hardware"	 		
K0001	HCPCS	No data	Standard Wheelchair	 		
K0003	HCPCS	No data	Lightweight Wheelchair	 		
K0004	HCPCS	No data	"High Strength, Lightweight Wheelchair"	 		
K0823	HCPCS	No data	"Power Wheelchair, Group 2 Standard, Captains Chair, Patient Weight Capacity Up To And Including 300 Pounds"			
L1686	HCPCS	No data	"Hip Orthosis, Abduction Control Of Hip Joint, Postoperative Hip Abduction Type, Prefabricated, Includes Fitting And Adjustment"			
041	ICD-9 Diagnosis	No data	Bacterial infection in conditions classified elsewhere and of unspecified site			
276	ICD-9 Diagnosis	No data	"Disorders of fluid, electrolyte, and acid-base balance"			
285	ICD-9 Diagnosis	No data	Other and unspecified anemias			
286	ICD-9 Diagnosis	No data	Coagulation defects			
428	ICD-9 Diagnosis	No data	Heart failure			
453	ICD-9 Diagnosis	No data	Other venous embolism and thrombosis			
507	ICD-9 Diagnosis	No data	Pneumonitis due to solids and liquids			
584	ICD-9 Diagnosis	No data	Acute kidney failure			
599	ICD-9 Diagnosis	No data	Other disorders of urethra and urinary tract			
682	ICD-9 Diagnosis	No data	Other cellulitis and abscess			
686	ICD-9 Diagnosis	No data	Other local infection of skin and subcutaneous tissue			
711	ICD-9 Diagnosis	No data	Arthropathy associated with infections			
715	ICD-9 Diagnosis	No data	Osteoarthrosis and allied disorders			
719	ICD-9 Diagnosis	No data	Other and unspecified disorders of joint			
721	ICD-9 Diagnosis	No data	Spondylosis and allied disorders			
727	ICD-9 Diagnosis	No data	"Other disorders of synovium, tendon, and bursa"			
728	ICD-9 Diagnosis	No data	"Disorders of muscle, ligament, and fascia"			
729	ICD-9 Diagnosis	No data	Other disorders of soft tissues			
733	ICD-9 Diagnosis	No data	Other disorders of bone and cartilage			
781	ICD-9 Diagnosis	No data	Symptoms involving nervous and musculoskeletal systems			
786	ICD-9 Diagnosis	No data	Symptoms involving respiratory system and other chest symptoms			
788	ICD-9 Diagnosis	No data	Symptoms involving urinary system			
820	ICD-9 Diagnosis	No data	Fracture of neck of femur			
821	ICD-9 Diagnosis	No data	Fracture of other and unspecified parts of femur			
835	ICD-9 Diagnosis	No data	Dislocation of hip			
959	ICD-9 Diagnosis	No data	"Injury, other and unspecified"			
996	ICD-9 Diagnosis	No data	Complications peculiar to certain specified procedures			
998	ICD-9 Diagnosis	No data	"Other complications of procedures, not elsewhere classified"			
V43	ICD-9 Diagnosis	No data	Organ or tissue replaced by other means			
V45	ICD-9 Diagnosis	No data	Other postprocedural status			
V54	ICD-9 Diagnosis	No data	Other orthopedic aftercare	 		
V57	ICD-9 Diagnosis	No data	Care involving use of rehabilitation procedures	 		
V58	ICD-9 Diagnosis	No data	Encounter for other and unspecified procedure and aftercare	 		
00.33	ICD-9 Procedure	No data	Computer assisted surgery with fluoroscopy	 		
38.08	ICD-9 Procedure	No data	"Incision of vessel, lower limb arteries"	 		
38.95	ICD-9 Procedure	No data	Venous catheterization for renal dialysis	 		
39.49	ICD-9 Procedure	No data	Other revision of vascular procedure	 		
39.95	ICD-9 Procedure	No data	Hemodialysis	 		
39.98	ICD-9 Procedure	No data	"Control of hemorrhage, not otherwise specified"	 		
44.43	ICD-9 Procedure	No data	Endoscopic control of gastric or duodenal bleeding	 		
44.49	ICD-9 Procedure	No data	Other control of hemorrhage of stomach or duodenum	 		
77.49	ICD-9 Procedure	No data	"Biopsy of bone, other bones"	 		
77.65	ICD-9 Procedure	No data	"Local excision of lesion or tissue of bone, femur"	 		
77.67	ICD-9 Procedure	No data	"Local excision of lesion or tissue of bone, tibia and fibula"	 		
77.69	ICD-9 Procedure	No data	"Local excision of lesion or tissue of bone, other bones"	 		
77.89	ICD-9 Procedure	No data	"Other partial ostectomy, other bones"	 		
79.35	ICD-9 Procedure	No data	"Open reduction of fracture with internal fixation, femur"	 		
79.75	ICD-9 Procedure	No data	Closed reduction of dislocation of hip	 		
79.85	ICD-9 Procedure	No data	Open reduction of dislocation of hip	 		
80.05	ICD-9 Procedure	No data	"Arthrotomy for removal of prosthesis without replacement, hip"	 		
80.15	ICD-9 Procedure	No data	"Other arthrotomy, hip"	 		
80.75	ICD-9 Procedure	No data	"Synovectomy, hip"	 		
80.85	ICD-9 Procedure	No data	"Other local excision or destruction of lesion of joint, hip"	 		
81.91	ICD-9 Procedure	No data	Arthrocentesis	 		
83.02	ICD-9 Procedure	No data	Myotomy	 		
83.09	ICD-9 Procedure	No data	Other incision of soft tissue	 		
83.14	ICD-9 Procedure	No data	Fasciotomy	 		
83.39	ICD-9 Procedure	No data	Excision of lesion of other soft tissue	 		
83.44	ICD-9 Procedure	No data	Other fasciectomy	 		
83.45	ICD-9 Procedure	No data	Other myectomy	 		
83.65	ICD-9 Procedure	No data	Other suture of muscle or fascia	 		
84.57	ICD-9 Procedure	No data	Removal of (cement) spacer	 		
86.04	ICD-9 Procedure	No data	Other incision with drainage of skin and subcutaneous tissue	 		
86.22	ICD-9 Procedure	No data	"Excisional debridement of wound, infection, or burn"	 		
86.28	ICD-9 Procedure	No data	"Nonexcisional debridement of wound, infection or burn"	 		
86.59	ICD-9 Procedure	No data	Closure of skin and subcutaneous tissue of other sites	 		
88.42	ICD-9 Procedure	No data	Aortography	 		
88.48	ICD-9 Procedure	No data	Arteriography of femoral and other lower extremity arteries	 		
88.49	ICD-9 Procedure	No data	Arteriography of other specified sites	 		
93.59	ICD-9 Procedure	No data	"Other immobilization, pressure, and attention to wound"	 		
93.89	ICD-9 Procedure	No data	"Rehabilitation, not elsewhere classified"			
96.59	ICD-9 Procedure	No data	Other irrigation of wound			
177	MS-DRG	No data	Respiratory Infections & Inflammations W Mcc	 		
178	MS-DRG	No data	Respiratory Infections & Inflammations W Cc	 		
179	MS-DRG	No data	Respiratory Infections & Inflammations W/O Cc/Mcc	 		
189	MS-DRG	No data	Pulmonary Edema & Respiratory Failure	 		
193	MS-DRG	No data	Simple Pneumonia & Pleurisy W Mcc	 		
194	MS-DRG	No data	Simple Pneumonia & Pleurisy W Cc	 		
195	MS-DRG	No data	Simple Pneumonia & Pleurisy W/O Cc/Mcc	 		
252	MS-DRG	No data	Other Vascular Procedures W Mcc	 		
253	MS-DRG	No data	Other Vascular Procedures W Cc	 		
254	MS-DRG	No data	Other Vascular Procedures W/O Cc/Mcc	 		
291	MS-DRG	No data	Heart Failure & Shock W Mcc	 		
292	MS-DRG	No data	Heart Failure & Shock W Cc	 		
293	MS-DRG	No data	Heart Failure & Shock W/O Cc/Mcc	 		
377	MS-DRG	No data	G.I. Hemorrhage W Mcc	 		
378	MS-DRG	No data	G.I. Hemorrhage W Cc	 		
379	MS-DRG	No data	G.I. Hemorrhage W/O Cc/Mcc	 		
463	MS-DRG	No data	"Wnd Debrid & Skn Grft Exc Hand, For Musculo-Conn Tiss Dis W Mcc"	 		
464	MS-DRG	No data	"Wnd Debrid & Skn Grft Exc Hand, For Musculo-Conn Tiss Dis W Cc"	 		
465	MS-DRG	No data	"Wnd Debrid & Skn Grft Exc Hand, For Musculo-Conn Tiss Dis W/O Cc/Mcc"	 		
480	MS-DRG	No data	Hip & Femur Procedures Except Major Joint W Mcc	 		
481	MS-DRG	No data	Hip & Femur Procedures Except Major Joint W Cc	 		
482	MS-DRG	No data	Hip & Femur Procedures Except Major Joint W/O Cc/Mcc	 		
498	MS-DRG	No data	Local Excision & Removal Int Fix Devices Of Hip & Femur W Cc/Mcc	 		
499	MS-DRG	No data	Local Excision & Removal Int Fix Devices Of Hip & Femur W/O Cc/Mcc	 		
500	MS-DRG	No data	Soft Tissue Procedures W Mcc	 		
501	MS-DRG	No data	Soft Tissue Procedures W Cc	 		
502	MS-DRG	No data	Soft Tissue Procedures W/O Cc/Mcc	 		
535	MS-DRG	No data	Fractures Of Hip & Pelvis W Mcc	 		
536	MS-DRG	No data	Fractures Of Hip & Pelvis W/O Mcc	 		
553	MS-DRG	No data	Bone Diseases & Arthropathies W Mcc	 		
554	MS-DRG	No data	Bone Diseases & Arthropathies W/O Mcc	 		
559	MS-DRG	No data	"Aftercare, Musculoskeletal System & Connective Tissue W Mcc"	 		
560	MS-DRG	No data	"Aftercare, Musculoskeletal System & Connective Tissue W Cc"	 		
561	MS-DRG	No data	"Aftercare, Musculoskeletal System & Connective Tissue W/O Cc/Mcc"	 		
579	MS-DRG	No data	"Other Skin, Subcut Tiss & Breast Proc W Mcc"	 		
580	MS-DRG	No data	"Other Skin, Subcut Tiss & Breast Proc W Cc"	 		
581	MS-DRG	No data	"Other Skin, Subcut Tiss & Breast Proc W/O Cc/Mcc"	 		
682	MS-DRG	No data	Renal Failure W Mcc	 		
683	MS-DRG	No data	Renal Failure W Cc	 		
684	MS-DRG	No data	Renal Failure W/O Cc/Mcc	 		
689	MS-DRG	No data	Kidney & Urinary Tract Infections W Mcc	 		
690	MS-DRG	No data	Kidney & Urinary Tract Infections W/O Mcc	 		
811	MS-DRG	No data	Red Blood Cell Disorders W Mcc	 		
812	MS-DRG	No data	Red Blood Cell Disorders W/O Mcc	 		
853	MS-DRG	No data	Infectious & Parasitic Diseases W O.R. Procedure W Mcc	 		
854	MS-DRG	No data	Infectious & Parasitic Diseases W O.R. Procedure W Cc	 		
855	MS-DRG	No data	Infectious & Parasitic Diseases W O.R. Procedure W/O Cc/Mcc	 		
856	MS-DRG	No data	Postoperative Or Post-Traumatic Infections W O.R. Proc W Mcc	 		
857	MS-DRG	No data	Postoperative Or Post-Traumatic Infections W O.R. Proc W Cc	 		
858	MS-DRG	No data	Postoperative Or Post-Traumatic Infections W O.R. Proc W/O Cc/Mcc	 		
862	MS-DRG	No data	Postoperative & Post-Traumatic Infections W Mcc	 		
863	MS-DRG	No data	Postoperative & Post-Traumatic Infections W/O Mcc	 		
871	MS-DRG	No data	Septicemia Or Severe Sepsis W/O Mv 96+ Hours W Mcc	 		
872	MS-DRG	No data	Septicemia Or Severe Sepsis W/O Mv 96+ Hours W/O Mcc	 		
901	MS-DRG	No data	Wound Debridements For Injuries W Mcc	 		
902	MS-DRG	No data	Wound Debridements For Injuries W Cc	 		
903	MS-DRG	No data	Wound Debridements For Injuries W/O Cc/Mcc	 		
907	MS-DRG	No data	Other O.R. Procedures For Injuries W Mcc	 		
908	MS-DRG	No data	Other O.R. Procedures For Injuries W Cc	 		
909	MS-DRG	No data	Other O.R. Procedures For Injuries W/O Cc/Mcc	 		
919	MS-DRG	No data	Complications Of Treatment W Mcc	 		
920	MS-DRG	No data	Complications Of Treatment W Cc	 		
921	MS-DRG	No data	Complications Of Treatment W/O Cc/Mcc	 		
939	MS-DRG	No data	O.R. Proc W Diagnoses Of Other Contact W Health Services W Mcc	 		
940	MS-DRG	No data	O.R. Proc W Diagnoses Of Other Contact W Health Services W Cc	 		
941	MS-DRG	No data	O.R. Proc W Diagnoses Of Other Contact W Health Services W/O Cc/Mcc	 		
945	MS-DRG	No data	Rehabilitation W Cc/Mcc	 		
946	MS-DRG	No data	Rehabilitation W/O Cc/Mcc	 		
981	MS-DRG	No data	Extensive O.R. Procedure Unrelated To Principal Diagnosis W Mcc	 		
982	MS-DRG	No data	Extensive O.R. Procedure Unrelated To Principal Diagnosis W Cc	 		
983	MS-DRG	No data	Extensive O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc	 		
987	MS-DRG	No data	Non-Extensive O.R. Proc Unrelated To Principal Diagnosis W Mcc	 		
988	MS-DRG	No data	Non-Extensive O.R. Proc Unrelated To Principal Diagnosis W Cc	 		
989	MS-DRG	No data	Non-Extensive O.R. Proc Unrelated To Principal Diagnosis W/O Cc/Mcc	 		
042	Revenue Center	No data	Physical Therapy	 		
043	Revenue Center	No data	Occupational Therapy	 		
044	Revenue Center	No data	Speech Language Pathology	 		
055	Revenue Center	No data	Skilled Nursing	 		
056	Revenue Center	No data	Medical Social Services	 		
057	Revenue Center	No data	Home Health Aid	 		
End of Worksheet						
