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Triggering and Grouping Codes			Table of Contents	
KNEE REPLACEMENT/REVISION				
Code	Code Type	Used in Trigger Rule	Code Description	
00.80	ICD-9 Procedure	Y	"Revision of knee replacement, total (all components)"	 
00.81	ICD-9 Procedure	Y	"Revision of knee replacement, tibial component"	 
00.82	ICD-9 Procedure	Y	"Revision of knee replacement, femoral component"	 
00.83	ICD-9 Procedure	Y	"Revision of knee replacement, patellar component"	 
00.84	ICD-9 Procedure	Y	"Revision of total knee replacement, tibial insert (liner)"	 
81.54	ICD-9 Procedure	Y	Total knee replacement	 
81.55	ICD-9 Procedure	Y	"Revision of knee replacement, not otherwise specified"	 
81.59	ICD-9 Procedure	Y	"Revision of joint replacement of lower extremity, not elsewhere classified"	 
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	 
27446	CPT-4	Y	"Arthroplasty, Knee, Condyle And Plateau; Medial Or Lateral Compartment"	 
27447	CPT-4	Y	"Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compartments With Or Without Patella Resurfacing (Total Knee Arthroplasty)"	 
27486	CPT-4	Y	"Revision Of Total Knee Arthroplasty, With Or Without Allograft; 1 Component"	 
27487	CPT-4	Y	"Revision Of Total Knee Arthroplasty, With Or Without Allograft; Femoral And Entire Tibial Component"	 
0008	APC	No data	Level III Incision and Drainage	 
0204	APC	No data	Level I Nerve Injections	 
0207	APC	No data	Level III Nerve Injections	 
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	 
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	 
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	 
0662	APC	No data	CT Angiography	 
152	CCS	No data	Arthroplasty knee	 
162	CCS	No data	Other OR therapeutic procedures on joints	 
163	CCS	No data	Other non-OR therapeutic procedures on musculoskeletal system	 
197	CCS	No data	Other diagnostic ultrasound	 
198	CCS	No data	Magnetic resonance imaging	 
209	CCS	No data	Radioisotope scan and function studies	 
212	CCS	No data	Diagnostic physical therapy	 
213	CCS	No data	"Physical therapy exercises, manipulation, and other procedures"	 
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	 
235	CCS	No data	Other Laboratory	 
237	CCS	No data	Ancillary Services	 
240	CCS	No data	"Medications (Injections, infusions and other forms)"	 
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"	 
E0935	HCPCS	No data	Continuous Passive Motion Exercise Device For Use On Knee Only	 
K0823	HCPCS	No data	"Power Wheelchair, Group 2 Standard, Captains Chair, Patient Weight Capacity Up To And Including 300 Pounds"	 
L1832	HCPCS	No data	"Knee Orthosis, Adjustable Knee Joints (Unicentric Or Polycentric), Positional Orthosis, Rigid Support, 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	 
338	ICD-9 Diagnosis	No data	"Pain, not elsewhere classified"	 
415	ICD-9 Diagnosis	No data	Acute pulmonary heart disease	 
428	ICD-9 Diagnosis	No data	Heart failure	 
453	ICD-9 Diagnosis	No data	Other venous embolism and thrombosis	 
486	ICD-9 Diagnosis	No data	"Pneumonia, organism unspecified"	 
531	ICD-9 Diagnosis	No data	Gastric ulcer	 
532	ICD-9 Diagnosis	No data	Duodenal ulcer	 
562	ICD-9 Diagnosis	No data	Diverticula of intestine	 
578	ICD-9 Diagnosis	No data	Gastrointestinal hemorrhage	 
584	ICD-9 Diagnosis	No data	Acute kidney failure	 
593	ICD-9 Diagnosis	No data	Other disorders of kidney and ureter	 
682	ICD-9 Diagnosis	No data	Other cellulitis and abscess	 
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	 
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	 
780	ICD-9 Diagnosis	No data	General symptoms	 
781	ICD-9 Diagnosis	No data	Symptoms involving nervous and musculoskeletal systems	 
782	ICD-9 Diagnosis	No data	Symptoms involving skin and other integumentary tissue	 
786	ICD-9 Diagnosis	No data	Symptoms involving respiratory system and other chest symptoms	 
788	ICD-9 Diagnosis	No data	Symptoms involving urinary system	 
793	ICD-9 Diagnosis	No data	Nonspecific (abnormal) findings on radiological and other examination of body structure	 
891	ICD-9 Diagnosis	No data	"Open wound of knee, leg (except thigh), and ankle"	 
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	 
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	 
39.95	ICD-9 Procedure	No data	Hemodialysis	 
44.42	ICD-9 Procedure	No data	Suture of duodenal ulcer site	 
44.43	ICD-9 Procedure	No data	Endoscopic control of gastric or duodenal bleeding	 
77.69	ICD-9 Procedure	No data	"Local excision of lesion or tissue of bone, other bones"	 
77.96	ICD-9 Procedure	No data	"Total ostectomy, patella"	 
80.06	ICD-9 Procedure	No data	"Arthrotomy for removal of prosthesis without replacement, knee"	 
80.16	ICD-9 Procedure	No data	"Other arthrotomy, knee"	 
80.26	ICD-9 Procedure	No data	"Arthroscopy, knee"	 
80.46	ICD-9 Procedure	No data	"Division of joint capsule, ligament, or cartilage, knee"	 
80.76	ICD-9 Procedure	No data	"Synovectomy, knee"	 
80.86	ICD-9 Procedure	No data	"Other local excision or destruction of lesion of joint, knee"	 
81.22	ICD-9 Procedure	No data	Arthrodesis of knee	 
81.47	ICD-9 Procedure	No data	Other repair of knee	 
81.91	ICD-9 Procedure	No data	Arthrocentesis	 
81.95	ICD-9 Procedure	No data	Suture of capsule or ligament of other lower extremity	 
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	 
83.61	ICD-9 Procedure	No data	Suture of tendon sheath	 
83.64	ICD-9 Procedure	No data	Other suture of tendon	 
83.65	ICD-9 Procedure	No data	Other suture of muscle or fascia	 
83.82	ICD-9 Procedure	No data	Graft of muscle or fascia	 
83.83	ICD-9 Procedure	No data	Tendon pulley reconstruction other than hand	 
83.86	ICD-9 Procedure	No data	Quadricepsplasty	 
83.88	ICD-9 Procedure	No data	Other plastic operations on tendon	 
84.56	ICD-9 Procedure	No data	Insertion or replacement of (cement) spacer	 
84.57	ICD-9 Procedure	No data	Removal of (cement) spacer	 
86.01	ICD-9 Procedure	No data	Aspiration of skin and subcutaneous tissue	 
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	 
86.69	ICD-9 Procedure	No data	Other skin graft to other sites	 
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	 
93.29	ICD-9 Procedure	No data	Other forcible correction of musculoskeletal deformity	 
96.59	ICD-9 Procedure	No data	Other irrigation of wound	 
175	MS-DRG	No data	Pulmonary Embolism W Mcc	 
176	MS-DRG	No data	Pulmonary Embolism W/O Mcc	 
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	 
299	MS-DRG	No data	Peripheral Vascular Disorders W Mcc	 
300	MS-DRG	No data	Peripheral Vascular Disorders W Cc	 
301	MS-DRG	No data	Peripheral Vascular Disorders W/O Cc/Mcc	 
326	MS-DRG	No data	"Stomach, Esophageal & Duodenal Proc W Mcc"	 
327	MS-DRG	No data	"Stomach, Esophageal & Duodenal Proc W Cc"	 
328	MS-DRG	No data	"Stomach, Esophageal & Duodenal Proc W/O Cc/Mcc"	 
329	MS-DRG	No data	Major Small & Large Bowel Procedures W Mcc	 
330	MS-DRG	No data	Major Small & Large Bowel Procedures W Cc	 
331	MS-DRG	No data	Major Small & Large Bowel Procedures W/O Cc/Mcc	 
356	MS-DRG	No data	Other Digestive System O.R. Procedures W Mcc	 
357	MS-DRG	No data	Other Digestive System O.R. Procedures W Cc	 
358	MS-DRG	No data	Other Digestive System O.R. Procedures 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	 
485	MS-DRG	No data	Knee Procedures W Pdx Of Infection W Mcc	 
486	MS-DRG	No data	Knee Procedures W Pdx Of Infection W Cc	 
487	MS-DRG	No data	Knee Procedures W Pdx Of Infection W/O Cc/Mcc	 
488	MS-DRG	No data	Knee Procedures W/O Pdx Of Infection W Cc/Mcc	 
489	MS-DRG	No data	Knee Procedures W/O Pdx Of Infection W/O Cc/Mcc	 
492	MS-DRG	No data	"Lower Extrem & Humer Proc Except Hip,Foot,Femur W Mcc"	 
493	MS-DRG	No data	"Lower Extrem & Humer Proc Except Hip,Foot,Femur W Cc"	 
494	MS-DRG	No data	"Lower Extrem & Humer Proc Except Hip,Foot,Femur W/O Cc/Mcc"	 
495	MS-DRG	No data	Local Excision & Removal Int Fix Devices Exc Hip & Femur W Mcc	 
496	MS-DRG	No data	Local Excision & Removal Int Fix Devices Exc Hip & Femur W Cc	 
497	MS-DRG	No data	Local Excision & Removal Int Fix Devices Exc 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	 
515	MS-DRG	No data	Other Musculoskelet Sys & Conn Tiss O.R. Proc W Mcc	 
516	MS-DRG	No data	Other Musculoskelet Sys & Conn Tiss O.R. Proc W Cc	 
517	MS-DRG	No data	Other Musculoskelet Sys & Conn Tiss O.R. Proc W/O Cc/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"	 
602	MS-DRG	No data	Cellulitis W Mcc	 
603	MS-DRG	No data	Cellulitis W/O 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	 
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	 
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