Formulate a PDPM group to review the chart and come up with the residents primary or principal diagnosis and do the ICD-10 clinical category mapping. In this fourth webinar of our six part series, learn which items on the MDS or Medicare claim will be used to determine the NTA score and its impact on payment. or privately paid by the patient if he/she does not qualify under the Medi-Cal program. %%EOF You only need one SLP co-morbidity (either in one of those check boxes or listed in I8000) to meet that SLP co-morbidity qualifier. Lets breakdown the PDPM model to better understand how reimbursement is determined. The individual NTA conditions have points ranging from 1 to 8. endstream endobj 1697 0 obj <>stream They likely need the extra protein because either they have protein malnutrition (can be verified by lab results) or they are "at risk" for protein malnutrition. In this post Im going to take a deeper look at it and calculate the average NTA payment by state and facility. If your facility has a low NTA rate, it may just mean you have work to do, documentation-wise. comorbidities used under PDPM for NTA classification is assigned a certain number of points, between one and eight, based on its relative costliness. Patient classification system where patients are grouped according to their care and resource needs. 3HFDRkse$:stHqPJoHK-qL_sh|Kg?unioWAsfH8[^9{'~-? CMS identified a . As a result, patients with AIDS are assigned the highest point value (8 points) of any condition or service for purposes of classification under the PDPMs NTA component, and they also receive a special 18% add-on to the nursing component of the payment. (2019) Fact Sheet: NTA Comorbidity Score https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/Downloads/PDPM_Fact_Sheet_NTAComorbidityScoring_v2_508.pdf, Center for Medicare and Medicaid Services. you could miss something. When these conditions and extensive services are reported on the MDS 3.0, they are weighted and used to classify a resident into a specific NTA case-mix group. Some sources even noting companies are finding losses of $500 to just over $1500 due to missed diagnoses, of both malnutrition and obesity, throughout total admissions spans of residents 2. PDPM or Patient-Driven Payment Model is the new system, replacing the RUG-IV, for calculating reimbursement by Medicare in the skilled nursing setting. These nurses are also trained to complete a full All Rights Reserved By Nursingcecentral 2022 |. by Proactive LTC Consulting | Jan 6, 2020 | Audits, Compliance, Education, MDS, Medical Review, PDPM. There are a total of five rates that make up your pay under PDPM.) Coding of these areas will affect the, Postpartum Preeclampsia Diagnosis and Management, Hyperemesis Gravidarum: More Than Just Morning Sickness. This NTA CMI is added to the other components to calculate the total reimbursement for the patient. Far more items than would actually fit on the MDS 3.0 Instrument. 0000003961 00000 n Next you multiply the case-mix index by the rate, either rural ($74.56) or urban ($78.05). With postpartum preeclampsia, patients are now not seeing a health care provider by NCC News and Content Team | Jan 24, 2023 | Specialties. Yes, I am aware that ICD-10 codes do change occasionally. Items on this list could change at any time with new legislative and You can read more about this in the Official ICD10 Guidelines for Coding and Reporting FY2020, Section II, Subsection K. For example: The definition of Group Therapy has changed. These maps look significantly different from a lot of the others weve seen. the design of the PDPM case-mix system implemented in FY 2020. Under PDPM, 50 conditions and extensive services are considered for NTA classification. thead { For example, IV medications (5 points) coded in MDS item O0100H2 or isolation (1 point) coded in O0100M2. The Centers for Medicare and Medicaid Services (CMS) introduced the Patient Driven Payment Model (PDPM) in the FY 2019 Proposed and Final Rule process in 2018. requires an analytical mind and financial knowledge to determine the highest allowable reimbursement for the facility. Understanding the Value of the MDS Nurse Under PDPM, Psoriatic Arthropathy & Systemic Sclerosis, Myelodysplastic Syndromes and Myelofibrosis. hVmk#7+xG{ZMaMu{vB{[ciF3Viee2!VpIbDAy_X%_A0,R99Kb! 0000011153 00000 n "FE"u PsFO;416ib_z/[E>#~.G+Y6l|)31}Q50B}Wk?/1wo USIek~)zR*u:1\np2}HPs}@I#RM=e1JtJ22;3(TYt&8W1UN@ID7{V Z +MykUW? These conditions, along with the number of points associated with the condition and how it is reported, can be found by downloading the CMS document titled "Fact Sheet: NTA Comorbidity Score. There are two look back periods that must be met when coding conditions on the MDS: #1 Diagnosis Identification - Documented by the physician or physician extender within the last 60 days. ordered by the patients attending physician in the facility. SNF FY 2022 Proposed Rule Learn the Facts Behind the Headlines Part 3: How is My Rate Calculated, Regulatory Reminder! The MDS software programs such as PointClick Care, Matrix, Net Solutions, to name just a few, automatically calculate the PDPM rates once the MDS assessment is completed. The most up to date guidelines are available at. Evansville, IN 47711, Phone: (812) 471-7777 The resulting sum is the NTA comorbidity score, which is used to classify each resident into an NTA case-mix group. Hoo0Gw7I18J+-+hLC&QI$[3iB:s]:?\GqA ATc#(R2:nl/?e. ` 0!RJ3t f{ WN"Y@L1+;HXZL@\uB*4c*fi$1( )}hciksm2hn 1cU(YTS46ye&? &JHyBIQ fF What do I need to know? This PDPM model aims to utilize the individual patient's characteristics and needs based on diagnosis as opposed to the RUG-IV system relying on volume of services. Non-Therapy Ancillary (NTA) Services - At a Glance The Patient-Driven Payment Model (PDPM) takes effect on October 1, 2019 and represents a significantly different approach to reimbursement for care in Skilled Nursing Facilities (SNFs). Anyone involved with ICD-10 coding should have ready access to the coding guidelines. .center {text-align: center;}, Foot Code, Except Diabetic Foot Ulcer Code, Once we have totaled the score from the table above, we use it to map to a case-mix group and case-mix index. While the SNF certs and the Therapy Certs may contain this documentation, they are often not signed or approved until after the ARD. The long-term care facilities have emerged not only as a permanent home for the elderly during their retirement or post-retirement years but as respite and recuperative facilities even for the younger patients. The adjusted PT, OT, and NTA per diem rates are then added together with the unadjusted SLP and nursing component rates and the non-case-mix component, as is done under RUG-IV, to determine the full per diem rate for a given resident. Five of the six are case-mix adjusted. When also coded in I8000, I69.091 will also contribute again to the case mix group because it is on the SLP comorbidity list. We earn 1 NTA point for second or third degree burn coded in M1040F. The functional scoring is based on residents performance in eating, oral hygiene, toileting hygiene, sit to lying, lying to sitting on side of bed, sit to stand, chair/bed-to-chair transfer, and toilet transfer assessed on the first three days of admission to the facility with the admission day counted as day 1. Learn more about Jessica, Eleisha, and the rest of the Proactive team. The Non-Therapy Ancillary Services (NTA) component is a total score of all listed conditions and/or extensive services that apply to the resident. by NCC News and Content Team | Mar 1, 2023 | Hospitals, Specialties. And so, you will need to determine how your facility will obtain the initial Diagnosis Identification documentation by the ARD, because it is a "look back" period. You can view either rural, urban or both. endstream endobj 451 0 obj <>stream Yes, you can, just not in I0020B. Zi@Ym"l?]L?*;YaRxwFhSGkhSFRQJIp.V4v!fbN91GE]Y:+s Not having the correct codes can have a domino effect and result in missed reimbursement, or claim inaccuracies. Given that CMS has released the distribution of case-mix groups for NTA for all skilled nursing facilities, we can calculate an average case-mix index for everyone. List the 3 MDS items that qualify a resident for the Extensive Nursing Service group. PDPM or Patient-Driven Payment Model is the new system, replacing the RUG-IV, for calculating reimbursement by Medicare in the skilled nursing setting. Great info! Click the comorbidity and see the ICD-10 codes that are most likely to occur. Overview In July 2018, CMS finalized a new case-mix classification model, the Patient Driven Payment Model (PDPM), that, effective beginning October 1, 2019, will be used under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) for classifying SNF patients in a covered Part A stay. such has bed mobility, transfers in and out of bed, walking in the room, walking in the corridor, locomotion on unit peripheral to the patients room, locomotion off unit which involves areas farther from the patients room such as dining areas, rehabilitation rooms, activity rooms and other administrative offices, toileting, eating, personal hygiene and bathing. Seek advice from experts, trainers and other MDS nurses when needed to clarify any areas in the MDS assessment or PDPM calculation. SNF FY 2022 Proposed Rule Learn the Facts Behind the Headlines Part 3: How is My Rate Calculated, Regulatory Reminder! Character 3: Nursing Case Mix Group (NSG CMG) Character 4: NTA Case Mix Group (NTA CMG) Character 5: Assessment Indicator HIPPS Code PT/OT CMG SLP CMG NSG CMG NTA CMG HIPPS Code A TA SA ES3 NA A B TB SB ES2 NB B C TC SC ES1 NC . The NTA case-mix groups are based on NTA score ranges: 0 (NF), 1 2 (NE), 3 5 (ND), 6 8 (NC), 9 11 (NB), or 12+ (NA), according to table 17, NTA Case-Mix Groups, in chapter 6 of the Long-Term Care Facility Resident Assessment Instrument 3.0 Users Manual. The RUG-IV consists of two case-mix adjusted components: Therapy which is based on volume of services provided and nursing. As outlined in the SNF PDPM technical report, CMS was looking for the new reimbursement plan to account accurately and appropriately for the increased costs associated with caring for patients with AIDS. This simply shows you a starting point. It more accurately accounts for expenses and isnt overshadowed by therapy. The categories impact a resident's case-mix classification. info@proactivemedicalreview.com, Blog by Jessica Cairns, RN, RAC-CT, CMAC, and Eleisha Wilkes, RN, RAC-CTA, Click to share on LinkedIn (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Twitter (Opens in new window), Deep Dive into Federal Regulations in a Year, Mission Possible: SNF Department Head Briefing, https://www.cms.gov/Medicare/Coding/ICD10/Downloads/2020-Coding-Guidelines.pdf, https://www.cms.gov/Medicare/Quality-Initiatives-Patient- Assessment-Instruments/NursingHomeQualityInits/MDS30RAIManual.html, https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/Downloads/PDPM_Fact_Sheet_NTAComorbidityScoring_v2_508.pdf, https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/Downloads/PDPM_Fact_Sheet_AIDS_v3_508.pdf, Special Treatments/Programs: Intravenous Medication Post-admit Code, Special Treatments/Programs: Ventilator or Respirator Post-admit Code, Special Treatments/Programs: Transfusion Post-admit Code, Major Organ Transplant Status, Except Lung, Active Diagnoses: Multiple Sclerosis Code, Active Diagnoses: Asthma COPD Chronic Lung Disease Code, Bone/Joint/Muscle Infections/Necrosis Except: Aseptic Necrosis of Bone, Active Diagnoses: Diabetes Mellitus (DM) Code, Other Foot Skin Problems: Diabetic Foot Ulcer Code, Special Treatments/Programs: Tracheostomy Care Post-admit Code, Active Diagnoses: Multi-Drug Resistant Organism (MDRO) Code, Special Treatments/Programs: Isolation Post-admit Code, Specified Hereditary Metabolic/Immune Disorders, Special Treatments/Programs: Radiation Post-admit Code, Stage 4 Unhealed Pressure Ulcer Currently present, Psoriatic Arthropathy and Systemic Sclerosis, Proliferative Diabetic Retinopathy and Vitreous Hemorrhage, Other Foot Skin Problems: Foot Infection Code, Other Open Lesion on Foot Code, Except Diabetic Foot Ulcer Code, Complications of Specified Implanted Device or Graft, Bladder and Bowel Appliances: Intermittent catheterization, Special Treatments/Programs: Suctioning Post-admit Code, Myelodysplastic Syndromes and Myelofibrosis, Systemic Lupus Erythematosus, Other Connective Tissue Disorders, and Inflammatory Spondylopathies, Diabetic Retinopathy Except: Proliferative Diabetic Retinopathy and Vitreous Hemorrhage, Nutritional Approaches While a Resident: Feeding Tube, Disorders of Immunity Except: RxCC97: Immune Disorders, Pulmonary Fibrosis and Other Chronic Lung Disorders. Reimbursement for these services is covered under the. For more information on preparing for the transition to PDPM, register for our 9-Part PDPM Webinar Series. Wound Care? endstream endobj 454 0 obj <>stream CMS identified a list of 50 conditions and extensive services that were associated with increases in NTA costs. The correct coding for NTA will require a team effort and diligent review of coding and supporting documentation. Incorporate NTA identification into the daily clinical meeting as it is ever important to identify when a change in condition or services takes place. Which codes are you most likely to actually see in the wild? The presence of these conditions and extensive services is reported by providers . PDPM includes a new pay category, the non-therapy ancillary or NTA. Facilities that work to establish these best practices associated with the NTA component will increase revenue and see other benefits such as improved Quality Measures, reduced readmission rates, and improve skilled documentation. } Preparedness for coding changes will be the key to a smooth transition. The Primary Diagnosis in I0020B and the Principal Diagnosis should match. When the severe skin burn is also coded in MDS section I8000, we qualify for the Nursing Clinically Complex Category. Your NTA payment is driven by the presence of a number of conditions and/or extensive services. SAMPLE Task List for the Nurse Assessment Coordinator (NAC) November 23, 2022. Often overlooked, Non-Therapy Ancillaries or NTAs will be more important than ever in PDPM. Under PDPM, long-term care facilities will receive reimbursement based on services that each resident receives. Lastly, lets look a little more closely at rural versus urban. Condition/Extensive Service Source Points Aseptic Necrosis of Bone MDS Item I8000 1 Asthma COPD Chronic Lung Disease MDS Item I6200 2 Skilled nursing facilities now have more than a year of experience with the Patient-Driven Payment Model (PDPM), the updated case-mix classification system used in the Medicare Part A Skilled Nursing Facility Prospective Payment System (SNF PPS) that includes five case-mix-adjusted payment components: physical therapy (PT), occupational therapy (Right). Reimbursement for these services is covered under the State of Californias Medi-Cal program or privately paid by the patient if he/she does not qualify under the Medi-Cal program. It is for this type of services they offer which also categorize them as skilled nursing and rehabilitation facilities becoming a step-down facility from an acute hospital stay. On day 4 it goes back to the rate shown. How should you prioritize your search for ICD-10 codes? But, since it's new, we're going to have to work on understanding how it's supposed to work, and how we can most easily and efficiently complete the assessment with accurate information. Remember this is using 2017 data so it assumes that providers make no adjustments which is not realistic. The administration of IV fluids may qualify for the Parenteral/IV Feeding - High or Parenteral/IV Feeding - low NTA points. MDS Item Field rows in tan represent MDS item groups identified in CMS PDPM documentation and do not have data entry fields. (4.0CSVMEB3nHSQ(9gvNtp}|srUzUX/%3vf+R6Fe Kb`Mr"yWz~tck~>1gK\,)?yt_Jy2Z2poUa-GFjRC'.`?/`;Mwk!$e#W,rLz:+ZL`Y4;Z%Up|h\/nzD]#N. hrmct 8cq1o22#|Bm1il,4iw&C|E^F+oq:>_|M\v+iTOigWJ:dCa$Qv_n/q|wCuukk+e';iJB2C &!Ar8c _~r startxref Also, there is a 25% combined limit on concurrent and/or group therapy. mp:U@|8B *zL$#Tk\*SU%mQlTYA Rj&-N _VjWpb[5R8'i, At the direction of the attending physician, a patient needs skilled care from and/or under the supervision of a skilled nursing or therapy staff daily. One can see from the table above that if comorbidities are missed, the facility could possibly miss out on reimbursement. 0000003037 00000 n We must also understand all the aspects of PDPM coding from every single angle, the relationship between each facet of the components, and the impact on care and revenue. The patients NTA comorbidity score is the sum of the points associated with each relevant comorbidity. Additionally, PDPM applies variable per diem payment adjustments to three components, PT, OT, and NTA, to account for changes in resource use over a stay. tr:nth-child(even) {background-color: #f2f2f2;} Continuous training is the key and implementation of what was learned in coordination with the facility team members will ensure success in providing skilled care for the patients and maximizing facility reimbursement. Under PDPM, CMS identified 50 conditions that were related to increases in NTA costs for a skilled nursing facility (SNF). HVmo0)>bbJS:i>h4B6u~>!bB8lr lk4-M~V CIExej[_@{wpuCm/8yU\mqpC1!Ll%5##P:a,Orh[a%zDUd V#~RLXP9BZ,/Y798(|&a"#.G. A SANE nurse is an RN who has been trained to examine and assess clients who have a reported a sexual assault. ~,/-I\!/JfB. Fax: (812) 471-7802 var divElement = document.getElementById('viz1528375166404'); var vizElement = divElement.getElementsByTagName('object')[0]; vizElement.style.width='100%';vizElement.style.height=(divElement.offsetWidth*0.75)+'px'; var scriptElement = document.createElement('script'); scriptElement.src = 'https://public.tableau.com/javascripts/api/viz_v1.js'; vizElement.parentNode.insertBefore(scriptElement, vizElement); Use the rate filter to show only the highest or lowest NTA rates. Each component has its case mix index to determine the component rate. program for a limited time or on a short-time basis and must meet the following requirements: hospital insurance and have eligible days left to use during the benefit period. Other specific items will be recorded in various parts of the MDS including Section K, M, N, and O. Educate yourself on the. Always be on the lookout for new updates which usually happen every year and usually effective by October 1 of each updated year. On any device & OS. The correct coding for NTA will require a team effort and diligent review of coding and supporting documentation to ensure 100% accuracy. The RUG-IV consists of two case-mix adjusted components: Therapy which is based on volume of services provided and nursing. A list of these specific retinopathy codes are in the SLP mapping file from CMS. Functional scoring is one of the factors used to calculate the PDPM rate for the PT, OT and Nursing components. View D0AD3F24-D6BD-4273-B139-8FCA97487E6A.jpeg from NURSING MISC at St. Clair County Community College. But, since its new, were going to have to work on understanding how its supposed to work, and how we can most easily and efficiently complete the assessment with accurate information. Remember that after the 3 day interrupted stay he is considered a new admission for purposes of Part A PDPM. It is critical that all coded conditions are accurate AND supported by nursing and physician documentation. F Remember that on the therapy plan of care the Treatment Diagnoses should be directly linked the Medical Diagnoses. When expanded it provides a list of search options that will switch the search inputs to match the current selection. CMS (I did abbreviate a few of the names for sanity.) The Patient-Driven Payment Model (PDPM), is fast approaching with implementation set for October 2019. (This isnt going to work well on mobile devices, FYI.). For the NTA, an adjustment factor of 3.0 is applied to the total NTA CMI for days 1-3. The AHCA Patient Driven Payment Model (PDPM) Resource Center provides AHCA provider members with a suite of original content, tools, and training options and resources to assist providers in how to be successful in implementing the new Medicare Part A PDPM SNF PPS, effective October 2019. CMS 100-2 Chapter 8 Series Part I: Access to Medicare Part A Benefits In a SNF. To further understand the difference between long-term care facilities and skilled nursing/rehabilitation facilities, we will focus on the services they offer. Stay tuned. The general method for calculation of any NTA category is as follows: 0000000016 00000 n You can also zoom in to see detail. If the 25% is exceeded, a non-fatal warning will appear on the final validation report during the MDS submission process. Click here to visit our shop. All Rights Reserved. Speaking of individual facilities, lets take a look at that as well. (10 items fit). The Patient-Driven Payment Model focuses on the patients unique characteristics and needs based on diagnosis which arise during inpatient hospital stay. Q: Our EMR system will calculate the BMI. The idea is that the facility should be paid for the care they are delivering, based on the patients characteristics. Hospitals | Specialties Postpartum Preeclampsia Diagnosis and Management Postpartum preeclampsia is a condition that can affect women from the time after delivery and up to 6 weeks after. A Knowledgeable and Compassionate partner. b!+XQ{ +LgOIYe/Q6RVpYY_N/.~iMu1fY*eR}W_E[,7vrR!XSF};qZW&e"S5!CW}3GU|muc?_X`dcg7(zRU8k? In this article, we discuss the non-therapy ancillary (NTA) component. This item also impacts your MDS High Risk Pressure Ulcer QM because it is a high risk qualifier (along with impaired bed mobility impaired transfer, or comatose) for the numerator and denominator of the calculation. Inappropriate Schizophrenia Diagnosis/Coding and Survey Citation Posting, Regulatory Reminders: Consolidated Billing Update 2023, Osteomyelitis of vertebra, site unspecified, Other acute osteomyelitis, unspecified ankle and foot, Staphylococcal arthritis, unspecified knee, Other acute osteomyelitis, unspecified site, Pneumococcal arthritis, unspecified joint, Other chronic osteomyelitis, unspecified ankle and foot, Other acute osteomyelitis, unspecified tibia and fibula, Other chronic osteomyelitis, unspecified site, Direct infection of unspecified joint in infectious and parasitic diseases classified elsewhere, Staphylococcal arthritis, unspecified hip, Direct infection of unspecified knee in infectious and parasitic diseases classified elsewhere, Staphylococcal arthritis, unspecified shoulder, Other chronic osteomyelitis, unspecified tibia and fibula, Other acute osteomyelitis, unspecified femur, Direct infection of vertebrae in infectious and parasitic diseases classified elsewhere, Other chronic osteomyelitis, unspecified thigh, Direct infection of multiple joints in infectious and parasitic diseases classified elsewhere, Other acute osteomyelitis, multiple sites, Staphylococcal arthritis, unspecified ankle and foot, Chronic myeloid leukemia, BCR/ABL-positive, not having achieved remission, Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, Infection and inflammatory reaction due to unspecified internal joint prosthesis, initial encounter, Embolism due to internal orthopedic prosthetic devices, implants and grafts, initial encounter, Embolism due to vascular prosthetic devices, implants and grafts, initial encounter, Other mechanical complication of unspecified internal joint prosthesis, initial encounter, Dislocation of unspecified internal joint prosthesis, initial encounter, Infection and inflammatory reaction due to other internal prosthetic devices, implants and grafts, initial encounter, Infection and inflammatory reaction due to internal fixation device of unspecified site, initial encounter, Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, initial encounter, Other mechanical complication of aortic (bifurcation) graft (replacement), initial encounter, Other mechanical complication of other internal orthopedic devices, implants and grafts, initial encounter, Breakdown (mechanical) of internal fixation device of unspecified bone of limb, initial encounter, Infection and inflammatory reaction due to cardiac valve prosthesis, initial encounter, Mechanical loosening of unspecified internal prosthetic joint, initial encounter, Broken internal joint prosthesis, unspecified site, initial encounter, Embolism due to genitourinary prosthetic devices, implants and grafts, initial encounter, Secondary esophageal varices without bleeding, Secondary esophageal varices with bleeding, Alcoholic cirrhosis of liver without ascites, Antineoplastic chemotherapy induced pancytopenia, Agranulocytosis secondary to cancer chemotherapy, Acute respiratory failure, unspecified whether with hypoxia or hypercapnia, Acute and chronic respiratory failure, unspecified whether with hypoxia or hypercapnia, Chronic respiratory failure, unspecified whether with hypoxia or hypercapnia, Acute and chronic postprocedural respiratory failure, Acute pulmonary insufficiency following thoracic surgery, Acute and subacute infective endocarditis, Acute and subacute endocarditis, unspecified, Endocarditis and heart valve disorders in diseases classified elsewhere, Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, with status epilepticus, Epilepsy, unspecified, intractable, with status epilepticus, Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, with status epilepticus, Generalized idiopathic epilepsy and epileptic syndromes, intractable, with status epilepticus, Respiratory bronchiolitis interstitial lung disease, Respiratory disorders in diseases classified elsewhere, Other alveolar and parieto-alveolar conditions, Idiopathic interstitial pneumonia, not otherwise specified, Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema, Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema, Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edema, Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema, Morbid (severe) obesity due to excess calories, Morbid (severe) obesity with alveolar hypoventilation, Body mass index (BMI) 70 or greater, adult, Ulcerative colitis, unspecified, without complications, Crohns disease, unspecified, without complications, Other ulcerative colitis without complications, Ulcerative (chronic) pancolitis without complications, Ulcerative (chronic) proctitis without complications, Crohns disease of small intestine without complications, Crohns disease of large intestine without complications, Idiopathic aseptic necrosis of unspecified femur, Idiopathic aseptic necrosis of unspecified bone, Idiopathic aseptic necrosis of bone, other site, Systemic lupus erythematosus, organ or system involvement unspecified, Ankylosing spondylitis of unspecified sites in spine, Wegeners granulomatosis without renal involvement, Polymyositis, organ involvement unspecified, Dermatopolymyositis, unspecified, organ involvement unspecified, Systemic involvement of connective tissue, unspecified, Unspecified inflammatory spondylopathy, site unspecified, Refractory anemia without ring sideroblasts, so stated, Other specified disorders involving the immune mechanism, not elsewhere classified, Disorder involving the immune mechanism, unspecified.
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