Hospital Referral Guidelines

GUIDELINE

MH&SC CODES

Abdominal Aortic Aneurysm (AAA) Repair The open surgical procedures used to treat AAAs and the closed procedures used to treat AAAs including all types of endovascular approaches. An aneurysm is an abnormal dilation of the abdominal portion of the aorta (the major artery from the heart).

Procedure codes equal 38.34, 38.44, 38.64, 39.25, 39.51 or 39.71 (regardless of diagnosis codes). Note that only one occurrence of a given procedure is counted on a given day.  Exclude patients age 17 and younger.

Carotid Endarterectomy SurgeryA surgical procedure to remove fat and cholesterol build-up (plaque) from inside the carotid artery in the neck and restore adequate blood flow to the brain. The procedures to treat carotid artery disease can be open surgical repairs or other closed procedures including endarterectomies, angioplasties, and insertion of stents.

Procedure codes equal 38.12, 38.32 or 38.42, 0.63 (Effective 10/1/04 for percutaneous insertion of carotid artery stent).

Esophagectomy Surgical removal of the esophagus.

Principle or secondary procedure code of 42.40-42.59, 42.61-42.69 43.99. For 43.99 only: use with principal diagnosis code 150.0-151.0, 197.8, 230.1 or 235.5. Exclude patients age 17 and younger.

Infants with Congenital AnomaliesA diverse group of infants who are born with major congenital anomalies and require admission to the NICU. (A hospital’s volume of these infants is not reported nor collected. It is only used to determine whether there are sub-specialist services available for infants of this type.)

Procedure codes equal 741.XX, 742.0X, 742.2-742.59, 742.8, 742.9, 745.XX, 746-746.85, 747.1X-747.9, 748, 748.2-748.8X, 750.16, 750.3, 750.4, 750.6, 751.XX, 752.7, 753.1X, 753.3, 753.6, 756.4, 756.51, 756.55, 756.59, 756.6, 756.7X, 756.89, or 756.9.

Low Birthweight Infants Low, very low, and extremely low birth weight are measured by the percent of infants who are below a specific weight at birth: 2,500 grams for low birth weight (LBW); 1,500 grams for very low birth weight (VLBW); and 1,000 grams for extremely low birth weight (ELBW). For the purposes of this survey, low birthweight infants are defined as those who weigh less than 1500 grams at birth. 

Diagnosis codes equal Major Diagnostic Code 15 combined with 764.01 - 764.05, 764.11 - 764.15, 764.21 - 764.25, 764.91 - 764.95, 765.00, 765.01 - 765.05, 765.10 or 765.11 - 765.15.

Open Heart Surgery (Including CABG)Any surgery where the chest is opened and surgery is performed on the heart is called an open heart surgery. The term "open" refers to the chest, not the heart itself (which may or may not be opened depending on the type of surgery). Open heart surgery includes surgery on the heart muscle, valves, arteries, or other structures. Coronary artery bypass graft surgery (CABG) is one example of an open heart surgery procedure. A heart-lung machine (also called heart-lung bypass) is usually used to help provide oxygen-rich blood to the brain, heart muscle, and other vital body areas. It pumps the blood, supplies oxygen to the blood, and removes carbon dioxide from the blood.

For the purposes of this survey, an open heart procedure includes coronary artery bypass graft surgeries as well as other open heart surgeries.  A coronary artery bypass surgery is defined by the following ICD-9 codes: 36.10, 36.11, 36.12, 36.13, 36.14, 36.15, 36.16, 36.17, or 36.19.  Other (non-CABG) open heart surgeries are defined by the following ICD-9 codes:  33.6, 35.10, 35.11, 35.12, 35.13, 35.14, 35.20, 35.21, 35.22, 35.23, 35.24, 35.25, 35.26, 35.27, 35.28, 35.31, 35.32, 35.33, 35.34, 35.35, 35.39, 35.50, 35.51, 35.52, 35.53, 35.54, 35.60, 35.61, 35.62, 35.63, 35.70, 35.71, 35.72, 35.81, 35.95, 35.98, 35.99, 36.03, 36.31, 36.39, 36.91, 36.99, 37.10, 37.11, 37.12, 37.31, 37.32, 37.33, 37.35, 37.4x, 37.5x, 37.62, 37.63, 37.64, 37.65, 37.66, or 37.67.  For both CABG and other open heart procedures, include only those cases where age was greater than 17 years of age at the time of surgery.

Percutaneous Coronary Interventions These interventions include transluminal percutaneous coronary angioplasty as well as rotational atherectomy, directional atherectomy, extraction atherectomy, laser angioplasty, implantation of intracoronary stents and other catheter devices used to treat coronary atherosclerosis.

Procedure codes for PCI equal 00.66 (effective 10/01/2005), 36.06, 36.07, or 36.09. Exclude patients age 17 and younger. Note: Code 00.66 replaced codes 36.01, 36.02 and 36.05 effective 10/1/2005; use the deleted codes for any time periods prior to that effective date.