2. William E. Haik, M.D., F.C.C.P. A Clinical Review of the CC/MCC List ©DRG Review, Inc.

3. DRG Complication/Comorbidity References: Guidelines for Reporting Other (Additional) Diagnoses UHDDS #11 B defines “Other Diagnoses” as “all conditions that coexist at the time of admission, that develop subsequently, or that affect the treatment receives and/or length of stay. Diagnoses that relate to an earlier episode which have no bearing on the current hospital stay are to be excluded.” General Rule For reporting purposes the definition for “other diagnoses” is interpreted as additional conditions that affect patient care in terms of requiring the following: Clinical evaluation; or Therapeutic treatment; or Diagnostic procedures; or Extended length of hospital stay; or Increased nursing care and/or monitoring; or Has implications for future health care needs. AHA’s Coding Clinic for ICD-9-CM, Second Quarter 1990, pages 12-16. AHA’s Coding Clinic for ICD-9-CM, Third Quarter 2007, page 13. AHA’s Coding Clinic for ICD-9-CM, Fourth Quarter, annually. NOTE: The last general rule, “ has implications for future health care needs,” applies to newborn coding only. ©DRG Review, Inc.

4. Complications/Comorbid Conditions Clinical Groupings Cardiovascular – Acute myocardial ischemia without MI – Angina, unstable, decubitus, Prinzmetal – Atrial flutter – Block – complete, AV, Mobitz II, trifascicular, BBBB – CAD of bypass graft – Cardiomyopathy (except ischemic) – CHF – left heart failure, systolic or diastolic (chronic or unspecified) – Dressler’s syndrome (post MI syndrome) – Endocarditis (some types, not acute) – Hypertension, accelerated or malignant – Hypertensive encephalopathy – Pericarditis (most types) – Tachycardia – paroxysmal supraventricular/ventricular – Thrombosis/embolism of artery or vein – Thrombosis/embolism of coronary artery stent/graft – Thrombophlebitis ©DRG Review, Inc.

5. COMPLICATION AND COMORBIDITY (CC) LIST FY2011 The intent of this alphabetical list of complications and comorbidities is to include most of the "CCs" in a form that is useful to doctors and nurse reviewers. Terms are cross ‑ referenced to promote easy retrieval. The “x” is used to alert the reviewer that the code is incomplete and requires further investigation into the coding book. ©DRG Review, Inc.

6. COMPLICATION AND COMORBIDITY (CC) LIST FY2011 ©DRG Review, Inc.

7. COMPLICATION AND COMORBIDITY (CC) LIST FY2011 ©DRG Review, Inc.

8. Systolic/Diastolic Heart Failure Systolic heart failure relates to the inability of the ventricle to contract normally; therefore, eject sufficient blood resulting in a reduced cardiac output. An echocardiogram is helpful as it may reveal impairment in the ventricular wall systolic contraction with a reduced cardiac ejection fraction of < 40%. The most common cause of chronic systolic heart failure is ischemic heart disease or idiopathic cardiomyopathy. Diastolic heart failure results from an inability of the ventricle to relax and fill normally because the ventricle wall is stiff and/or hypertrophied. EKG may reveal left ventricular hypertrophy. An echocardiogram may demonstrate a thickened myocardial ventricular wall, normal contraction with a normal ejection fraction (> 50%). The most common cause of diastolic heart failure is hypertension (especially in females) or hypertrophic cardiomyopathy. Note: In many patients with chronic heart failure, abnormalities of both ventricular contraction and relaxation coexist; therefore, chronic systolic and diastolic heart failure may occur simultaneously. ©DRG Review, Inc.

9. COMPLICATION AND COMORBIDITY (CC) LIST FY2011 ©DRG Review, Inc.

10. COMPLICATION AND COMORBIDITY (CC) LIST FY2011 ©DRG Review, Inc.

11. Major Complications/Comorbid Conditions (MCC) Clinical Groupings Cardiovascular – Cardiac arrest (if discharged alive) – CHF – acute (or acute on chronic); systolic or diastolic – Cor pulmonale, acute – Endocarditis/Myocarditis, acute (excluding rheumatic) – MI, acute Pericarditis (a few rare types such as due to Histoplasmosis) – Shock (cardiogenic or other shock without trauma) (if discharged alive) – Ventricular fibrillation (if discharged alive) ©DRG Review, Inc.

12. MAJOR COMPLICATION AND COMORBIDITY (MCC) LIST FY2011 ©DRG Review, Inc.

13. MAJOR COMPLICATION AND COMORBIDITY (MCC) LIST FY2011 ©DRG Review, Inc.