With PDPM payment method, the determinants of payment are categorized into the following case-mix adjusted components: The PDPM rate is adjusted over the course of facility stay by the inclusion of a variable per diem (VPD) adjustment on the following three components: PT, OT and NTA. Fillable Online SKILLED Fax Email Print - pdfFiller 0000277284 00000 n PDPM ICD10 Consulting Confidential 2019 A Native American-Owned business Page . . To assist stakeholders in understanding the potential impacts of the proposed PDPM, we are providing a provider-specific impact analysis file, which details the estimated . startxref 0000001405 00000 n With the transition from Resource Utilization Group Version IV (, ) to the Patient-Driven Payment Model (PDPM) on October 1, 2019, the. Skilled nursing services are covered under the Federal Governments. Note that for the first 3 days of the stay you get 3 times the rate shown on the map. CMS 100-2 Chapter 8 Series Part I: Access to Medicare Part A Benefits In a SNF. Your NTA payment is driven by the presence of a number of conditions and/or extensive services. CMS identified 50 conditions and services that were related to an increased cost for skilled nursing facilities. CMS Under PDPM, Section GG drives PT and OT, and nursing which affects reimbursement. table, th, td { 0000190726 00000 n Patients are assigned a clinical category based on the primary diagnosis for SNF stay. For the NTA, an adjustment factor of 3.0 is applied to the total NTA CMI for days 1-3. Do whatever you want with a SKILLED: fill, sign, print and send online instantly. hb```b``ia`e`ff@ a(meU=r%::@`uH@V01:000x1p`5`gy4AuG/Dg* ZF:&'[-@ >` t!R the design of the PDPM case-mix system implemented in FY 2020. Intermittent Catheterization? endstream endobj 447 0 obj <> endobj 448 0 obj <> endobj 449 0 obj [278 0 0 0 0 889 0 0 333 333 0 0 278 333 0 278 556 556 556 556 556 556 556 556 556 556 278 0 0 584 0 0 0 667 667 722 722 667 611 778 722 278 500 667 556 833 722 778 667 0 722 667 611 722 667 944 0 667 0 0 0 0 0 0 0 556 556 500 556 556 278 556 556 222 222 500 222 833 556 556 556 0 333 500 278 556 500 722 500 500 500] endobj 450 0 obj <>stream Admitted in the Skilled nursing facility (SNF) within a short time (generally 30 days) of leaving the hospital and require skilled services related to hospital stay. ^(:eOCQ'SM7(Rmnvr/+eO.)hicZjz.,vO&u. You are never alone in this field and resources are available in seminars, webinars, the CMS website, MDS manual, etc. Le^#N"TaAKTt In summary, the NTA component is an important component to capture and reimburse the facility for costly medications and supplies that are needed to support patient characteristics. Nursing and NTA Components of PDPM - Hansen Hunter & Co. P.C. View fullsize The PDPM Rate is derived from the sum of all the PDPM component rates: PT base rate x PT case mix index (CMI) x VPD adjustment factor, OT base rate x OT CMI x VPD adjustment factor, NTA base rate x NTA CMI x VPD adjustment factor, Nursing base rate x Nursing CMI x 18% Nursing adjustment factor (only for AIDS patients). 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. Center for Medicare and Medicaid Services. Its interesting to note that the data CMS provided, that I am using here, came from some assessments that we no longer will be doing. Section I has a lot of items that can effect NTA pay. Good talk. For example, if a resident admits and the dietitian notes the BMI is over 40, query the physician to confirm a morbid obesity diagnosis. Title: Microsoft Word - FINAL PDPM Triple Check Checklist.docx Author: jleatherbarrow Created Date: 1/29/2020 4:19:17 PM PDF Skilled Nursing Facility PPS Final Rule for FY 2022 The individual NTA conditions have points ranging from 1 to 8. ~,/-I\!/JfB. Ensure you have staff who are trained in ICD-10 coding. NAC Resources for Post-Acute Care Nurses - AAPACN HU]o0}G?G< m*-$R5k'EC(K@!BE`;s 2I2,[fy@770&05 Bal[|# f1 `j[>,Uf[OrGUXore:qVKP2T(r`~F& +g80qjM8#)A{)@c}A,F^Ec{HN"!l!]_J3? 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. A good first resource is the PDPM NTA Comorbidity Mapping spreadsheet. code. The patients functional score which is coded on Section GG of the MDS form is derived by assessing the patients usual self-performance in the ADL task areas during the first three days of facility stay. Consider adding the list of NTAs to current pre-admission screening forms or otherwise creating a way to identify and communicate potential conditions and services that may continue during the SNF stay. If a resident is admitted into a Part A stay within 30 days after major surgical procedure (as a hospital inpatient) that carried some degree of risk to life or had the potential for severe disability, then J2100 (recent surgery requiring active SNF care) is checked "yes". The required MDS data would be entered in the sub-items listed below the item group identifier. Your PDPM Questions Answered - Part 4: Non-Therapy - Relias (By the way, we created a PDPM Calculator for you to experiment with and get a better understanding of how PDPM works. It is not clear why this would be the case. Just 1 NTA point can have an average worth of anywhere from $18 to $55 per day. As we continue to become more knowledgeable in coding accuracy to drive care and maximize reimbursement, here are 15 quick tips to keep in mind: Those were just a few quick tips that are derived from recent Q&A's with clients. comorbidities used under PDPM for NTA classification is assigned a certain number of points, between one and eight, based on its relative costliness. 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. Group therapy now allows for as few as 2 residents and as many as 6 residents. 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. I0020 is also a gateway to the I0020B Primary Diagnosis code. 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. Recently, a provider stated that its not that important because the QM high risk determination includes impaired mobility and transfer, which most of their residents with pressure ulcers already have, so that already qualifies them for high risk even if I5600 is not coded. PDPM (Patient-Driven Payment Model) | Let's Break It Down! Coding Speech Related Comorbidities Under PDPM - Language Fundamentals Custodial care does not require the assistance of a licensed staff. 0000002742 00000 n Next you multiply the case-mix index by the rate, either rural ($74.56) or urban ($78.05). The RUG-IV consists of two case-mix adjusted components: Therapy which is based on volume of services provided and nursing. (4.0CSVMEB3nHSQ(9gvNtp}|srUzUX/%3vf+R6Fe Kb`Mr"yWz~tck~>1gK\,)?yt_Jy2Z2poUa-GFjRC'.`?/`;Mwk!$e#W,rLz:+ZL`Y4;Z%Up|h\/nzD]#N. hrmct Report the diagnosis code that provides an 18% add-on to the nursing component when coded on the UB-04 even when not coded on the MDS. SNF Reimbursement - TRICARE West Perhaps the most "transformative" component relates to Non-Therapy Ancillary (NTA) Services. background-color: #2c4a88; All about coding rehabilitation for joint replacements: Its important to know the reason for the joint replacement since coding a joint replacement due to a fracture is different than when a joint replacement is due to an elective surgery. [|Qc\0aXjK@ EdO4&_? The Financial Impact of Malnutrition and PDPM We know now that every diagnosis and condition counts. endstream endobj 438 0 obj <>/Metadata 434 0 R/OutputIntents[<>]/Pages 433 0 R/StructTreeRoot 3 0 R/Type/Catalog>> endobj 439 0 obj <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Rotate 0/StructParents 0/Type/Page>> endobj 440 0 obj <> endobj 441 0 obj <> endobj 442 0 obj <> endobj 443 0 obj [226 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 606 0 529 0 0 0 0 0 0 0 0 0 0 659 0 0 0 0 0 495 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 503 0 0 0 0 0 0 0 813 537 538 537 0 0 0 347] endobj 444 0 obj <> endobj 445 0 obj [278 0 0 0 0 0 0 0 0 0 0 584 0 333 278 278 556 556 556 556 556 556 556 556 556 556 0 0 0 0 0 0 0 722 722 722 722 667 611 778 0 278 0 0 0 833 722 0 667 0 0 667 611 0 0 0 0 0 0 0 0 0 0 0 0 556 611 556 611 556 333 611 0 278 0 0 278 889 611 611 611 0 389 556 333 611 556 0 556 556] endobj 446 0 obj <>stream <<50FFC127310FCF468ABFE4B7414A5B70>]/Prev 423154>> Was there a need for an IV? 0000002038 00000 n 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. CMS identified a . Its important to comprehend more than just the basics of PDPM. 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. 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). 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. Skilled nursing services are covered under the Federal Governments Medicare program for a limited time or on a short-time basis and must meet the following requirements: The role of the Minimum Data Set (MDS) nurses has evolved all these years from being a clinician to a financial analytical nurse because the MDS assessments have become the basis for facility reimbursement by the Medicare program. But now, if the resident also happens to have diabetic retinopathy, we can earn an extra NTA point if we also include the specific Diabetic Retinopathy code in I8000. The correct coding for NTA will require a team effort and diligent review of coding and supporting documentation. Share our insider knowledge and tips! PDF FINAL PDPM Triple Check Checklist PDF Comorbidities Included in NTA Comorbidity Score and Assigned Points Suctioning? Facilities must ensure efficient processes are in place when selecting the primary diagnosis. Patient Driven Payment Model | CMS The PDPM program has six payment components. endstream endobj 1696 0 obj <>stream SLP: NSG: NTA: This audit format form contains the MDS 3.0 items that drive payment for the Part A Medicare PDPM SNF-PPS payment. The administration of IV fluids may qualify for the Parenteral/IV Feeding - High or Parenteral/IV Feeding - low NTA points. 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. Resolved conditions should not be listed since therapy would not be treated for a resolved condition. Try Now! PDPM payments will be based on six groupsone non-case mix group (CMG) and five specific CMGs: PT, OT, SLP, NTA and nursing. Find toolkits, webinars, on-demand trainings, templates, and much more to meet the needs of your facility. I am sure we'll continue to understand even more as the months go by. Click the comorbidity and see the ICD-10 codes that are most likely to occur. 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. PDPM includes a new pay category, the non-therapy ancillary or NTA. The PDPM clinical categories represent groups of similar diagnosis codes, which are used as part of the resident's classification under the PT, OT, and . PDPM or Patient-Driven Payment Model is the new system, replacing the RUG-IV, for calculating reimbursement by Medicare in the skilled nursing setting. The functional scoring is based on residents performance in. 0000189184 00000 n PDPM MDS Items ! Zi@Ym"l?]L?*;YaRxwFhSGkhSFRQJIp.V4v!fbN91GE]Y:+s Payment is based on services provided by five disciplines: physical therapy, occupational therapy, speech language pathology, nursing, and non-therapy ancillary (NTA). Once completing his Part A stay, the hip fracture will no longer appear on his claim, and Parkinson's Disease now returns as the Principal Diagnosis. Click here to visit our shop. endstream endobj 1697 0 obj <>stream The saying, haste makes waste applies in the completion of MDS assessments and calculation of the maximized PDPM rate for the patient. }|YAxz .diS\]0}3sfowMm@ by NCC News and Content Team | Mar 1, 2023 | Hospitals, Specialties. Reimbursement, LW Consulting, Inc.5925 Stevenson Avenue, Suite GHarrisburg, PA 17112, Ph:800-320-5401Local Ph: 717-233-6100Fx:717-233-4633. RUG Classification Groups based on the volume and intensity of therapy provided to patient: Determinants of Payment for PDPM are summarized below. 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. The calculation of payments is based on the five case-mix adjusted components: Physical Therapy (PT), Occupational Therapy (OT), Speech Language Pathology (SLP), Nursing and Non-therapy ancillary (NTA). 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. border: 1px solid black; Hoo0Gw7I18J+-+hLC&QI$[3iB:s]:?\GqA ATc#(R2:nl/?e. ` 0!RJ3t f{ WN"Y@L1+;HXZL@\uB*4c*fi$1( )}hciksm2hn 1cU(YTS46ye&? &JHyBIQ fF hVmk#7+xG{ZMaMu{vB{[ciF3Viee2!VpIbDAy_X%_A0,R99Kb! To find out if you're leaving any money on the table email MDS Consultants for a PDPM review at info@mds-consultants.com, Find the PDPM ICD-10 Mapping tool at: https://mds-consultants.com/helpful-cms-info/, PDPM step-by-step scoring guide at https://mds-consultants.com/mds-tools/, https://mds-consultants.com/helpful-cms-info/, Coding N2001 N2005: Part A Drug Regimen Review, The Struggle with Antipsychotic Reduction . h4Pj0^z[ 8 >BRA$+Vfa Classroom Walkthrough Checklist Resource Center K 12 Resources Frontline Education April 18th, 2019 - Broken Arrow Public Schools a large urban suburban district with deep roots in the community serves more than 19 000 students Recognized as one of the top Request for labs, imaging studies and surgical reports whichever is applicable. When reviewing the CMI components driving PDPM reimbursement it's important to consider the critical role of the Non-Therapy Ancillary (NTA) score. On day 4 it goes back to the rate shown. Basic versions of many 2019 AHCA PDPM Academy copyrighted document resources and webinars are available to . Highlights: This has been a key consideration in designing the various elements of the new model. If the Primary Diagnosis you listed in I0020B also happens to be a SLP Comorbidity qualifier from the SLP Comorbidity list, the grouper software will pick it up as a comorbidity from I8000. We earn 1 NTA point when Other Skin Problems (foot ulcers/lesions) is coded in MDS item M1040A (infection of the foot such as cellulitis or purulent drainage), M1040B (diabetic foot ulcer), or M1040C (other open lesion of foot). At the start of 2019, 63% of respondents to SNN's annual outlook survey identified a greater emphasis on coding as a a key PDPM strategy. Either way, you must still also code the I0020B primary condition I0010 through I8000. Notice there is a big pocket of low NTA rates that covers most of Iowa. 0000003961 00000 n The calculation of payments is based on the five case-mix adjusted components: Physical Therapy (PT), Occupational Therapy (OT), Speech Language Pathology (SLP), Nursing and Non-therapy ancillary (, Behavioral Symptoms and Cognitive Performance Problems, The Centers for Medicare and Medicaid Services (. HUMk@(h; ! This is especially important for those residents who are long-term and later qualify for skilled care. The NTA comorbidity score is a weighted count of certain comorbidities that a SNF patient has, which is then used to classify the patient into an NTA component payment group. This PDPM model aims to utilize the individual patients characteristics and needs based on diagnosis as opposed to the RUG-IV system relying on volume of services. Under PDPM, an adjustment is applied to certain PDPM components that varies the per diem payment over the course of the stay. Everyone Ive talked to agrees the NTA payment is a good idea. MDS 3.0 RAI Manual. PDPM includes a new pay category, the non-therapy ancillary or NTA. Retrieved from: https://www.cms.gov/Medicare/Quality-Initiatives-Patient- Assessment-Instruments/NursingHomeQualityInits/MDS30RAIManual.html, Center for Medicare and Medicaid Services. PDF PDPM Chart Audit PDPM Non-Therapy Ancillary Pay - Broad River Rehabilitation His I0020B Primary Diagnosis and his claim's Principal Diagnosis is now the aftercare of the hip fracture. PDF Welcome to Gravity healthcare Consulting & Online Education Non-Therapy Ancillaries: What are you missing? | MDS Consultants A frequent question: "If the mapping file lists a code as "return to provider", can I still use it on the MDS?". Incorporate NTA identification into the daily clinical meeting as it is ever important to identify when a change in condition or services takes place. 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. Below is the full listing of conditions and services used for NTA classification and the associated number of points for that comorbidity. (PPS) based primarily on the type and intensity of therapy services provided to the patients regardless of their acuity, unique characteristics, specific needs, or goals. The NTA Component of PDPM: Best Practices for Accurate Scoring 6/23/22 Capturing Non-Therapy Ancillary (NTA) in PDPM - GEM Health Care Under PDPM, long-term care facilities will receive reimbursement based on services that each resident receives. The non-therapy ancillary (NTA) part of the patient driven payment model (PDPM) is considered by most people Ive talked to as being better than what were currently doing. (At this point, I can feel the cold stares from our MDS Experts. Patient has at least three qualifying inpatient days in an acute hospital. PDF PMR MDS Items PDPM - nehca.org Diligent review of the medical history and clinical record is essential. Actually, were going to limit our scope to only I8000 items. Re-calculate expected daily rate based on the completed Rehab and Nursing Functional Scores and re-review principal diagnosis. Securely download your document with other editable templates, any time, with PDFfiller. You can rely on us. The Patient Driven Payment Model (PDPM) - FHCA Pulse Understanding PDPM and the NTA Component - LW Consult AVONA confirms that rural facilities do indeed have lower NTA case-mix. We earn 1 NTA point for second or third degree burn coded in M1040F. It more accurately accounts for expenses and isn't overshadowed by therapy. Under PDPM, CMS identified 50 conditions that were related to increases in NTA costs for a skilled nursing facility (SNF). Yes, I am aware that ICD-10 codes do change occasionally. Refer to the CMS PDPM ICD-10 NTA Comorbidity Crosswalk for I8000-derived comorbidities with acceptable ICD-10 codes that map to the NTA component and the NTA item listing for a complete list of NTA conditions/services. PATIENT DRIVEN PAYMENT MODEL |4 . Patient classification system where patients are grouped according to their care and resource needs. One can see from the table above that if comorbidities are missed, the facility could possibly miss out on reimbursement. Refer to RAI pages J37-J38 for more on coding J2100. Verify coding, dont assume. The table below shows how the sum of the NTA points converts to an NTA Case Mix Group and a corresponding NTA CMI. PDPM: 15 Quick Tips - LinkedIn Any delay in getting this information is going to be problematic. The NTA looks at conditions and extensive services that are associated with significant increase in costs for a skilled nursing facility. SANE is an acronym that stands for Sexual Assault Nurse Examiner. PDF MDS Item Fields - All PDPM Case-Mix Adjusted Components This information is essential. Our wound certified educators train, educate, and guide our providers and client facilities on the most efficacious wound care treatments and follow up. endstream endobj 453 0 obj <>stream Item I0020 and I0020B: Item I0020 (primary medical condition category that best describes the primary reason for admission lists several options. Remember, a diagnosis has to be active and documented by a physician or nonphysician extender to qualify as an NTA item. These clinical categories are PT, OT, and SLP. Yes, I get that is bad. PDPM Goes Beyond Therapy: Finding the Hidden - Skilled Nursing News You should understand those things too, reader.). It's easy to get to those 50, but the tricky part is understanding which ICD-10 codes match to the comorbidities. 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 All disciplines should complete all their assessments ON TIME to CAPTURE all skilled services and accurately calculate residents daily rate PRIOR TO completion and transmission of the MDS 5-day assessment. The higher the score, the higher the NTA rate. 0000006770 00000 n CMS stated in the final rule for FY 2023 that they intend to take a more cautious approach to mitigate the potential negative impacts on the nursing home industry with this parity adjustment by spreading it across a two-year period. Functional scoring is one of the factors used to calculate the PDPM rate for the PT, OT and Nursing components. 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.