N.Y. Comp. Codes R. & Regs. tit. 10 § 400.13
NEW YORK STATE DEPARTMENT OF HEALTH
DIVISION OF HEALTH CARE FINANCING
INSTRUCTIONS: HOSPITAL AND COMMUNITY PATIENT
REVIEW INSTRUMENT (H/C-PRI)
GENERAL CONCEPTS
* TIME PERIOD - The time period for the questions is the past week. For the patients who have been in the hospital less than one week use the time from admission to H/C-PRI completion as the timeframe. If the community assessor (e.g., certified home health care agency, RHCF assessor) does not have any history on the patient, then the day of the H/C-PRI assessment is the timeframe. See "Sources of Information" below.
* FREQUENCY - The frequency specifies how often something needs to occur to meet the qualifier. For example, suctioning needs to occur daily for at least one week or the PRI cannot be checked for this patient as receiving this care.
* DOCUMENTATION - Some of the questions require specific medical record documentation to be present. Otherwise, the question cannot be answered "yes" for the patient.
* EXCLUSIONS - Some of the questions specifically state to omit certain types of care or behavior when answering the question. For example, inhalators are excluded from oxygen therapy.
INSTRUCTIONS: H/C-PRI QUESTIONS
# 1 RHCF Application from Hospital means the patient resides in the hospital at the time of this H/C-PRI review and is applying for admission into a residential health care facility (RHCF, HRF or SNF). This H/C-PRI is being completed by a qualified hospital assessor or another qualified assessor (i.e., RHCF assessor, certified home health care agency assessor) who enters the hospital to review the patient.
# 2 RHCF Application for Community means the patient resides in the community during this H/C-PRI review. Include Adult Homes and other domicillary care facilities.
Documentation For a patient to be coded as level 4, documentation by a licensed clinician must exist which describes the following three components: * A description of the patient's decubitus. * Circumstances or medical condition which led to the decubitus. * An active treatment plan.
Definition
LEVELS:
#0 No reddened skin or breakdown.
#1 Reddened skin, potential breakdown.
#2 Blushed skin, dusty colored, superficial layer of broken or blistered skin.
#3 Subcutaneous skin is broken down.
#4 Necrotic breakdown of skin and subcutaneous tissue which may involve muscle, fascia and bone.
#5 Patient is at level 4, but the documentation qualifier has not been met.
Time Period Condition must have existed during the past week.
Documentation Written support exists that the patient has the condition.
Definitions See chart below. (Examples are for clarification and are not intended to be all-inclusive.)
| DEFINITION | EXAMPLES OF CAUSES | EXAMPLES OF TREATMENTS |
|---|---|---|
| 17A. COMATOSE: Unconscious, cannot be aroused, and at most can respond only to powerful stimuli. The coma must be present for at least four days. | Brain insult Hepatic encephalopathy Cardiovascular accident | Total ADL Intake & output Parenteral feeding |
| 17B. DEHYDRATION: Excessive loss of body fluids requiring immediate medical treatment and ADL care. | Fever Acute urinary tract infections Pneumonia Vomiting Unstable diabetes | Intake & output Electrolyte lab tests Parental hydration Nasal feedings |
| 17C. INTERNAL BLEEDING: Blood loss stemming from a subacute or chronic condition (e.g., gastrointestinal, respiratory or genito-urinary conditions) which may result in low blood pressure and hemoglobin, pallor, dizziness, fatigue, rapid respiration. | Use only the causes presented in the definition. Exclude external Hemorrhoids and other minor blood loss which is not dangerous and requires only minor intervention. | Critical monitoring of vital signs Transfusion Use of blood pressure elevators Plasma expanders Blood every 60 days likely to be needed |
| 17D. STASIS ULCER: Open lesion, usually In lower extremities, caused by decreased blood flow from chronic venous insufficiency. | Severe edema Diabetes PVD | Sterile dressing Compresses Whirlpool Leg elevation |
| End stages of: | ADL Care | |
| 17E. TERMINALLY ILL: Professional prognosis (judgment) is that patient is rapidly deteriorating and will likely die within three months. | Carcinoma, Renal disease, and Cardiac diseases | Social/ emotional support |
| 17F. CONTRACTURES: Shortening and tightening of ligaments and muscles resulting in loss of joint movement. Determine whether range of motion loss is actually due to contractures and not only due to spasticity or paralysis or in joint pain. | Comatose, Bedbound High dependence with ADLs Low physical tolerance for exercise. Exclude range of motion loss due to spasticity or paralysis only. | Range of Motion Ambulation Splint care PT/OT regimen |
| It is important to observe the patient to confirm whether a contracture exists and check the chart for confirmatory documentation. To qualify as "YES" on the H/C PRI the following qualifiers must be met: | ||
| 1. The contracture must be documented by a physician, physical therapist or occupational therapist. | ||
| 2. The status of the contracture must be reevaluated and documented by the physician, physical therapist or occupational therapist on an annual basis. | ||
| There does not need to be an active treatment plan to enter "YES" to contractures. | ||
| 17G. DIABETES MELLITUS: A metabolic disorder in which the ability to oxidize carbohydrates is compromised due to inadequate pancreatic activity resulting in disturbance of normal insulin production. This may or may not be the primary problem (Q.29) or primary diagnosis. It should be diagnosed by a physician. Include any degree of diabetes, stable or unstable, and any manner it is controlled. | Destruction/ malfunction of the pancreas Exclude hypoglycemia or hyperglycemia which may be a diabetic condition, but by itself does not constitute diabetes mellitus. | Special diet Oral agents Insulin Exercise |
| 17H. URINARY TRACT INFECTION: During the past week, signs and symptoms of a UTI have been exhibited or it has been diagnosed by lab tests. | Exclude if symptoms are present, but the lab values are negative | Antibiotics Fluids |
| Symptoms may include frequent voiding, foul smelling urine, voiding small amounts, cloudy urine, sediment and an elevated temperature. May or may not be the primary problem under Q.29. Include as a UTI if it has not been confirmed yet by lab tests, but the symptoms are present. Include patients who appear asymptomatic but whose lab values are positive (e.g., mentally confused or incontinent patients). |
| 18. MEDICAL TREATMENTS: For a "YES" to be answered for any of these, the following qualifiers must be met: | |
| Time Period | -Treatment must have been given during the past week and is still required. |
| Frequency | -As specified in the chart below. |
| Documentation | -Physician order specifies that treatment should be given and includes frequency as cited below, where appropriate. |
| Exclusions | See chart below. |
| DEFINITION | SPECIFIC FREQUENCY | EXCLUSIONS |
|---|---|---|
| 18A. TRACHEOSTOMY CARE: Care for a tracheostomy, including suctioning. Exclude any self-care patients who do not need daily staff help. | Daily for the past week (7 days) or will continue to be required for 7 days. | Self-care patients |
| 18B. SUCTIONING: Nasal or oral techniques for clearing away fluid or secretions. May be for a respiratory problem. | Daily for the past week (7 days) or will continue to be required for 7 days. | Any tracheostomy Suctioning |
| 18C. RESPIRATORY CARE: Care for any portion of the respiratory tract, especially the lungs (for example COPD, pneumonia.) This care may include one or more of the following: percussion or cupping, postural drainage, positive pressure machine, possibly oxygen to administer drugs, etc. | Daily for the past week (7 days) or will continue to be required for 7 days. | Suctioning |
| 18D. OXYGEN THERAPY: Administration of oxygen by nasal catheter, mask (nasal or oronasal), funnel/cone, or oxygen tent for conditions resulting from oxygen deficiency (e.g., cardiopulmonary condition). | Daily for the past week (7 days) or will continue to be required for 7 days. | Inhalators Oxygen in room, but not in use |
| 18E. NASAL GASTRIC FEEDING: Primary food intake is by a tube inserted into nasal passage; resorted to when it is the only route to the stomach. | None | None Gastrostomy not applicable |
| 18F. PARENTERAL FEEDING: Intravenous or subcutaneous route for the administration of fluids used to maintain fluid, nutritional intake, electrolyte balance (for example, comatose, damaged stomach). | None | None Gastrostomy not applicable |
| 18G. WOUND CARE: Subcutaneous lesion(s) resulting from surgery, trauma, or open cancerous ulcers. | Care has been provided or is professionally judged to be needed for at least 3 consecutive weeks | Decubiti Stasis ulcers Skin tears Feeding tubes |
| 18H. CHEMOTHERAPY: Treatment of carcinoma through IV and/or oral chemical agents, as ordered by a physician. (Community-based patient may have to go to a hospital for treatment.) | None | None |
| 18I. TRANSFUSIONS: Introduction of whole blood or blood components directly into the bloodstream. (Community-based patient may have to go to a hospital for treatment.) | None | None |
| 18J. DIALYSIS: The process of separating components, as in kidney dialysis (e.g., renal failures, leukemia, blood dyscrasia). (Community-based patient may have to go to a hospital for treatment.) | None | None |
| 18K. BOWEL AND/OR BLADDER REHABILITATION: The goal of this treatment is to gain or regain optimal bowel and/or bladder function and to reestablish a pattern. It is much more than just a toileting schedule or a maintenance/ conditioning program. Rather it is an intense treatment which to very specific and unique for each patient and is of short term duration (i.e., usually not longer than six weeks). NOT all patients at level 5 under Toileting Q.22 may be a "YES" with this question. The specific definition for bladder rehabilitation differs from bowel rehabilitation; refer below: | Very specific and unique for each patient | Maintenance toileting schedule Restorative toileting program but does not meet the treatment requirements specified in the definitions |
| Bladder rehabilitation: Will generally include these step-by-step procedures which are closely monitored, evaluated and documented: (1) mental and physical assessment of the patient to determine training capacity; (2) a 24-hour flow sheet or chart documenting voiding progress; (3) possibly increased fluid intake during the daytime; (4) careful attention to skin care; (5) prevention of constipation; (6) in the beginning may be toileted 8 to 12 times per day with decreased frequency with progress. | ||
| Bowel rehabilitation: A program to prevent chronic constipation/impaction. The plan will generally include: (1) assessment of past bowel movements, relevant medical problems, medication use; (2) a dietary regimen of increased fluids and bulk (e.g., bran, fruits); (3) regular toileting for purposes of bowel evacuation; (4) use of glycerine suppositories or laxatives; (5) documentation on a worksheet or Kardex. | Exclude a bowel maintenance program which controls bowel incontinence by development of a routine bowel schedule. | |
| 18L. CATHETER: During the past week, an indwelling or external catheter has been needed. Indwelling catheter has been used for any duration during the past week. The external catheter was used on a continuous basis (with proper removal and replacement during this period) for one or more days during the past week; a physician order is required. | Exclude catheters used to empty the bladder once, secure a specimen or instill medication | |
| 18M. PHYSICAL RESTRAINTS: A device was used during the daytime during the past week to limit, restrict or keep under control patient movement. To qualify as a "YES" on the PRI, the restraints must have been given for at least two continuous hours and provided during the daytime. There must be a physician order for the daytime restraints restraints. Daytime includes all the time from when the patient wakes up in the morning to when the patient goes to sleep at night. Include belts, cuffs, mitts, geriatric chairs, harnesses, locked doors/gates, nets, bedrails and domes as restraints. (Include bedrails only for hospitalized patients, if there is a physician's order.) | Two continuous hours anytime during the past week (7 days) | Exclude chemical restraints Application only at night Application for less than two continuous hours Use only for transportation Devices which the patient can manipulate and loosen/remove, such as velcro seatbelts |
Use the following qualifiers in answering each ADL question:
| Time Period | - Past week (7 days). |
| Frequency | - Assess the capability level of the patient to perform each ADL 60% or more of time performed since the ADL status may fluctuate during a 24-hour period. |
| CHANGED CONDITION RULE: When a patient's ADL has improved or deteriorated during the past week (7 days) and this course is unlikely to change, measure the ADL according to its present status. |
MEASUREMENT APPROACH: Measure the present capability of the patient to complete each ADL. This may be in contrast to what the patient may actually be doing. The reason why you are assessing capacity, rather than actual performance, is so that only patient characteristics are taken into account when measuring ADLs. Omit nonpatient considerations when assessing ADLs. For example, physical barriers, such as stairs or no ramps, may prevent the patient from performing ADLs at the level s/he is actually capable. Or a facility safety policy or clinical order, such as bedrest, may prevent the patient from performing ADLs. Or informal supports in the community or hospital staff may be providing more assistance with ADLs (e.g., toileting) that the patient actually needs.
Definitions -
* SUPERVISION means verbal encouragement and observation, not physical hands-on care.
* ASSISTANCE means physical hands-on care.
* INTERMITTENT means that a staff person does not have to be present during the entire activity, nor does the help have to be on a one-to-one basis.
* CONSTANT means one-to-one care that requires a staff person to be present during the entire activity. If the staff person is not present, the patient will not complete the activity.
Note how these terms are used together in the ADLs. For example, there is intermittent supervision and intermittent assistance.
CLARIFICATION OF ADL RESPONSES
#3 "Requires continual help..." means that the patient requires a staff person's continual presence and help for reasons such as: patient tends to choke, has a swallowing problem, is learning to feed self, or is quite confused and forgets to eat.
#5 "Tube or parenteral feeding..." means that all food and drink is given by nursing staff through the means specified.
#3 "Walks with constant supervision and/or assistance. . ." may be required if the patient cannot maintain balance, has a history of falls, has stress fracture potential, or is relearning to ambulate.
#4 "Requires two people. . ." may be required for reasons such as: the patient is obese, has contractures, has fractures (or stress fracture potential), has attached equipment that makes transfer difficult (for example, tubes). There must be logical medical reasons why the patient needs the help of two people to transfer. This reason should be documented in the medical record.
#5 "Bedfast. . ." may refer to a patient with acute dehydration, severe decubitus, or terminal illness.
Definition - INCONTINENT 60% or more of the time the patient loses control of his/her bladder or bowel functions, with or without equipment.
#1 "Continent. . . Requires no or intermittent supervision" and
#2 ". . . and/or assistance" can refer to the continent patient or the incontinent patient who needs no/little help with his/her toileting equipment (for example, catheter).
#3 "Continent. . . Requires constant supervision/total assistance..." refers to a patient who may not be able to balance him/her self and transfer, has contractures, has a fracture, is confused or is on a rehabilitation program. In addition this level refers to the patient who needs constant help with elimination/incontinence equipment (for example, colostomy, ileostomy).
#4 "Incontinent. . . Does not use a bathroom" refers to the patient who does not go to a toilet room, but instead may use a bedpan or continence pads. This patient may be bedbound or is mentally confused to the extent that a scheduled toileting program is not beneficial.
#5 "Incontinent. . . Taken to a Bathroom. . ." refers to a patient who is on a formal toileting schedule; this should be documented in the medical record. This patient may be on a formal bowel and bladder rehabilitation program to regain or maintain control, or the toileting pattern is known and it is better psychologically and physically for the patient to be taken to the toilet (for example, prevent decubiti).
A patient may have different levels of toileting capacity for bowel and bladder function. To determine the level of such a patient, note that level four and five refer to incontinence of either bladder or bowel. Thus if a patient receives the type of care described in one of these levels for either type of incontinence, enter that level.
Example 1:
A patient needs constant assistance with a catheter (level 3) and is incontinent of bowel and is taken to the bathroom every four hours (level 5). In this instance, enter level 5 on the PRI because they are receiving the type of care described in this question for bowel incontinence.
Example 2:
The patient requires intermittent supervision for bowel function (level 2), and is taken to the toilet every two hours as part of a bladder rehabilitation program. Enter level 5, as the patient is receiving this type of care for bladder incontinence.
The following qualifiers must be met:
Time Period - Past week (7 days).
Frequency - As stated in the responses to each behavioral question.
Documentation - To qualify a patient as LEVEL 4 or to qualify the patient as a "YES" to HALLUCINATIONS, the following conditions must be met:
* Active treatment plan for the behavioral problem must be in current use.
* Psychiatric assessment by a recognized professional with psychiatric training/education must exist to support the fact that the patient has a severe behavioral problem. This assessment must still be exhibited by the patient.
Definitions - The terms used on the PRI should be interpreted only as they are defined below:
* PATIENT'S BEHAVIOR: Measure it as displayed with the behavior modification and treatment plan in effect during the past week.
* DISRUPTION: Through verbal outbursts and/or physical actions, the patient interferes with the staff and/or other patients. This interference causes the staff to stop or change what they are doing immediately to control the situation. Without this staff assistance, the disruption would persist or a problem would occur.
* NONDISRUPTION: Verbal outbursts and/or physical actions by the patient may be irritating, but do not create a need for immediate action by the staff.
* UNPREDICTABLE BEHAVIOR: The staff cannot predict when (that is, under what circumstances) the patient will exhibit the behavioral problem. There is no evident pattern.
* PREDICTABLE BEHAVIOR: Based on observations and experiences with the patient, the staff can discern when a patient will exhibit a behavioral problem and plan appropriate responses in advance. The behavioral problem may occur during activities of daily living (for example, bathing), specific treatments (for example, contracture care, ambulation exercises), or when criticized, bumped into, etc.
CLARIFICATION OF RESPONSES TO BEHAVIORAL QUESTIONS
EXCLUDE the following behaviors:
* Verbal outbursts
* Social withdrawal
* Hoarding
* Paranoia
* For each therapy these three types of information will be entered on the PRI: "Level," "Days" and "Time" (hours and minutes).
* For a patient not receiving a therapy at all, the "Level" will always be entered in the answer key as #1 ("does not receive"), the "Days" will be entered 0 (zero) and the "Time" will be 0 (zero).
* Use the chart on the following page to understand the qualifiers for each of the three types of information that will be entered. Whether patient is receiving maintenance or restorative therapy will make a difference in terms of the qualifiers to be used.
| Qualifiers for Level | Maintenance Therapy | Restorative Therapy | Qualifier Not Met |
|---|---|---|---|
| Level 2 | Level 3 | Level 4 | |
| DOCUMENTATION QUALIFIERS: | |||
| POTENTIAL FOR INCREASED FUNCTIONAL/ ADL ABILITY | No potential for increased functional ADL ability. Therapy is provided to maintain and/or retard deterioration of current functional /ADL status. Therapy plan of care and progress notes should support that patient has no potential for further or any significant improvement. | There IS positive potential for improved functional status within a short and predictable period of time. Therapy plan of care and progress notes should support that patient has this potential/is improving. | Enter level 4 if any one of the qualifiers under qualifiers for level 2 or 3 is not met. |
| PHYSICIAN ORDER QUALIFIER | Yes | Yes, monthly | |
| PROGRAM DESIGN AND EVALUATION QUALIFIER | Licensed professional person with a 4-year, specialized therapy degree evaluates program on a monthly basis. | Licensed professional person with a 4-year, specialized therapy degree evaluated program on a monthly basis. | |
| TIME PERIOD QUALIFIER | Treatments have been provided during the past week. | Treatments have been provided during the past week. | |
| NEW ADMISSION QUALIFIER | Not applicable | New admissions of less than one week can be marked for restorative therapy if: | |
| * There is a physician order for therapy and patient is receiving it. | |||
| A new admission includes readmissions to a residential health care facility. | |||
| * The licensed therapist has documented in the care/plan that therapy is needed for at least one week. |
| Qualifiers for Days and Time* | Maintenance Therapy | Restorative therapy |
|---|---|---|
| (i.e., level 2 or 4 under "Level" question) | (i.e., if level 3 or 4 under "Level" question) | |
| TYPE OF THERAPY SESSION | Count only one-to-one care. Exclude group sessions (e.g., PT exercise session, OT cooking session). | Count only one-to-one care. Exclude group sessions (e.g., PT exercise session, OT cooking session). |
| SPECIALIZED PROFESSIONAL ON-SITE (ON-SITE MEANS WITHIN THE FACILITY) | A certified (2-year) or licensed (4-year) specialized professional is on-site supervising or providing therapy. | A licensed (4-year) specialized professional is on-site supervising or providing care. (Do not include care provided by PT or OT aides.) |
* Qualifiers not met: Do not enter on the PRI any days and time of therapy which do not meet both these qualifiers under each type of therapy.
* Do not answer this question for hospitalized patients, unless an alternate level of of care status. Enter "0" (zero).
* PATIENT TYPE/NEED QUALIFIERS: The patient has a medical condition that (1) is unstable and changing or (2) is stable, but there is high risk of instability. If this patient is not closely monitored and treated by medical staff, an acute episode or severe deterioration can result. Documentation must support that the patient is of this type (for example, terminally ill, acute episode, recent hospitalization, post-operative).
* PHYSICIAN VISIT QUALIFIER: If, and only if, the patient meets the PATIENT TYPE/NEED QUALIFIER, then enter the number of physician visits during the past week that meets the following qualifications:
* A visit qualifies only if there is physician documentation that s/he has personally examined the patient to address the pertinent medical problem. The physician must make a notation or documentation in the medical record as to the result of the visit for the unstable medical condition (e.g., change medications, renew treatment orders, nursing orders, order lab tests).
* Do not include phone calls as a visit nor visits which could have been accomplished over the phone.
* For community-based patient, the physician visit may occur in the patient's own home, physician's office, outpatient clinic or hospital.
* NURSING TIME The primary medical problem should be selected based on the condition that has created the most need for nursing time during the past week (7 days). A review of the medical record for nursing and physician notes during the past week may be necessary. For community-based patients review what is requiring the most care time from informal supports and health care professionals if any.
* JUDGMENT This decision may require the assessor to use her/his own professional judgment in deciding upon the primary problem.
* ICD-9 Refer to the ICD-9 codes for common diagnoses (attached at the end of these instructions) for easy access to the most frequently used numbers. An ICD-9 code book containing the complete ICD-9 listing should be available in the nursing and/or medical records office of a facility.
* NO ICD-9 NUMBER - Enter "0" zero in the far right box if no ICD-9 number can be found for the patient's primary problem (or if the patient does not have a primary medical problem). If you cannot locate the ICD-9 code for the primary medical problem, PRINT THE NAME OF THE PRIMARY MEDICAL PROBLEMin the space provided on the PRI.
QUALIFIED ASSESSOR NUMBER:
ICD-9 CODES FOR COMMON DIAGNOSES
(Listed alphabetically within body system category)
| Blood and Blood-forming Organ Disorders | |
|---|---|
| Anemia, NOS* | 285.9 |
| Circulatory Diseases | |
| Angina pectoris, NOS | 413.9 |
| Atherosclerosis, generalized & unspecified | 440.9 |
| Atherosclerotic cardiovascular disease (ASCVD) | 429.2 |
| Arteriosclerotic heart disease (ASHD) | 414.0 |
| Cardiac dysrnythmias, unspecified | 427.9 |
| Chronic ischemic heart disease, NOS | 414.9 |
| Congestive heart failure | 428.0 |
| Congestive heart failure with acute pulmonary edema | 428.1 |
| Hypertension, essential, NOS | 401.9 |
| Hypertensive heart disease without congestive heart failure NOS | 402.90 |
| Peripheral vascular disease, NOS | 443.9 |
| Endocrine and Metabolic Disorders | |
| Diabetes, non-insulin dependent, adult onset or NOS | 250.00 |
| Diabetes, insulin dependent, adult onset or NOS | 250.01 |
| Genitourinary Disorders | |
| Urinary tract infection, site not specified | 599.0 |
| Mental Problems | |
| Alcoholism, chronic | 303.9 |
| Alzheimer's disease | 331.0 |
| Arteriosclerotic dementia | 290.40 |
| Chronic organic brain syndrome, NOS | 294.9 |
| Depression, NOS | 311 |
| Mental disorder (non-psychotic) following organic brain damage | 310.9 |
| Mental retardation, NOS | 319 |
| Organic personality syndrome | 310.1 |
| Presenile dementia, NOS | 290.10 |
| Psychosis, NOS | 298.9 |
| Schizophrenia, NOS | 295.9 |
| Senile dementia, NOS | 290.0 |
| Senility without psychosis | 797 |
| Musculoskeletal Disability | |
| Arthritis, excluding osteoarthrosis, site unspecified | 716.90 |
| Fracture, neck of femur | 820.09 |
| Fracture, other unspecified part of femur | 821.00 |
| Fracture, vertebra, closed NOS | 805.8 |
| Hip fracture, NOS | 820.0 |
| Osteoarthritis, generalized, NOS | 715.00 |
| Osteoarthritis, unspecified whether generalized or localized | 715.90 |
| Osteoporosis | 733.00 |
| Rheumatoid arthritis | 714.0 |
| Traumatic amputation, late effect | 905.9 |
| Neoplasms | |
| Carcinoma of female breast, NOS (if removed, use V10.3) | 174.9 |
| Carcinoma of colon, NOS | 153.9 |
| Carcinoma of lung and bronchus, NOS | 162.9 |
| Carcinomatosis, generalized cancer, unspecified site | 199.0 |
| Neurological Motor Dysfunction | |
| Cerebral arteriosclerosis | 437.0 |
| Cerebral degeneration, unspecified | 331.9 |
| Cerebral infarction, NOS | 434.9 |
| Cerebral palsy, NOS | 343.9 |
| Cerebral thrombosis | 434.0 |
| Cerebrovascular accident, NOS, acute phase (CVA) | 436 |
| Cerebrovascular disease, late effects | 438 |
| Convulsions | 780.3 |
| Hemiplegia | 342 |
| Huntington's chorea | 333.4 |
| Multiple sclerosis | 340 |
| Parkinson's disease | 332.0 |
| Quadriplegia | 344.0 |
| Transient ischemic attack (TIA) | 435.9 |
| Pulmonary Disease | |
| Chronic obstructive pulmonary disease, (COPD) | 496 |
| Pneumonia, organism unspecified | 486 |
| Upper respiratory infection, acute, NOS | 465.9 |
| Sensory Disorders | |
| Blindness and low vision, unspecified | 369.9 |
| Cataract, unspecified | 366.9 |
| Glaucoma, unspecified | 365.9 |
| Hearing loss, unspecified | 389.9 |
| Skin Disorders | |
| Chronic skin ulcer, NOS | 707.9 |
| Decubitus ulcer | 707.0 |
| SEE ICD-9 CODING BOOK FOR DIAGNOSES NOT LISTED HERE. |
* Not otherwise specified
Footnotes
* Qualifiers not met: Do not enter on the PRI any days and time of therapy which do not meet both these qualifiers under each type of therapy.
N.Y. Comp. Codes R. & Regs. Tit. 10 § 400.13
ICD-9 codes sometimes have two digits after the decimal, sometimes one, and sometimes none. Write the codes exactly as shown.