W. Va. Code R. § 65-20-10
Statement of Purpose: In order to ensure an appropriate supply of health services to the citizens of West Virginia while discouraging unnecessary duplication and high costs, the Health Care Cost Review Authority shall conduct a through public review and evaluation of proposed projects.
The goal of the Certificate of Need Program is to provide for the continued orderly development of the health care system in West Virginia through a public review of proposed applications that are evaluated in accordance with established Criteria and Standards. The purpose of the Criteria and Standards is twofold:
(1) To serve as guidelines in the continued orderly development of the health care system in West Virginia in accordance with the Certificate of Need statute; and
(2) To promote cost-effective alternatives to higher-cost services.
SKILLED NURSING UNIT DRG'S
DRG
GROUP
NUMBERDESCRIPTION
009 Spinal Disorders & Injuries
010 Nervous System Neoplasms With CC
012 Degenerative Nervous Neoplasms With CC
014 Specific Cerebrovascular Disorders Except TIA
018 Cranial & Peripheral Nerve Disorders With CC
024 Seizure & Headache Age 17 With CC
034 Other Disorders Of Nervous System With CC
044 Acute Major Eye Infections
075 Major Chest Procedures
078 Pulmonary Embolism
079 Respiratory Infections & Inflammations Age 17 With CC
082 Respiratory Neoplasms
083 Major Chest Trauma With CC
085 Pleural Effusion With CC
087 Pulmonary Edema & Respiratory Failure
088 Chronic Obstructive Pulmonary Disease
089 Simple Pneumonia & Pleurisy Age 17 With CC
094 Pneumothorax With CC
096 Bronchitis & Asthma Age 17 With CC
101 Other Respiratory System Diagnoses With CC
106 Cornary Bypass With Cardiac Cath
107 Cornary Bypass W/O Cariac Cath
110 Major Cardiovascular Procedures With CC
113 Amputation For Circ System Disorders Except Upper Limb & Toe
115 Perm Cardiac Pacemaker Implant With Ami, Heart Failure or Shock
121 Circulatory Disorders With Ami & C.V. Comp. Disch. Alive
DRG
GROUP
NUMBERDESCRIPTION
126 Acute & Subacute Endocarditis
127 Heart Failure & Shock
128 Deep Vein Thrombophlebitis
130 Peripheral Vascular Disorders With CC
132 Atherosclerosis With CC
134 Hypertension
135 Cardiac Congenital & Valvular Disorders Age 17 With CC
138 Cardiac Arrhythmia & Conduction Disorders With CC
140 Angina Pectoris
144 Other Circulatory System Diagnoses With CC
146 Rectal Resection With CC
148 Major Small & Large Bowel Procedures With CC
150 Peritoneal Adhesiolysis Age 69 And/Or CC
164 Appendectomy With Complicated Princ. Diag Age 69/And/Or CC
172 Digestive Malignancy Age 69 And/Or CC
174 G.I. Hemorrhage Age 69 And/Or CC
179 Inflammatory Bowel Disease
180 G.I. Obstruction With CC
182 Esophagitis, Gastroent. & Misc. Digest. Disorders Age 17 With CC
188 Other Digistive System Diagnosis Ages 69 And/Or CC
191 Major Pancreas, Liver & Shunt Procedures With CC
195 Total Cholecystectomy W C.D.E. With CC
197 Total Cholecystectomy W/O C.D.E. With CC
203 Malignancy Of Hepatobiliary System Or Pancreas
204 Disorders Of Pancreas Except Malignancy
205 Disorders Of Liver Exc Malig. Cirr. Alc Hepa With Cc
207 Disorders Of The Biliary Tract With CC
209 Major Joint And Limb Reattachment Procedures
210 Hip & Femur Procedures Except Major Joint Age 17 With Cc
213 Amputations For Musculoskeletal System & Conn. Tissue Disorders
217 Wnd Debrid & Skn Grft Exc Hand, For Muscskeletal & Conn. Tiss. Dis.
221 Major Shoulder/Elbow Proc. Or Other Upper Extremity Proc. W CC
223 Upper Extremity Proc. Exc. Humerus + Hand Age 69 And/Or CC
233 Other Musculoskelet Sys. & Conn. Tiss. O.R. Proc. With CC
235 Fractures Of Femur
236 Fractures Of Hip & Pelvis
238 Osteomyelitis
239 Pathological Fractures & Musculoskeletal & Conn. Tiss. Malignancy
240 Connective Tissue Disorders With CC
242 Septic Arthritis
244 Bone Diseases & Specific Arthropathies With CC
257 Total Mastectomy For Malignancy With CC
259 Subtotal Mastectomy For Malignancy With CC
263 Skin-Grafts And/Or Debrid Ulcer Or Cllulitis With CC
271 Skin Ulcers
DRG
GROUP
NUMBERDESCRIPTION
272 Major Skin Disorders With CC
274 Malignant Breast Disorders With CC
277 Cellulitis Age 17 With CC
285 Amputation Of Lower Limb For Endocrine, Nutritional & Metabolic Dis.
294 Diabetes Age = 35
296 Nutritional & Misc. Metabolic Disorders With CC
300 Endocrine Disorders Age 69 And/Or CC
306 Prostatectomy With CC
310 Transurethral Procedures With CC
318 Kidney & Urinary Tract Neoplasms Age 17 With CC
320 Kidney & Urinary Tract Infections Age 17 With CC
331 Other Kidney & Urinary Tract Diagnoses Age 17 With CC
336 Transurethral Prostatectomy With CC
346 Malignancy, Male Reproductive System With CC
366 Malignancy, Female Reproductive System With CC
400 Lymphoma And Leukemia With Major O.R. Procedure
401 Lymphoma And Non-Acute Leukemia With Other O.R. Proc. With CC
403 Lymphoma And Non-Acute Leukemia With CC
416 Septicemia Age 17
423 Other Infectious & Parasitic Diseases Diagnoses
444 Traumatic Injury Age 17 With CC
449 Poisoning And Toxic Effects Of Drugs Age 69 And/Or CC
462 Rehabilitation
W. Va. Code R. § 65-20-10