Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 10 - Office of the Director › Chapter 33 - Hospital and Ambulatory Surgical Center Data Disclosure › Section 19 CSR 10-33.020 - Reporting Charges for Leading Diagnoses and Procedures by Hospitals and Ambulatory Surgical Centers

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule establishes procedures for
				  reporting charges for leading diagnoses and procedures by hospitals and
				  ambulatory surgical centers to the Department of Health.
(1) Hospitals and ambulatory surgical centers
				shall report to the Department of Health by March 1 of each year, the charges
				as of December 31 of the previous year for the diagnoses and procedures listed
				in Exhibit C of this rule, included herein.
(2) The Department of Health may develop and
				publish reports pertaining to individual providers. The reports and the data
				they contain shall be public information and may be released on magnetic media.
				The Department of Health shall make the reports and data available for a
				reasonable charge based upon incurred costs.
(3) The Department of Health may develop
				reports and release data upon request which do not directly or indirectly
				identify individual providers. The reports and data shall be public information
				and may be released on magnetic media. The Department of Health shall make the
				reports and data available for a reasonable charge based upon incurred
				costs.
(4) Any provider which
				determines it temporarily will be unable to comply with any part of this rule
				or with the provisions of a previously submitted plan of correction can provide
				the Department of Health with written notification of the expected deficiencies
				and a written plan of correction. The notification and plan of correction shall
				include the section number and text of the rule in question, specific reasons
				why the provider cannot comply with the rule, an explanation of any extenuating
				factors which may be relevant, the means the provider will employ for
				correcting the expected deficiency, and the date by which each corrective
				measure will be completed.
(5) Any
				provider which is not in compliance with this rule shall be notified in writing
				by the Department of Health. The notification shall specify the deficiency and
				the action which must be taken to be in compliance. The chief executive officer
				or designee shall have ten (10) working days following receipt of the written
				notification of noncompliance to provide the Department of Health with a
				written plan for correcting the deficiency. The plan of correction shall
				specify the means the provider will employ for correcting the cited deficiency
				and the date that each corrective measure will be completed.
(6) Upon receipt of a required plan of
				correction, the Department of Health shall review the plan to determine the
				appropriateness of the corrective action. If the plan is acceptable, the
				Department of Health shall notify the chief executive officer or designee in
				writing and indicate that implementation of the plan should proceed. If the
				plan is not acceptable, the Department of Health shall notify the chief
				executive officer or designee in writing and indicate the reasons why the plan
				was not accepted. A revised, acceptable plan of correction shall be provided to
				the Department of Health within ten (10) working days.
(7) Failure of the provider to submit an
				acceptable plan of correction within the required time shall be considered
				continued and substantial noncompliance with this rule unless determined
				otherwise by the director of the Department of Health.
(8) Failure of any provider to follow its
				accepted plan of correction shall be considered continued and substantial
				noncompliance with this rule unless determined otherwise by the director of the
				Department of Health.
(9) Any
				provider in continued and substantial noncompliance with this rule shall be
				notified by registered mail and reported by the Department of Health to its
				Bureau of Hospital Licensing and Certification, Bureau of Narcotics and
				Dangerous Drugs, Bureau of Emergency Medical Services, Bureau of Home Health
				Licensing and Certification, Bureau of Radiological Health, State Public Health
				Laboratory, Bureau of Special Health Care Needs, the Division of Medical
				Services of the Department of Social Services, the Division of Vocational
				Rehabilitation of the Department of Elementary and Secondary Education and to
				other state agencies that administer a program with provider participation. The
				Department of Health shall notify the agencies that the provider is no longer
				eligible for participation in a state program.
(10) Any provider that has been declared to
				be ineligible for participation in a state program shall be eligible for
				reinstatement by correcting the deficiencies and making written application for
				reinstatement to the Department of Health. Any provider meeting the
				requirements for reinstatement shall be notified by registered mail. The
				Department of Health shall notify state agencies that administer a program with
				provider participation that the provider's eligibility for participation in a
				state program has been reinstated.
EXHIBIT C
List of Diagnoses and Procedures List of Inpatient
				  Diagnoses
Cesarean section without complications or comorbidities, or
				  both
Four-day stay
DRG 371
Vaginal delivery without complicating diagnoses
Two-day stay
DRG 373
Normal newborn
Two-day stay
DRG 391
List of Outpatient Procedures*
Operations on the Nervous System
Epidural pain block
CPT-4 62278 Injection of anesthetic substance (including
				  narcotics), diagnostic or therapeutic; lumbar or caudal epidural, single
ICD-9 03.91 Injection of anesthetic into spinal canal for
				  analgesia
Carpal tunnel release
CPT-4 64721 Neuroplasty or transposition, or both; median
				  nerve at carpal tunnel
ICD-9 04.43 Release of carpal tunnel
Operations on the Eye
Radial keratotomy (surgical correction of myopia)
CPT-4 65771 Radial keratotomy
ICD-9 11.75 Radial keratotomy
Cataract removal, with intraocular lens implant
CPT-4 66983 Intracapsular cataract extraction with insertion
				  of intraocular lens prosthesis (one stage procedure)
CPT-4 66984 Extracapsular cataract removal with insertion of
				  intraocular lens prosthesis (one stage procedure), manual or mechanical
				  technique (for example, irrigation and aspiration or
				  phacoemulsification)
ICD-9 13.19 Other intracapsular extraction of lens,
				  plus
ICD-9 13.71 Insertion of intraocular lens prosthesis at time
				  of cataract extraction, one (1) stage
ICD-9 13.59 Other extracapsular extraction of lens,
				  plus
ICD-9 13.71 Insertion of intraocular lens prosthesis at time
				  of cataract extraction, one (1) stage Removal of secondary cataract
CPT-4 66821 Discussion of secondary membranous cataract
				  (opacified posterior lens capsule, anterior haloid, or both); laser surgery
				  (for example, YAG laser) (one (1) or more stages)
ICD-9 13.64 Discussion of secondary membrane (after cataract)
				  Secondary insertion of intraocular lens/Exchange of intraocular lens
CPT-4 66985 Insertion of intraocular lens prosthesis
				  (secondary implant), not associated with concurrent cataract removal
CPT-4 66986 Exchange of intraocular lens
ICD-9 13.72 Secondary insertion of intraocular lens
				  prosthesis
Operations on the Ear, Nose, Mouth and Pharynx
Myringotomy, with or without tubes
CPT-4 69421 Myringotomy including aspiration or eustachian
				  tube inflation, or both, requiring general anesthesia
CPT-4 69436 Tympanostomy (requiring insertion of ventilating
				  tube), general anesthesia
ICD-9 20.01 Myringotomy with insertion of tube
Nasal fracture, closed reduction
CPT-4 21320 Manipulative treatment, nasal bone fracture; with
				  stabilization
ICD-9 21.71 Closed reduction of nasal fracture
Septoplasty
CPT-4 30520 Septoplasty or submucous resection, with or
				  without cartilage scoring, contouring or replacement with graft
ICD-9 21.88 Other septoplasty
Tonsillectomy without adenoidectomy
CPT-4 42825 Tonsillectomy, primary or secondary; under age
				  12
CPT-4 42826 age 12 or over
ICD-9 28.2 Tonsillectomy without adenoidectomy
Tonsillectomy with adenoidectomy
CPT-4 42820 Tonsillectomy and adenoidectomy; under age
				  12
CPT-4 42821 age 12 or over
ICD-9 28.3 Tonsillectomy with adenoidectomy
Operations on the Cardiovascular System
Cardiac catheterization, left heart
CPT-4 93510 Left heart catheterization, retrograde, from the
				  brachial artery, axillary artery or femoral artery; percutaneous
CPT-4 93511 by cutdown
CPT-4 93514 Left heart catheterization by left ventricular
				  puncture
CPT-4 93524 Combined transseptal and retrograde left heart
				  catheterization
ICD-9 37.22 Left heart cardiac catheterization
Varicose vein ligation and stripping
CPT-4 37720 Ligation and division and complete stripping of
				  long or short saphenous veins
ICD-9 38.5 Ligation and stripping of varicose veins
Endoscopic Procedures
Bronchoscopy, diagnostic
CPT-4 31622 Bronchoscopy; diagnostic, (flexible or rigid),
				  with or without cell washing or brushing
ICD-9 33.22 Fiber-optic bronchoscopy
ICD-9 33.23 Other bronchoscopy
Dilation of esophagus
CPT-4 43455 Dilation of esophagus, by balloon or dilator;
				  under fluoroscopic guidance
CPT-4 43456 retrograde
ICD-9 42.92 Dilation of esophagus
Upper GI endoscopy, diagnostic
CPT-4 43235 Upper gastrointestinal endoscopy including
				  esophagus, stomach and either the duodenum, jejunum, or both, as appropriate;
				  complex diagnostic
ICD-9 44.13 Other endoscopy of small intestine
Endoscopy of small intestine, diagnostic
CPT-4 44360 Small intestinal endoscopy, enteroscopy beyond
				  second portion of duodenum; diagnostic
ICD-9 45.13 Other endoscopy of small intestine Colonoscopy,
				  diagnostic
CPT-4 45378 Colonoscopy, fiber-optic, beyond splenic flexure;
				  diagnostic, with or without colon decompression
ICD-9 45.23 Colonoscopy
Sigmoidoscopy, diagnostic
CPT-4 45330 Sigmoidoscopy, flexible fiber-optic;
				  diagnostic
ICD-9 45.24 Flexible sigmoidoscopy
Operations on the Digestive System
Cholecystectomy (gall bladder removal)
CPT-4 49310 Laparoscopy, surgical; cholecystectomy (any
				  method)
ICD-9 51.23 Laparoscopic cholecystectomy
Inguinal hernia repair
CPT-4 49500 Repair inguinal hernia, under age 5 years, with
				  or without hydrocelectomy
CPT-4 49505 Repair inguinal hernia, age 5 or over
ICD-9 53.00 Unilateral repair of inguinal hernia, not
				  otherwise specified
ICD-9 53.01 Repair of direct inguinal hernia
ICD-9 53.02 Repair of indirect inguinal hernia
Diagnostic laparoscopy
CPT-4 58980 Laparoscopy, diagnostic (separate
				  procedure)
ICD-9 54.21 Laparoscopy
Cystoscopy
CPT-4 52000 Cystourethroscopy (separate procedure)
ICD-9 57.32 Other cystoscopy
Sterilization
Vasectomy
CPT-4 55250 Vasectomy, unilateral or bilateral (separate
				  procedure), including postoperative semen examination(s)
ICD-9 63.73 Vasectomy
Tubal ligation
CPT-4 58982 Laparoscopy, surgical; with fulguration of
				  oviducts (with or without transection)
CPT-4 58983 with occlusion of oviducts by device (for
				  example, band, clip, or Falope ring)
ICD-9 66.21 Bilateral endoscopic ligation and crushing of
				  fallopian tubes
ICD-9 66.22 Bilateral endoscopic ligation and division of
				  fallopian tubes
ICD-9 66.29 Other bilateral endoscopic destruction or
				  occlusion of fallopian tubes
Gynecological Operations
Conization of cervix
CPT-4 57520 Conization of cervix, with or without
				  fulguration, with or without dilation and curettage, with or without repair
				  (any method)
ICD-9 67.2 Conization of cervix
Laser destruction of cervical lesion
CPT-4 57513 Cauterization of cervix; laser ablation
ICD-9 67.39 Other excision or destruction of lesion or tissue
				  of cervix
Diagnostic D & C
CPT-4 58120 Dilation and curettage, diagnostic therapeutic
				  (nonobstetrical), or both
ICD-9 69.09 Other dilation and curettage
Operations on the Musculoskeletal System
Bunionectomy
CPT-4 28110 Ostectomy, partial excision, fifth metatarsal
				  head (bunionette) (separate procedure)
CPT-4 28290 Hallux valgus (bunion) correction, with or
				  without sesamoidectomy; simple exostectomy (Silver type procedure)
CPT-4 28292 Keller, McBride or Mayo type procedure
CPT-4 28293 resection of joint with implant
CPT-4 28294 with tendon transplants (Joplin type
				  procedure)
CPT-4 28296 with metatarsal osteotomy (for example, Mitchell,
				  Chevron, or concentric type procedures)
CPT-4 28297 Lapidus type procedure
CPT-4 28298 by phalanx osteotomy
CPT-4 28299 by other methods (for example, double
				  osteotomy)
ICD-9 77.51 Bunionectomy with soft tissue correction and
				  osteotomy of the first metatarsal
ICD-9 77.52 Bunionectomy with soft tissue correction and
				  arthrodesis
ICD-9 77.53 Other bunionectomy with soft tissue
				  correction
ICD-9 77.54 Excision or correction of bunionette
ICD-9 77.57 Repair of claw toe
ICD-9 77.58 Other excision, fusion and repair of toes
ICD-9 77.59 Other bunionectomy
Hammertoe correction
CPT-4 28285 Hammertoe operation; one toe (for example,
				  interphalangeal fusion, filleting, phalangectomy)
ICD-9 77.56 Repair of hammertoe
Knee arthroscopy, diagnostic
CPT-4 29870 Arthroscopy, knee, diagnostic, with or without
				  synovial biopsy (separate procedure)
ICD-9 80.26 Arthroscopy, knee
ICD-9 80.36 Biopsy of joint structure, knee
Knee arthroscopy, removal of cartilage
CPT-4 29881 Arthroscopy, knee, surgical; with meniscectomy
				  (medial OR lateral including any meniscal shaving)
ICD-9 80.6 Excision of semilunar cartilage of knee
Ganglionectomy, hand or wrist
CPT-4 25111 Excision of ganglion, wrist (dorsal or volar);
				  primary
CPT-4 26160 Excision of lesion of tendon sheath or capsule
				  (for example, cyst, mucous cyst, or ganglion), hand or finger
ICD-9 82.21 Excision of lesion of tendon sheath of
				  hand
Operations on the Integumentary System
Breast biopsy, incisional
CPT-4 19101 Biopsy of breast; incisional
ICD-9 85.12 Open biopsy of breast Removal of breast
				  lesion
CPT-4 19120 Excision of cyst, fibroadenoma, or other benign
				  or malignant tumor, aberrant breast tissue, duct lesion or nipple lesion
				  (except 19140), male or female, one or more lesions
ICD-9 85.21 Local excision of lesion of breast
Miscellaneous Diagnostic and Therapeutic Procedures
CAT scan of head, without contrast
CPT-4 70450 Computerized axial tomography, head or brain;
				  without contrast material
ICD-9 87.03 Computerized axial tomography of head
CAT scan of head, with and without contrast
CPT-4 70470 Computerized axial tomography, head or brain;
				  without contrast material, followed by contrast material(s) and further
				  sections
ICD-9 87.03 Computerized axial tomography of head
Contrast myelogram of spine
CPT-4 61055 Cisternal or lateral cervical (C1-C2) puncture;
				  with injection of drug or other substance for diagnosis or treatment (C1-C2)
				  or
CPT-4 62284 Injection procedure for myelography or
				  computerized axial tomography, or both, spinal (other than C1-C2 and posterior
				  fossa), plus
CPT-4 72270 Myelography, entire spinal canal, radiological
				  supervision and interpretation
ICD-9 87.21 Contrast myelogram
Mammography
CPT-4 76092 Screening mammography, bilateral (two view film
				  study of each breast)
ICD-9 87.37 Other mammography (X-ray imaging of the breast,
				  other than xerography)
CAT scan of abdomen, without contrast
CPT-4 74150 Computerized axial tomography, abdomen; without
				  contrast material
ICD-9 88.01 Computerized axial tomography of abdomen
CAT scan of abdomen, with and without contrast
CPT-4 74170 Computerized axial tomography, abdomen; without
				  contrast material, followed by contrast material(s) and further sections
ICD-9 88.01 Computerized axial tomography of abdomen
Diagnostic ultrasound, abdomen and retroperitoneum
CPT-4 76700 Echography, abdominal, B-scan or real time with
				  image documentation, or both; complete
CPT-4 76770 Echography, retroperitoneal (for example, renal,
				  aorta, nodes), B-scan or real time with image documentation, or both;
				  complete
ICD-9 88.76 Diagnostic ultrasound of abdomen and
				  retroperitoneu
Diagnostic ultrasound, gravid uterus
CPT-4 76805 Echography, pregnant uterus, B-scan or real time
				  with image documentation, or both; complete (complete fetal and maternal
				  evaluation)
CPT-4 76810 complete (complete fetal and maternal
				  evaluation), multiple gestation, after the first trimester
ICD-9 88.78 Diagnostic ultrasound of gravid uterus
Magnetic resonance imaging, brain, without contrast
CPT-4 70551 Magnetic resonance (for example, proton) imaging,
				  brain (including brain stem); without contrast material
ICD-9 88.91 Magnetic resonance imaging of brain and brain
				  stem
Magnetic resonance imaging, brain, with and without
				  contrast
CPT-4 70553 Magnetic resonance (for example, proton) imaging,
				  brain (including brain stem); without contrast material, followed by contrast
				  material(s) and further sequences
ICD-9 88.91 Magnetic resonance imaging of brain and brain
				  stem
Magnetic resonance imaging, spinal canal, without
				  contrast
CPT-4 72141 Magnetic resonance (for example, proton) imaging,
				  spinal canal and contents, cervical; without contrast material
CPT-4 72146 Magnetic resonance (for example, proton) imaging,
				  spinal canal and contents, thoracic; without contrast material
CPT-4 72148 Magnetic resonance (for example, proton) imaging,
				  spinal canal and contents, lumbar; without contrast material
ICD-9 88.93 Magnetic resonance imaging of spinal canal
Magnetic resonance imaging, spinal canal, with and without
				  contrast
CPT-4 72156 Magnetic resonance (for example, proton) imaging,
				  spinal canal and contents, without contrast material, followed by contrast
				  material(s) and further sequences; cervical
CPT-4 72157 thoracic
CPT-4 72158 lumbar
ICD-9 88.93 Magnetic resonance imaging of spinal canal
Treadmill stress test
CPT-4 93015 Cardiovascular stress test using maximal or
				  submaximal treadmill or bicycle exercise or pharmacological stress, or both;
				  continuous electrocardiographic monitoring, with interpretation and
				  report
ICD-9 89.41 Cardiovascular stress test using treadmill
Electrocardiogram
CPT-4 93000 Electrocardiogram, routine ECG with at least 12
				  leads; with interpretation and report
ICD-9 89.52 Electrocardiogram
Extracorporeal shockwave lithotripsy, kidney, ureter or
				  bladder, or any combination of these
CPT-4 50590 Lithotripsy, extracorporeal shockwave
ICD-9 98.51 Extracorporeal shock wave lithotripsy (ESWL) of
				  the kidney, ureter or bladder, or any combination of these
*Charges for outpatient procedures shall include the
				  facility's total customary charges for a specific procedure or group of
				  procedures defined according to ICD-9-CM or CPT-4 codes. Charges shall include
				  fees associated with the preparation of the patient (preoperative phase),
				  performance of the procedure (intraoperative phase) and recovery (postoperative
				  phase): Preoperative phase includes those services and procedures that prepare
				  the patient for the surgical procedure. It shall include, but is not limited
				  to, charges for standard preoperative diagnostic laboratory testing,
				  radiological services, preparatory pharmaceuticals (preoperative medications),
				  skin preparation supplies, and the like. Intraoperative phase includes those
				  services and procedures during the period of time of the actual surgical
				  procedure itself (as identified by ICD-9-CM or CPT-4 code) as performed to
				  eliminate or improve the patient's diagnostic condition. It shall include, but
				  is not limited to, room charges for the surgery suite, anesthesia and other
				  intraoperative pharmaceuticals, equipment and supplies (drapes/barriers,
				  electrocautery tips and grounding pads, specialized scalpel blades, dressing
				  materials, casting materials and orthopedic supplies, and the like).
				  Postoperative phase includes those services and procedures that are provided to
				  the patient from the point at which the patient exits the surgery suite to the
				  point at which the patient is discharged from the facility. It shall include,
				  but is not limited to, charges for use of the recovery room, dressings,
				  pharmaceuticals, respiratory therapy, supplies and the like. Professional fees
				  for facility-based radiologists, pathologists, anesthesiologists and the like,
				  if they are reported by the facility, shall be reported
				  separately.
*Original authority: 192.667, RSMo 1992, amended 1993,
					 1995.