SUMMARY OF CODING ELEMENTS

OVERVIEW OF THE FY 2019IPPS FINAL RULE

Published in the Federal Register August 17th Rule to take effect October 1st

8/13/2018 NHA

1

MS-DRG CHANGES – PRE MDC

• Revision of the titles of Pre-MDC MS-DRGs 11, 12, and 13• New titles:

• MS-DRG 11 (Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy with MCC

• MS-DRG 12 (Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy with CC

• MS-DRG 13 (Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy without CC/MCC

• Chimeric Antigen Receptor (CAR) T-Cell Therapy• Assign procedure codes XW033C3 and XW043C3 to MS-DRG 016 for FY 2019

• Rename the MS-DRG to reflect this change

• New title: “Autologous Bone Marrow Transplant with CC/MCC or T-cell Immunotherapy”

8/13/2018 NHA 2

MS-DRG CHANGES –MDC 1 (DISEASES AND DISORDERS OF THE NERVOUS SYSTEM)

• Addition of 2 diagnosis codes to MS-DRG 023• G40.109 (Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with

simple partial seizures, not intractable, without status epilepticus)

• G40.111 (Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, with status epilepticus)

8/13/2018 NHA 3

MS-DRG CHANGES –MDC 5 (DISEASES AND DISORDERS OF THE CIRCULATORY SYSTEM)

• Finalized proposal to recreate pairs of procedure code combinations that are designated as O.R. procedures outside of MDC 5 when reported together• Combinations include the insertion of the pacemaker device and the leads

• When either of these types of procedures is reported alone, they will be classified as non-O.R. procedures

8/13/2018 NHA 4

MS-DRG CHANGES –MDC 6 (DISEASES AND DISORDERS OF THE DIGESTIVE SYSTEM)

• Reassignment of ICD-10-CM diagnosis code D17.71 from MS-DRGs 393, 394, and 395 under MDC 06 to MS-DRGs 686, 687, and 688 under MDC 11

• Reassignment of ICD-10-CM diagnosis code D17.72 from MS-DRGs 606 and 607 under MDC 09 to MS-DRGs 686, 687, and 688 under MDC 11

8/13/2018 NHA 5

FY 2018 FY 2019 Relative Weight Change

393 (1.6408) 686 (1.7176) (+0.0768)

394 (0.9431) 687 (1.0537) (+0.1106)

395 (0.6746) 688 (0.7909) (+0.1163)

606 (1.3823) 686 (1.7176) (+0.3353)

607 (0.7899) 688 (0.7909) (+0.001)

MS-DRG CHANGES –MDC 11 (DISEASES AND DISORDERS OF THE KIDNEY AND URINARY TRACT)

• Deletion of MS-DRG 685 (Admit for Renal Dialysis) and reassignment of the codes to MS-DRGs 698, 699, and 700• 4 codes to be reassigned: Z49.01, Z49.02, Z49.31, and Z49.32

• 3 of the 4 codes are on the “Unacceptable Principal Diagnosis” edit code list in the Medicare Code Editor (MCE), so they can’t be reported as a principal diagnosis for inpatient admission

8/13/2018 NHA 6

FY 2018 FY 2019 Relative Weight Change

685 (1.055) 698 (1.6151) (+0.5601)

685 (1.055) 699 (1.0279) (-0.0271)

685 (1.055) 700 (0.7597) (-0.2953)

MS-DRG CHANGES –MDC 14 (PREGNANCY, CHILDBIRTH AND THE PUERPERIUM)

• Complex technical requirements • MS-DRGs pertaining to vaginal delivery under consideration: 767, 768, 774, 775, and 781

• There are groups within these MS-DRGs that do not involve vaginal delivery

• Three main issues identified:• Introduce the concept of vaginal delivery “with/without CC/MCC” to replace the older

“complicating condition” logic

• The cesarean section MS-DRGs do not include logic for the sterilization procedure, though a patient can have the procedure done• Introduce the concept of “c-section with/without sterilization with MCC, with CC, and without MCC/CC”

and “vaginal delivery with/without sterilization with MCC, with CC, and without MCC/CC”

• Review MS-DRGs where there is an abortion or no delivery (MS-DRGs 770, 777, 778, 779, 780, and 782)• Consolidation of the groups where no delivery occurs

8/13/2018 NHA 7

MS-DRG CHANGES –MDC 14 (PREGNANCY, CHILDBIRTH AND THE PUERPERIUM)

• 8 procedure codes removed from MS-DRG 767 and reassigned to MDC 13 (Diseases and Disorders of the Female Reproductive System) MS-DRGs 744 & 745

• Removed the “CC for C-section” list under MS-DRGs 765 & 766 and allow the existing CC and MCC code list logic to apply for these MS-DRGs

• Renamed procedure codes 10D00Z0 and 10D00Z1• New titles:

• 10D00Z0 (Extraction of products of conception, high, open approach)

• 10D00Z1 (Extraction of products of conception, low, open approach)

• 2 procedure codes removed from MS-DRGs 767 and 775

• Modification of MDC 14• Deletion of MS-DRGs 765 and 766 to create 6 new MS-DRGs

• Deletion of MS-DRGs 768, 774 and 775 to create 6 new MS-DRGs

• Deletion of MS-DRGs 777, 778, 780, 781 and 782 to create 6 new MS-DRGs

8/13/2018 NHA 8

MS-DRG CHANGES –MDC 14 (PREGNANCY, CHILDBIRTH AND THE PUERPERIUM):

SUMMARY OF MODIFICATIONS

8/13/2018 NHA 9

MS-DRGs for Deletion MS-DRGs for Creation

765: Cesarean Section with CC/MCC 783: Cesarean Section with Sterilization with MCC

766: Cesarean Section without CC/MCC 784: Cesarean Section with Sterilization with CC

767: Vaginal Delivery with Sterilization and/or D&C 785: Cesarean Section with Sterilization without CC/MCC

774: Vaginal Delivery with Complicating Diagnosis 786: Cesarean Section without Sterilization with MCC

775: Vaginal Delivery without Complicating Diagnosis 787: Cesarean Section without Sterilization with CC

777: Ectopic Pregnancy 788: Cesarean Section without Sterilization without CC/MCC

778: Threatened Abortion 796: Vaginal Delivery with Sterilization/D&C with MCC

780: False Labor 797: Vaginal Delivery with Sterilization/D&C with CC

781: Other Antepartum Diagnoses with Medical Complications 798: Vaginal Delivery with Sterilization/D&C without CC/MCC

782: Other Antepartum Diagnoses without Medical Complications 805: Vaginal Delivery without Sterilization/D&C with MCC

806: Vaginal Delivery without Sterilization/D&C with CC

807: Vaginal Delivery without Sterilization/D&C without CC/MCC

817: Other Antepartum Diagnoses with O.R. Procedure with MCC

818: Other Antepartum Diagnoses with O.R. Procedure with CC

819: Other Antepartum Diagnoses with O.R. Procedure without CC/MCC

831: Other Antepartum Diagnoses without O.R. Procedure with MCC

832: Other Antepartum Diagnoses without O.R. Procedure with CC

833: Other Antepartum Diagnoses without O.R. Procedure without CC/MCC

MS-DRG CHANGES –MDC 18 (INFECTIOUS AND PARASITIC DISEASES (SYSTEMIC OR

UNSPECIFIED SITES))

• Systemic Inflammatory Response Syndrome (SIRS) of Non-Infectious Origin• Reassignment of 2 ICD-10-CM codes (R65.10 and R65.11) to a more clinically appropriate MS-

DRG

• Currently assigned to MS-DRGs 870, 871 and 872 (DRGs descriptive of the treatments relating to Septicemia or Severe Sepsis)

• New assignment:

• Assign codes to MS-DRG 864 and rename the DRG “Fever and Inflammatory Conditions”

8/13/2018 NHA 10

FY 2018 FY 2019 Relative Weight Change

870 (6.0896) 864 (0.8643) (-5.2253)

871 (1.8229) 864 (0.8643) (-0.9586)

872 (1.0546) 864 (0.8643) (-0.1903)

CHANGES TO THE MEDICARE CODE EDITOR (MCE)

• Age Conflict• Detects inconsistencies between a patient’s age and diagnosis

• Four age diagnosis categories:

• Perinatal/Newborn – 0 years only; for diagnoses that only occur during the perinatal or newborn period

• Diagnoses occurring during the first 28 days of life

• Pediatric – 0-17 years (inclusive)

• Maternity – 12-55 years (inclusive)

• Adult – 15-124 years (inclusive)

8/13/2018 NHA 11

CHANGES TO THE MCE AGE CONFLICT EDIT

• Addition of 14 ICD-10-CM codes to the Perinatal/Newborn Diagnoses category • Codes: Z05.0, Z05.1, Z05.2, Z05.3, Z05.41, Z05.42, Z05.43, Z05.5, Z05.6, Z05.71, Z05.72, Z05.73,

Z05.8 and Z05.9

• Codes describe the observation and evaluation of a newborn for specific case types

• Removal of 1 ICD-10-CM code from the Pediatric Diagnoses category• Code: Z13.4

• Describes an encounter for screening for developmental disorders in childhood

• Addition of 20 ICD-10-CM codes to the Maternity Diagnoses category• Codes: F53.0, F53.1, O30.131, O30.132, O30.133, O30.139, O30.231, O30.233, O30.239,

O30.831, O30.832, O30.833, O30.839, O86.00, O86.01,O86.02, O86.03, O86.04 and O86.09

• Description of conditions pertaining to pregnancy and the postpartum period

8/13/2018 NHA 12

CHANGES TO THE MCE SEX CONFLICT EDIT

• Sex Conflict • Detects inconsistencies between a patient’s sex and any diagnosis or procedure on the patient’s record

• Female Only Codes• 3 ICD-10-CM Codes removed:

• F53 (Puerperal psychosis), O86.00 (Infection of obstetric surgical wound), Q51.20 (Other doubling of uterus, unspecified)

• 3 ICD-10-CM Codes added:• Z30.015 (Encounter for initial prescription of vaginal ring hormonal contraceptive), Z31.7 (Encounter for procreative

management and counseling for gestational carrier), Z98.891 (History of uterine scare from previous surgery)• Additional codes to be added to this category can be found in Appendix A

• 3 ICD-10-PCS Codes added:• 0UY90Z0 (Transplantation of uterus, allogeneic, open approach), 0UY90Z1 (Transplantation of uterus, syngeneic, open

approach), 0UY90Z2 (Transplantation of uterus, zooplastic, open approach)

• Male Only Codes• 19 ICD-10-CM Codes added to the “males only” conflict list

• See Appendix B for full list of codes to be added to the Males Only edit code

8/13/2018 NHA 13

CHANGES TO MANIFESTATION CODE AS PRINCIPAL DIAGNOSIS EDIT

• Manifestation codes describe the manifestation of an underlying disease• Manifestation Codes not allowed as the principal diagnosis

• Addition of 2 ICD-10-CM codes to the list:• K82.A1 (Gangrene of gallbladder in cholecystitis)

• K82.A2 (Perforation of gallbladder in cholecystitis)

8/13/2018 NHA 14

CHANGES TO THE QUESTIONABLE ADMISSION EDIT

• Questionable Admissions → Some diagnoses don’t usually justify an inpatient stay at an acute care hospital

• Creation of a “Questionable Obstetric Admission Edit”• “ICD-10-PCS procedure codes describing a cesarean section or vaginal delivery are considered to

be a questionable admission except when reported with a corresponding secondary diagnosis code describing the outcome of delivery.”

• See Appendix C for the procedure code list

8/13/2018 NHA 15

CHANGES TO THE UNACCEPTABLE PRINCIPAL DIAGNOSIS EDIT

• Unacceptable principal diagnosis codes are those that describe a circumstance that influences a patient’s health status, but does not actually describe a current illness or injury

• Addition of a code to the list:• Z49.01 (Encounter for fitting and adjustment of extracorporeal dialysis catheter)

• Deletion of a code from the list:• Z13.4 (Encounter for screening for certain developmental disorders in childhood)

8/13/2018 NHA 16

CHANGES TO SURGICAL HIERARCHIES

• Surgical hierarchy – an ordering of surgical classes from most resource-intensive to least resource-intensive that performs the function of assigning an inpatient case to the appropriate MS-DRG

• Revision of the surgical hierarchy for MDC 14:• Sequence new MS-DRGs 783, 784 and 785 above new MS-DRGs 786, 787 and 788

• Sequence MS-DRGs 786, 787 and 788 above 768

• Sequence MS-DRGs 796, 797 and 798 below 768 and above 770

• Sequence MS-DRGs 817, 818 and 819 below 770 and above 769

8/13/2018 NHA 17

CHANGES TO THE MS-DRG DIAGNOSIS CODES FOR FY 2019

• Designate diagnosis codes K35.20 and T81.44XA as CC severity levels• Other proposed additions and deletions of diagnosis codes with their

corresponding severity level designations for FY 2019 can be found in Tables 6I.1, 6I.2, 6J.1 and 6J.2

• Removal of special logic in the GROUPER for processing claims containing a code on the “Principal Diagnosis Is Its Own CC or MCC” list • Deletion of tables containing list of principal diagnosis codes

• Assignment of Dx code K35.20 to MS-DRGs 371, 372 and 373

• Severity level adjustments have been finalized on certain diagnosis codes

8/13/2018 NHA 18

REVIEW OF DIAGNOSIS/PROCEDURE CODES IN MS-DRGS 981-983 AND 987-989

• The current structure of MS-DRGs 981 through 983 and MS-DRGs 987 through 989 will be maintained through FY 2019.

• Reassignment of ICD-10-CM codes Q67.6, Q67.7, Q76.6, Q76.7, Q76.8, Q76.9 and Q77.2 from MDC 4 to MDC 8 in MS-DRGS 564, 565 and 566 where the other related conditions are to keep them from being inappropriately grouped to MS-DRGs 981, 982 or 983

• Reassignment of ICD-10-CM codes S22.20XA, S22.02XB,S22.21XA, S22.21XB, S22.22XA, S22.22XB, S22.23XA, S22.23XB, S22.24XA and S22.24XB from MDC 4 to MDC 8

8/13/2018 NHA 19

CHANGES TO THE ICD-10-CM AND ICD-10-PCS CODING SYSTEMS

• Total number of codes and changes in total number of codes for FY 2019:• ICD-10-CM

• Total Number of Codes: 71,932

• Change: +228

• ICD-10-PCS

• Total Number of Codes: 78,881

• Change: +176

• Additional information on ICD-10-CM and ICD-10-PCS coding can be found:• http://www.cms.gov/Medicare/Coding/ICD10/index.html

• http://www.cdc.gov/nchs/icd/icd10.htm

8/13/2018 NHA 20

RECALIBRATION OF THE FY 2019 MS-DRG RELATIVE WEIGHTS

• Two data sources: claims data (MedPAR file) and cost report data• Using the FY 2017 MedPAR file• Using the Medicare cost report data from the 12/31/17 update of the FY 2016 HCRIS

• FY 2019 cost-based relative weights normalized by adjustment factor of 1.761194774• Ensures that recalibration does not increase or decrease total payments under IPPS

• Minimum of 10 cases required to compute a reasonable rate for each MS-DRG• 7 MS-DRGs contained fewer than 10 cases in the FY 2017 MedPAR file (789, 790, 791, 792, 793, 794,

and 795 → relating to neonates)• Final FY 2018 relative weight – adjusted by the percent change in average weight for cases in other MS-DRGs –

will be used

• Relative weights for FY 2019 will be recalibrated at the same level as FY 2018 in cases where the FY 2018 relative weight decreased by 20% from FY 2017 and the FY 2019 relative weight would have decreased 20% or more from FY 2018

8/13/2018 NHA 21

ADD-ON PAYMENTS FOR NEW SERVICES AND TECHNOLOGIES FOR FY 2019

• Table 10 contains the thresholds used to evaluate applications for new medical service and technology add-on payments for the following fiscal year

• Beginning with FY 2020, table 10 will be removed from the list of data tables and include it as a data file • It will appear in the same location where the impact data file can be found

• Purpose: to clarify for the public that the listed thresholds are applicable for the next fiscal year rather than for the fiscal year that is subject to the rulemaking

8/13/2018 NHA 22

NEW HEALTH ANALYTICSSUPPORT@NEWHEALTHANALYTICS.COM

804-245-8240

PERFORMANCE INS IGHT

8/13/2018 NHA 23

8/13/2018 NHA 24

APPENDIX

APPENDIX A –DIAGNOSIS CODES APPLICABLE FOR SEX CONFLICT (FEMALE ONLY) EDIT

8/13/2018 NHA 25

ICD-10-CM Code Code Description ICD-10-CM Code (cont.) Code Description (cont.)

F53.0 Postpartum depression O30.833 Other specified multiple gestation, number of chorions and amnions are both equal to the number of fetuses, third trimester

F53.1 Puerperal psychosis O30.839 Other specified multiple gestation, number of chorions and amnions are both equal to the number of fetuses, unspecified trimester

N35.82 Other urethral stricture, female O86.00 Infection of obstetric surgical wound, unspecified

N35.92 Unspecified urethral stricture, female O86.01 Infection of obstetric surgical wound, superficial incisional site

O30.131 Triplet pregnancy, trichorionic/triamniotic, first trimester O86.02 Infection of obstetric surgical wound, deep incisional site

O30.132 Triplet pregnancy, trichorionic/triamniotic, second trimester O86.03 Infection of obstetric surgical wound, organ and space site

O30.133 Triplet pregnancy, trichorionic/triamniotic, third trimester O86.04 Sepsis following an obstetrical procedure

O30.139 Triplet pregnancy, trichorionic/triamniotic, unspecified trimester O86.09 Infection of obstetric surgical wound, other surgical site

O30.231 Quadruplet pregnancy, quadrachorionic/quadra-amniotic, first trimester Q51.20 Other doubling of uterus, unspecified

O30.232 Quadruplet pregnancy, quadrachorionic/quadra-amniotic, second trimester

Q51.21 Other complete doubling of uterus

O30.233 Quadruplet pregnancy, quadrachorionic/quadra-amniotic, third trimester Q51.22 Other partial doubling of uterus

O30.239 Quadruplet pregnancy, quadrachorionic/quadra-amniotic, unspecified trimester

Q51.28 Other doubling of uterus, other specified

O30.831 Other specified multiple gestation, number of chorions and amnions are both equal to the number of fetuses, first trimester

Z13.32 Encounter for screening for maternal depression

O30.832 Other specified multiple gestation, number of chorions and amnions are both equal to the number of fetuses, second trimester

APPENDIX B –DIAGNOSIS CODES APPLICABLE FOR SEX CONFLICT (MALE ONLY) EDIT

ICD-10-CM Code Code Description

N35.016 Post-traumatic urethral stricture, male, overlapping sites

N35.116 Postinfective urethral stricture, not elsewhere classified, male, overlapping sites

N35.811 Other urethral stricture, male, meatal

N35.812 Other urethral bulbous stricture, male

N35.813 Other membranous urethral stricture, male

N35.814 Other anterior urethral stricture, male, anterior

N35.816 Other urethral stricture, male, overlapping sites

N35.819 Other urethral stricture, male, unspecified site

N35.911 Unspecified urethral stricture, male, meatal

N35.912 Unspecified bulbous urethral stricture, male

N35.913 Unspecified membranous urethral stricture, male

N35.914 Unspecified anterior urethral stricture, male

N35.916 Unspecified urethral stricture, male, overlapping sites

N35.919 Unspecified urethral stricture, male, unspecified site

N99.116 Postprocedural urethral stricture, male, overlapping sites

R93.811 Abnormal radiologic findings on diagnostic imaging of right testicle

R93.812 Abnormal radiologic findings on diagnostic imaging of left testicle

R93.813 Abnormal radiologic findings on diagnostic imaging of testicles, bilateral

R93.819 Abnormal radiologic findings on diagnostic imaging of unspecified testicle8/13/2018 NHA 26

APPENDIX C: PROCEDURE CODE LIST FOR PROPOSED QUESTIONABLE OBSTETRIC ADMISSION EDIT

ICD-10-PCS PX Codes for Cesarean Section ICD-10-PCS PX Codes for Vaginal Delivery ICD-10-CM Secondary DX Codes for Outcome of Delivery

10D00Z0 (Extraction of products of conception, high, open approach)

10D07Z3 (Extraction of products of conception, low forceps, via natural or artificial opening)

Z37.0 (Single live birth)Z37.1 (Single stillbirth)

10D00Z1 (Extraction of products of conception, low, open approach)

10D07Z4 (Extraction of products of conception, mid forceps, via natural or artificial opening)

Z37.2 (Twins, both liveborn)Z37.3 (Twins, one liveborn and one stillborn)

10D00Z2 (Extraction of products of conception, extraperitoneal, open approach)

10D07Z5 (Extraction of products of conception, high forceps, via natural or artificial opening)

Z37.4 (Twins, both stillborn)Z37.50 (Multiple births, unspecified, all liveborn)

10D07Z6 (Extraction of products of conception, vacuum, via natural or artificial opening)

Z37.51 (Triplets, all liveborn)Z37.52 (Quadruplets, all liveborn)

10D07Z7 (Extraction of products of conception, internal version, via natural or artificial opening)

Z37.53 (Quintuplets, all liveborn)Z37.54 (Sextuplets, all liveborn)

10D07Z8 (Extraction of products of conception, other, via natural or artificial opening)

Z37.59 (Other multiple births, all liveborn)Z37.60 (Multiple births, unspecified, some liveborn)

10D17Z9 (Manual extraction of products of conception, retained, via natural or artificial opening)

Z37.61 (Triplets, some liveborn)Z37.62 (Quadruplets, some liveborn)

10D18Z9 (Manual extraction of products of conception, retained, via natural or artificial opening)

Z37.63 (Quintuplets, some liveborn)Z37.64 (Sextuplets, some liveborn)

10E0XZZ (Delivery of products of conception, external approach) Z37.69 (Other multiple births, some liveborn)Z37.7 (Other multiple births, all liveborn)

Z37.9 (Outcome of delivery, unspecified)8/13/2018 NHA 27

CMS FY 2019 TABLES 6A – 6K AND 6P.1C-6P.1FLIST OF NEW DIAGNOSIS AND PROCEDURE CODES, INVALID CODES, CC EXCLUSIONS, MCC AND CC

8/13/2018 NHA 28

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Diagnosis Code Description CC MDC MS-DRG

C43.111 Malignant melanoma of right upper eyelid, including canthus N 02 124, 125

C43.112 Malignant melanoma of right lower eyelid, including canthus N 02 124, 125

C43.121 Malignant melanoma of left upper eyelid, including canthus N 02 124, 125

C43.122 Malignant melanoma of left lower eyelid, including canthus N 02 124, 125

C44.1021 Unspecified malignant neoplasm of skin of right upper eyelid, including canthus N 02 124, 125

C44.1022 Unspecified malignant neoplasm of skin of right lower eyelid, including canthus N 02 124, 125

C44.1091 Unspecified malignant neoplasm of skin of left upper eyelid, including canthus N 02 124, 125

C44.1092 Unspecified malignant neoplasm of skin of left lower eyelid, including canthus N 02 124, 125

C44.1121 Basal cell carcinoma of skin of right upper eyelid, including canthus N 02 124, 125

C44.1122 Basal cell carcinoma of skin of right lower eyelid, including canthus N 02 124, 125

C44.1191 Basal cell carcinoma of skin of left upper eyelid, including canthus N 02 124, 125

C44.1192 Basal cell carcinoma of skin of left lower eyelid, including canthus N 02 124, 125

C44.1221 Squamous cell carcinoma of skin of right upper eyelid, including canthus N 02 124, 125

C44.1222 Squamous cell carcinoma of skin of right lower eyelid, including canthus N 02 124, 125

C44.1291 Squamous cell carcinoma of skin of left upper eyelid, including canthus N 02 124, 125

C44.1292 Squamous cell carcinoma of skin of left lower eyelid, including canthus N 02 124, 125

C44.131 Sebaceous cell carcinoma of skin of unspecified eyelid, including canthus N 02 124, 125

C44.1321 Sebaceous cell carcinoma of skin of right upper eyelid, including canthus N 02 124, 125

C44.1322 Sebaceous cell carcinoma of skin of right lower eyelid, including canthus N 02 124, 125

C44.1391 Sebaceous cell carcinoma of skin of left upper eyelid, including canthus N 02 124, 125

C44.1392 Sebaceous cell carcinoma of skin of left lower eyelid, including canthus N 02 124, 125

C44.1921 Other specified malignant neoplasm of skin of right upper eyelid, including canthus N 02 124, 125

C44.1922 Other specified malignant neoplasm of skin of right lower eyelid, including canthus N 02 124, 125

C44.1991 Other specified malignant neoplasm of skin of left upper eyelid, including canthus N 02 124, 125

C44.1992 Other specified malignant neoplasm of skin of left lower eyelid, including canthus N 02 124, 125

C4A.111 Merkel cell carcinoma of right upper eyelid, including canthus N 09 595, 596

C4A.112 Merkel cell carcinoma of right lower eyelid, including canthus N 09 595, 596

TABLE 6A - NEW DIAGNOSIS CODES