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PATIENT SCENARIO. [Insert Scenario Description]. Total Cost = $______. 54.59 Lysis of Adhesions (Abdomen) 45.60 Other Small Bowel Excision 46.01 Loop Ileostomy 46.03 Loop Colostomy 46.11 Temporary Colostomy 46.20 Ileostomy 46.21 Temporary Ileostomy 46.51 Intestinal Stoma Closure

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  1. PATIENT SCENARIO [Insert Scenario Description] Total Cost = $______

  2. 54.59 Lysis of Adhesions (Abdomen) 45.60 Other Small Bowel Excision 46.01 Loop Ileostomy 46.03 Loop Colostomy 46.11 Temporary Colostomy 46.20 Ileostomy 46.21 Temporary Ileostomy 46.51 Intestinal Stoma Closure 45.90 Intestinal Anastimosis PATIENT WORKSHEET 1.0: COLON CANCER AND NEOPLASMS Overview of all diagnosis and procedures. Recurrence ofPrimary Disease Discharge Other Disease Processes Subsequent Procedures Planned Subsequent Procedures Discharge Surgical Treatment Medical Treatment Discharge Surgical Treatment Small BowelObstruction InitialComplication Complication* Anastomotic Problems Discharge Surgical Treatment Planned Subsequent Procedures Recurrence ofPrimary Disease Other Complications Complication* Adjuvant Therapy 45.75 Left Hemicolectomy 45.73 Right Hemicolectomy 45.8 Total Intra-Abd Colectomy 45.74 Transverse Colon Resect 45.76 Sigmoidectomy 46.03 Loop Colostomy (Exterz Large Intestine)46.10 Colostomy NOS 46.11 Temporary Colostomy 46.21 Temporary Ileostomy 54.59 Lysis of Adhesions (Abdomen) 153.0 Hepatic Flexure 153.1 Transverse Colon 153.2 Descending Colon 153.3 Sigmoid Colon 153.4 Cecum 153.6 Ascending Colon 153.7 Splenic Flexure 153.8 Colon NEC 153.9 Colon NOS 154.0 Rectosigmoid JCT 159.0 Intestine NOS 45.75 Left Hemicolectomy 45.73 Right Hemicolectomy 45.8 Total Intra-Abd Colectomy 45.74 Transverse Colon Resect 45.76 Sigmoidectomy 46.10 Colostomy NOS 48.69 Closure of HartmanXX.XX NG Suction 54.59 Lysis of Adhesions (Abdomen46.03 Loop Colostomy 46.11 Temporary Colostomy 46.01 Loop Ileostomy 46.20 Ileostomy 46.21 Temporary Ileostomy) 46.03 Loop Colostomy 46.11 Temporary Colostomy 46.01 Loop Ileostomy 46.20 Ileostomy 46.21 Temporary Ileostomy 45.7 Partial Large Bowel Excision 54.59 Lysis of Adhesions (Abdomen) Pharm IV Fluid Pharm IV TPN Labs Blood WorkLabs All other excluding Blood work Rad Plain Abd X-ray Contrast Upper/Lower Rad Chest X-ray Pharm AntibioticsPharm All other Meds Rad CT Scan (Abdomen) 997.4 Anastomotic Leak 997.4 Anastomotic Stricture 998.11 Post-op Hemorrhage V55.2 Attention to IleostomyV55.3 Attention to Colostomy 553.21 Incisional Hernia NOTE: THE FOLLOWING HOLDS TRUE FOR EVERY SCENARIO: REIMBURSEMENTS ARE NOT A REQUIRED FIELD. NOT ALL HOSPITALS PROVIDE ACCURATE REIMBURSEMENTS. THEY DO NOT EVEN PROVIDE ESTIMATED REIMBURSEMENTS. A MEDICARE REIMBURSEMENT SCHEDULE MAY BE MORE ACCURATE SINCE SOME OF THESE STATISTICS MAY BE UNDERREPORTED.

  3. DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03 DRG 153Minor Small and Large Bowel Procedures without CCAverage National Payment $4,769.84 PATIENT WORKSHEET 1.1: COLON CANCER AND NEOPLASMS 10-15% Incidence A 70-year-old man presents with nausea, vomiting, and abdominal distention. He has guiac positive stool and has a dilated right colon on abdominal x-rays. A water-soluble contrast enema demonstrates an obstruction. The patient has an urgent abdominal colectomy, ileostomy and a Hartman’s closure of his rectum. He is discharged on POD #7. Two months later, he has an ileostomy taken down and an ileorectal anastomosis is performed. He recovered from both operations without complications. He is discharged on POD #4. Recurrence ofPrimary Disease Discharge Other Disease Processes Subsequent Procedures Planned Subsequent Procedures Discharge Surgical Treatment Medical Treatment Discharge Surgical Treatment Small BowelObstruction InitialComplication Complication* Anastomotic Problems Discharge Surgical Treatment Planned Subsequent Procedures Recurrence ofPrimary Disease Other Complications Complication* Adjuvant Therapy 153.4 Colon cancer V55.2 Attention to Ileostomy P 45.8 Total Intra-Abd Colectomy **NO PATIENTS FOUND WITH EITHER SECONDARY PROCEDURE USING THESE CODES.** S 4X.XX Hartman Resection of Rectum S 46.21 Temporary Ileostomy P 46.51 Closure stoma small intestine 8 patientsALOS 10.75 $13,681 (Cost) 56 PatientsALOS 3.89 $4,693 (Cost) Total Cost = $18,374

  4. DRG 150Peritoneal Adhesiolysis without CCAverage National Payment $11,114.69 DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03 P 46.51 Closure Stoma small intestine S 54.59 Lysis of Adhesions PATIENT WORKSHEET 1.2: COLON CANCER AND NEOPLASMS 10-15% Incidence A 70-year-old man presents with nausea, vomiting, and abdominal distention. He has guiac positive stool and has a dilated right colon on abdominal x-rays. A water-soluble contrast enema demonstrates an obstruction. The patient has an urgent abdominal colectomy, ileostomy and a Hartman’s closure of his rectum. He is discharged on POD #7. Two months later, he has an ileostomy taken down with lysis of adhesions and an ileorectal anastomosis is performed. He is discharged on POD #7. Recurrence ofPrimary Disease Discharge Other Disease Processes Subsequent Procedures Planned Subsequent Procedures Discharge Surgical Treatment Medical Treatment Discharge Surgical Treatment Small BowelObstruction InitialComplication Complication* Anastomotic Problems Discharge Surgical Treatment Planned Subsequent Procedures Recurrence ofPrimary Disease Other Complications Complication* Adjuvant Therapy 153.4 Colon Cancer V55.2 Attention to Ileostomy P 45.8 Total Intra-Abd Colectomy **NO PATIENTS FOUND WITH EITHER SECONDARY PROCEDURE USING THESE CODES.** S 48.69 Closure of Hartman S 46.21 Temporary Ileostomy 8 patientsALOS 10.75 $13,681 (Cost) 2 PatientsALOS 6.5 $ 7,476 (Cost) Total Cost = $21,157

  5. DRG 181GI Obstruction without CCAverage National Payment $2,133.64 DRG 153Minor Small and Large Bowel Procedures without CCAverage National Payment $4,769.94 DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03 PATIENT WORKSHEET 1.3: COLON CANCER AND NEOPLASMS 10-15% Incidence A 70-year-old man presents with nausea, vomiting, and abdominal distention. He has guiac positive stool and has a dilated right and transverse colon on abdominal x-rays. A water-soluble contrast enema demonstrates an obstruction sigmoid cancer. The patient has an urgent sigmoid colectomy with a left colon colostomy and a Hartman’s closure of his rectum. Two months after this operation he has his colostomy taken down. On POD #4 he is given liquids and develops nausea and abdominal distention. Abdominal x-rays suggest a partial small bowel obstruction. This is treated with nasogastric suction and intravenous fluids. After 3 days the patient passes gas and his distention resolves. He resumes his diet and is discharged on POD #9. Recurrence ofPrimary Disease Discharge Other Disease Processes Subsequent Procedures Planned Subsequent Procedures Discharge Surgical Treatment Medical Treatment Discharge Surgical Treatment Small BowelObstruction InitialComplication Complication* Anastomotic Problems Discharge Surgical Treatment Planned Subsequent Procedures Recurrence ofPrimary Disease Other Complications Complication* Adjuvant Therapy 153.3 Sigmoid Colon V55.3 Attention to colostomy 560.9 SBO P 45.76 Sigmoidectomy S 46.11 Temporary Colostomy S 4X.XX Hartman Resection of Rectum **DID NOT FIND ANY PATIENTS WITH SECOND SECONDARY PROCEDURE USING THAT CODE.** P 46.52 Closure stoma large intestine P 96.07 Non operative Insert naso-gastric tube Pharm IV TPNPharm AntibioticsPharm Other MedsX-ray Plain Abd (S800XR1000 ) 13 patientsALOS 14.69 $15,722 (Cost) 124 patientsALOS 5.65 $ 5,609 (Cost) 657 patientsALOS 3.68 $2,568 (Cost) $396.79 IV TPN $738 Antibiotics $1,756 Other Meds Total Cost = $23,899 $62.80 XRay (Tests/Meds already included in procedures)

  6. P 54.59 Lysis of Adhesions (Abdomen) DRG 153Minor Small and Large Bowel Procedures without CCAverage National Payment $4,769.94 DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03 PATIENT WORKSHEET 1.4: COLON CANCER AND NEOPLASMS 10-15% Incidence A 70-year-old man presents with nausea, vomiting, and abdominal distention. He has guiac positive stool and has a dilated right and transverse colon on abdominal x-rays. A water-soluble contrast enema demonstrates an obstruction sigmoid cancer. The patient has an urgent sigmoid colectomy with a left colon colostomy and a Hartman’s closure of his rectum. Two months after this operation he has his colostomy taken down. On POD #4 he is given liquids and develops nausea and abdominal distention. Abdominal x-rays suggest small bowel obstruction. Small bowel obstruction diagnosed. Patient is surgically treated. Lysis of adhesions. He is discharged on POD #19. Recurrence ofPrimary Disease Discharge Other Disease Processes Subsequent Procedures Planned Subsequent Procedures Discharge Surgical Treatment Medical Treatment Discharge Surgical Treatment Small BowelObstruction InitialComplication Complication* Anastomotic Problems Discharge Surgical Treatment Planned Subsequent Procedures Recurrence ofPrimary Disease Other Complications Complication* Adjuvant Therapy 153.3 Sigmoid Colon V55.3 Attention to colostomy P 560.9 Small Bowel Obstruction P 45.76 Sigmoidectomy S 46.11 Temporary Colostomy S 4X.XX Hartman Resection of Rectum **DID NOT FIND ANY PATIENTS WITH SECOND SECONDARY PROCEDURE USING THAT CODE.** P 46.52 Closure stoma large intestine DRG 150Peritoneal Adhesiolysis with CCAverage National Payment $11,114.69 13 patientsALOS 14.69 $15,722 (Cost) 124 patientsALOS 5.65 $ 5,609 (Cost) 15 PatientsALOS 12.93 $10,633 (Cost) Total Cost = $31,964

  7. DRG 149Major Small and Large Bowel Procedures without CCAverage National Payment $6,352.95 P 45.73 Right Hemicolectomy PATIENT WORKSHEET 1.5: COLON CANCER AND NEOPLASMS 50-75% Incidence A 65-year-old women presents with fatigue and melana. A colonoscope reveals a 6 cm lesion of the cecum. She undergoes a right hemicolectomy with ileocolic anastomosis. She has an uneventful recovery and is discharged on POD #6.  Recurrence ofPrimary Disease Discharge Other Disease Processes Subsequent Procedures Planned Subsequent Procedures Discharge Surgical Treatment Medical Treatment Discharge Surgical Treatment Small BowelObstruction InitialComplication Complication* Anastomotic Problems Discharge Surgical Treatment Planned Subsequent Procedures Recurrence ofPrimary Disease Other Complications Complication* Adjuvant Therapy 153.4 Cecum Cancer 46 PatientsALOS 6.11 $ 6,462 (Cost) Total Cost = $6,462

  8. DRG 149Major Small and Large Bowel Procedures without CCAverage National Payment $6,352.95 DRG 494 Laparoscopic Cholecystectomy without Common Duct without CCAverage National Payment $3,854.00 PATIENT WORKSHEET 1.6: COLON CANCER AND NEOPLASMS 50-75% Incidence A 51-year-old woman is found with a large sessile polyp on screening flexible sigmoidoscopy. Colonoscopy reveals no other lesions, but the polyp is too big to remove with a colonoscope. She undergoes a sigmoid colectomy without complications. She is discharged on POD #6. Two years later, she develops RUQ abdominal pain and is found to have cholethiasis. She undergoes an uneventful cholecystectomy. She is discharged on POD #3. Recurrence ofPrimary Disease Discharge Other Disease Processes Subsequent Procedures Planned Subsequent Procedures Discharge Surgical Treatment Medical Treatment Discharge Surgical Treatment Small BowelObstruction InitialComplication Complication* Anastomotic Problems Discharge Surgical Treatment Planned Subsequent Procedures Recurrence ofPrimary Disease Other Complications Complication* Adjuvant Therapy 153.3 Sigmoid 57410 Calculus of gallbladder with other cholecystitis, without mention of obstruction P 45.76 Sigmoidectomy 51.23 Laparascopic Cholecystectomy 88 Patients ALOS 6.15 $6,108 (Cost) 1576 PatientsALOS 1.95 $3,760 (Cost) Total Cost = $9,868

  9. 50.3 Right Hepatic Lobectomy DRG 149Major Small and Large Bowel Procedures without CCAverage National Payment $6,352.95 DRG 191 Pancreas, Liver and Shunt Procedures with CCAverage National Payment $17,830.90 PATIENT WORKSHEET 1.7: COLON CANCER AND NEOPLASMS 50-75% Incidence A 51-year-old woman is found with a large sessile polyp on screening flexible sigmoidoscopy. Colonoscopy reveals no other lesions, but the polyp is too big to remove with a colonoscope. She undergoes a sigmoid colectomy without complications. She is discharged on POD #6. Two years later, she develops RUQ abdominal pain. A CT scan reveals a solitary liver metastasis. She has a right lobectomy of her liver and is discharged two weeks later. Discharged POD #9. Recurrence ofPrimary Disease Discharge Other Disease Processes Subsequent Procedures Planned Subsequent Procedures Discharge Surgical Treatment Medical Treatment Discharge Surgical Treatment Small BowelObstruction InitialComplication Complication* Anastomotic Problems Discharge Surgical Treatment Planned Subsequent Procedures Recurrence ofPrimary Disease Other Complications Complication* Adjuvant Therapy 153.3 Sigmoid 197.7 Liver Metastasis P 45.76 Sigmoidectomy Rad CT Scan (abdomen)S800CT1000 CT scan of abdomen w and w/o contrast 88 Patients ALOS 6.15 $6,108 (Cost) $187.92 19 PatientsALOS 8.58 $14,086 (Cost) Total Cost = $20,194 (Test already included in procedures)

  10. 46.03 Loop Colostomy 46.11 Temporary Colostomy 46.01 Loop Ileostomy 46.20 Ileostomy NOS 46.21 Temporary Ileostomy 45.70 Partial resection of Large Intestine 54.59 Lysis of Adhesions (Abdomen) 54.59 Lysis of Adhesions (Abdomen) 45.60 Small Bowel Resection 46.01 Loop Ileostomy 46.03 Loop Colostomy 46.11 Temporary Colostomy 46.01 Loop Ileostomy 46.20 Ileostomy NOS 46.21 Temp. Ileostomy46.51 Intestinal Stoma Closure 45.90 Intestinal Anastomosis 46.51 Intestinal Stoma Closure 45.90 Intestinal Anastomosis 46.10 Colostomy NOS 48.69 Closure of Hartman XX.XX NG Suction 54.59 Lysis of Adhesions (Abdomen) 46.03 Loop Colostomy 46.11 Temporary Colostomy 46.01 Loop Ileostomy 46.20 Ileostomy NOS 46.21 Temporary Ileostomy PATIENT WORKSHEET 2.0: RECTAL CANCER Overview of all diagnosis and procedures. Recurrence ofPrimary Disease Discharge Other Disease Processes Subsequent Procedures Planned Subsequent Procedures Discharge Surgical Treatment Medical Treatment Discharge Surgical Treatment Small BowelObstruction InitialComplication Complication* Anastomotic Problems Discharge Surgical Treatment Planned Subsequent Procedures Recurrence ofPrimary Disease Other Complications Complication* Adjuvant Therapy 48.41 Soave submucosal Rectal Pull Through48.49 Other Rectal Pull Through 48.5 Abd-Perineal Rectum Resection 48.62 Anterior Rectum Resection w/Colostomy 48.69 Rectal Resection NEC 48.63 Anterior Rectum Resection NEC 46.03 Loop Colostomy (Exterz Large Intestine) 46.10 Colostomy NOS 46.11 Temporary Colostomy 46.21 Temp Ileostomy 54.59 Lysis of Adhesions (Abdomen) XX.XX Small Bowel Suspension w/Sling 153.0 Hepatic Flexure 153.1 Transverse Colon 153.2 Descending Colon 153.3 Sigmoid Colon 153.4 Cecum 153.5 Appendix 153.6 Ascending Colon 153.7 Splenic Flexure 153.8 Colon NEC 153.9 Colon NOS 154.0 Neoplasm Colon 154.1 Rectum 154.8 Rectum/Anus NEC 159.0 Intestine NOS Pharm IV Fluid Pharm IV TPNLabs Bloodwork Labs All other excluding Blood work Rad Plain Abd X-ray Rad CT Scan (Abdomen)Pharm Coumadin (aka Warfarin), Heparin Pharm AntibioticsPharm All other Meds V55.2 Attention to Ileostomy V55.3 Attention to Colostomy 997.4 Anastomotic Leak 998.11 Post-op Hemorrhage 553.21 Incisional Hernia

  11. DRG 147Rectal Resection without CCAverage National Payment $6,512.85 P 48.63 Anterior Rectum Resection NEC P 99.25 Chemoradiation V58.1 Chemotherapy PATIENT WORKSHEET 2.1: RECTAL CANCER 50-75% Incidence A 68-year-old man presents with rectal bleeding. A colonocsope reveals a 4 cm lesion of the rectum. He receives a low anterior resection. He has an uneventful recovery and is discharged on POD #7. Pathology revealed the tumor to be a T3N1 tumor. The patient received adjuvant chemoradiation. Recurrence ofPrimary Disease Discharge Other Disease Processes Subsequent Procedures Planned Subsequent Procedures Discharge Surgical Treatment Medical Treatment Discharge Surgical Treatment Small BowelObstruction InitialComplication Complication* Anastomotic Problems Discharge Surgical Treatment Planned Subsequent Procedures Recurrence ofPrimary Disease Other Complications Complication* Adjuvant Therapy 154.1 Malignant Neoplasm Rectum No DRG - Outpatient procedure 25 PatientsALOS 6.8 $7,029 (Cost) 136 PatientsALOS 0 (outpatient) $501 (Cost) Total Cost = $7,530

  12. DRG 147Rectal Resection without CCAverage National Payment $6,512.85 DRG 150Peritoneal Adhesiolysis without CCAverage National Payment $11,114.69 P 48.63 Anterior Rectum Resection NEC P 99.25 Chemoradiation V58.1 Chemotherapy P 46.51 Closure Stoma small intestine S 54.59 Lysis of Adhesions V55.2 Attention to Ileostomy PATIENT WORKSHEET 2.2: RECTAL CANCER 50-75% Incidence A 68-year-old man presents with rectal bleeding. A colonocsope reveals a 4 cm lesion of the rectum. He receives a low anterior resection. He has an uneventful recovery and is discharged on POD #7. Pathology revealed the tumor to be a T3N1 tumor. The patient received adjuvant chemoradiation. Recurrence ofPrimary Disease Discharge Other Disease Processes Subsequent Procedures Planned Subsequent Procedures Discharge Surgical Treatment Medical Treatment Discharge Surgical Treatment Small BowelObstruction InitialComplication Complication* Anastomotic Problems Discharge Surgical Treatment Planned Subsequent Procedures Recurrence ofPrimary Disease Other Complications Complication* Adjuvant Therapy 154.1 Malignant Neoplasm Rectum No DRG - Outpatient procedure 25 PatientsALOS 6.8 $7,029 (Cost) 2 PatientsALOS5.6.50 $ 7,476 (Cost) 136 PatientsALOS 0 (outpatient) $501 (Cost) Total Cost = $15,006

  13. DRG 181GI Obstruction without CCAverage National Payment $2,133.64 DRG 147Rectal Resection without CCAverage National Payment $6,512.85 P 48.63 Anterior Rectum Resection NEC P 99.25 Chemoradiation V58.1 Chemotherapy PATIENT WORKSHEET 2.3: RECTAL CANCER 50-75% Incidence A 68-year-old man presents with rectal bleeding. A colonocsope reveals a 4 cm lesion of the rectum. He receives a low anterior resection. He has an uneventful recovery and is discharged on POD #7. Pathology revealed the tumor to be a T3N1 tumor. The patient received adjuvant chemoradiation. Recurrence ofPrimary Disease Discharge Other Disease Processes Subsequent Procedures Planned Subsequent Procedures Discharge Surgical Treatment Medical Treatment Discharge Surgical Treatment Small BowelObstruction InitialComplication Complication* Anastomotic Problems Discharge Surgical Treatment Planned Subsequent Procedures Recurrence ofPrimary Disease Other Complications Complication* Adjuvant Therapy 154.1 Malignant Neoplasm Rectum 560.9 SBO P 96.07 Non operative Insert naso-gastric tube Pharm IV TPNPharm AntibioticsPharm Other MedsX-ray Plain Abd (S800XR1000 ) No DRG - Outpatient procedure 25 PatientsALOS 6.8 $7,029 (Cost) 657 PatinetsALOS 3.68 $2,568 (Cost) $396.79 IV TPN 136 PatientsALOS 0 (outpatient) $501 (Cost) $738 Antibiotics $1,756 Other Meds Total Cost = $10,098 $62.80 XRay (Tests/Meds already included in procedures)

  14. P 54.59 Lysis of Adhesions (Abdomen) DRG 147Rectal Resection without CCAverage National Payment $6,512.85 P 48.63 Anterior Rectum Resection NEC P 99.25 Chemoradiation V58.1 Chemotherapy PATIENT WORKSHEET 2.4: RECTAL CANCER 50-75% Incidence A 68-year-old man presents with rectal bleeding. A colonocsope reveals a 4 cm lesion of the rectum. He receives a low anterior resection. He has an uneventful recovery and is discharged on POD #7. Pathology revealed the tumor to be a T3N1 tumor. The patient received adjuvant chemoradiation. Recurrence ofPrimary Disease Discharge Other Disease Processes Subsequent Procedures Planned Subsequent Procedures Discharge Surgical Treatment Medical Treatment Discharge Surgical Treatment Small BowelObstruction InitialComplication Complication* Anastomotic Problems Discharge Surgical Treatment Planned Subsequent Procedures Recurrence ofPrimary Disease Other Complications Complication* Adjuvant Therapy 154.1 Malignant Neoplasm Rectum P 560.9 Small Bowel Obstruction No DRG - Outpatient procedure DRG 150Peritoneal Adhesiolysis with CCAverage National Payment $11,114.69 25 PatientsALOS 6.8 $7,029 (Cost) 15 PatientsALOS 12.93 $10,633 (Cost) 136 PatientsALOS 0 (outpatient) $501 (Cost) Total Cost = $18,163

  15. DRG 146Rectal Resection with CCAverage National Payment $11,215.96 P 48.5 Abdominoperin Rectum Resection P 99.25 Chemoradiation V58.1 Chemotherapy PATIENT WORKSHEET 2.5: RECTAL CANCER 50-75% Incidence A 70-year-old man presents with anal pain and bleeding. Evaluation reveals a lesion. He received an abdominal perineal resection. He is discharged on POD #10. The patient received adjuvant chemoradiation. Recurrence ofPrimary Disease Discharge Other Disease Processes Subsequent Procedures Planned Subsequent Procedures Discharge Surgical Treatment Medical Treatment Discharge Surgical Treatment Small BowelObstruction InitialComplication Complication* Anastomotic Problems Discharge Surgical Treatment Planned Subsequent Procedures Recurrence ofPrimary Disease Other Complications Complication* Adjuvant Therapy P 154.1 Malignant Neoplasm Rectum No DRG - Outpatient procedure 117 PatientsALOS 10.53 $11,900 (Cost) 136 PatientsALOS 0 (outpatient) $501 (Cost) Total Cost = $12,401

  16. DRG 146Rectal Resection with CCAverage National Payment $11,215.96 DRG 153 Minor Small and Large Bowel Procedures without CCAverage National Payment $4,769.94 PATIENT WORKSHEET 2.6: RECTAL CANCER 15-25% Incidence A 63-year-old woman undergoes a low anterior resection for a rectal cancer. On POD #4, she develops a fever and abdominal pain. A water-soluble contrast enema demonstrates a leaking anastomosis. She receives an end colostomy and Hartman’s closure of her rectum. Three months later, she undergoes takedown of her colostomy with a colorectal anastomosis. Recurrence ofPrimary Disease Discharge Other Disease Processes Subsequent Procedures Planned Subsequent Procedures Discharge Surgical Treatment Medical Treatment Discharge Surgical Treatment Small BowelObstruction InitialComplication Complication* Anastomotic Problems Discharge Surgical Treatment Planned Subsequent Procedures Recurrence ofPrimary Disease Other Complications Complication* Adjuvant Therapy P 154.1 Malignant Neoplasm RectumS 997.4 Anastomotic Leak P V55.3 Attention to Colostomy P 46.52 Closure stoma large intestine P 48.62 Anterior Rectum Resection w/ Colostomy**NO PATIENTS FOUND WITH A SECONDARY DIAGNOSIS OF 48.69 - Rectum Resection Contrast Enema (Lower GI series) **NOT ABLE TO BREAK OUT COST SEPARATELY** 3 PatientsALOS 11.67 $12,297 (Cost) 124 PatientsALOS 5.65 $5,609 (Cost) Total Cost = $17,906

  17. 46.51 Intestinal Stoma Closure 45.9 0 Intestinal Anastomosis46.03 Loop Colostomy 46.11 Temporary Colostomy 46.01 Loop Ileostomy 46.20 Ileostomy NOS 46.21 Temp. Ileostomy 46.03 Loop Colostomy 46.1 Colostomy 46.11 Temporary Colostomy 46.01 Loop Ileostomy 46.20 Ileostomy NOS 46.21 Temporary Ileostomy 45.7 Partial Large Bowel Excision 45.75 Left Hemicolectomy 45.73 Right Hemicolectomy 45.8 Total Intra-Abd Colectomy 45.74 Transverse Colon Resect 45.76 Sigmoidectomy 46.03 Loop Colostomy (Exterz Large Intestine) 46.10 Colostomy NOS 46.11 Temporary Colostomy 48.62 Anterior Rectum Resection w/Colostomy 48.63 Anterior Rectum Resection NEC 54.59 Lysis of Adhesions (Abdomen) 54.59 Lysis of Adhesions (Abdomen) 45.60 Small Bowel Resection46.51 Intestinal Stoma Closure 45.90 Intestinal Anastomosis V55.2 Attention to Ileostomy V55.3 Attention to Colostomy PATIENT WORKSHEET 3.0: DIVERTICULAR DISEASE Overview of all diagnosis and procedures. Discharge Other Disease Processes Subsequent Procedures Planned Subsequent Procedures Discharge Surgical Treatment Medical Treatment Discharge Small BowelObstruction Surgical Treatment InitialComplication Complication* Anastomotic Problems Discharge Surgical Treatment Planned Subsequent Procedures Recurrence ofPrimary Disease Other Complications Complication* Pharm IV Fluid Pharm IV TPN Foley (CATH insertion) Labs Blood WorkLabs All other excluding Blood work Rad Plain Abd X-ray Contrast Upper/Lower Rad CT Scan (Abdomen)Pharm Water Soluble Contrast Upper/Lower Endoscopy Pharm Antibiotics and Meds 562.10 Diverticulosis of Colon 562.11 Diverticulitis of Colon 562.12 Diverticulosis of Colon with Hemorrhage 562.13 Diverticulitis of Colon with Hemorrhage 997.4 Anastomotic Leak 997.4 Anastomotic Stricture 998.11 Post-op Hemorrhage 553.21 Incisional Hernia

  18. DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03 DRG 153Minor Small and Large Bowel Procedures without CCAverage National Payment$ 4,769.94 PATIENT WORKSHEET 3.1: DIVERTICULAR DISEASE 10-15% Incidence A 53-year-old moderately obese Missouri farmer presents with a 4-day history of left lower quadrant abdominal pain, fever of 39oC, and a WBC of 16,000. A CT scan shows a 5 cm abscess in the left lower quadrant adjacent to the sigmoid colon, which has numerous diverticuli. The patient has 3 previous episodes of left lower quadrant pain and has been hospitalized once before to receive antibiotics. Colonoscopy showed no other lesion one year ago. The patient was taken immediately to the operating room where a sigmoid colectomy was performed and a Hartman’s rectal stump with end colostomy were constructed. Discharged POD #10. Six months later the patient returned to the operating room for colostomy closure. He is discharged POD #6. Discharge Other Disease Processes Subsequent Procedures Planned Subsequent Procedures Discharge Surgical Treatment Medical Treatment Discharge Small BowelObstruction Surgical Treatment InitialComplication Complication* Anastomotic Problems Discharge Surgical Treatment Planned Subsequent Procedures Recurrence ofPrimary Disease Other Complications Complication* 562.11 Diverticulitis of Colon P V55.3 Attention to Colostomy Rad CT ScanS800CT1001 - CT Scan abdomen w/contrast LAB Blood Work P 46.52 Closure stoma of large intestine P 45.75 Left Hemicolectomy S 46.11 Temporary Colostomy 9 PatientsALOS 10.11 $12,786 (Cost) $216.58 CT Scan 124 PatientsALOS 5.65 $5,609 (Cost) $454.19 Blood work Total Cost = $18,395 (Tests already included in procedures)

  19. DRG 150Peritoneal Adhesiolysis without CCAverage National Payment $11,114.69 DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03 P 45.75 Left Hemicolectomy S 46.11 Temporary Colostomy S 4X.XX Hartman Resection of Rectum P 46.52 Closure Stoma large intestine S 54.59 Lysis of Adhesions PATIENT WORKSHEET 3.2: DIVERTICULAR DISEASE 10-15% Incidence A 53-year-old moderately obese Missouri farmer presents with a 4-day history of left lower quadrant abdominal pain, fever of 39oC, and a WBC of 16,000. A CT scan shows a 5 cm abscess in the left lower quadrant adjacent to the sigmoid colon, which has numerous diverticuli. The patient has 3 previous episodes of left lower quadrant pain and has been hospitalized once before to receive antibiotics. Colonoscopy showed no other lesion one year ago. The patient was taken immediately to the operating room where a sigmoid colectomy was performed and a Hartman’s rectal stump with end colostomy were constructed. Discharged POD #10. Six months later the patient returned to the operating room for colostomy closure. Adhesions are encountered and lysed. Patient is discharged on POD #9. Discharge Other Disease Processes Subsequent Procedures Planned Subsequent Procedures Discharge Surgical Treatment Medical Treatment Discharge Small BowelObstruction Surgical Treatment InitialComplication Complication* Anastomotic Problems Discharge Surgical Treatment Planned Subsequent Procedures Recurrence ofPrimary Disease Other Complications Complication* V55.3 Attention to Colostomy 562.11 Diverticulitis of Colon Rad CT ScanS800CT1001 - CT Scan abdomen w/contrast LAB Blood Work 9 PatientsALOS 10.11 $12,786 (Cost) $216.58 CT Scan 69 PatientsALOS9.07 $ 9,678 (Cost) $454.19 Blood work Total Cost = $22,464 (Tests already included in procedures. Italicized costs are not included.)

  20. DRG 181GI Obstruction without CCAverage National Payment $2,133.64 DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03 PATIENT WORKSHEET 3.3: DIVERTICULAR DISEASE 10-15% Incidence A 72-year-old woman is admitted with massive lower GI hemorrhage. An angiogram revealed left-sided diverticuli with rapid bleeding. Vasopressin was used to stop the bleeding, and colonoscopy was performed after a rapid bowel prep. Diverticuli were noted throughout the sigmoid and left colon. The patient was taken immediately to the operating room where a sigmoid colectomy was performed and a Hartman’s rectal stump with end colostomy were constructed. Discharged POD #15. Six months later the patient returned to the operating room for colostomy closure through a major laparotomy incision. Seven days after left colectomy, the patient develops abdominal distension, nausea, and WBC of 14,000. Abdominal x-ray suggests partial SBO- this is treated with NG suction; and IV fluids. After 3 days distention resolves. Patient is discharged on POD #8. Discharge Other Disease Processes Subsequent Procedures Planned Subsequent Procedures Discharge Surgical Treatment Medical Treatment Discharge Small BowelObstruction Surgical Treatment InitialComplication Complication* Anastomotic Problems Discharge Surgical Treatment Planned Subsequent Procedures Recurrence ofPrimary Disease Other Complications Complication* P 46.52 Closure stoma large intestine 560.9 SBO 562.12 Diverticulosis of Colon with Hemorrhage P 45.76 Sigmoidectomy S 46.11 Temporary Colostomy**NO PATIENTS FOUND WITH SECONDARY PROCEDURE OF RECTUM RESECTION S 4X.XX Hartman Resection of Rectum Pharm IV Fluid LAB Blood Work Pharm IV TPNPharm AntibioticsPharm Other MedsX-ray Plain Abd (S800XR1000 ) P V55.3 Attention to Colostomy P 96.07 Non operative Insert naso-gastric tube DRG 152 Major Small and Large Bowel Procedures with CCAverage National Payment $7,846.99 3 PatientsALOS 15.00 $34,840 (Cost) $151.61 IV fluid 136 PatientsALOS 6.91 $7,306 (Cost) 657 PatientsALOS 3.68 $2,568 (Cost) $396.79 IV TPN $738 Antibiotics $10.57 Blood work $1,756 Other Meds $62.80 XRay Total Cost = $44,714 (Tests/Meds already included in procedures)

  21. P 54.59 Lysis of Adhesions (Abdomen) DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03 PATIENT WORKSHEET 3.4: DIVERTICULAR DISEASE 10-15% Incidence A 72-year-old woman is admitted with massive lower GI hemorrhage. An angiogram revealed left-sided diverticuli with rapid bleeding. Vasopressin was used to stop the bleeding, and colonoscopy was performed after a rapid bowel prep. Diverticuli were noted throughout the sigmoid and left colon. The patient was taken immediately to the operating room where a sigmoid colectomy was performed and a Hartman’s rectal stump with end colostomy were constructed. Discharged POD #15. Six months later the patient returned to the operating room for colostomy closure through a major laparotomy incision. Seven days after left colectomy, the patient develops abdominal distension, nausea, and WBC of 14,000. NG suction, IV fluid -- after two days and after initial symptoms show no progress, SBO diagnosed -- Lysis of Adhesion. Patient is discharged on POD #18. Discharge Other Disease Processes Subsequent Procedures Planned Subsequent Procedures Discharge Surgical Treatment Medical Treatment Discharge Small BowelObstruction Surgical Treatment InitialComplication Complication* Anastomotic Problems Discharge Surgical Treatment Planned Subsequent Procedures Recurrence ofPrimary Disease Other Complications Complication* P 46.52 Closure stoma large intestine 562.12 Diverticulosis of Colon with Hemorrhage P 560.9 Small Bowel Obstruction P V55.3 Attention to Colostomy P 45.76 Sigmoidectomy S 46.11 Temporary Colostomy**NO PATIENTS FOUND WITH SECONDARY PROCEDURE OF RECTUM RESECTION S 4X.XX Hartman Resection of Rectum Pharm IV Fluid LAB Blood Work DRG 152 Major Small and Large Bowel Procedures with CCAverage National Payment $7,846.99 DRG 150Peritoneal Adhesiolysis with CCAverage National Payment $11,114.69 3 PatientsALOS 15.00 $34,840 (Cost) $151.61 IV fluid 136 PatientsALOS 6.91 $7,306 (Cost) 15 PatientsALOS 12.93 $10,633 (Cost) $10.57 Blood work Total Cost = $52,779 (Tests already included in procedures)

  22. DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03 P 45.75 Left Hemicolectomy PATIENT WORKSHEET 3.5: DIVERTICULAR DISEASE 50-75% Incidence A 53-year-old moderately obese Missouri farmer presents with a 4-day history of left lower quadrant abdominal pain, fever of 39oC, and a WBC of 16,000. A CT scan shows a 5 cm abscess in the left lower quadrant adjacent to the sigmoid colon, which has numerous diverticuli. When the pain and palpable mass resolved, the patient underwent a left colectomy with primary anastomosis. Patient is discharged on POD#9. Discharge Other Disease Processes Subsequent Procedures Planned Subsequent Procedures Discharge Surgical Treatment Medical Treatment Discharge Small BowelObstruction Surgical Treatment InitialComplication Complication* Anastomotic Problems Discharge Surgical Treatment Planned Subsequent Procedures Recurrence ofPrimary Disease Other Complications Complication* 562.11 Diverticulitis of Colon 130 PatientsALOS 10.76 $11,747 (Cost) Total Cost = $11,747

  23. DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03 DRG 153Minor Small and Large Bowel Procedures without CCAverage National Payment$ 4,769.94 DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03 DRG 153Minor Small and Large Bowel Procedures without CCAverage National Payment $4,769.94 P 45.75 Left Hemicolectomy S 46.11 Temporary Colostomy S 4X.XX Hartman Resection of Rectum PATIENT WORKSHEET 3.6: DIVERTICULAR DISEASE 10-15% Incidence A 53-year-old moderately obese Missouri farmer presents with a 4-day history of left lower quadrant abdominal pain, fever of 39oC, and a WBC of 16,000. A CT scan shows a 5 cm abscess in the left lower quadrant adjacent to the sigmoid colon, which has numerous diverticuli. The patient has 3 previous episodes of left lower quadrant pain and has been hospitalized once before to receive antibiotics. Colonoscopy showed no other lesion one year ago. The patient was taken immediately to the operating room where a sigmoid colectomy was performed and a Hartman’s rectal stump with end colostomy were constructed. Six months later the patient returned to the operating room for colostomy closure through a major laparotomy incision. Seven days after left colectomy, the patient develops abdominal distension, nausea, fever of 39oC, and WBC of 14,000. A CT scan revealed an abscess in the pelvis with a leak of contrast from the colorectal anastomosis. The patient is returned to the operating room for abdominal washout, repair/revision of the anastomosis, placement of pelvic drains and diverting loop ileostomy. The loop ileostomy is closed eight weeks later after a hypaque enema reveals no leak. Discharge Other Disease Processes Subsequent Procedures Planned Subsequent Procedures Discharge Surgical Treatment Medical Treatment Discharge Small BowelObstruction Surgical Treatment InitialComplication Complication* Anastomotic Problems Discharge Surgical Treatment Planned Subsequent Procedures Recurrence ofPrimary Disease Other Complications Complication* 562.11 Diverticulitis of Colon P V55.3 Attention to Colostomy P 997.4 Anastomotic LeakS 569.5 Abscess of intestine **NO PATIENTS FOUND WITH ABSCESS AS SECONDARY DIAGNOSIS. P V55.2 Attention to Ileostomy Rad CT ScanS800CT1001 - CT Scan abdomen w/contrast LAB Blood Work P 46.52 Closure stoma of large intestine 46.51 Closure Stoma Small Intestine 46.20 Ileostomy NOS 9 PatientsALOS 10.11 $12,786 (Cost) $216.58 CT Scan 124 PatientsALOS 5.65 $5,609 (Cost) 3 PatientsALOS 17.00 $21,117 (Cost) 56 PatientsALOS 3.89 $4,693 (Cost) $454.19 Blood work Total Cost = $45,902 (Tests already included in procedures)

  24. DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03 DRG 153Minor Small and Large Bowel Procedures without CCAverage National Payment$ 4,769.94 DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03 DRG 153Minor Small and Large Bowel Procedures without CCAverage National Payment $4,769.94 P 45.75 Left Hemicolectomy S 46.11 Temporary Colostomy S 4X.XX Hartman Resection of Rectum PATIENT WORKSHEET 3.7: DIVERTICULAR DISEASE 10-15% Incidence A 53-year-old moderately obese Missouri farmer presents with a 4-day history of left lower quadrant abdominal pain, fever of 39oC, and a WBC of 16,000. A CT scan shows a 5 cm abscess in the left lower quadrant adjacent to the sigmoid colon, which has numerous diverticuli. The patient has 3 previous episodes of left lower quadrant pain and has been hospitalized once before to receive antibiotics. Colonoscopy showed no other lesion one year ago. The patient was taken immediately to the operating room where a sigmoid colectomy was performed and a Hartman’s rectal stump with end colostomy were constructed. Six months later the patient returned to the operating room for colostomy closure through a major laparotomy incision. Dense adhesions were encountered and an enterotomy occurred during their division. This was repaired and the colostomy was closed. Four days after this procedure, the patient develops abdominal distension, nausea, fever of 39oC, and WBC of 14,000. A CT scan revealed an abscess in the pelvis with a leak of contrast from the small bowel. The patient is returned to the operating room for abdominal washout, and a diverting ileostomy using the site of the leak. The ileostomy is closed eight weeks later. Discharge Other Disease Processes Subsequent Procedures Planned Subsequent Procedures Discharge Surgical Treatment Medical Treatment Discharge Small BowelObstruction Surgical Treatment InitialComplication Complication* Anastomotic Problems Discharge Surgical Treatment Planned Subsequent Procedures Recurrence ofPrimary Disease Other Complications Complication* 562.11 Diverticulitis of Colon P V55.3 Attention to Colostomy P 997.4 Anastomotic LeakS 569.5 Abscess of intestine **NO PATIENTS FOUND WITH ABSCESS AS SECONDARY DIAGNOSIS. P V55.2 Attention to Ileostomy Rad CT ScanS800CT1001 - CT Scan abdomen w/contrast LAB Blood Work P 46.52 Closure stoma of large intestine 46.51 Closure Stoma Small Intestine 46.20 Ileostomy NOS 9 PatientsALOS 10.11 $12,786 (Cost) $216.58 CT Scan 124 PatientsALOS 5.65 $5,609 (Cost) 3 PatientsALOS 17.00 $21,117 (Cost) 56 PatientsALOS 3.89 $4,693 (Cost) $454.19 Blood work Too High? Total Cost = $45,902 (Tests already included in procedures)

  25. PATIENT WORKSHEET 4.0: INTESTINAL TRAUMA Overview of all diagnosis and procedures. Discharge Other Disease Processes Subsequent Procedures Planned Subsequent Procedures Discharge Surgical Treatment Medical Treatment Discharge Small BowelObstruction Surgical Treatment InitialComplication Complication* Anastomotic Problems Discharge Surgical Treatment Planned Subsequent Procedures Other Complications Complication* 46.03 Loop Colostomy 46.11 Temporary Colostomy 46.01 Loop Ileostomy 46.20 Ileostomy NOS 46.21 Temporary Ileostomy 46.93 Revision of Small Bowel Anastomosis 46.94 Rev of Large Bowel Anastomosis 45.7 Partial Large Bowel Excision 46.51 Intestinal Stoma Closure 45.90 Intestinal Anastomosys46.03 Loop Colostomy 46.11 Temporary Colostomy 46.01 Loop Ileostomy 46.20 Ileostomy NOS 46.21 Temporary Ileostomy 54.59 Lysis of Adhesions (Abdomen) 45.60 Small Bowel Resection46.51 Intestinal Stoma Closure 45.90 Intestinal Anastomosis 863.20 Small Intestine Injury-Closed 863.21 Duodenum Injury-Closed 863.29 Small Intestine Injury NEC-Closed863.39 Small Intestine Injury Open 863.40 Colon Injury NOS-Closed 863.41 Ascending Colon Injury-Closed 863.42 Transverse Colon Injury-Closed 863.43 Descending Colon Injury-Closed 863.44 Sigmoid Colon Injury-Closed 863.45 Rectum Injury-Closed 863.46 Colon Injury Mult Site-Closed 863.49 Colon Injury NEC-Closed 863.89 GI Injury NEC-Closed 997.4 Anastomotic Leak 997.4 Anastomotic Stricture 998.11 Post-op Hemorrhage Pharm IV Fluid Pharm IV TPN Foley (CATH insertion) Labs Blood WorkLabs All other excluding Blood work Rad Plain Abd X-ray Contrast Upper/Lower Rad CT Scan (Abdomen)Pharm Water Soluble Contrast Upper/Lower Endoscopy Pharm Antibiotics and Meds V55.2 Attention to IleostomyV55.3 Attention to Colostomy 45.61 Multiple Seg Small Bowel Excision 45.71 Multiple Seg Large Bowel Excision 45.72 Cectomy 45.73 Right Hemicolectomy 45.74 Transverse Colectomy 45.75 Left Hemicolectomy 45.76 Sigmoidectomy 46.03 Loop Colostomy 45.8 Total Intra Abd Colectomy 46.10 Colostomy NOS 46.11 Temporary Colostomy 48.62 Anterior Rectum Resection w/Colostomy 48.63 Anterior Rectum Resection NEC 48.69 Other resection Rectum 48.5 Abd-Perineal Rectum Resection 48.79 Repair of Rectum NEC 45.61 Multiple segmental resection of small intestine45.62 Other partial resection of small intestine 46.75 Suture Large Bowel Laceration 46.73 Small Bowel Suture NEC 553.21 Incisional Hernia

  26. DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03 DRG 153Minor Small and Large Bowel Procedures without CCAverage National Payment $4,769.94 P 46.52 Closure stoma large intestine PATIENT WORKSHEET 4.1: INTESTINAL TRAUMA 15-25% Incidence A 22-year-old man sustains a gunshot wound to the abdomen. At abdominal exploration, he has a hole in his colon and two small bowel injuries. He receives a small bowel resection, an end sigmoid colostomy, and Hartman’s closure of his rectum. He is discharged on POD #7. Two months later his colostomy is closed. He is discharged on POD #6. Discharge Other Disease Processes Subsequent Procedures Planned Subsequent Procedures Discharge Surgical Treatment Medical Treatment Discharge Small BowelObstruction Surgical Treatment InitialComplication Complication* Anastomotic Problems Discharge Surgical Treatment Planned Subsequent Procedures Other Complications Complication* ** DID NOT FIND ANY PATIENTS WITH EITHER OF THESE DIAGNOSIS *863.44 Sigmoid Colon Injury-Closed 863.89 GI Injury NEC-ClosedUSED 863.30 - Injury unspecified site with open wound cavity P V55.3 Attention to colostomy *DID NOT FIND THIS PROCEDURE AS EITHERPRINCIPAL OR SECONDARY* 48.62 Anterior Rectum Resection w/ Colostomy P 45.62 Other Small Bowel Excision S 46.79 Other repair of intestine 4 PatientsALOS 11.75 $10,232 (Cost) 124 PatientsALOS 5.65 $5,609 (Cost) Total Cost = $15,841

  27. DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03 DRG 150Peritoneal Adhesiolysis without CCAverage National Payment $11,114.69 P 46.52 Closure Stoma large intestine S 54.59 Lysis of Adhesions V55.3 Attention to Colostomy PATIENT WORKSHEET 4.2: INTESTINAL TRAUMA 15-25% Incidence A 22-year-old man sustains a gunshot wound to the abdomen. At abdominal exploration, he has a hole in his colon and two small bowel injuries. He receives a small bowel resection, an end sigmoid colostomy, and Hartman’s closure of his rectum. He is discharged on POD #7. Two months later his colostomy is closed. Adhesions are encountered and lysed. He is discharged on POD #9. Discharge Other Disease Processes Subsequent Procedures Planned Subsequent Procedures Discharge Surgical Treatment Medical Treatment Discharge Small BowelObstruction Surgical Treatment InitialComplication Complication* Anastomotic Problems Discharge Surgical Treatment Planned Subsequent Procedures Other Complications Complication* ** DID NOT FIND ANY PATIENTS WITH EITHER OF THESE DIAGNOSIS *863.44 Sigmoid Colon Injury-Closed 863.89 GI Injury NEC-ClosedUSED 863.30 - Injury unspecified site with open wound cavity *DID NOT FIND THIS PROCEDURE AS EITHERPRINCIPAL OR SECONDARY* 48.62 Anterior Rectum Resection w/ Colostomy P 45.62 Other Small Bowel Excision S 46.79 Other repair of intestine 4 PatientsALOS 11.75 $10,232 (Cost) 69 PatientsALOS 9.07 $ 9,678 (Cost) Total Cost = $19,910

  28. DRG 181GI Obstruction without CCAverage National Payment $2,133.64 DRG 153Minor Small and Large Bowel Procedures without CCAverage National Payment $4,769.94 DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03 P 46.52 Closure stoma large intestine PATIENT WORKSHEET 4.3: INTESTINAL TRAUMA 15-25% Incidence A 22-year-old man sustains a gunshot wound to the abdomen. At abdominal exploration, he has a hole in his colon and two small bowel injuries. He receives a small bowel resection, an end sigmoid colostomy, and Hartman’s closure of his rectum. He is discharged on POD #7. Two months later his colostomy is closed. On POD #4, he develops nausea and distension. X-ray suggests a partial small bowel obstruction. This is treated with NG suction and IV fluids. After 3 days, the patient passes gas and his distention is resolved. He is discharged on POD #9. Discharge Other Disease Processes Subsequent Procedures Planned Subsequent Procedures Discharge Surgical Treatment Medical Treatment Discharge Small BowelObstruction Surgical Treatment InitialComplication Complication* Anastomotic Problems Discharge Surgical Treatment Planned Subsequent Procedures Other Complications Complication* 560.9 SBO ** DID NOT FIND ANY PATIENTS WITH EITHER OF THESE DIAGNOSIS *863.44 Sigmoid Colon Injury-Closed 863.89 GI Injury NEC-ClosedUSED 863.30 - Injury unspecified site with open wound cavity P V55.3 Attention to colostomy *DID NOT FIND THIS PROCEDURE AS EITHERPRINCIPAL OR SECONDARY* 48.62 Anterior Rectum Resection w/ Colostomy P 45.62 Other Small Bowel Excision S 46.79 Other repair of intestine Pharm IV TPNPharm AntibioticsPharm Other MedsX-ray Plain Abd (S800XR1000 ) P 96.07 Non operative Insert naso-gastric tube 4 PatientsALOS 11.75 $10,232 (Cost) 657 PatientsALOS 3.68 $2,568 (Cost) $396.79 IV TPN 124 PatientsALOS 5.65 $5,609 (Cost) $738 Antibiotics $1,756 Other Meds $62.80 XRay Total Cost = $18,409 (Tests/Meds already included in procedures)

  29. P 54.59 Lysis of Adhesions (Abdomen) DRG 153Minor Small and Large Bowel Procedures without CCAverage National Payment $4,769.94 DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03 P 46.52 Closure stoma large intestine PATIENT WORKSHEET 4.4: INTESTINAL TRAUMA 15-25% Incidence A 22-year-old man sustains a gunshot wound to the abdomen. At abdominal exploration, he has a hole in his colon and two small bowel injuries. He receives a small bowel resection, an end sigmoid colostomy, and Hartman’s closure of his rectum. He is discharged on POD #7. Two months later his colostomy is closed. Four days after procedure, patient develops abdominal distention and nausea. Abdominal x-ray reveals small bowel obstruction. Patient is operated for small bowel obstruction and lysis of adhesion. Patient is discharged on POD #18. Discharge Other Disease Processes Subsequent Procedures Planned Subsequent Procedures Discharge Surgical Treatment Medical Treatment Discharge Small BowelObstruction Surgical Treatment InitialComplication Complication* Anastomotic Problems Discharge Surgical Treatment Planned Subsequent Procedures Other Complications Complication* ** DID NOT FIND ANY PATIENTS WITH EITHER OF THESE DIAGNOSIS *863.44 Sigmoid Colon Injury-Closed 863.89 GI Injury NEC-ClosedUSED 863.30 - Injury unspecified site with open wound cavity P 560.9 Small Bowel Obstruction P V55.3 Attention to colostomy *DID NOT FIND THIS PROCEDURE AS EITHERPRINCIPAL OR SECONDARY* 48.62 Anterior Rectum Resection w/ Colostomy P 45.62 Other Small Bowel Excision S 46.79 Other repair of intestine DRG 150Peritoneal Adhesiolysis with CCAverage National Payment $11,114.69 4 PatientsALOS 11.75 $10,232 (Cost) 15 PatientsALOS 12.93 $10,633 (Cost) 124 PatientsALOS 5.65 $5,609 (Cost) Total Cost = $26,474

  30. 46.01 Loop Ileostomy 46.20 Ileostomy NOS 46.21 Temp. Ileostomy 45.95 Endo Rectal Ileal Pouch 54.59 Lysis of Adhesions (Abdomen) 45.79 Resection of Colon 45.8 Total Colectomy 48.49 Rectal Pull Through 48.5 Abd-Perineal Rectum Resection 45.95 Endo Rectal Ileal Pouch 46.01 Loop Ileostomy 46.20 Ileostomy 46.21 Temporary Ileostomy 46.22 Continent Ileostomy 54.59 Lysis of Adhesions (Abdomen) 46.51 Intestinal Stoma Closure 45.90 Intestinal Anastomosis 45.79 Resection of Colon 45.8 Total Colectomy 48.49 Rectal Pull Through 48.5 Abd-Perineal Rectum Resection 45.95 Endo Rectal Ileal Pouch 46.01 Loop Ileostomy 46.20 Ileostomy NOS 46.21 Temporary Ileostomy 46.22 Continent Ileostomy 54.59 Lysis of Adhesions (Abdomen) 54.59 Lysis of Adhesions (Abdomen) 45.60 Small Bowel Resection46.51 Intestinal Stoma Closure 45.90 Intestinal Anastomosis 54.59 Lysis of Adhesions (Abdomen) PATIENT WORKSHEET 5.0: ULCERATIVE COLITIS and FAMILIAL POLYPOSIS DISEASE Overview of all diagnosis and procedures. Discharge Other Disease Processes Subsequent Procedures Planned Subsequent Procedures Discharge Surgical Treatment Medical Treatment Discharge Small BowelObstruction Surgical Treatment InitialComplication Complication* Anastomotic Problems Discharge Surgical Treatment Planned Subsequent Procedures Other Complications Complication* Pharm IV Fluid Pharm IV TPN Foley (CATH insertion) Labs Blood WorkLabs All other excluding Blood work Rad Plain Abd X-ray Contrast Upper/Lower Rad CT Scan (Abdomen)Pharm Water Soluble Contrast Upper/Lower Endoscopy Pharm Antibiotics and Meds 556.3 Ulcerative 556.4 Left Sided UC 556.6 Universal UC 556.8 Other UC 211.2 Familial Polyposis XXXX HNPCC V55.2 Attention to IleostomyV55.3 Attention to Colostomy 997.4 Anastomotic Leak 997.4 Anastomotic Stricture 998.11 Post-op Hemorrhage 553.21 Incisional Hernia

  31. P 46.51 Closure Intestinal StomaS 87.64 Hypaque Enema (Lower GI Series) DRG 153Minjor Small and Large Bowel Procedures without CCAverage National Payment $4,769.94 P 45.8 Total Colectomy S 45.95 Endo Rectal Ileal Pouch S 46.01 Loop Ileostomy PATIENT WORKSHEET 5.1: ULCERATIVE COLITIS and FAMILIAL POLYPOSIS DISEASE 90% Incidence An 18-year-old female student develops severe abdominal pain, distension, bloody diarrhea, and elevated WBC. A short flexible sigmoidoscopy reveals acute severe fulminant colitis—either ulcerative colitis or Crohn’s Disease. The patient fails to respond to medication over the next 48 hours and begins to deteriorate with fever, peritoneal signs, and sepsis. She receives restorative proctocolectomy and an ileal J pouch, ileoanal anastomosis, and loop ileostomy. Discharge POD #9. Her ileostomy is closed two months after her initial operation when a hypaque enema shows no leak. Discharge POD #4. Discharge Other Disease Processes Subsequent Procedures Planned Subsequent Procedures Discharge Surgical Treatment Medical Treatment Discharge Small BowelObstruction Surgical Treatment InitialComplication Complication* Anastomotic Problems Discharge Surgical Treatment Planned Subsequent Procedures Other Complications Complication* 556.6 Universal UC P V55.2 Attention to ileostomy DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03 5 PatientsALOS 16.20 $20,758 (Cost) 56 PatientsALOS 3.89 $4,693 (Cost) Total Cost = $25,451

  32. DRG 150Peritoneal Adhesiolysis without CCAverage National Payment $11,114.69 P 45.8 Total Colectomy S 45.95 Endo Rectal Ileal Pouch S 46.01 Loop Ileostomy P 46.51 Closure Stoma small intestine S 54.59 Lysis of Adhesions V55.2 Attention to Ileostomy PATIENT WORKSHEET 5.2: ULCERATIVE COLITIS and FAMILIAL POLYPOSIS DISEASE 90% Incidence An 18-year-old female student develops severe abdominal pain, distension, bloody diarrhea, and elevated WBC. A short flexible sigmoidoscopy reveals acute severe fulminant colitis—either ulcerative colitis or Crohn’s Disease. The patient fails to respond to medication over the next 48 hours and begins to deteriorate with fever, peritoneal signs, and sepsis. She receives restorative proctocolectomy and an ileal J pouch, ileoanal anastomosis, and loop ileostomy. Discharge POD #16. Her ileostomy is closed two months after her initial operation. Adhesions are encountered and lysed. Discharge POD #7. Discharge Other Disease Processes Subsequent Procedures Planned Subsequent Procedures Discharge Surgical Treatment Medical Treatment Discharge Small BowelObstruction Surgical Treatment InitialComplication Complication* Anastomotic Problems Discharge Surgical Treatment Planned Subsequent Procedures Other Complications Complication* 556.6 Universal UC DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03 5 PatientsALOS 16.20 $20,758 (Cost) 2 PatientsALOS5.6.50 $ 7,476 (Cost) Total Cost = $28,234

  33. DRG 153Minjor Small and Large Bowel Procedures without CCAverage National Payment $4,769.94 DRG 181GI Obstruction without CCAverage National Payment $2,133.64 P 45.8 Total Colectomy S 45.95 Endo Rectal Ileal Pouch S 46.01 Loop Ileostomy P 46.51 Closure Intestinal StomaS 87.64 Hypaque Enema (Lower GI Series) PATIENT WORKSHEET 5.3: ULCERATIVE COLITIS and FAMILIAL POLYPOSIS DISEASE 90% Incidence An 18-year-old female student develops severe abdominal pain, distension, bloody diarrhea, and elevated WBC. A short flexible sigmoidoscopy reveals acute severe fulminant colitis—either ulcerative colitis or Crohn’s Disease. The patient fails to respond to medication over the next 48 hours and begins to deteriorate with fever, peritoneal signs, and sepsis. She receives restorative proctocolectomy and an ileal J pouch, ileoanal anastomosis, and loop ileostomy. Discharge POD #16. Her ileostomy is closed two months after her initial operation. Three days after procedure, patient develops abdominal distention and nausea. X-ray reveals partial small bowel obstruction, which is treated with NG suction and IV fluid. Three days after diagnosis, patient passes gas and distention resolves. Discharge POD #8. Discharge Other Disease Processes Subsequent Procedures Planned Subsequent Procedures Discharge Surgical Treatment Medical Treatment Discharge Small BowelObstruction Surgical Treatment InitialComplication Complication* Anastomotic Problems Discharge Surgical Treatment Planned Subsequent Procedures Other Complications Complication* 560.9 SBO 556.6 Universal UC P V55.2 Attention to ileostomy Pharm IV TPNPharm AntibioticsPharm Other MedsX-ray Plain Abd (S800XR1000 ) P 96.07 Non operative Insert naso-gastric tube DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03 5 PatientsALOS 16.20 $28,758 (Cost) 56 PatientsALOS 3.89 $4,693 (Cost) 657 PatientsALOS 3.68 $2,568 (Cost) $396.79 IV TPN $738 Antibiotics $1,756 Other Meds $62.80 XRay Total Cost = $36,019 (Tests/Meds already included in procedures)

  34. P 54.59 Lysis of Adhesions (Abdomen) P 46.51 Closure Intestinal StomaS 87.64 Hypaque Enema (Lower GI Series) DRG 153Minjor Small and Large Bowel Procedures without CCAverage National Payment $4,769.94 P 45.8 Total Colectomy S 45.95 Endo Rectal Ileal Pouch S 46.01 Loop Ileostomy PATIENT WORKSHEET 5.4: ULCERATIVE COLITIS and FAMILIAL POLYPOSIS DISEASE 90% Incidence An 18-year-old female student develops severe abdominal pain, distension, bloody diarrhea, and elevated WBC. A short flexible sigmoidoscopy reveals acute severe fulminant colitis—either ulcerative colitis or Crohn’s Disease. The patient fails to respond to medication over the next 48 hours and begins to deteriorate with fever, peritoneal signs, and sepsis. She receives restorative proctocolectomy and an ileal J pouch, ileoanal anastomosis, and loop ileostomy. Discharge POD #16. Her ileostomy is closed two months after her initial operation. Seven days after procedure, patient experiences abdominal distention, nausea, and WBC 14,000. X-ray reveals small bowel obstruction and lysis of adhesion. Discharge POD #17. Discharge Other Disease Processes Subsequent Procedures Planned Subsequent Procedures Discharge Surgical Treatment Medical Treatment Discharge Small BowelObstruction Surgical Treatment InitialComplication Complication* Anastomotic Problems Discharge Surgical Treatment Planned Subsequent Procedures Other Complications Complication* 556.6 Universal UC P V55.2 Attention to ileostomy P 560.9 Small Bowel Obstruction DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03 DRG 150Peritoneal Adhesiolysis with CCAverage National Payment $11,114.69 5 PatientsALOS 16.20 $20,758 (Cost) 56 PatientsALOS 3.89 $4,693 (Cost) 15 PatientsALOS 12.93 $10,633 (Cost) Total Cost = $36,084

  35. P 45.8 Total Colectomy S 46.01 Ileostomy DRG 147Rectal resection without CCAverage National Payment $6,512.85 DRG 153Minor small and large bowel procedures without CCAverage National Payment $4,769.94 46.51 Closure stoma small intestine P 48.5 Abdominoperin resection rectum PATIENT WORKSHEET 5.5: ULCERATIVE COLITIS and FAMILIAL POLYPOSIS DISEASE 90% Incidence An 18-year-old female student develops severe abdominal pain, distension, bloody diarrhea, and elevated WBC. A short flexible sigmoidoscopy reveals acute severe fulminant colitis—either ulcerative colitis or Crohn’s Disease. The patient fails to respond to medication over the next 48 hours and begins to deteriorate with fever, peritoneal signs, and sepsis. Total abdominal colectomy with ileostomy and Hartman’s stump of rectum are performed emergently. The patient improves. Discharge POD #4. Three months later undergoes completion proctectomy with ileal J pouch and ileoanal anastomosis with loop ileostomy. Discharge POD #7. The ileostomy is closed three months later. Discharge POD #4. One year after ileostomy closure, the patient complains of incomplete evacuation of the pouch requiring 20 trips to the toilet daily. Examination reveals a narrowed 3 cm long segment of the pouch just proximal to the staple line of the anastomosis. Daily self intubations of the pouch with a catheter to empty the pouch. Discharge POD #4. Discharge Other Disease Processes Second Planned Subsequent Procedure Subsequent Procedures Planned Subsequent Procedures Discharge Surgical Treatment Medical Treatment Discharge Small BowelObstruction Surgical Treatment InitialComplication Complication* Anastomotic Problems Discharge Surgical Treatment Planned Subsequent Procedures Other Complications Complication* P V55.2 Attention to ileostomy 556.6 Universal UC DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03 6 PatientsALOS 27.83 $31,645 (Cost) 29 PatientsALOS 6.76 $8,219 (Cost) 56 PatientsALOS 3.89 $4,693 (Cost) Total Cost = $44,557

  36. 45.79 Resection of Colon 45.75 Left Colectomy 45.73 Right Hemicolectomy 45.76 Sigmoid Colectomy 45.62 Partial Small BowelResection 45.8 Total Colectomy 48.5 Abd-Perineal Rectum Resection 46.01 Loop Ileostomy 46.20 Ileostomy NOS 46.21 Temp. Ileostomy 54.59 Lysis of Adhesions (Abdomen)46.51 Intestinal Stoma Closure 45.60 Small Bowel Resection 45.90 Intestinal Anastomosis 46.50 Intestinal Stoma Closure 45.90 Intestinal Anastomosis 45.79 Resection of Colon 45.8 Total Colectomy 48.5 Abd-Perineal Rectum Resection 46.01 Loop Ileostomy 46.20 Ileostomy NOS 46.21 Temporary Ileostomy 54.59 Lysis of Adhesions (Abdomen) 45.79 Resection of Colon 45.75 Left Colectomy 45.73 Right Hemicolectomy 45.76 Sigmoid Colectomy 45.62 Partial Small Bowel resection 45.8 Total Colectomy 48.5 Abd-Perineal Rectum Resection 46.01 Loop Ileostomy 46.20 Ileostomy NOS 46.21 Temporary Ileostomy 46.79 Other Repair of Intestine 46.10 Colostomy 46.03 Loop Colostomy 54.59 Lysis of Adhesions (Abdomen) PATIENT WORKSHEET 6.0: CROHN’S DISEASE (REGIONAL ENTERITIS) Overview of all diagnosis and procedures. Discharge Other Disease Processes Subsequent Procedures Planned Subsequent Procedures Discharge Surgical Treatment Medical Treatment Discharge Small BowelObstruction Surgical Treatment InitialComplication Complication* Anastomotic Problems Discharge Surgical Treatment Planned Subsequent Procedures Recurrence ofPrimary Disease Other Complications Complication* Pharm IV Fluid Pharm IV TPN Foley (CATH insertion) Labs Blood WorkLabs All other excluding Blood work Rad Plain Abd X-ray Contrast Upper/Lower Rad CT Scan (Abdomen)Pharm Water Soluble Contrast Upper/Lower Endoscopy Pharm Antibiotics and Meds V55.2 Attention to IleostomyV55.3 Attention to Colostomy 555.0 Small Intestine 555.1 Large Intestine 555.2 Ileocolitis 555.9 Unspecified Site 997.4 Anastomotic Leak 997.4 Anastomotic Stricture 998.11 Post-op Hemorrhage 553.21 Incisional Hernia

  37. DRG 153Minor Small and Large Bowel Procedures without CCAverage National Payment $4,769.94 PATIENT WORKSHEET 6.1: CROHN’S DISEASE (REGIONAL ENTERITIS) 15% Incidence A 24-year-old sales representative of a biotech company develops acute right lower quadrant pain. An upper GI/small bowel follow through subsequently shows 20 cm of inflammatory bowel disease in the terminal ileum to the ileosecal valve. The patient’s symptoms improve only slightly with medication until another acute episode occurs. A CT scan shows phegman in the right lower quadrant adjacent to the cecum. Exploration, ileocolic resection, drains, ileotransverse colon anastomosis and loop ileostomy. Patient discharged POD #9. Ileostomy is closed three months later. Patient is discharged POD#4 Discharge Other Disease Processes Subsequent Procedures Planned Subsequent Procedures Discharge Surgical Treatment Medical Treatment Discharge Small BowelObstruction Surgical Treatment InitialComplication Complication* Anastomotic Problems Discharge Surgical Treatment Planned Subsequent Procedures Recurrence ofPrimary Disease Other Complications Complication* 555.2 Regional Enteritis of Small Intestine with Large Intestine V55.2 Attention to Ileostomy 46.51 Closure Stoma small intestine P 45.73 Right Hemicolectomy S 46.01 Loop Ileostomy DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03 56 PatientsALOS 3.89 $4,693 (Cost) 27 PatientsALOS 8.76 $9,403 (Cost) Total Cost = $14,096

  38. DRG 150Peritoneal Adhesiolysis without CCAverage National Payment $11,114.69 P 46.51 Closure Stoma small intestine S 54.59 Lysis of Adhesions V55.2 Attention to Ileostomy PATIENT WORKSHEET 6.2: CROHN’S DISEASE (REGIONAL ENTERITIS) 15% Incidence A 24-year-old sales representative of a biotech company develops acute right lower quadrant pain. An upper GI/small bowel follow through subsequently shows 20 cm of inflammatory bowel disease in the terminal ileum to the ileosecal valve. The patient’s symptoms improve only slightly with medication until another acute episode occurs. A CT scan shows phegman in the right lower quadrant adjacent to the cecum. Exploration, ileocolic resection, drains, ileotransverse colon anastomosis and loop ileostomy. Patient discharged POD #9. Ileostomy is closed three months later. Adhesion is encountered and lysed. Patient is discharged on POD #7. Discharge Other Disease Processes Subsequent Procedures Planned Subsequent Procedures Discharge Surgical Treatment Medical Treatment Discharge Small BowelObstruction Surgical Treatment InitialComplication Complication* Anastomotic Problems Discharge Surgical Treatment Planned Subsequent Procedures Recurrence ofPrimary Disease Other Complications Complication* 555.2 Regional Enteritis of Small Intestine with Large Intestine P 45.73 Right Hemicolectomy S 46.01 Loop Ileostomy DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03 27 PatientsALOS 8.76 $9,403 (Cost) 2 PatientsALOS5.6.50 $ 7,476 (Cost) Total Cost = $16,879

  39. DRG 181GI Obstruction without CCAverage National Payment $2,133.64 DRG 153Minor Small and Large Bowel Procedures without CCAverage National Payment $4,769.94 PATIENT WORKSHEET 6.3: CROHN’S DISEASE (REGIONAL ENTERITIS) 15% Incidence A 24-year-old sales representative of a biotech company develops acute right lower quadrant pain. An upper GI/small bowel follow through subsequently shows 20 cm of inflammatory bowel disease in the terminal ileum to the ileosecal valve. The patient’s symptoms improve only slightly with medication until another acute episode occurs. A CT scan shows phegman in the right lower quadrant adjacent to the cecum. Exploration, ileocolic resection, drains, ileotransverse colon anastomosis and loop ileostomy. Patient discharged POD #9. Ileostomy is closed three months later. Four days after procedure, patient develops nausea and abdominal distention. X-ray reveals partial small bowel obstruction. This is treated with NG suction and IV fluids. After 3 days distention resolved and patient is discharged on POD #8. Discharge Other Disease Processes Subsequent Procedures Planned Subsequent Procedures Discharge Surgical Treatment Medical Treatment Discharge Small BowelObstruction Surgical Treatment InitialComplication Complication* Anastomotic Problems Discharge Surgical Treatment Planned Subsequent Procedures Recurrence ofPrimary Disease Other Complications Complication* 560.9 SBO 555.2 Regional Enteritis of Small Intestine with Large Intestine V55.2 Attention to Ileostomy 46.51 Closure of Intestinal Stoma small intestine P 96.07 Non operative Insert naso-gastric tube Pharm IV TPNPharm AntibioticsPharm Other MedsX-ray Plain Abd (S800XR1000 ) P 45.73 Right Hemicolectomy S 46.01 Loop Ileostomy DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03 56 PatientsALOS 3.89 $4,693 (Cost) 27 PatientsALOS 8.76 $9,3040 (Cost) 657 PatinetsALOS 3.68 $2,568 (Cost) $396.79 IV TPN $738 Antibiotics $1,756 Other Meds $62.80 XRay Total Cost = $16,664 (Tests/Meds already included in procedures)

  40. P 54.59 Lysis of Adhesions (Abdomen) DRG 153Minor Small and Large Bowel Procedures without CCAverage National Payment $4,769.94 PATIENT WORKSHEET 6.4: CROHN’S DISEASE (REGIONAL ENTERITIS) 15% Incidence A 24-year-old sales representative of a biotech company develops acute right lower quadrant pain. An upper GI/small bowel follow through subsequently shows 20 cm of inflammatory bowel disease in the terminal ileum to the ileosecal valve. The patient’s symptoms improve only slightly with medication until another acute episode occurs. A CT scan shows phegman in the right lower quadrant adjacent to the cecum. Exploration, ileocolic resection, drains, ileotransverse colon anastomosis and loop ileostomy. Patient discharged POD #9. Ileostomy is closed three months later. Seven days after procedure, patient experiences abdominal distention, nausea, and WBC 14,000. X-ray reveals small bowel obstruction and lysis of adhesion. Discharge POD #17. Discharge Other Disease Processes Subsequent Procedures Planned Subsequent Procedures Discharge Surgical Treatment Medical Treatment Discharge Small BowelObstruction Surgical Treatment InitialComplication Complication* Anastomotic Problems Discharge Surgical Treatment Planned Subsequent Procedures Recurrence ofPrimary Disease Other Complications Complication* 555.2 Regional Enteritis of Small Intestine with Large Intestine V55.2 Attention to Ileostomy P 560.9 Small Bowel Obstruction 46.51 Closure of Intestinal Stoma small intestine P 45.73 Right Hemicolectomy S 46.01 Loop Ileostomy DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03 DRG 150Peritoneal Adhesiolysis with CCAverage National Payment $11,114.69 56 PatientsALOS 3.89 $4,693 (Cost) 27 PatientsALOS 8.76 $9,403 (Cost) 15 PatientsALOS 12.93 $10,633 (Cost) Total Cost = $24,729

  41. P 45.73 Right Hemicolectomy PATIENT WORKSHEET 6.5: CROHN’S DISEASE (REGIONAL ENTERITIS) 75-80% Incidence Five years after a first episode, the now 29-year-old vice president of sales develops nausea and vomiting with an obstructive picture. Recurrent disease with structuring found at the ileocolic anastomosis. Repeat ileocolic resection. ALOS is six days. Discharge Other Disease Processes Subsequent Procedures Planned Subsequent Procedures Discharge Surgical Treatment Medical Treatment Discharge Small BowelObstruction Surgical Treatment InitialComplication Complication* Anastomotic Problems Discharge Surgical Treatment Planned Subsequent Procedures Recurrence ofPrimary Disease Other Complications Complication* 555.2 Regional Enteritis of Small Intestine with Large Intestine DRG 149Major Small and Large Bowel Procedures without CCAverage National Payment $6,352.95 6 PatientsALOS 5.83 $6,879 (Cost) Total Cost = $6,879

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