CODING REIMBURSE- MENT AND COST CARE PATH DIAGRAM PROCEDURE CODING PATIENT SCENARIO HISTORY Point of Care Targeted by Seprafilm TM 1 © Premier Innovation.

CODING REIMBURSE- MENT AND COST CARE PATH DIAGRAM PROCEDURE CODING PATIENT SCENARIO HISTORY Point of Care Targeted by Seprafilm TM 1 © Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute. [Insert Scenario Description] PATIENT SCENARIO Total Cost = $______

CODING REIMBURSE- MENT AND COST CARE PATH DIAGRAM PROCEDURE CODING PATIENT SCENARIO HISTORY Point of Care Targeted by Seprafilm TM 2 © Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute. Surgical Treatment Surgical Treatment PATIENT WORKSHEET 1.0: COLON CANCER AND NEOPLASMS Overview of all diagnosis and procedures. 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. Recurrence of Primary Disease 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 46.03Loop Colostomy 46.11Temporary Colostomy 46.01Loop Ileostomy 46.20Ileostomy 46.21Temporary Ileostomy 45.7Partial Large Bowel Excision 54.59Lysis of Adhesions (Abdomen) PharmIV Fluid PharmIV TPN Labs Blood Work Labs All other excluding Blood work RadPlain Abd X-ray Contrast Upper/Lower RadChest X-ray PharmAntibiotics Pharm All other Meds Rad CT Scan (Abdomen) 45.75Left Hemicolectomy 45.73Right Hemicolectomy 45.8Total Intra-Abd Colectomy 45.74Transverse Colon Resect 45.76Sigmoidectomy 46.03Loop Colostomy (Exterz Large Intestine) 46.10Colostomy NOS 46.11Temporary Colostomy 46.21Temporary Ileostomy 54.59Lysis of Adhesions (Abdomen) Subsequent Procedures Subsequent Procedures Surgical Treatment Surgical Treatment Initial Complication Discharge Complication* Small Bowel Obstruction Planned Subsequent Procedures Planned Subsequent Procedures Surgical Treatment Surgical Treatment Medical Treatment Medical Treatment 45.75Left Hemicolectomy 45.73Right Hemicolectomy 45.8Total Intra-Abd Colectomy 45.74Transverse Colon Resect 45.76Sigmoidectomy 46.10Colostomy NOS 48.69 Closure of Hartman XX.XX NG Suction 54.59Lysis of Adhesions (Abdomen 46.03 Loop Colostomy 46.11 Temporary Colostomy 46.01 Loop Ileostomy 46.20 Ileostomy 46.21 Temporary Ileostomy) Adjuvant Therapy Adjuvant Therapy Recurrence of Primary Disease Other Disease Processes Other Disease Processes 553.21Incisional Hernia Other Complications Other Complications Anastomotic Problems Anastomotic Problems 997.4 Anastomotic Leak 997.4 Anastomotic Stricture 998.11Post-op Hemorrhage V55.2 Attention to Ileostomy V55.3 Attention to Colostomy Planned Subsequent Procedures Planned Subsequent Procedures 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

CODING REIMBURSE- MENT AND COST CARE PATH DIAGRAM PROCEDURE CODING PATIENT SCENARIO HISTORY Point of Care Targeted by Seprafilm TM 3 © Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute. PATIENT WORKSHEET 1.1: COLON CANCER AND NEOPLASMS 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. Anastomotic Problems Anastomotic Problems Subsequent Procedures Subsequent Procedures Surgical Treatment Surgical Treatment Initial Complication Discharge Other Complications Other Complications Discharge Complication* Small Bowel Obstruction Planned Subsequent Procedures Planned Subsequent Procedures Surgical Treatment Surgical Treatment Surgical Treatment Surgical Treatment Medical Treatment Medical Treatment Adjuvant Therapy Adjuvant Therapy Recurrence of Primary Disease Other Disease Processes Other Disease Processes Planned Subsequent Procedures Planned Subsequent Procedures 153.4Colon cancer P 45.8Total 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 8 patients ALOS 10.75 $13,681 (Cost) 56 Patients ALOS 3.89 $4,693 (Cost) P 46.51 Closure stoma small intestine Total Cost = $18,374 DRG 148 Major Small and Large Bowel Procedures with CC Average National Payment $13,892.03 V55.2 Attention to Ileostomy DRG 153 Minor Small and Large Bowel Procedures without CC Average National Payment $4,769.84 10-15% Incidence

CODING REIMBURSE- MENT AND COST CARE PATH DIAGRAM PROCEDURE CODING PATIENT SCENARIO HISTORY Point of Care Targeted by Seprafilm TM 4 © Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute. PATIENT WORKSHEET 1.2: COLON CANCER AND NEOPLASMS Total Cost = $21,157 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. Anastomotic Problems Anastomotic Problems Subsequent Procedures Subsequent Procedures Surgical Treatment Surgical Treatment Initial Complication Discharge Other Complications Other Complications Discharge Complication* Small Bowel Obstruction Planned Subsequent Procedures Planned Subsequent Procedures Surgical Treatment Surgical Treatment Surgical Treatment Surgical Treatment Medical Treatment Medical Treatment Adjuvant Therapy Adjuvant Therapy Recurrence of Primary Disease Other Disease Processes Other Disease Processes P 46.51 Closure Stoma small intestine S 54.59 Lysis of Adhesions Planned Subsequent Procedures Planned Subsequent Procedures 2 Patients ALOS 6.5 $ 7,476 (Cost) P 45.8Total Intra-Abd Colectomy **NO PATIENTS FOUND WITH EITHER SECONDARY PROCEDURE USING THESE CODES.** S 48.69Closure of Hartman S 46.21Temporary Ileostomy 153.4 Colon Cancer DRG 148 Major Small and Large Bowel Procedures with CC Average National Payment $13,892.03 8 patients ALOS 10.75 $13,681 (Cost) DRG 150 Peritoneal Adhesiolysis without CC Average National Payment $11,114.69 10-15% Incidence V55.2 Attention to Ileostomy

CODING REIMBURSE- MENT AND COST CARE PATH DIAGRAM PROCEDURE CODING PATIENT SCENARIO HISTORY Point of Care Targeted by Seprafilm TM 5 © Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute. PATIENT WORKSHEET 1.3: COLON CANCER AND NEOPLASMS Total Cost = $23,899 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. Subsequent Procedures Subsequent Procedures Discharge Complication* Planned Subsequent Procedures Planned Subsequent Procedures Surgical Treatment Surgical Treatment Surgical Treatment Surgical Treatment Adjuvant Therapy Adjuvant Therapy Surgical Treatment Surgical Treatment Recurrence of Primary Disease Anastomotic Problems Anastomotic Problems Other Complications Other Complications Recurrence of Primary Disease Other Disease Processes Other Disease Processes Initial Complication Small Bowel Obstruction Planned Subsequent Procedures Planned Subsequent Procedures Pharm IV TPN PharmAntibiotics Pharm Other Meds X-ray Plain Abd (S800XR1000 ) $62.80 XRay $396.79 IV TPN124 patients ALOS 5.65 $ 5,609 (Cost) 153.3Sigmoid Colon 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.** 13 patients ALOS 14.69 $15,722 (Cost) $738 Antibiotics $1,756 Other Meds (Tests/Meds already included in procedures) DRG 148 Major Small and Large Bowel Procedures with CC Average National Payment $13,892.03 P 46.52 Closure stoma large intestine V55.3 Attention to colostomy DRG 153 Minor Small and Large Bowel Procedures without CC Average National Payment $4,769.94 10-15% Incidence 657 patients ALOS 3.68 $2,568 (Cost) DRG 181 GI Obstruction without CC Average National Payment $2,133.64 P 96.07 Non operative Insert naso-gastric tube 560.9 SBO Medical Treatment Medical Treatment

CODING REIMBURSE- MENT AND COST CARE PATH DIAGRAM PROCEDURE CODING PATIENT SCENARIO HISTORY Point of Care Targeted by Seprafilm TM 6 © Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute. PATIENT WORKSHEET 1.4: COLON CANCER AND NEOPLASMS Total Cost = $31,964 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. Subsequent Procedures Subsequent Procedures Discharge Complication* Planned Subsequent Procedures Planned Subsequent Procedures Surgical Treatment Surgical Treatment Surgical Treatment Surgical Treatment Adjuvant Therapy Adjuvant Therapy Surgical Treatment Surgical Treatment Recurrence of Primary Disease Anastomotic Problems Anastomotic Problems Other Complications Other Complications Recurrence of Primary Disease Other Disease Processes Other Disease Processes Medical Treatment Medical Treatment Initial Complication Small Bowel Obstruction Planned Subsequent Procedures Planned Subsequent Procedures 124 patients ALOS 5.65 $ 5,609 (Cost) 153.3Sigmoid Colon 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.** 13 patients ALOS 14.69 $15,722 (Cost) DRG 148 Major Small and Large Bowel Procedures with CC Average National Payment $13,892.03 P 46.52 Closure stoma large intestine V55.3 Attention to colostomy DRG 153 Minor Small and Large Bowel Procedures without CC Average National Payment $4,769.94 10-15% Incidence 15 Patients ALOS 12.93 $10,633 (Cost) DRG 150 Peritoneal Adhesiolysis with CC Average National Payment $11,114.69 P 560.9 Small Bowel Obstruction P 54.59 Lysis of Adhesions (Abdomen)

CODING REIMBURSE- MENT AND COST CARE PATH DIAGRAM PROCEDURE CODING PATIENT SCENARIO HISTORY Point of Care Targeted by Seprafilm TM 7 © Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute. PATIENT WORKSHEET 1.5: COLON CANCER AND NEOPLASMS Total Cost = $6,462 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. 50-75% Incidence 153.4Cecum Cancer P 45.73 Right Hemicolectomy Anastomotic Problems Anastomotic Problems Subsequent Procedures Subsequent Procedures Surgical Treatment Surgical Treatment Initial Complication Discharge Other Complications Other Complications Discharge Complication* Small Bowel Obstruction Planned Subsequent Procedures Planned Subsequent Procedures Surgical Treatment Surgical Treatment Surgical Treatment Surgical Treatment Medical Treatment Medical Treatment Planned Subsequent Procedures Planned Subsequent Procedures Adjuvant Therapy Adjuvant Therapy Recurrence of Primary Disease Other Disease Processes Other Disease Processes 46 Patients ALOS 6.11 $ 6,462 (Cost) DRG 149 Major Small and Large Bowel Procedures without CC Average National Payment $6,352.95

CODING REIMBURSE- MENT AND COST CARE PATH DIAGRAM PROCEDURE CODING PATIENT SCENARIO HISTORY Point of Care Targeted by Seprafilm TM 8 © Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute. Adjuvant Therapy Adjuvant Therapy PATIENT WORKSHEET 1.6: COLON CANCER AND NEOPLASMS Total Cost = $9,868 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. Initial Complication Discharge Complication* Planned Subsequent Procedures Planned Subsequent Procedures Surgical Treatment Surgical Treatment Surgical Treatment Surgical Treatment Surgical Treatment Surgical Treatment Recurrence of Primary Disease Medical Treatment Medical Treatment Anastomotic Problems Anastomotic Problems Other Complications Other Complications Small Bowel Obstruction Recurrence of Primary Disease Other Disease Processes Other Disease Processes Subsequent Procedures Subsequent Procedures 51.23 Laparascopic Cholecystectomy Planned Subsequent Procedures Planned Subsequent Procedures Discharge 88 Patients ALOS 6.15 $6,108 (Cost) 1576 Patients ALOS 1.95 $3,760 (Cost) 153.3Sigmoid 57410 Calculus of gallbladder with other cholecystitis, without mention of obstruction DRG 494 Laparoscopic Cholecystectomy without Common Duct without CC Average National Payment $3,854.00 DRG 149 Major Small and Large Bowel Procedures without CC Average National Payment $6,352.95 50-75% Incidence P 45.76 Sigmoidectomy

CODING REIMBURSE- MENT AND COST CARE PATH DIAGRAM PROCEDURE CODING PATIENT SCENARIO HISTORY Point of Care Targeted by Seprafilm TM 9 © Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute. Adjuvant Therapy Adjuvant Therapy PATIENT WORKSHEET 1.7: COLON CANCER AND NEOPLASMS Total Cost = $20,194 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. 50.3 Right Hepatic Lobectomy Discharge Complication* Planned Subsequent Procedures Planned Subsequent Procedures Surgical Treatment Surgical Treatment Surgical Treatment Surgical Treatment Medical Treatment Medical Treatment Discharge Other Complications Other Complications Small Bowel Obstruction Recurrence of Primary Disease Other Disease Processes Other Disease Processes Planned Subsequent Procedures Planned Subsequent Procedures Initial Complication Subsequent Procedures Subsequent Procedures Rad CT Scan (abdomen) S800CT1000 CT scan of abdomen w and w/o contrast Recurrence of Primary Disease Anastomotic Problems Anastomotic Problems Surgical Treatment Surgical Treatment $187.92 88 Patients ALOS 6.15 $6,108 (Cost) 197.7 Liver Metastasis P 45.76 Sigmoidectomy 19 Patients ALOS 8.58 $14,086 (Cost) 153.3Sigmoid (Test already included in procedures) DRG 149 Major Small and Large Bowel Procedures without CC Average National Payment $6,352.95 DRG 191 Pancreas, Liver and Shunt Procedures with CC Average National Payment $17,830.90 50-75% Incidence

CODING REIMBURSE- MENT AND COST CARE PATH DIAGRAM PROCEDURE CODING PATIENT SCENARIO HISTORY Point of Care Targeted by Seprafilm TM 10 © Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute. Adjuvant Therapy Adjuvant Therapy 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 153.0Hepatic Flexure 153.1Transverse Colon 153.2Descending Colon 153.3Sigmoid Colon 153.4Cecum 153.5Appendix 153.6Ascending Colon 153.7Splenic Flexure 153.8Colon NEC 153.9Colon NOS 154.0Neoplasm Colon 154.1Rectum 154.8Rectum/Anus NEC 159.0Intestine NOS 48.41Soave submucosal Rectal Pull Through 48.49 Other Rectal Pull Through 48.5Abd-Perineal Rectum Resection 48.62Anterior Rectum Resection w/Colostomy 48.69Rectal Resection NEC 48.63Anterior Rectum Resection NEC 46.03Loop Colostomy (Exterz Large Intestine) 46.10Colostomy NOS 46.11Temporary Colostomy 46.21Temp Ileostomy 54.59Lysis of Adhesions (Abdomen) XX.XX Small Bowel Suspension w/Sling 997.4 Anastomotic Leak 998.11 Post-op Hemorrhage 54.59Lysis of Adhesions (Abdomen) 45.60Small Bowel Resection 46.01Loop Ileostomy 46.03Loop Colostomy 46.11Temporary Colostomy 46.01Loop Ileostomy 46.20Ileostomy NOS 46.21Temp. Ileostomy 46.51Intestinal Stoma Closure 45.90Intestinal Anastomosis 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) Anastomotic Problems Anastomotic Problems Subsequent Procedures Subsequent Procedures Initial Complication Discharge Complication* Small Bowel Obstruction Planned Subsequent Procedures Planned Subsequent Procedures Surgical Treatment Surgical Treatment Surgical Treatment Surgical Treatment Planned Subsequent Procedures Planned Subsequent Procedures Recurrence of Primary Disease Other Disease Processes Other Disease Processes Surgical Treatment Surgical Treatment Overview of all diagnosis and procedures. 553.21Incisional Hernia Other Complications Other Complications V55.2 Attention to Ileostomy V55.3 Attention to Colostomy Medical Treatment Medical Treatment PharmIV Fluid PharmIV TPN LabsBloodwork Labs All other excluding Blood work RadPlain Abd X-ray Rad CT Scan (Abdomen) PharmCoumadin (aka Warfarin), Heparin PharmAntibiotics Pharm All other Meds

CODING REIMBURSE- MENT AND COST CARE PATH DIAGRAM PROCEDURE CODING PATIENT SCENARIO HISTORY Point of Care Targeted by Seprafilm TM 11 © Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute. PATIENT WORKSHEET 2.1: RECTAL CANCER 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. 154.1 Malignant Neoplasm Rectum Anastomotic Problems Anastomotic Problems Subsequent Procedures Subsequent Procedures Initial Complication Discharge Other Complications Other Complications Discharge Complication* Small Bowel Obstruction Planned Subsequent Procedures Planned Subsequent Procedures Surgical Treatment Surgical Treatment Surgical Treatment Surgical Treatment Medical Treatment Medical Treatment Planned Subsequent Procedures Planned Subsequent Procedures Recurrence of Primary Disease Other Disease Processes Other Disease Processes Surgical Treatment Surgical Treatment P 48.63 Anterior Rectum Resection NEC 25 Patients ALOS 6.8 $7,029 (Cost) Total Cost = $7,530 V58.1 Chemotherapy P 99.25 Chemoradiation 136 Patients ALOS 0 (outpatient) $501 (Cost) DRG 147 Rectal Resection without CC Average National Payment $6,512.85 No DRG - Outpatient procedure 50-75% Incidence Adjuvant Therapy Adjuvant Therapy

CODING REIMBURSE- MENT AND COST CARE PATH DIAGRAM PROCEDURE CODING PATIENT SCENARIO HISTORY Point of Care Targeted by Seprafilm TM 12 © Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute. Adjuvant Therapy Adjuvant Therapy PATIENT WORKSHEET 2.2: RECTAL CANCER 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. 154.1 Malignant Neoplasm Rectum Discharge Complication* Planned Subsequent Procedures Planned Subsequent Procedures Surgical Treatment Surgical Treatment Surgical Treatment Surgical Treatment Medical Treatment Medical Treatment Planned Subsequent Procedures Planned Subsequent Procedures Recurrence of Primary Disease Surgical Treatment Surgical Treatment P 48.63 Anterior Rectum Resection NEC 25 Patients ALOS 6.8 $7,029 (Cost) Total Cost = $15,006 V58.1 Chemotherapy P 99.25 Chemoradiation 136 Patients ALOS 0 (outpatient) $501 (Cost) DRG 147 Rectal Resection without CC Average National Payment $6,512.85 No DRG - Outpatient procedure 50-75% Incidence Subsequent Procedures Subsequent Procedures Recurrence of Primary Disease Other Disease Processes Other Disease Processes Anastomotic Problems Anastomotic Problems Other Complications Other Complications Small Bowel Obstruction P 46.51 Closure Stoma small intestine S 54.59 Lysis of Adhesions 2 Patients ALOS5.6.50 $ 7,476 (Cost) DRG 150 Peritoneal Adhesiolysis without CC Average National Payment $11,114.69 V55.2 Attention to Ileostomy Initial Complication

CODING REIMBURSE- MENT AND COST CARE PATH DIAGRAM PROCEDURE CODING PATIENT SCENARIO HISTORY Point of Care Targeted by Seprafilm TM 13 © Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute. PATIENT WORKSHEET 2.3: RECTAL CANCER 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. 154.1 Malignant Neoplasm Rectum Anastomotic Problems Anastomotic Problems Subsequent Procedures Subsequent Procedures Initial Complication Discharge Other Complications Other Complications Discharge Complication* Small Bowel Obstruction Planned Subsequent Procedures Planned Subsequent Procedures Surgical Treatment Surgical Treatment Surgical Treatment Surgical Treatment Medical Treatment Medical Treatment Recurrence of Primary Disease Other Disease Processes Other Disease Processes Surgical Treatment Surgical Treatment P 48.63 Anterior Rectum Resection NEC 25 Patients ALOS 6.8 $7,029 (Cost) Total Cost = $10,098 V58.1 Chemotherapy P 99.25 Chemoradiation 136 Patients ALOS 0 (outpatient) $501 (Cost) DRG 147 Rectal Resection without CC Average National Payment $6,512.85 No DRG - Outpatient procedure 50-75% Incidence Planned Subsequent Procedures Planned Subsequent Procedures Adjuvant Therapy Adjuvant Therapy Pharm IV TPN PharmAntibiotics Pharm Other Meds X-ray Plain Abd (S800XR1000 ) 560.9 SBO P 96.07 Non operative Insert naso-gastric tube DRG 181 GI Obstruction without CC Average National Payment $2,133.64 657 Patinets ALOS 3.68 $2,568 (Cost) $62.80 XRay (Tests/Meds already included in procedures) $396.79 IV TPN $738 Antibiotics $1,756 Other Meds

CODING REIMBURSE- MENT AND COST CARE PATH DIAGRAM PROCEDURE CODING PATIENT SCENARIO HISTORY Point of Care Targeted by Seprafilm TM 14 © Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute. Adjuvant Therapy Adjuvant Therapy PATIENT WORKSHEET 2.4: RECTAL CANCER 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. 154.1 Malignant Neoplasm Rectum Anastomotic Problems Anastomotic Problems Subsequent Procedures Subsequent Procedures Initial Complication Discharge Other Complications Other Complications Discharge Complication* Small Bowel Obstruction Planned Subsequent Procedures Planned Subsequent Procedures Surgical Treatment Surgical Treatment Surgical Treatment Surgical Treatment Medical Treatment Medical Treatment Recurrence of Primary Disease Other Disease Processes Other Disease Processes Surgical Treatment Surgical Treatment P 48.63 Anterior Rectum Resection NEC 25 Patients ALOS 6.8 $7,029 (Cost) Total Cost = $18,163 V58.1 Chemotherapy P 99.25 Chemoradiation 136 Patients ALOS 0 (outpatient) $501 (Cost) DRG 147 Rectal Resection without CC Average National Payment $6,512.85 No DRG - Outpatient procedure 50-75% Incidence Planned Subsequent Procedures Planned Subsequent Procedures 15 Patients ALOS 12.93 $10,633 (Cost) DRG 150 Peritoneal Adhesiolysis with CC Average National Payment $11,114.69 P 560.9 Small Bowel Obstruction P 54.59 Lysis of Adhesions (Abdomen)

CODING REIMBURSE- MENT AND COST CARE PATH DIAGRAM PROCEDURE CODING PATIENT SCENARIO HISTORY Point of Care Targeted by Seprafilm TM 15 © Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute. Adjuvant Therapy Adjuvant Therapy PATIENT WORKSHEET 2.5: RECTAL CANCER 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. Subsequent Procedures Subsequent Procedures Initial Complication Discharge Other Complications Other Complications Discharge Complication* Small Bowel Obstruction Planned Subsequent Procedures Planned Subsequent Procedures Surgical Treatment Surgical Treatment Surgical Treatment Surgical Treatment Medical Treatment Medical Treatment Planned Subsequent Procedures Planned Subsequent Procedures Recurrence of Primary Disease Other Disease Processes Other Disease Processes Surgical Treatment Surgical Treatment Anastomotic Problems Anastomotic Problems P 48.5 Abdominoperin Rectum Resection 117 Patients ALOS 10.53 $11,900 (Cost) Total Cost = $12,401 P 154.1 Malignant Neoplasm Rectum V58.1 Chemotherapy P 99.25 Chemoradiation No DRG - Outpatient procedure 136 Patients ALOS 0 (outpatient) $501 (Cost) DRG 146 Rectal Resection with CC Average National Payment $11,215.96 50-75% Incidence

CODING REIMBURSE- MENT AND COST CARE PATH DIAGRAM PROCEDURE CODING PATIENT SCENARIO HISTORY Point of Care Targeted by Seprafilm TM 16 © Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute. PATIENT WORKSHEET 2.6: RECTAL CANCER 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. P 46.52Closure stoma large intestine Subsequent Procedures Subsequent Procedures Discharge Other Complications Other Complications Discharge Complication* Surgical Treatment Surgical Treatment Surgical Treatment Surgical Treatment Planned Subsequent Procedures Planned Subsequent Procedures Recurrence of Primary Disease Other Disease Processes Other Disease Processes Adjuvant Therapy Adjuvant Therapy Surgical Treatment Surgical Treatment Anastomotic Problems Anastomotic Problems Medical Treatment Medical Treatment P V55.3 Attention to Colostomy Small Bowel Obstruction Complication* Initial Complication P 48.62Anterior Rectum Resection w/ Colostomy **NO PATIENTS FOUND WITH A SECONDARY DIAGNOSIS OF 48.69 - Rectum Resection 3 Patients ALOS 11.67 $12,297 (Cost) Contrast Enema (Lower GI series) **NOT ABLE TO BREAK OUT COST SEPARATELY** 124 Patients ALOS 5.65 $5,609 (Cost) Planned Subsequent Procedures Planned Subsequent Procedures Total Cost = $17,906 P 154.1 Malignant Neoplasm Rectum S 997.4 Anastomotic Leak DRG 146 Rectal Resection with CC Average National Payment $11,215.96 DRG 153 Minor Small and Large Bowel Procedures without CC Average National Payment $4,769.94 15-25% Incidence

CODING REIMBURSE- MENT AND COST CARE PATH DIAGRAM PROCEDURE CODING PATIENT SCENARIO HISTORY Point of Care Targeted by Seprafilm TM 17 © Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute. 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) 562.10Diverticulosis of Colon 562.11Diverticulitis of Colon 562.12Diverticulosis of Colon with Hemorrhage 562.13Diverticulitis of Colon with Hemorrhage PATIENT WORKSHEET 3.0: DIVERTICULAR DISEASE 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 Anastomotic Problems Anastomotic Problems Recurrence of Primary Disease Subsequent Procedures Subsequent Procedures Surgical Treatment Surgical Treatment Discharge Other Complications Other Complications Discharge Complication* Small Bowel Obstruction Planned Subsequent Procedures Planned Subsequent Procedures Surgical Treatment Surgical Treatment Other Disease Processes Other Disease Processes V55.2 Attention to Ileostomy V55.3 Attention to Colostomy 46.51Intestinal Stoma Closure 45.9 0Intestinal Anastomosis 46.03 Loop Colostomy 46.11 Temporary Colostomy 46.01 Loop Ileostomy 46.20 Ileostomy NOS 46.21 Temp. Ileostomy Surgical Treatment Surgical Treatment 54.59 Lysis of Adhesions (Abdomen) 45.60 Small Bowel Resection 46.51 Intestinal Stoma Closure 45.90 Intestinal Anastomosis Overview of all diagnosis and procedures. Medical Treatment Medical Treatment Planned Subsequent Procedures Planned Subsequent Procedures Initial Complication PharmIV Fluid PharmIV TPN Foley (CATH insertion) Labs Blood Work Labs All other excluding Blood work RadPlain Abd X-ray Contrast Upper/Lower Rad CT Scan (Abdomen) PharmWater Soluble Contrast Upper/Lower Endoscopy PharmAntibiotics and Meds 553.21Incisional Hernia 997.4 Anastomotic Leak 997.4 Anastomotic Stricture 998.11 Post-op Hemorrhage

CODING REIMBURSE- MENT AND COST CARE PATH DIAGRAM PROCEDURE CODING PATIENT SCENARIO HISTORY Point of Care Targeted by Seprafilm TM 18 © Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute. A 53-year-old moderately obese Missouri farmer presents with a 4-day history of left lower quadrant abdominal pain, fever of 39 o C, 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. PATIENT WORKSHEET 3.1: DIVERTICULAR DISEASE P 46.52 Closure stoma of large intestine Recurrence of Primary Disease Subsequent Procedures Subsequent Procedures Initial Complication Discharge Other Complications Other Complications Discharge Complication* Small Bowel Obstruction Other Disease Processes Other Disease Processes Surgical Treatment Surgical Treatment Surgical Treatment Surgical Treatment Medical Treatment Medical Treatment Anastomotic Problems Anastomotic Problems Planned Subsequent Procedures Planned Subsequent Procedures Planned Subsequent Procedures Planned Subsequent Procedures $216.58 CT Scan $454.19 Blood work 562.11Diverticulitis of Colon Surgical Treatment Surgical Treatment P 45.75 Left Hemicolectomy S 46.11 Temporary Colostomy 9 Patients ALOS 10.11 $12,786 (Cost) 124 Patients ALOS 5.65 $5,609 (Cost) (Tests already included in procedures) Total Cost = $18,395 Rad CT Scan S800CT1001 - CT Scan abdomen w/contrast LAB Blood Work P V55.3 Attention to Colostomy DRG 148 Major Small and Large Bowel Procedures with CC Average National Payment $13,892.03 DRG 153 Minor Small and Large Bowel Procedures without CC Average National Payment $ 4,769.94 10-15% Incidence

CODING REIMBURSE- MENT AND COST CARE PATH DIAGRAM PROCEDURE CODING PATIENT SCENARIO HISTORY Point of Care Targeted by Seprafilm TM 19 © Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute. A 53-year-old moderately obese Missouri farmer presents with a 4-day history of left lower quadrant abdominal pain, fever of 39 o C, 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. PATIENT WORKSHEET 3.2: DIVERTICULAR DISEASE Recurrence of Primary Disease Subsequent Procedures Subsequent Procedures Initial Complication Discharge Other Complications Other Complications Discharge Complication* Small Bowel Obstruction Other Disease Processes Other Disease Processes Surgical Treatment Surgical Treatment Surgical Treatment Surgical Treatment Medical Treatment Medical Treatment Anastomotic Problems Anastomotic Problems Planned Subsequent Procedures Planned Subsequent Procedures Planned Subsequent Procedures Planned Subsequent Procedures $216.58 CT Scan $454.19 Blood work 562.11Diverticulitis of Colon Surgical Treatment Surgical Treatment P 45.75 Left Hemicolectomy S 46.11 Temporary Colostomy S 4X.XX Hartman Resection of Rectum 9 Patients ALOS 10.11 $12,786 (Cost) (Tests already included in procedures. Italicized costs are not included.) Total Cost = $22,464 Rad CT Scan S800CT1001 - CT Scan abdomen w/contrast LAB Blood Work V55.3 Attention to Colostomy DRG 148 Major Small and Large Bowel Procedures with CC Average National Payment $13,892.03 10-15% Incidence P 46.52 Closure Stoma large intestine S 54.59 Lysis of Adhesions 69 Patients ALOS9.07 $ 9,678 (Cost) DRG 150 Peritoneal Adhesiolysis without CC Average National Payment $11,114.69

CODING REIMBURSE- MENT AND COST CARE PATH DIAGRAM PROCEDURE CODING PATIENT SCENARIO HISTORY Point of Care Targeted by Seprafilm TM 20 © Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute. 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. PATIENT WORKSHEET 3.3: DIVERTICULAR DISEASE Recurrence of Primary Disease Subsequent Procedures Subsequent Procedures Surgical Treatment Surgical Treatment Discharge Other Complications Other Complications Discharge Complication* Small Bowel Obstruction Planned Subsequent Procedures Planned Subsequent Procedures Other Disease Processes Other Disease Processes Surgical Treatment Surgical Treatment Surgical Treatment Surgical Treatment Medical Treatment Medical Treatment Anastomotic Problems Anastomotic Problems Planned Subsequent Procedures Planned Subsequent Procedures Pharm IV Fluid LAB Blood Work Initial Complication P V55.3 Attention to Colostomy P 46.52 Closure stoma large intestine $151.61 IV fluid $10.57 Blood work 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 3 Patients ALOS 15.00 $34,840 (Cost) 136 Patients ALOS 6.91 $7,306 (Cost) Total Cost = $44,714 562.12Diverticulosis of Colon with Hemorrhage DRG 148 Major Small and Large Bowel Procedures with CC Average National Payment $13,892.03 DRG 152 Major Small and Large Bowel Procedures with CC Average National Payment $7,846.99 10-15% Incidence $62.80 XRay $396.79 IV TPN $738 Antibiotics $1,756 Other Meds 657 Patients ALOS 3.68 $2,568 (Cost) 560.9 SBO P 96.07 Non operative Insert naso-gastric tube DRG 181 GI Obstruction without CC Average National Payment $2,133.64 Pharm IV TPN PharmAntibiotics Pharm Other Meds X-ray Plain Abd (S800XR1000 ) (Tests/Meds already included in procedures)

CODING REIMBURSE- MENT AND COST CARE PATH DIAGRAM PROCEDURE CODING PATIENT SCENARIO HISTORY Point of Care Targeted by Seprafilm TM 21 © Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute. 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. PATIENT WORKSHEET 3.4: DIVERTICULAR DISEASE P 54.59 Lysis of Adhesions (Abdomen) Recurrence of Primary Disease Subsequent Procedures Subsequent Procedures Surgical Treatment Surgical Treatment Discharge Other Complications Other Complications Discharge Complication* Small Bowel Obstruction Planned Subsequent Procedures Planned Subsequent Procedures Other Disease Processes Other Disease Processes Surgical Treatment Surgical Treatment Surgical Treatment Surgical Treatment Medical Treatment Medical Treatment Anastomotic Problems Anastomotic Problems Planned Subsequent Procedures Planned Subsequent Procedures Pharm IV Fluid LAB Blood Work Initial Complication P V55.3 Attention to Colostomy P 46.52 Closure stoma large intestine $151.61 IV fluid $10.57 Blood work 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 3 Patients ALOS 15.00 $34,840 (Cost) 136 Patients ALOS 6.91 $7,306 (Cost) 15 Patients ALOS 12.93 $10,633 (Cost) (Tests already included in procedures) Total Cost = $52,779 562.12Diverticulosis of Colon with Hemorrhage DRG 148 Major Small and Large Bowel Procedures with CC Average National Payment $13,892.03 DRG 152 Major Small and Large Bowel Procedures with CC Average National Payment $7,846.99 DRG 150 Peritoneal Adhesiolysis with CC Average National Payment $11,114.69 P 560.9 Small Bowel Obstruction 10-15% Incidence

CODING REIMBURSE- MENT AND COST CARE PATH DIAGRAM PROCEDURE CODING PATIENT SCENARIO HISTORY Point of Care Targeted by Seprafilm TM 22 © Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute. 562.11Diverticulitis of Colon PATIENT WORKSHEET 3.5: DIVERTICULAR DISEASE Anastomotic Problems Anastomotic Problems Recurrence of Primary Disease Subsequent Procedures Subsequent Procedures Surgical Treatment Surgical Treatment Initial Complication Discharge Other Complications Other Complications Discharge Complication* Small Bowel Obstruction Planned Subsequent Procedures Planned Subsequent Procedures Other Disease Processes Other Disease Processes Surgical Treatment Surgical Treatment Surgical Treatment Surgical Treatment Planned Subsequent Procedures Planned Subsequent Procedures A 53-year-old moderately obese Missouri farmer presents with a 4-day history of left lower quadrant abdominal pain, fever of 39 o C, 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. Medical Treatment Medical Treatment P 45.75 Left Hemicolectomy 130 Patients ALOS 10.76 $11,747 (Cost) Total Cost = $11,747 DRG 148 Major Small and Large Bowel Procedures with CC Average National Payment $13,892.03 50-75% Incidence

CODING REIMBURSE- MENT AND COST CARE PATH DIAGRAM PROCEDURE CODING PATIENT SCENARIO HISTORY Point of Care Targeted by Seprafilm TM 23 © Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute. A 53-year-old moderately obese Missouri farmer presents with a 4-day history of left lower quadrant abdominal pain, fever of 39 o C, 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 39 o C, 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. PATIENT WORKSHEET 3.6: DIVERTICULAR DISEASE P 46.52 Closure stoma of large intestine Recurrence of Primary Disease Subsequent Procedures Subsequent Procedures Initial Complication Discharge Other Complications Other Complications Discharge Complication* Small Bowel Obstruction Other Disease Processes Other Disease Processes Surgical Treatment Surgical Treatment Surgical Treatment Surgical Treatment Medical Treatment Medical Treatment Anastomotic Problems Anastomotic Problems Planned Subsequent Procedures Planned Subsequent Procedures Planned Subsequent Procedures Planned Subsequent Procedures $216.58 CT Scan $454.19 Blood work 562.11Diverticulitis of Colon Surgical Treatment Surgical Treatment P 45.75 Left Hemicolectomy S 46.11 Temporary Colostomy S 4X.XX Hartman Resection of Rectum 9 Patients ALOS 10.11 $12,786 (Cost) 124 Patients ALOS 5.65 $5,609 (Cost) 46.51 Closure Stoma Small Intestine 56 Patients ALOS 3.89 $4,693 (Cost) (Tests already included in procedures) Total Cost = $45,902 Rad CT Scan S800CT1001 - CT Scan abdomen w/contrast LAB Blood Work P V55.3 Attention to Colostomy DRG 148 Major Small and Large Bowel Procedures with CC Average National Payment $13,892.03 DRG 153 Minor Small and Large Bowel Procedures without CC Average National Payment $ 4,769.94 46.20Ileostomy NOS P 997.4 Anastomotic Leak S 569.5 Abscess of intestine **NO PATIENTS FOUND WITH ABSCESS AS SECONDARY DIAGNOSIS. DRG 148 Major Small and Large Bowel Procedures with CC Average National Payment $13,892.03 3 Patients ALOS 17.00 $21,117 (Cost) P V55.2 Attention to Ileostomy DRG 153 Minor Small and Large Bowel Procedures without CC Average National Payment $4,769.94 10-15% Incidence

CODING REIMBURSE- MENT AND COST CARE PATH DIAGRAM PROCEDURE CODING PATIENT SCENARIO HISTORY Point of Care Targeted by Seprafilm TM 24 © Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute. A 53-year-old moderately obese Missouri farmer presents with a 4-day history of left lower quadrant abdominal pain, fever of 39 o C, 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 39 o C, 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. PATIENT WORKSHEET 3.7: DIVERTICULAR DISEASE P 46.52 Closure stoma of large intestine Recurrence of Primary Disease Subsequent Procedures Subsequent Procedures Initial Complication Discharge Other Complications Other Complications Discharge Complication* Small Bowel Obstruction Other Disease Processes Other Disease Processes Surgical Treatment Surgical Treatment Surgical Treatment Surgical Treatment Medical Treatment Medical Treatment Anastomotic Problems Anastomotic Problems Planned Subsequent Procedures Planned Subsequent Procedures Planned Subsequent Procedures Planned Subsequent Procedures $216.58 CT Scan $454.19 Blood work Too High? 562.11Diverticulitis of Colon Surgical Treatment Surgical Treatment P 45.75 Left Hemicolectomy S 46.11 Temporary Colostomy S 4X.XX Hartman Resection of Rectum 9 Patients ALOS 10.11 $12,786 (Cost) 124 Patients ALOS 5.65 $5,609 (Cost) 46.51 Closure Stoma Small Intestine 56 Patients ALOS 3.89 $4,693 (Cost) (Tests already included in procedures) Total Cost = $45,902 Rad CT Scan S800CT1001 - CT Scan abdomen w/contrast LAB Blood Work P V55.3 Attention to Colostomy DRG 148 Major Small and Large Bowel Procedures with CC Average National Payment $13,892.03 DRG 153 Minor Small and Large Bowel Procedures without CC Average National Payment $ 4,769.94 46.20Ileostomy NOS P 997.4 Anastomotic Leak S 569.5 Abscess of intestine **NO PATIENTS FOUND WITH ABSCESS AS SECONDARY DIAGNOSIS. DRG 148 Major Small and Large Bowel Procedures with CC Average National Payment $13,892.03 3 Patients ALOS 17.00 $21,117 (Cost) P V55.2 Attention to Ileostomy DRG 153 Minor Small and Large Bowel Procedures without CC Average National Payment $4,769.94 10-15% Incidence

CODING REIMBURSE- MENT AND COST CARE PATH DIAGRAM PROCEDURE CODING PATIENT SCENARIO HISTORY Point of Care Targeted by Seprafilm TM 25 © Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute. Anastomotic Problems Anastomotic Problems Other Complications Other Complications Small Bowel Obstruction 863.20Small Intestine Injury-Closed 863.21Duodenum Injury-Closed 863.29Small Intestine Injury NEC-Closed 863.39 Small Intestine Injury Open 863.40Colon Injury NOS-Closed 863.41Ascending Colon Injury-Closed 863.42Transverse Colon Injury-Closed 863.43Descending Colon Injury-Closed 863.44Sigmoid Colon Injury-Closed 863.45Rectum Injury-Closed 863.46Colon Injury Mult Site-Closed 863.49Colon Injury NEC-Closed 863.89GI Injury NEC-Closed PATIENT WORKSHEET 4.0: INTESTINAL TRAUMA 553.21Incisional Hernia 46.51 Intestinal Stoma Closure 45.90 Intestinal Anastomosys 46.03 Loop Colostomy 46.11 Temporary Colostomy 46.01 Loop Ileostomy 46.20 Ileostomy NOS 46.21 Temporary Ileostomy V55.2 Attention to Ileostomy V55.3 Attention to Colostomy 997.4 Anastomotic Leak 997.4 Anastomotic Stricture 998.11 Post-op Hemorrhage 46.03Loop Colostomy 46.11Temporary Colostomy 46.01Loop Ileostomy 46.20Ileostomy NOS 46.21Temporary Ileostomy 46.93Revision of Small Bowel Anastomosis 46.94Rev of Large Bowel Anastomosis 45.7Partial Large Bowel Excision Subsequent Procedures Subsequent Procedures Surgical Treatment Surgical Treatment Initial Complication Discharge Complication* Other Disease Processes Other Disease Processes Surgical Treatment Surgical Treatment Planned Subsequent Procedures Planned Subsequent Procedures Medical Treatment Medical Treatment 54.59 Lysis of Adhesions (Abdomen) 45.60 Small Bowel Resection 46.51 Intestinal Stoma Closure 45.90 Intestinal Anastomosis Planned Subsequent Procedures Planned Subsequent Procedures Surgical Treatment Surgical Treatment Overview of all diagnosis and procedures. PharmIV Fluid PharmIV TPN Foley (CATH insertion) Labs Blood Work Labs All other excluding Blood work RadPlain Abd X-ray Contrast Upper/Lower Rad CT Scan (Abdomen) PharmWater Soluble Contrast Upper/Lower Endoscopy PharmAntibiotics and Meds 45.61Multiple Seg Small Bowel Excision 45.71Multiple Seg Large Bowel Excision 45.72Cectomy 45.73Right Hemicolectomy 45.74Transverse Colectomy 45.75Left Hemicolectomy 45.76Sigmoidectomy 46.03Loop Colostomy 45.8Total Intra Abd Colectomy 46.10Colostomy NOS 46.11Temporary Colostomy 48.62Anterior Rectum Resection w/Colostomy 48.63Anterior Rectum Resection NEC 48.69Other resection Rectum 48.5Abd-Perineal Rectum Resection 48.79Repair of Rectum NEC 45.61Multiple segmental resection of small intestine 45.62Other partial resection of small intestine 46.75Suture Large Bowel Laceration 46.73Small Bowel Suture NEC

CODING REIMBURSE- MENT AND COST CARE PATH DIAGRAM PROCEDURE CODING PATIENT SCENARIO HISTORY Point of Care Targeted by Seprafilm TM 26 © Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute. PATIENT WORKSHEET 4.1: INTESTINAL TRAUMA 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. ** DID NOT FIND ANY PATIENTS WITH EITHER OF THESE DIAGNOSIS * 863.44Sigmoid Colon Injury-Closed 863.89GI Injury NEC-Closed USED 863.30 - Injury unspecified site with open wound cavity P 46.52 Closure stoma large intestine Anastomotic Problems Anastomotic Problems Small Bowel Obstruction Subsequent Procedures Subsequent Procedures Surgical Treatment Surgical Treatment Initial Complication Discharge Complication* Other Disease Processes Other Disease Processes Planned Subsequent Procedures Planned Subsequent Procedures Medical Treatment Medical Treatment Planned Subsequent Procedures Planned Subsequent Procedures Surgical Treatment Surgical Treatment Surgical Treatment Surgical Treatment P V55.3 Attention to colostomy Other Complications Other Complications *DID NOT FIND THIS PROCEDURE AS EITHER PRINCIPAL OR SECONDARY * 48.62 Anterior Rectum Resection w/ Colostomy P 45.62 Other Small Bowel Excision S 46.79 Other repair of intestine 4 Patients ALOS 11.75 $10,232 (Cost) 124 Patients ALOS 5.65 $5,609 (Cost) Total Cost = $15,841 DRG 148 Major Small and Large Bowel Procedures with CC Average National Payment $13,892.03 DRG 153 Minor Small and Large Bowel Procedures without CC Average National Payment $4,769.94 15-25% Incidence

CODING REIMBURSE- MENT AND COST CARE PATH DIAGRAM PROCEDURE CODING PATIENT SCENARIO HISTORY Point of Care Targeted by Seprafilm TM 27 © Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute. PATIENT WORKSHEET 4.2: INTESTINAL TRAUMA 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. ** DID NOT FIND ANY PATIENTS WITH EITHER OF THESE DIAGNOSIS * 863.44Sigmoid Colon Injury-Closed 863.89GI Injury NEC-Closed USED 863.30 - Injury unspecified site with open wound cavity Anastomotic Problems Anastomotic Problems Small Bowel Obstruction Subsequent Procedures Subsequent Procedures Surgical Treatment Surgical Treatment Initial Complication Discharge Complication* Other Disease Processes Other Disease Processes Planned Subsequent Procedures Planned Subsequent Procedures Medical Treatment Medical Treatment Planned Subsequent Procedures Planned Subsequent Procedures Surgical Treatment Surgical Treatment Surgical Treatment Surgical Treatment Other Complications Other Complications *DID NOT FIND THIS PROCEDURE AS EITHER PRINCIPAL OR SECONDARY * 48.62 Anterior Rectum Resection w/ Colostomy P 45.62 Other Small Bowel Excision S 46.79 Other repair of intestine 4 Patients ALOS 11.75 $10,232 (Cost) Total Cost = $19,910 DRG 148 Major Small and Large Bowel Procedures with CC Average National Payment $13,892.03 15-25% Incidence P 46.52 Closure Stoma large intestine S 54.59 Lysis of Adhesions 69 Patients ALOS 9.07 $ 9,678 (Cost) DRG 150 Peritoneal Adhesiolysis without CC Average National Payment $11,114.69 V55.3 Attention to Colostomy

CODING REIMBURSE- MENT AND COST CARE PATH DIAGRAM PROCEDURE CODING PATIENT SCENARIO HISTORY Point of Care Targeted by Seprafilm TM 28 © Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute. PATIENT WORKSHEET 4.3: INTESTINAL TRAUMA 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. ** DID NOT FIND ANY PATIENTS WITH EITHER OF THESE DIAGNOSIS * 863.44Sigmoid Colon Injury-Closed 863.89GI Injury NEC-Closed USED 863.30 - Injury unspecified site with open wound cavity P 46.52 Closure stoma large intestine Anastomotic Problems Anastomotic Problems Small Bowel Obstruction Subsequent Procedures Subsequent Procedures Surgical Treatment Surgical Treatment Initial Complication Discharge Complication* Other Disease Processes Other Disease Processes Planned Subsequent Procedures Planned Subsequent Procedures Medical Treatment Medical Treatment Planned Subsequent Procedures Planned Subsequent Procedures Surgical Treatment Surgical Treatment Surgical Treatment Surgical Treatment P V55.3 Attention to colostomy Other Complications Other Complications *DID NOT FIND THIS PROCEDURE AS EITHER PRINCIPAL OR SECONDARY * 48.62 Anterior Rectum Resection w/ Colostomy P 45.62 Other Small Bowel Excision S 46.79 Other repair of intestine 4 Patients ALOS 11.75 $10,232 (Cost) 124 Patients ALOS 5.65 $5,609 (Cost) Total Cost = $18,409 DRG 148 Major Small and Large Bowel Procedures with CC Average National Payment $13,892.03 DRG 153 Minor Small and Large Bowel Procedures without CC Average National Payment $4,769.94 15-25% Incidence 560.9 SBO DRG 181 GI Obstruction without CC Average National Payment $2,133.64 657 Patients ALOS 3.68 $2,568 (Cost) P 96.07 Non operative Insert naso-gastric tube $62.80 XRay $396.79 IV TPN $738 Antibiotics $1,756 Other Meds Pharm IV TPN PharmAntibiotics Pharm Other Meds X-ray Plain Abd (S800XR1000 ) (Tests/Meds already included in procedures)

CODING REIMBURSE- MENT AND COST CARE PATH DIAGRAM PROCEDURE CODING PATIENT SCENARIO HISTORY Point of Care Targeted by Seprafilm TM 29 © Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute. PATIENT WORKSHEET 4.4: INTESTINAL TRAUMA 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. ** DID NOT FIND ANY PATIENTS WITH EITHER OF THESE DIAGNOSIS * 863.44Sigmoid Colon Injury-Closed 863.89GI Injury NEC-Closed USED 863.30 - Injury unspecified site with open wound cavity P 46.52 Closure stoma large intestine Anastomotic Problems Anastomotic Problems Small Bowel Obstruction Subsequent Procedures Subsequent Procedures Surgical Treatment Surgical Treatment Initial Complication Discharge Complication* Other Disease Processes Other Disease Processes Planned Subsequent Procedures Planned Subsequent Procedures Medical Treatment Medical Treatment Planned Subsequent Procedures Planned Subsequent Procedures Surgical Treatment Surgical Treatment Surgical Treatment Surgical Treatment P V55.3 Attention to colostomy Other Complications Other Complications *DID NOT FIND THIS PROCEDURE AS EITHER PRINCIPAL OR SECONDARY * 48.62 Anterior Rectum Resection w/ Colostomy P 45.62 Other Small Bowel Excision S 46.79 Other repair of intestine 4 Patients ALOS 11.75 $10,232 (Cost) 124 Patients ALOS 5.65 $5,609 (Cost) Total Cost = $26,474 DRG 148 Major Small and Large Bowel Procedures with CC Average National Payment $13,892.03 DRG 153 Minor Small and Large Bowel Procedures without CC Average National Payment $4,769.94 15-25% Incidence 15 Patients ALOS 12.93 $10,633 (Cost) DRG 150 Peritoneal Adhesiolysis with CC Average National Payment $11,114.69 P 560.9 Small Bowel Obstruction P 54.59 Lysis of Adhesions (Abdomen)

CODING REIMBURSE- MENT AND COST CARE PATH DIAGRAM PROCEDURE CODING PATIENT SCENARIO HISTORY Point of Care Targeted by Seprafilm TM 30 © Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute. PATIENT WORKSHEET 5.0: ULCERATIVE COLITIS and FAMILIAL POLYPOSIS DISEASE 45.79Resection of Colon 45.8Total Colectomy 48.49Rectal Pull Through 48.5Abd-Perineal Rectum Resection 45.95Endo Rectal Ileal Pouch 46.01Loop Ileostomy 46.20Ileostomy 46.21Temporary Ileostomy 46.22Continent Ileostomy 54.59 Lysis of Adhesions (Abdomen) 556.3Ulcerative 556.4Left Sided UC 556.6Universal UC 556.8Other UC 211.2Familial Polyposis XXXXHNPCC 46.01Loop Ileostomy 46.20Ileostomy NOS 46.21Temp. Ileostomy 45.95Endo Rectal Ileal Pouch 54.59Lysis of Adhesions (Abdomen) Anastomotic Problems Anastomotic Problems Small Bowel Obstruction Subsequent Procedures Subsequent Procedures Surgical Treatment Surgical Treatment Initial Complication Discharge Complication* Other Disease Processes Other Disease Processes Surgical Treatment Surgical Treatment Planned Subsequent Procedures Planned Subsequent Procedures 46.51Intestinal Stoma Closure 45.90Intestinal Anastomosis 45.79Resection of Colon 45.8Total Colectomy 48.49Rectal Pull Through 48.5Abd-Perineal Rectum Resection 45.95Endo Rectal Ileal Pouch 46.01Loop Ileostomy 46.20Ileostomy NOS 46.21Temporary Ileostomy 46.22Continent Ileostomy 54.59Lysis of Adhesions (Abdomen) V55.2 Attention to Ileostomy V55.3 Attention to Colostomy Planned Subsequent Procedures Planned Subsequent Procedures 997.4 Anastomotic Leak 997.4 Anastomotic Stricture 998.11 Post-op Hemorrhage Surgical Treatment Surgical Treatment 54.59 Lysis of Adhesions (Abdomen) 45.60 Small Bowel Resection 46.51 Intestinal Stoma Closure 45.90 Intestinal Anastomosis 54.59 Lysis of Adhesions (Abdomen) Overview of all diagnosis and procedures. Medical Treatment Medical Treatment 553.21Incisional Hernia Other Complications Other Complications PharmIV Fluid PharmIV TPN Foley (CATH insertion) Labs Blood Work Labs All other excluding Blood work RadPlain Abd X-ray Contrast Upper/Lower Rad CT Scan (Abdomen) PharmWater Soluble Contrast Upper/Lower Endoscopy PharmAntibiotics and Meds

CODING REIMBURSE- MENT AND COST CARE PATH DIAGRAM PROCEDURE CODING PATIENT SCENARIO HISTORY Point of Care Targeted by Seprafilm TM 31 © Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute. PATIENT WORKSHEET 5.1: ULCERATIVE COLITIS and FAMILIAL POLYPOSIS DISEASE 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. Anastomotic Problems Anastomotic Problems Other Complications Other Complications Small Bowel Obstruction Subsequent Procedures Subsequent Procedures Initial Complication Discharge Complication* Other Disease Processes Other Disease Processes Surgical Treatment Surgical Treatment Medical Treatment Medical Treatment Planned Subsequent Procedures Planned Subsequent Procedures Surgical Treatment Surgical Treatment Planned Subsequent Procedures Planned Subsequent Procedures 556.6Universal UC P 45.8 Total Colectomy S 45.95 Endo Rectal Ileal Pouch S 46.01 Loop Ileostomy Surgical Treatment Surgical Treatment P 46.51 Closure Intestinal Stoma S 87.64 Hypaque Enema (Lower GI Series) 5 Patients ALOS 16.20 $20,758 (Cost) 56 Patients ALOS 3.89 $4,693 (Cost) Total Cost = $25,451 DRG 148 Major Small and Large Bowel Procedures with CC Average National Payment $13,892.03 P V55.2 Attention to ileostomy DRG 153 Minjor Small and Large Bowel Procedures without CC Average National Payment $4,769.94 90% Incidence

CODING REIMBURSE- MENT AND COST CARE PATH DIAGRAM PROCEDURE CODING PATIENT SCENARIO HISTORY Point of Care Targeted by Seprafilm TM 32 © Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute. PATIENT WORKSHEET 5.2: ULCERATIVE COLITIS and FAMILIAL POLYPOSIS DISEASE 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. Anastomotic Problems Anastomotic Problems Other Complications Other Complications Small Bowel Obstruction Subsequent Procedures Subsequent Procedures Initial Complication Discharge Complication* Other Disease Processes Other Disease Processes Surgical Treatment Surgical Treatment Medical Treatment Medical Treatment Planned Subsequent Procedures Planned Subsequent Procedures Surgical Treatment Surgical Treatment Planned Subsequent Procedures Planned Subsequent Procedures 556.6Universal UC P 45.8 Total Colectomy S 45.95 Endo Rectal Ileal Pouch S 46.01 Loop Ileostomy Surgical Treatment Surgical Treatment 5 Patients ALOS 16.20 $20,758 (Cost) Total Cost = $28,234 DRG 148 Major Small and Large Bowel Procedures with CC Average National Payment $13,892.03 90% Incidence P 46.51 Closure Stoma small intestine S 54.59 Lysis of Adhesions 2 Patients ALOS5.6.50 $ 7,476 (Cost) DRG 150 Peritoneal Adhesiolysis without CC Average National Payment $11,114.69 V55.2 Attention to Ileostomy

CODING REIMBURSE- MENT AND COST CARE PATH DIAGRAM PROCEDURE CODING PATIENT SCENARIO HISTORY Point of Care Targeted by Seprafilm TM 33 © Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute. PATIENT WORKSHEET 5.3: ULCERATIVE COLITIS and FAMILIAL POLYPOSIS DISEASE 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. Anastomotic Problems Anastomotic Problems Other Complications Other Complications Small Bowel Obstruction Subsequent Procedures Subsequent Procedures Initial Complication Discharge Complication* Other Disease Processes Other Disease Processes Surgical Treatment Surgical Treatment Medical Treatment Medical Treatment Planned Subsequent Procedures Planned Subsequent Procedures Surgical Treatment Surgical Treatment Planned Subsequent Procedures Planned Subsequent Procedures 556.6Universal UC P 45.8 Total Colectomy S 45.95 Endo Rectal Ileal Pouch S 46.01 Loop Ileostomy Surgical Treatment Surgical Treatment P 46.51 Closure Intestinal Stoma S 87.64 Hypaque Enema (Lower GI Series) 5 Patients ALOS 16.20 $28,758 (Cost) 56 Patients ALOS 3.89 $4,693 (Cost) Total Cost = $36,019 DRG 148 Major Small and Large Bowel Procedures with CC Average National Payment $13,892.03 P V55.2 Attention to ileostomy DRG 153 Minjor Small and Large Bowel Procedures without CC Average National Payment $4,769.94 90% Incidence 560.9 SBO DRG 181 GI Obstruction without CC Average National Payment $2,133.64 657 Patients ALOS 3.68 $2,568 (Cost) P 96.07 Non operative Insert naso-gastric tube $62.80 XRay $396.79 IV TPN $1,756 Other Meds Pharm IV TPN PharmAntibiotics Pharm Other Meds X-ray Plain Abd (S800XR1000 ) (Tests/Meds already included in procedures) $738 Antibiotics

CODING REIMBURSE- MENT AND COST CARE PATH DIAGRAM PROCEDURE CODING PATIENT SCENARIO HISTORY Point of Care Targeted by Seprafilm TM 34 © Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute. PATIENT WORKSHEET 5.4: ULCERATIVE COLITIS and FAMILIAL POLYPOSIS DISEASE 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. Anastomotic Problems Anastomotic Problems Other Complications Other Complications Small Bowel Obstruction Subsequent Procedures Subsequent Procedures Initial Complication Discharge Complication* Other Disease Processes Other Disease Processes Surgical Treatment Surgical Treatment Medical Treatment Medical Treatment Planned Subsequent Procedures Planned Subsequent Procedures Surgical Treatment Surgical Treatment Planned Subsequent Procedures Planned Subsequent Procedures 556.6Universal UC P 45.8 Total Colectomy S 45.95 Endo Rectal Ileal Pouch S 46.01 Loop Ileostomy Surgical Treatment Surgical Treatment P 46.51 Closure Intestinal Stoma S 87.64 Hypaque Enema (Lower GI Series) 5 Patients ALOS 16.20 $20,758 (Cost) 56 Patients ALOS 3.89 $4,693 (Cost) Total Cost = $36,084 DRG 148 Major Small and Large Bowel Procedures with CC Average National Payment $13,892.03 P V55.2 Attention to ileostomy DRG 153 Minjor Small and Large Bowel Procedures without CC Average National Payment $4,769.94 90% Incidence P 54.59 Lysis of Adhesions (Abdomen) 15 Patients ALOS 12.93 $10,633 (Cost) DRG 150 Peritoneal Adhesiolysis with CC Average National Payment $11,114.69 P 560.9 Small Bowel Obstruction

CODING REIMBURSE- MENT AND COST CARE PATH DIAGRAM PROCEDURE CODING PATIENT SCENARIO HISTORY Point of Care Targeted by Seprafilm TM 35 © Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute. PATIENT WORKSHEET 5.5: ULCERATIVE COLITIS and FAMILIAL POLYPOSIS DISEASE 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. Anastomotic Problems Anastomotic Problems Small Bowel Obstruction Subsequent Procedures Subsequent Procedures Initial Complication Discharge Complication* Other Disease Processes Other Disease Processes Surgical Treatment Surgical Treatment Planned Subsequent Procedures Planned Subsequent Procedures Surgical Treatment Surgical Treatment Medical Treatment Medical Treatment Other Complications Other Complications Second Planned Subsequent Procedure Second Planned Subsequent Procedure Surgical Treatment Surgical Treatment Planned Subsequent Procedures Planned Subsequent Procedures P 45.8 Total Colectomy S 46.01 Ileostomy P 48.5 Abdominoperin resection rectum 6 Patients ALOS 27.83 $31,645 (Cost) 29 Patients ALOS 6.76 $8,219 (Cost) 46.51Closure stoma small intestine 56 Patients ALOS 3.89 $4,693 (Cost) Total Cost = $44,557 556.6Universal UC DRG 148 Major Small and Large Bowel Procedures with CC Average National Payment $13,892.03 P V55.2 Attention to ileostomy DRG 147 Rectal resection without CC Average National Payment $6,512.85 DRG 153 Minor small and large bowel procedures without CC Average National Payment $4,769.94 90% Incidence

CODING REIMBURSE- MENT AND COST CARE PATH DIAGRAM PROCEDURE CODING PATIENT SCENARIO HISTORY Point of Care Targeted by Seprafilm TM 36 © Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute. PATIENT WORKSHEET 6.0: CROHN’S DISEASE (REGIONAL ENTERITIS) 45.79Resection of Colon 45.75Left Colectomy 45.73Right Hemicolectomy 45.76Sigmoid Colectomy 45.62Partial Small Bowel resection 45.8Total Colectomy 48.5Abd-Perineal Rectum Resection 46.01Loop Ileostomy 46.20Ileostomy NOS 46.21Temporary Ileostomy 46.79Other Repair of Intestine 46.10Colostomy 46.03Loop Colostomy 54.59 Lysis of Adhesions (Abdomen) 997.4 Anastomotic Leak 997.4 Anastomotic Stricture 998.11 Post-op Hemorrhage Anastomotic Problems Anastomotic Problems Small Bowel Obstruction Subsequent Procedures Subsequent Procedures Surgical Treatment Surgical Treatment Initial Complication Discharge Complication* Other Disease Processes Other Disease Processes Surgical Treatment Surgical Treatment 46.50Intestinal Stoma Closure 45.90Intestinal Anastomosis 45.79Resection of Colon 45.8Total Colectomy 48.5Abd-Perineal Rectum Resection 46.01Loop Ileostomy 46.20Ileostomy NOS 46.21Temporary Ileostomy 54.59Lysis of Adhesions (Abdomen) Surgical Treatment Surgical Treatment Medical Treatment Medical Treatment Recurrence of Primary Disease Overview of all diagnosis and procedures. Other Complications Other Complications Planned Subsequent Procedures Planned Subsequent Procedures V55.2 Attention to Ileostomy V55.3 Attention to Colostomy Planned Subsequent Procedures Planned Subsequent Procedures 45.79Resection of Colon 45.75Left Colectomy 45.73Right Hemicolectomy 45.76Sigmoid Colectomy 45.62Partial Small BowelResection 45.8Total Colectomy 48.5Abd-Perineal Rectum Resection 46.01Loop Ileostomy 46.20Ileostomy NOS 46.21Temp. Ileostomy 54.59Lysis of Adhesions (Abdomen) 46.51Intestinal Stoma Closure 45.60 Small Bowel Resection 45.90Intestinal Anastomosis 555.0Small Intestine 555.1Large Intestine 555.2Ileocolitis 555.9Unspecified Site 553.21Incisional Hernia PharmIV Fluid PharmIV TPN Foley (CATH insertion) Labs Blood Work Labs All other excluding Blood work RadPlain Abd X-ray Contrast Upper/Lower Rad CT Scan (Abdomen) PharmWater Soluble Contrast Upper/Lower Endoscopy PharmAntibiotics and Meds

CODING REIMBURSE- MENT AND COST CARE PATH DIAGRAM PROCEDURE CODING PATIENT SCENARIO HISTORY Point of Care Targeted by Seprafilm TM 37 © Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute. Anastomotic Problems Anastomotic Problems Other Complications Other Complications Small Bowel Obstruction 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 PATIENT WORKSHEET 6.1: CROHN’S DISEASE (REGIONAL ENTERITIS) 555.2Regional Enteritis of Small Intestine with Large Intestine Subsequent Procedures Subsequent Procedures Surgical Treatment Surgical Treatment Initial Complication Discharge Complication* Other Disease Processes Other Disease Processes Planned Subsequent Procedures Planned Subsequent Procedures Surgical Treatment Surgical Treatment Surgical Treatment Surgical Treatment Medical Treatment Medical Treatment Recurrence of Primary Disease Planned Subsequent Procedures Planned Subsequent Procedures 27 Patients ALOS 8.76 $9,403 (Cost) P 45.73 Right Hemicolectomy S 46.01 Loop Ileostomy 56 Patients ALOS 3.89 $4,693 (Cost) 46.51Closure Stoma small intestine Total Cost = $14,096 DRG 148 Major Small and Large Bowel Procedures with CC Average National Payment $13,892.03 V55.2Attention to Ileostomy DRG 153 Minor Small and Large Bowel Procedures without CC Average National Payment $4,769.94 15% Incidence

CODING REIMBURSE- MENT AND COST CARE PATH DIAGRAM PROCEDURE CODING PATIENT SCENARIO HISTORY Point of Care Targeted by Seprafilm TM 38 © Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute. Anastomotic Problems Anastomotic Problems Other Complications Other Complications Small Bowel Obstruction 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. PATIENT WORKSHEET 6.2: CROHN’S DISEASE (REGIONAL ENTERITIS) 555.2Regional Enteritis of Small Intestine with Large Intestine Subsequent Procedures Subsequent Procedures Surgical Treatment Surgical Treatment Initial Complication Discharge Complication* Other Disease Processes Other Disease Processes Planned Subsequent Procedures Planned Subsequent Procedures Surgical Treatment Surgical Treatment Surgical Treatment Surgical Treatment Medical Treatment Medical Treatment Recurrence of Primary Disease Planned Subsequent Procedures Planned Subsequent Procedures 27 Patients ALOS 8.76 $9,403 (Cost) P 45.73 Right Hemicolectomy S 46.01 Loop Ileostomy Total Cost = $16,879 DRG 148 Major Small and Large Bowel Procedures with CC Average National Payment $13,892.03 15% Incidence P 46.51 Closure Stoma small intestine S 54.59 Lysis of Adhesions 2 Patients ALOS5.6.50 $ 7,476 (Cost) DRG 150 Peritoneal Adhesiolysis without CC Average National Payment $11,114.69 V55.2 Attention to Ileostomy

CODING REIMBURSE- MENT AND COST CARE PATH DIAGRAM PROCEDURE CODING PATIENT SCENARIO HISTORY Point of Care Targeted by Seprafilm TM 39 © Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute. Anastomotic Problems Anastomotic Problems Other Complications Other Complications Small Bowel Obstruction 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. PATIENT WORKSHEET 6.3: CROHN’S DISEASE (REGIONAL ENTERITIS) 555.2Regional Enteritis of Small Intestine with Large Intestine Subsequent Procedures Subsequent Procedures Surgical Treatment Surgical Treatment Initial Complication Discharge Complication* Other Disease Processes Other Disease Processes Planned Subsequent Procedures Planned Subsequent Procedures Surgical Treatment Surgical Treatment Surgical Treatment Surgical Treatment Medical Treatment Medical Treatment Recurrence of Primary Disease Planned Subsequent Procedures Planned Subsequent Procedures 27 Patients ALOS 8.76 $9,3040 (Cost) P 45.73 Right Hemicolectomy S 46.01 Loop Ileostomy 56 Patients ALOS 3.89 $4,693 (Cost) 46.51Closure of Intestinal Stoma small intestine Total Cost = $16,664 DRG 148 Major Small and Large Bowel Procedures with CC Average National Payment $13,892.03 V55.2Attention to Ileostomy DRG 153 Minor Small and Large Bowel Procedures without CC Average National Payment $4,769.94 15% Incidence 560.9 SBO DRG 181 GI Obstruction without CC Average National Payment $2,133.64 657 Patinets ALOS 3.68 $2,568 (Cost) P 96.07 Non operative Insert naso-gastric tube $62.80 XRay $396.79 IV TPN $738 Antibiotics $1,756 Other Meds Pharm IV TPN PharmAntibiotics Pharm Other Meds X-ray Plain Abd (S800XR1000 ) (Tests/Meds already included in procedures)

CODING REIMBURSE- MENT AND COST CARE PATH DIAGRAM PROCEDURE CODING PATIENT SCENARIO HISTORY Point of Care Targeted by Seprafilm TM 40 © Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute. Anastomotic Problems Anastomotic Problems Other Complications Other Complications Small Bowel Obstruction 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. PATIENT WORKSHEET 6.4: CROHN’S DISEASE (REGIONAL ENTERITIS) 555.2Regional Enteritis of Small Intestine with Large Intestine Subsequent Procedures Subsequent Procedures Surgical Treatment Surgical Treatment Initial Complication Discharge Complication* Other Disease Processes Other Disease Processes Planned Subsequent Procedures Planned Subsequent Procedures Surgical Treatment Surgical Treatment Surgical Treatment Surgical Treatment Medical Treatment Medical Treatment Recurrence of Primary Disease Planned Subsequent Procedures Planned Subsequent Procedures 27 Patients ALOS 8.76 $9,403 (Cost) P 45.73 Right Hemicolectomy S 46.01 Loop Ileostomy 56 Patients ALOS 3.89 $4,693 (Cost) 46.51Closure of Intestinal Stoma small intestine Total Cost = $24,729 DRG 148 Major Small and Large Bowel Procedures with CC Average National Payment $13,892.03 V55.2Attention to Ileostomy DRG 153 Minor Small and Large Bowel Procedures without CC Average National Payment $4,769.94 15% Incidence P 54.59 Lysis of Adhesions (Abdomen) 15 Patients ALOS 12.93 $10,633 (Cost) DRG 150 Peritoneal Adhesiolysis with CC Average National Payment $11,114.69 P 560.9 Small Bowel Obstruction

CODING REIMBURSE- MENT AND COST CARE PATH DIAGRAM PROCEDURE CODING PATIENT SCENARIO HISTORY Point of Care Targeted by Seprafilm TM 41 © Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute. Recurrence of Primary Disease PATIENT WORKSHEET 6.5: CROHN’S DISEASE (REGIONAL ENTERITIS) 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. Anastomotic Problems Anastomotic Problems Other Complications Other Complications Small Bowel Obstruction Subsequent Procedures Subsequent Procedures Surgical Treatment Surgical Treatment Initial Complication Discharge Complication* Other Disease Processes Other Disease Processes Planned Subsequent Procedures Planned Subsequent Procedures Surgical Treatment Surgical Treatment Planned Subsequent Procedures Planned Subsequent Procedures Surgical Treatment Surgical Treatment Medical Treatment Medical Treatment P 45.73 Right Hemicolectomy 6 Patients ALOS 5.83 $6,879 (Cost) Total Cost = $6,879 DRG 149 Major Small and Large Bowel Procedures without CC Average National Payment $6,352.95 75-80% Incidence 555.2Regional Enteritis of Small Intestine with Large Intestine

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CODING REIMBURSE- MENT AND COST CARE PATH DIAGRAM PROCEDURE CODING PATIENT SCENARIO HISTORY Point of Care Targeted by Seprafilm TM 1 © Premier Innovation.

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Presentation on theme: "CODING REIMBURSE- MENT AND COST CARE PATH DIAGRAM PROCEDURE CODING PATIENT SCENARIO HISTORY Point of Care Targeted by Seprafilm TM 1 © Premier Innovation."— Presentation transcript:

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