An example is a moderate cardiotho racic trauma

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diagnosis that is at least a moderate severity of illness level. An example is a moderate cardiotho- racic trauma diagnosis (category 18) and a moderate head and neck trauma with coma diagnosis (category 24). A type 15 combination consists of two secondary diagnosis categories that contain minor severity of illness level diagnoses, plus any third secondary diagnosis that is at least a minor severity of illness level. An example is a minor severity of illness level head and neck trauma without coma diagnosis (category 43) and a minor severity of illness level pulmonary diag- nosis (category 75). 18. Compute the final patient severity of illness subclass The final patient severity of illness subclass is computed based on the Phase II base patient severity of illness subclass and the Phase III modified patient severity of illness subclasses. If all the Phase III modified severity subclasses are greater than or equal to the Phase II base severity of illness subclass, then the final severity of illness subclass is computed as the maximum of the Phase II and III severity subclasses. If all of the modified Phase III severity of illness subclasses are less than or equal to the Phase II base severity of illness subclass, then the final severity of ill- ness subclass is computed as the Phase II base severity of illness subclass minus one. If the Phase III modified severity of illness subclasses include modified severity of illness subclasses that are both greater and less than the Phase II based severity of illness subclass, then the modi- fied Phase III subclass relating to procedures and combinations of secondary diagnoses will take priority in determining the final severity of illness subclass. The combination of the APR-DRG and the final patient severity of illness subclass constitute the complete APR-DRG description of the severity of illness of the patient.
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44 Summary of APR-DRG severity of illness subclass assignment logic The following is a summary of the steps involved in computing the APR- DRG severity of illness subclass of a patient. Phase I—Determine the severity of illness level of each secondary diagnosis 1. Eliminate secondary diagnoses that are associated with the principal diagnosis. 2. Assign each secondary diagnosis its standard severity of illness level. 3. Modify the standard severity of illness level of each secondary diagnosis based on the age of the patient. 4. Modify the standard severity of illness level of each secondary diagnosis based on the principal diagnosis and the APR-DRG to which the patient is assigned (applicable only to APR-DRG 190 Acute Myocardial Infarct). 5. Modify the standard severity of illness level of each secondary diagnosis based on the APR-DRG to which the patient is assigned. 6. Modify the standard severity of illness level of each secondary diagnosis based on the presence of certain non-OR procedures.
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  • Fall '18
  • Diagnosis-related group, DRGs

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