5 million discharges which included all payer

Info icon This preview shows pages 28–30. Sign up to view the full content.

8.5 million discharges, which included all payer discharges from 1,000 general hospitals from 10 states, and all payer discharges from 47 children’s hospitals in the United States. Development of the base APR-DRG The AP-DRGs (see chapter 1) were initially used as the base DRGs in the formation of the initial APR-DRGs. A series of consolidations, additions, and modifications were then made to these ini- tial APR-DRGs to create the base APR-DRGs. Similar to the Yale research, the first step in forming the APR-DRGs was to consolidate all age, CC and major CC splits. The APR-DRGs also consolidated all splits based on discharge status of death. This was necessary so that death as an outcome variable could be examined across all the APR-DRGs. In addition to these uniform consolidations, the APR-DRG system introduced an extensive set of consolidations, additions, and refinements to the initial APR-DRG categories. This includes the diagnoses and procedures and birthweight ranges (for newborns) that define an APR-DRG, the procedure codes that are considered OR procedures, and the placement of surgical APR-DRGs in their respective MDC surgical hierarchies. The APR-DRG system has also introduced numer-
Image of page 28

Info icon This preview has intentionally blurred sections. Sign up to view the full version.

23 ous changes to the definition of MDCs and the pre-MDC hierarchies and categories. Finally, the APR-DRG system has introduced a new kind of logic referred to as “rerouting logic,” that reas- signs a patient to a new MDC and APR-DRG in certain circumstances where the principal diagnosis is overly broad or the sequencing of principal and secondary diagnosis is unclear. Alto- gether these changes result in a set of base APR-DRGs that are very different from those of other DRG classification systems. Following is a summary description of these changes. Consolidate APR-DRGs based on complicated principal diagnosis APR-DRGs that were defined based on complicated principal diagnoses were consolidated. For example, in the initial version of APR-DRGs, appendectomies with a complicated principal diag- nosis (e.g., appendicitis with peritonitis) were assigned to a different APR-DRG than uncomplicated appendectomies. The APR-DRGs for appendectomies were consolidated and rec- ognition of the complicated principal diagnosis was subsequently incorporated into the subclass assigned within the APR-DRG. Other examples of this kind of consolidation include vaginal deliv- ery with complicating diagnoses and other antepartum diagnoses with complicating diagnoses. Consolidate APR-DRGs based upon complicated OR procedures The APR-DRG system consolidated certain surgical categories that, in both the CMS DRGs and AP-DRGs, are subdivided based upon more complicated types of OR procedures. Examples of surgical category consolidations are cholecystectomy with common duct exploration versus chole- cystectomy without common duct exploration, and total mastectomy versus subtotal mastectomy.
Image of page 29
Image of page 30
This is the end of the preview. Sign up to access the rest of the document.
  • Fall '18
  • Diagnosis-related group, DRGs

{[ snackBarMessage ]}

What students are saying

  • Left Quote Icon

    As a current student on this bumpy collegiate pathway, I stumbled upon Course Hero, where I can find study resources for nearly all my courses, get online help from tutors 24/7, and even share my old projects, papers, and lecture notes with other students.

    Student Picture

    Kiran Temple University Fox School of Business ‘17, Course Hero Intern

  • Left Quote Icon

    I cannot even describe how much Course Hero helped me this summer. It’s truly become something I can always rely on and help me. In the end, I was not only able to survive summer classes, but I was able to thrive thanks to Course Hero.

    Student Picture

    Dana University of Pennsylvania ‘17, Course Hero Intern

  • Left Quote Icon

    The ability to access any university’s resources through Course Hero proved invaluable in my case. I was behind on Tulane coursework and actually used UCLA’s materials to help me move forward and get everything together on time.

    Student Picture

    Jill Tulane University ‘16, Course Hero Intern