0 apr drg through the various phase i steps to

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circumstances and these received special attention in version 20.0 APR-DRG through the various Phase I steps. To illustrate, there are circumstances where secondary diagnosis code 3481 Anoxic brain damage may be part of the patient’s acute presenting condition (e.g., major trauma, poisoning, major neurological, respiratory, cardiac or infectious condition) and an indicator of high severity of illness. There are other instances where anoxic brain damage is not ordinarily expected and may represent the use of code 3481 for long standing anoxic brain damage (from a prior event), or possibly an unexpected complication of treatment. To take into account these dif- ferent circumstances, version 20.0 APR-DRGs lowered the standard severity of illness level for anoxic brain damage from extreme to minor, but then, in a later Phase I step, adjusts the severity level back up to extreme for selected APR-DRGs where it is reasonable to expect that the anoxic brain damage may be part of the patient’s presenting condition. (This was handled the same way for risk of mortality.) Another set of secondary diagnoses that received special attention is the secondary diagnoses of cardiac arrest, ventricular fibrillation and ventricular flutter. In version 15.0 APR-DRGs, these diagnoses were all assigned a severity of illness level of extreme (likewise for risk of mortality.) These secondary diagnoses unquestionably represent very extreme acute diagnoses. At the same time, there is a unique aspect to these diagnoses in that they can potentially be coded for most patients who die and whose admitting condition is not cardiac or cardiac related. If this was to occur, the subclass assignment logic, especially for risk of mortality, could become somewhat circular. To avoid this possibility, the standard severity of illness level (and standard risk of mortal- ity level) in version 20.0 APR-DRGs was changed from extreme to minor, and then for a small subset of APR-DRGs adjusted back up to extreme. The subset includes APR-DRGs for major neurological, respiratory, cardiovascular, and infectious conditions, and poisonings. For these APR-DRGs, the patients are at a clear risk of having a cardiac arrest, ventricular fibrillation, or ventricular flutter and so these secondary diagnoses contribute to the severity of illness (and risk of mortality) assignment. This is different from other APR-DRGs where the patient is not at an apparent risk of a cardiac arrest, ventricular fibrillation, or ventricular flutter. Patients in these other APR-DRGs could still have a cardiac arrest, ventricular fibrillation, or ventricular flutter as part of the course of their hospitalization, but since their principal diagnosis is not cardiac or car- diac related, there is the concern for potential overcoding of these secondary diagnoses for patients who die. Version 20.0 APR-DRGs do not let these occurrences contribute to the patient’s severity of illness level or risk of mortality level.
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  • Fall '18
  • Diagnosis-related group, DRGs

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