An example of a medical rerouting within an mdc is a

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An example of a medical rerouting within an MDC is a patient with a principal diagnosis of chest pain and a secondary diagnosis of angina pectoris or coronary atherosclerosis. The chest pain diagnosis is a symptom of the angina or coronary atherosclerosis and should have been recorded as a secondary diagnosis. The rerouting logic will assign this patient to APR-DRG 198 Angina Pectoris & Coronary Atherosclerosis instead of APR-DRG 203 Chest Pain, and will resequence the diagnosis of angina or coronary atherosclerosis as the principal diagnosis so that these diag- noses do not make a redundant contribution to the severity of illness and risk of mortality subclass assignment. An example of a medical patient rerouting across MDCs is a patient with a principal diagnosis of hypovolemia (dehydration) and a secondary diagnosis of gastroenteritis. There is some ambigu- ity in the sequencing of principal and secondary diagnosis, while the patient fundamentally is a gastroenteritis patient who has some level of dehydration. So, in this example there would be a rerouting from MDC 10, APR-DRG 422 Hypovolemia to MDC 6, APR-DRG 249 Non-Bacterial Gastroenteritis, Nausea & Vomiting. An example of a surgical patient rerouting across MDCs is amputation. In previous versions of APR-DRGs and other DRG systems, there are distinct amputation DRGs in MDCs 5, 8, and 10. In Version 20.0 APR-DRGs, most of these patients are rerouted to MDC 8 (Diseases & Disorders of the Musculoskeletal System and Connective Tissue) and grouped according to the MDC 8 surgi- cal hierarchy. The end result is that clinically similar amputation patients are grouped together rather than dispersed into separate lower volume amputation groups. The sequencing of principal diagnosis and secondary diagnosis on the patient discharge records is not altered by any of these resequencing processes. Rather, the APR-DRG grouper is redesig- nating principal diagnosis and secondary diagnosis for specified steps that are part of its logic. In the example of principal diagnosis hypovolemia and secondary diagnosis gastroenteritis, the
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28 APR-DRG grouper resequences principal diagnosis and secondary diagnosis for grouping pur- poses but when users examine their own discharge records hypovolemia will still be the principal diagnosis. This also means that when users examine their patients in MDC 6 (Diseases & Disor- ders of the Digestive System) and especially APR-DRG 249 Non-Bacterial Gastroenteritis, Nausea & Vomiting, some of the patients will have a principal diagnosis of hypovolemia, which is ordinarily assigned to MDC 10 (Endocrine, Nutritional & Metabolic Diseases and Disorders). A fuller explanation of the APR-DRG rerouting logic and a more extensive set of illustrations is in chapter 3. The end result of the consolidation and refinement process for Version 12.0 of the APR-DRG clas- sification system released in 1995 was the creation of 382 base APR-DRGs (plus two ungroupable or invalid APR-DRGs). This was further consolidated to 355 base APR-DRGs for Version 15.0 released in 1998 and to 314 base APR-DRGs (plus two ungroupable or invalid
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  • Fall '18
  • Diagnosis-related group, DRGs

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