52 tory infections inflammations with a principal

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52 tory Infections & Inflammations with a principal diagnosis of staphylococcal pneumonia and elderly patients age >79 years in APR-DRG 710 Septicemia & Disseminated Infections with most of the septicemia principal diagnoses, have their risk of mortality subclass increased by one up to a maximum subclass of moderate. Elderly patients age >69 years in APR-DRG 44 Intracranial Hemorrhage with a principal diagnosis of intracerebral hemorrhage have their risk of mortality subclass increased by one up to a maximum subclass of moderate. The increase indicates that intracranial hemorrhage in an elderly patient represents a higher risk of mortality. This step is also sometimes implemented for all patients in a specified age range in an APR-DRG rather than just for patients with a particular principal diagnoses. This approach is used for elderly patients age >84 years for 19 APR-DRGs involving major surgery. For example, patients age >84 years in APR-DRG 120 Major Chest & Respiratory Procedures have their risk of mortality sub- class increased by one to a maximum subclass of moderate. The last part of this step examines the relationship between APR-DRG and birthweight and pres- ence/absence of certain non-OR procedures for extremely low birthweight neonates in MDC 15. Many of the neonates at an extremely low birthweight (<750 grams or 1.6 pounds) are non-viable and receive comfort-only care. Nearly all of these newborns die and most of the time this is within a few days of being born. There are no ICD-9-CM diagnosis codes for non-viability due to extreme prematurity, which, if such codes existed, would allow a risk of mortality subclass of extreme to be assigned. In its place, the APR-DRG system has developed logic to identify these cases. Since newborns <750 grams will virtually always receive some therapeutic interventions if the goal is to maintain life (e.g., respiratory therapy, tube feedings), the absence of any of these non-OR proce- dures can be used to infer the newborn is receiving comfort-only measures and their risk of mortality subclass is increased to extreme for APR-DRGs 589 and 591. Without this logic, most of these newborns would be a risk of mortality subclass minor or moderate because of the lack of codes for identifying non-viability. 12. Modify the risk of mortality subclass for the patient based on combinations of APR-DRG and non-OR procedure For some APR-DRGs the presence of certain non-OR procedures is indicative of a more exten- sive disease process with a higher risk of mortality. In these instances, the risk of mortality subclass is increased by a specific increment up to a specified maximum. There are three non-OR procedures used for this step: mechanical ventilation 96+ hours, mechanical ventilation <96 hours, and balloon pulsation device. For example, for patients in APR-DRG 194 Heart Failure the risk of mortality subclass is increased by two up to a maximum subclass of extreme if mechanical ventilation 96+ hours is performed and is increased by one up to a maximum sub- class of major if mechanical ventilation <96 hours is performed.
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  • Fall '18
  • Diagnosis-related group, DRGs

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