Within specific apr drgs there are also some

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Within specific APR-DRGs there are also some principal diagnoses that are indicative of higher severity of illness relative to the other principal diagnoses in the APR-DRG. For example, the severity of illness subclass of patients in APR-DRG 221 Major Small & Large Bowel Procedures with a principal diagnosis of acute vascular insufficiency of the intestine is increased by one up to a maximum subclass of moderate. Relative to the other principal diagnoses associated with the procedures in APR-DRG 221 (e.g., diverticulosis of colon, bowel malignancies), acute vascular insufficiency of the intestine represents a more severely ill patient. A medical example is hemo- philia factor VIII that is increased by two up to major in APR-DRG 661 Coagulation Disorders. Conversely, within specific APR-DRGs some principal diagnoses are indicative of lower severity of illness relative to the other principal diagnoses in the APR-DRG. For example, within APR-DRG 404 Thyroid, Parathyroid & Thyroglossal Procedures, patients with a principal diagno- sis of nontoxic uninodular goiter will have their severity of illness subclass decreased by one if their severity of illness subclass up to this point in the process were major or moderate. Relative to the other principal diagnoses associated with the procedures in APR-DRG 404 (e.g., malignant neoplasm of thyroid), nontoxic uninodular goiter represents a less severely ill patient. A medical example is first degree burns, which is decreased from moderate to minor in APR-DRG 844 Par- tial Thickness Burns as these patients are less severely ill than second degree burn patients. 11. Modify severity of illness subclass for the patient based combinations of APR-DRG and age, or APR-DRG, principal diagnosis and age For some principal diagnoses in specific APR-DRGs, the patient’s age essentially represents a complicating factor. For specific principal diagnoses and age combinations in certain APR-DRGs, the severity of illness subclass of the patient is increased by a specified increment up to a speci- fied maximum subclass. For example, for pediatric patients in APR-DRG 344 Osteomyelitis, Septic Arthritis & Other Musculoskeletal Infections with bone infection as a principal diagnosis, the severity of illness subclass is increased by one up to a maximum of a moderate subclass. The increase in the severity of illness subclass indicates that bone infection in a pediatric patient rep- resents a more severely ill patient. Elderly patients with certain principal diagnoses have their
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38 severity of illness subclass increased by one to a maximum subclass of moderate. For example, patients age >69 years with certain septicemia principal diagnoses in APR-DRG 720 Septicemia and patients age >79 years with chronic/unspecified ulcer with hemorrhage without obstruction in APR-DRG 241 Peptic Ulcer & Gastritis have their severity of illness subclass increased by one to a maximum of moderate.
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  • Fall '18
  • Diagnosis-related group, DRGs

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