5 modify the standard risk of mortality level of each

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5. Modify the standard risk of mortality level of each secondary diagnosis based on the APR-DRG to which the patient is assigned. 6. Modify the standard risk of mortality level of each secondary diagnosis based on the pres- ence of certain non-OR procedures. Phase II—Determine the base risk of mortality subclass of the patient 7. Eliminate all secondary diagnoses that are in the same secondary diagnosis group except the secondary diagnosis with the highest risk of mortality level. 8. Compute the base patient risk of mortality subclass as the maximum of all the secondary diagnosis risk of mortality levels. 9. Reduce the base patient risk of mortality subclass if the patient does not have multiple secondary diagnoses at a significant risk of mortality, except for certain secondary diag- noses for which this requirement is removed or modified. Phase III—Determine the final risk of mortality subclass of the patient 10. Modify the patient risk of mortality subclass based on the APR-DRG and principal diagnosis. 11. Modify the patient risk of mortality subclass based on the APR-DRG and age, or APR-DRG and principal diagnosis and age, or APR-DRG and birthweight and absence of certain non-OR procedures. 12. Modify the patient risk of mortality subclass based on a combination of the APR-DRG and certain non-OR procedures. 13. Modify the patient risk of mortality subclass based on the APR-DRG and OR procedure. 14. Modify the patient risk of mortality subclass based on the APR-DRG and certain pairs of OR procedures. 15. Modify the patient risk of mortality subclass based on the APR-DRG 583 Neonate With ECMO and the presence/absence of certain OR procedures (this step is applicable only to severity of illness, not to risk of mortality). 16. Modify the patient risk of mortality subclass based upon the APR-DRG and principal diag- nosis and certain non-OR procedures (this step applicable only to severity of illness, not to risk of mortality).
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56 17. Establish a minimum risk of mortality subclass for the patient based on the presence of specific combinations of categories of secondary diagnoses. 18. Compute the final patient risk of mortality subclass based on the Phase II base patient risk of mortality subclass from Step 9 and the modifications of the patient risk of mortality subclass from Steps 10–17. Conclusion The APR-DRGs form a clinically coherent set of severity of illness and risk of mortality adjusted patient groups. The APR-DRGs are designed to describe the complete cross-section of patients seen in acute care hospitals. Through APR-DRGs, hospitals, consumers, payers, and regulators can gain an understanding of the patients being treated, the costs incurred, and, within reasonable limits, the services and out- comes expected. Through APR-DRGs, areas for improvement in efficiency and areas with potential quality problems can be identified. The classification of patients into APR-DRGs is con- stantly evolving. As the ICD-9-CM coding scheme changes or as medical technology or practice changes, the APR-DRG definitions will continue to be updated to reflect these changes.
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CHAPTER 3 3 Background and Explanation of Approach for Rerouting Logic in APR-DRG, Version 20.0
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  • Fall '18
  • Diagnosis-related group, DRGs

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