W6s pdx and sdx and medical æ occurrence of pdx sdx

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W6S: PDX and SDX and Medical Æ Occurrence of PDX-SDX determines APR-DRG assignment within same MDC; since the SDX is primarily responsible for the APR-DRG assignment, it is resequenced as the PDX for SOI/ROM purposes. If a medical patient in MDC 1 (Diseases & Disorders of the Nervous System) has a PDX of head trauma and an SDX of head trauma with coma >1 hour or hemorrhage, then assign patient to APR-DRG 55 Head Trauma W Coma >1 Hour or Hemorrhage and rese- quence the SDX of head trauma with coma >1 hour or hemorrhage as the PDX for SOI/ ROM purposes. If medical patient in MDC 5 (Diseases & Disorders of the Circulatory System) has a PDX of angina pectoris, coronary atherosclerosis or chest pain, and an SDX of acute myocar- dial infarct, then assign to APR-DRG 190 Acute Myocardial Infarct instead of APR-DRG 198 Angina Pectoris & Coronary Atherosclerosis or APR-DRG 203 Chest Pain, and rese- quence the acute myocardial infarct as the PDX for SOI/ROM purposes. If medical patient in MDC 5 (Diseases & Disorders of the Circulatory System) has a PDX of chest pain and an SDX of angina pectoris or coronary atherosclerosis, then assign patient to APR-DRG 198 Angina Pectoris & Coronary Atherosclerosis instead of APR-DRG 203 Chest Pain and resequence the diagnosis of angina pectoris or coronary atherosclerosis as the PDX for SOI/ROM purposes. If medical patient in MDC 23 (Rehabilitation, Aftercare, Other Factors Influencing Health Status & Other Health Service Contacts) has a PDX of Aftercare NEC and an SDX of Pre- maturity, then assign patient to APR-DRG 863 Neonatal Aftercare instead of APR-DRG 862 Other Aftercare & Convalescence, and resequence the diagnosis of prematurity as the PDX for SOI/ROM purposes. Note, if there exists more than one secondary diagnosis from the specified diagnosis list for this type of rerouting, then the APR-DRG system provides additional selection logic for designation of the PDX for SOI/ROM purposes. The selection logic is specific to each APR-DRG. It is the same kind of selection logic as that described for APR-DRG rerouting type W0S. W6X: PDX and SDX and Medical Æ SDX clarifies PDX and assignment to new APR-DRG within same MDC; there is no need to resequence PDX and SDX. If medical patient in MDC 7 (Diseases & Disorders of the Hepatobiliary System and Pan- creas) has a PDX of liver disease and an SDX of alcoholic liver disease, then assign patient to APR-DRG 280 Alcoholic Liver Disease instead of APR-DRG 283 Other Disor- ders of Liver.
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66 Detailed Examples of Across MDC Reroutings: A2X: PDX and Non-OR Procedure and Medical Æ PDX and Non-OR Procedure together clarify assignment to new MDC and APR-DRG. If medical patient in MDC 1 (Diseases & Disorders of the Nervous System) has PDX brain neoplasm and non-OR procedure Stereotactic Radiosurgery, then reassign patient to MDC 17 (Lymphatic, Hematopoietic, Other Malignancies, Chemotherapy and Radiother- apy), APR-DRG 693 Radiotherapy.
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  • Fall '18
  • Diagnosis-related group, DRGs

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