Mdc 21 was redefined and had its title changed from

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MDC 21 was redefined and had its title changed from “Injuries, Poisonings & Toxic Effects of Drugs” to “Poisonings, Toxic Effects, Other Injuries and Other Complications of Treatment.” The title change reflects that most of the injury diagnoses previously in MDC 21 have been moved to other body system specific MDCs, namely MDCs 1, 3, 5, 8, and 9. “Other Complica-
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26 tions of Treatment” was added into the title of MDC 21 since these diagnoses have always been in MDC 21. Cranial and face bone diagnoses, previously dispersed across MDCs 3, 8, and 21, were con- solidated into MDC 3 which is reflected in the revised title for MDC 3, “Ear, Nose, Mouth, Throat and Craniofacial Diseases and Disorders.” Prematurity diagnoses (for older neonates and infants) and orthopedic aftercare diagnoses were moved to MDC 23 (Rehabilitation, Aftercare, Other Factors Influencing Health Status & Other Health Service Contacts). In addition, other individual diagnoses were assigned to different MDCs. Revise MDC surgical hierarchies The APR-DRG system has introduced a number of changes to the MDC surgical hierarchies. Ver- sion 20.0 introduces changes to the surgical hierarchies for MDCs 1, 3, 5, 6, and 8. To illustrate, in MDC 6 (Diseases & Disorders of the Digestive System), APR-DRG 224 (Peritoneal Adhesioly- sis) was moved lower in the surgical hierarchy following the APR-DRGs for appendectomy, anal procedures, and hernia procedures because the peritoneal adhesiolysis is usually adjunct to these procedures and not the patient’s primary surgical procedure. Most of the patients who remain in APR-DRG 224 are having peritoneal adhesiolysis performed for intestinal obstruction. A similar example in MDC 8 (Diseases & Disorders of the Musculoskeletal System and Connec- tive Tissue), is APR-DRG 312 Skin Graft, Except Hand for Musculoskeletal and Connective Tissue Diagnoses, which was moved lower in the surgical hierarchy. It now follows the APR-DRGs for knee/lower leg procedures, foot & toe procedures, and shoulder, upper arm & forearm procedures because the skin graft is usually an adjunct to these procedures and not the patient’s primary surgical procedure. The skin graft procedure is indicative of the complexity of the procedure and is taken into consideration in the severity of illness and risk of mortality logic that deals with select combinations of OR procedures. Revise Pre-MDC hierarchies and categories The initial APR-DRGs started with the same pre-MDC hierarchies and categories as AP-DRGs: MDC 15 (Newborns & Other Neonates with Conditions Originating in the Perinatal Period), MDC 24 (Human Immunodeficiency Virus Infections), Transplants, two Tracheostomy APR-DRGs and MDC 25 (Multiple Significant Trauma). For Version 20.0 APR-DRGs, this was reordered as fol- lows: Transplants, MDC 15, Tracheostomy APR-DRGs, MDC 25, and MDC 24. The reordering of the pre-MDC hierarchies provided a clearer focus for classifying the most defining aspects of the hospitalization for these patients.
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  • Fall '18
  • Diagnosis-related group, DRGs

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