Decreased by one for patients with a severity of

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decreased by one for patients with a severity of illness subclass up to this point in the process that is moderate. 14. Modify the severity of illness subclass for the patient based on combinations of APR-DRG and pairs of OR procedures Within specific APR-DRGs some pairs of OR procedures are indicative of higher severity of ill- ness relative to the other patients in the APR-DRG. Areas where multiple procedures are a
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39 significant determinant of severity of illness include: peripheral bypass surgery plus lower limb amputation or skin graft, cranial procedures plus face bone or jaw procedures, multiple spinal fusion procedures (anterior and posterior), and multiple procedures related to trauma such as multiple limb procedures, limb procedure plus back procedure, and limb procedure plus skin or fascia graft. For example, if a patient in APR-DRG 308 Hip & Femur Procedure for Trauma receives both a femur procedure (upper leg) and one of a specified set of tibia/fibula procedures (lower leg) or shoulder/arm procedures, the severity of illness subclass will be increased by one up to a maximum subclass of extreme. Relative to other femur procedure patients, those who also have a procedure for trauma to other extremities have a higher severity of illness. 15. Modify the severity of illness subclass for the patient based upon combination of APR-DRG for ECMO and presence/absence of certain OR procedures This step is specific to the logic of how one APR-DRG is defined, APR-DRG 583 Neonate With ECMO (Extracorporeal Membrane Oxygenation). All of the patients who receive ECMO are severely ill but there are two subsets of ECMO patients, those who receive ECMO along with a major OR procedure for a congenital diaphragmatic hernia or heart condition and those who receive ECMO because conventional therapy has been unsuccessful at treating pulmonary hyper- tension and respiratory failure. To distinguish, those neonatal patients who do not have one of the major neonatal surgeries have their severity subclass decreased by one. 16. Modify the severity of illness subclass for the patient based upon combinations of APR-DRG, principal diagnosis and non-OR procedure Specific principal diagnoses within an APR-DRG in combination with certain non-OR procedures will increase the severity of illness subclass by a specified increment up to a specified maximum severity of illness subclass. This step applies to a limited number of patients, mostly cancer patients receiving chemotherapy or radiation therapy. For example, patients with a principal diag- nosis of malignancy in APR-DRG 343 (Musculoskeletal Malignancy and Pathological Fracture Due To Musculoskeletal Malignancy) are increased by one level up to a maximum subclass of major if radiation therapy or chemotherapy is performed.
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  • Fall '18
  • Diagnosis-related group, DRGs

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