As in the ap drgs the apr drg newborn mdc was

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As in the AP-DRGs, the APR-DRG newborn MDC was initially defined to include all neonates, with age 0–28 days at time of admission. For Version 20.0 APR-DRGs, the age definition for MDC 15 was redefined and narrowed to be more consistent with its title, “Newborns & Other Neonates with Conditions Originating in the Perinatal Period.” MDC 15 is now defined to include patients age 0–7 days and a subset of patients age 8–14 days who are low birthweight patients and may still have perinatal complications during this time period necessitating transfer to another hospital. This removes from MDC 15 virtually all readmissions to the hospital for community acquired infec- tions and other problems that occur after the first week of life. The new age definition for MDC 15 increases the clinical similarity of MDC 15 patients, better aligns MDC 15 patients with the organi- zation of patient care units and physician specialties, allows for the elimination of certain low volume APR-DRGs in MDC 15, and places the older neonatal patients (8–28 days) in other MDCs where they can be assigned to more disease specific APR-DRGs. Initially, the newborn MDC was organized into six birthweight ranges—the same as in AP-DRGs. For Version 20.0 APR-DRGs, the number of birthweight ranges was expanded to eight and the number of different APR-DRG categories within each birthweight range was decreased. The net effect of all APR-DRG category changes in MDC 15 was a reduction in the number of base APR-DRGs from 35 in Version 15.0 to 28 in Version 20.0. Version 20.0 of APR-DRGs also incorporates the use of gestational age codes that were intro- duced into ICD-9-CM in October 2002. Gestational age is used as part of the severity of illness and risk of mortality subclass assignment for newborns. Add APR-DRGs for mortality The same base APR-DRGs are used in conjunction with both the severity of illness subclasses and risk of mortality subclasses. Thus, some new APR-DRGs were necessary in order to reflect differences in mortality. For example, initial APR-DRG 45 (Specific Cerebrovascular Disorders Except TIA) was subdivided into APR-DRG 45 (CVA With Infarct) and APR-DRG 44 (Intracranial Hemorrhage) as a result of the significantly higher mortality rate for intracranial hemorrhage patients. In Version 20.0 APR-DRGs, neonates <500 grams (1.1 pounds) were placed in a new APR-DRG separate from neonates 500–749 grams (1.1–1.6 pounds) because the mortality rates are so much higher for neonates <500 grams. Other APR-DRG additions and refinements Chapter 1 of the APR-DRG Definitions Manual explains that the process of defining the medical and surgical categories in an MDC requires that each category be based on some organizing principle. The end goal is to create categories that are clinically coherent and have sufficient case volume to be useful. Following are examples of ways in which Version 20.0 APR-DRG modifica- tions improve clinical coherence:
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25 Consolidate APR-DRGs if there aren’t meaningful clinical differences; e.g., combine APR-DRG 202 Angina Pectoris and APR-DRG 198 Coronary Atherosclerosis.
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  • Fall '18
  • Diagnosis-related group, DRGs

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