G other pulmo nary insufficiency not elsewhere

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level of illness of a secondary diagnosis by an increment of two up to extreme; e.g., other pulmo- nary insufficiency not elsewhere classified (which includes adult respiratory distress syndrome) increases the standard severity of illness level from moderate to extreme and a diagnosis such as pneumonia NOS which is already a level of major increases to extreme if the patient had mechan- ical ventilation 96+ hours. In each of these instances, the need for mechanical ventilation is indicative of a patient with more severe pulmonary illness, especially those who require ventilation for 96+ hours. Among the other non-OR procedures that are used as part of this step, renal dialysis is used to increase the severity level of nephritis by an increment of one up to a maximum of major; total parenteral nutrition (TPN) is used to increase regional enteritis and ulcerative colitis by an incre- ment of one up to major; and temporary pacemaker is used to increase heart block diagnoses such as trifascicular block by an increment of one up to major. Overall, non-OR procedures as part of this step in the APR-DRG severity of illness logic are used more sparingly in version 20.0 than previous versions. Phase II—Determine the base severity of illness subclass for the patient Once each secondary diagnosis has been assigned its standard severity of illness level and the standard severity of illness level of each secondary diagnosis has been modified based on age, APR-DRG and principal diagnosis, APR-DRG, and presence of certain non-OR procedures, the Phase II base severity of illness subclass for the patient can be determined. The process of deter- mining the base patient severity of illness subclass of the patient begins with the elimination of certain secondary diagnoses that are closely related to other secondary diagnoses. The elimina- tion of these diagnoses prevents the double counting of clinically similar diagnoses in the determination of the severity of illness subclass of the patient. Once redundant diagnoses have been eliminated, the base severity of illness subclass is determined based on all of the remaining secondary diagnoses. There are three steps to Phase II. 7. Eliminate certain secondary diagnoses from the determination of the severity of iIlness subclass of the patient Closely related secondary diagnoses are grouped together with clinically similar diagnoses. If more than one secondary diagnosis from the same secondary diagnosis group is present, then only the secondary diagnosis with the highest severity of illness level is preserved. All other sec- ondary diagnoses in the group have their severity level reduced to minor, virtually eliminating them from contributing to the patient’s base subclass determination. There are 289 secondary diagnosis groups defined for this step. For example, the secondary diagnoses of cerebral embo- lism with infarct and precerebral occlusion are in the same secondary diagnosis group, Cerebrovascular Diagnoses. Since the cerebral embolism with infarct is an extreme severity of ill-
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  • Fall '18
  • Diagnosis-related group, DRGs

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