Some are very similar to each other but are

Info icon This preview shows pages 67–69. Sign up to view the full content.

Some are very similar to each other, but are technically different. The most frequently used com- bination of factors is #1, PDX or SDX and Medical. This means a diagnosis, whether recorded as PDX or SDX, determines the APR-DRG category assignment for medical patients. This logic existed in Version 15.0 APR-DRGs for APR-DRGs in MDCs 4, 15, 20, and 24. Version 15.0 APR-DRGs also contained one instance of #7, PDX and SDX and Medical (PDX head trauma and SDX head trauma with coma > 1 hour or hemorrhage) and a surgical rerouting for certain MDC 11 patients receiving a prostate procedure for benign prostatic hypertrophy. All the rest of the combinations of factors are new for Version 20.0 APR-DRGs. 0 – PDX or SDX and Medical 1 – PDX and Age and Medical 2 – PDX and Non-OR Procedure and Medical 3 – PDX and OR Procedure (and other OR procedures allowed if lower in MDC surgical hierarchy) 4 – PDX and Only OR Procedure Except Related OR Procedures 5 – SDX and OR Procedure (and any other OR procedures are allowed) 6 – DX and SDX and Medical 7 – DX and SDX and Either Surgical/Medical 8 – PDX and SDX and Only OR Procedure Except Related OR Procedures 9 – PDX and SDX and Only OR Procedure
Image of page 67

Info icon This preview has intentionally blurred sections. Sign up to view the full version.

62 There are fundamentally two ways that SDXs are used as part of the rerouting logic. One way is for the SDX to clarify the PDX. The APR-DRG grouper uses the clarifying information of the SDX to reassign the patient to a new APR-DRG, but does not, for grouping purposes, alter the sequence of PDX and SDX. This can be done within or across MDCs. An example of a Within MDC Rerouting is PDX liver disease and SDX alcoholic liver disease, clarifying that the patient should be assigned to APR-DRG 280 Alcoholic Liver Disease. An example of an Across MDC Rerouting is PDX complication of other vascular device (includes both peripheral vascular devices and renal dialysis shunt) and SDX renal failure (without heart failure) clarifying that the patient should be reassigned to MDC 11 (Diseases & Disorders of the Kidney & Urinary Tract), APR-DRG 466 Malfunction, Reaction, Complication of Genitourinary Device or Procedure. The second way the SDXs are used as part of the rerouting logic is to function as the PDX for APR-DRG grouping purposes. There are two ways that the APR-DRG system implements this: one way for Within MDC Reroutings and another way for Across MDC Reroutings. These are technically different approaches but accomplish the same end result. In the instance of Within MDC Reroutings, the technical approach is for the APR-DRG grouper to reassign the patient to a new APR-DRG and then resequence the SDX as PDX for Severity of Ill- ness (SOI) and Risk of Mortality (ROM) purposes. For example, a patient with a PDX of chest pain and an SDX of angina pectoris is reassigned from DRG 203 Chest Pain to DRG 198 Angina Pectoris and Coronary Atherosclerosis, and since the SDX of angina pectoris drove the APR-DRG assignment, it is resequenced as the PDX for the subsequent steps of assigning SOI and ROM levels. This prevents angina pectoris from contributing as a redundant SDX to the SOI and ROM levels.
Image of page 68
Image of page 69
This is the end of the preview. Sign up to access the rest of the document.
  • Fall '18
  • Diagnosis-related group, DRGs

{[ snackBarMessage ]}

What students are saying

  • Left Quote Icon

    As a current student on this bumpy collegiate pathway, I stumbled upon Course Hero, where I can find study resources for nearly all my courses, get online help from tutors 24/7, and even share my old projects, papers, and lecture notes with other students.

    Student Picture

    Kiran Temple University Fox School of Business ‘17, Course Hero Intern

  • Left Quote Icon

    I cannot even describe how much Course Hero helped me this summer. It’s truly become something I can always rely on and help me. In the end, I was not only able to survive summer classes, but I was able to thrive thanks to Course Hero.

    Student Picture

    Dana University of Pennsylvania ‘17, Course Hero Intern

  • Left Quote Icon

    The ability to access any university’s resources through Course Hero proved invaluable in my case. I was behind on Tulane coursework and actually used UCLA’s materials to help me move forward and get everything together on time.

    Student Picture

    Jill Tulane University ‘16, Course Hero Intern