The final variable used in the definition of the drgs

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The final variable used in the definition of the DRGs was the patient discharge status. Separate DRGs were formed for burn patients and newborns if the patients were transferred to another acute care facility. In addition, separate DRGs were formed for patients with alcoholism or drug abuse who left against medical advice and for acute myocardial infarction patients and newborns who died. There are five DRGs for patients whose medical record abstracts contain clinically atypical or invalid information. DRG 468 Extensive O.R. Procedure Unrelated to the Principal Diagnosis DRG 476 Prostatic O.R. Procedure Unrelated to the Principal Diagnosis
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10 DRG 477 Non-Extensive O.R. Procedure Unrelated to the Principal Diagnosis DRG 469 Principal Diagnosis Invalid as Discharge Diagnosis DRG 470 Ungroupable Patients are assigned to DRGs, 468, 476 or 477 when all the operating room procedures per- formed are unrelated to the major diagnostic category of the patient’s principal diagnosis. Typically, these are patients admitted for a particular diagnosis requiring no surgery, who develop a complication unrelated to the principal diagnosis and who have an operating room procedure performed for the complication or who have a diagnostic procedure performed for a secondary diagnosis. The unrelated operating room procedures have been divided into three groups based on hospital resource use: extensive, prostatic and non-extensive. For example, a patient with a principal diagnosis of congestive heart failure who develops acute cholecystitis and whose only procedure is a cholecystectomy, will be assigned to DRG 468 since a cholecystectomy is considered an extensive procedure. However, if a patient has a principal diagnosis of arrhythmia and has a biopsy performed for a breast mass discovered while in the hospital, the patient will be assigned to DRG 477 since the biopsy is considered a nonextensive procedure. Finally, a patient with benign prostatic hypertrophy who develops prostatic obstruction while hospitalized for a medical problem such as pneumonia will be assigned to DRG 476 if a transurethral prostatectomy is performed. Patients are assigned to DRG 469 when a principal diagnosis is coded which, although it is a valid ICD-9-CM code, is not precise enough to allow the patient to be assigned to a clinically coherent DRG. For example, ICD-9-CM code 64690 is an unspecified complication of pregnancy with the episode of care unspecified. This diagnosis code does not indicate the type of complication nor whether the episode of care was antepartum, postpartum or for delivery. Since the DRG defini- tions assign patients to different sets of DRGs depending on whether the episode of care was antepartum, postpartum or for delivery, a patient with a principal diagnosis of 64690 will be assigned to DRG 469.
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  • Fall '18
  • Diagnosis-related group, DRGs

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