The categories of secondary diagnoses used for this

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The categories of secondary diagnoses used for this step in risk of mortality are the same 83 core secondary diagnosis categories that are used for severity of illness (see table 2–5). The only dif- ference is that these same 83 secondary diagnosis categories are then subdivided by risk of mortality level, not severity of illness level. The additional 21 secondary diagnosis categories developed for use with neonatal APR-DRGs 626 and 640 are not used for risk of mortality. These additional 21 secondary diagnosis categories are intended to differentiate neonates with multiple minor or other problems from those who are normal newborns or who have a single minor prob- lem, which is significant for severity of illness but is not applicable for risk of mortality since these diagnoses do not increase the risk of dying. All of the secondary diagnosis category combination types for risk of mortality are the same as those defined for severity of illness (see table 2–7). Of the nine possible combination types, six are applicable for risk of mortality. These are combination types 1, 2, 3, 4, 5, and 13. A type 1 combination consists of two categories that contain major risk of mortality level diag- noses, plus any two additional secondary diagnoses that are at least major level. When a type 1 combination occurs, the minimum patient risk of mortality subclass is extreme. An example of a type 1 combination is a major pulmonary diagnosis (category 75) such as acute pulmonary edema and a major neurological diagnosis (category 64) such as cerebral thrombosis without inf- arct combined with any other two major secondary diagnoses. A type 2 combination is the same
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54 as type 1 except that the two categories consist of a major risk of mortality category and a moder- ate risk of mortality category. For a type 2 combination, the minimum patient risk of mortality subclass is extreme. An example of a type 2 combination is a major bacterial infection (category 9) such as peritonitis and a moderate level secondary malignancy (category 78) combined with any other two major secondary diagnoses. A type 3 combination consists of two categories that contain moderate risk of mortality level diag- noses, plus any two additional secondary diagnoses that are at least a moderate risk of mortality level. For a type 3 combination, the minimum patient risk of mortality is major. An example of a type 3 combination is a moderate bacterial infection (category 9) such as staphylococcal enteritis with chronic renal failure (category 20) combined with any other two moderate secondary diag- noses. A type 4 combination consists of a moderate risk of mortality category and a minor risk of mortality category, plus any two additional secondary diagnoses that are at least moderate. For a type 4 combination, the minimum patient risk of mortality subclass is major. An example of a type 4 combination is a decubitus ulcer (category 26) and hypovolemia (category 51) combined with two other secondary diagnoses that are at least moderate.
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  • Fall '18
  • Diagnosis-related group, DRGs

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