The process of determining the severity of illness

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The process of determining the severity of illness subclass for a patient begins by assigning each secondary diagnosis its standard severity of illness level. The next step is to modify the standard severity of illness level based on other patient attributes. The patient attributes which can modify the standard severity of illness level of a secondary diagnosis are the age of the patient, the APR-DRG and principal diagnosis, the APR-DRG, and the presence of certain non-operating room procedures. These potential modifiers are evaluated and applied sequentially through Phase I. 3. Modify the standard severity of illness level of a secondary diagnosis based on age The age of the patient will modify the standard severity of illness level assignment for some sec- ondary diagnoses. For pediatric patients there are some secondary diagnoses that are modified to a higher level throughout all childhood years. For example, hypertension is modified from minor to major and really represents a different disease in children than adults. There are other second- ary diagnoses that are modified only for certain childhood ages, most often early childhood. For example, many congenital anomalies and syndromes have their most difficult presentation in the neonatal time period and the first year of life, and are modified to a higher level for these ages. For example, hypoplastic left heart syndrome and combined immune deficiency are both modi- fied from major to extreme for children less than one year of age. There are also some secondary
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34 diagnoses that are modified to a lower level for pediatric patients. For example, thrush is modified from moderate to minor for children less than one year of age. In general, for elderly patients, for select secondary diagnoses, the severity of illness level is increased. For example, the secondary diagnoses of hypovolemia (dehydration) and chronic bronchitis are modified from minor to moderate and asthma with status asthmaticus is modified from moderate to major for patients age >69 years. 4. Modify the standard severity of illness level of a secondary diagnosis based on the APR-DRG and principal diagnosis The standard severity of illness level for some secondary diagnoses may be modified depending on the APR-DRG and principal diagnosis of the patient. In version 20.0, this logic is applied only to APR-DRG 190 Acute Myocardial Infarct. In general, secondary diagnoses that are closely related to the principal diagnosis are excluded from the determination of the severity of illness subclass. However, for a patient admitted for an acute anterior wall myocardial infarction, an acute anterolateral myocardial infarction represents an extension of the acute anterior wall myo- cardial infarction. Therefore, the acute anterolateral myocardial infarction is not excluded and is assigned a severity of illness level of moderate.
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  • Fall '18
  • Diagnosis-related group, DRGs

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