Surgical procedures were consolidated when the

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Surgical procedures were consolidated when the different procedures represented fundamentally the same type of patient and the difference in complexity could be captured through the APR-DRG severity of illness and risk of mortality subclasses. Consolidate APR-DRGs based on case volume The general trend toward outpatient surgery made some of the initial APR-DRGs extremely low in volume. Such APR-DRGs were consolidated into other similar APR-DRGs. For example, carpal tunnel releases are now rarely performed on an inpatient basis. Thus, the APR-DRG for carpal tunnel release was consolidated into the APR-DRG for nervous system procedures for peripheral nerve disorders, which includes procedures such as tarsal tunnel release, and, subsequently, all of these procedures were consolidated into the APR-DRG for other nervous system and related OR procedures. Since the early 1990’s when the APR-DRGs were first developed, there have been many areas where hospitalization rates have decreased. This is examined carefully and in each subsequent update of the APR-DRG classification system, there have been a number of fur- ther consolidations for low volume APR-DRG categories for both medical and surgical patients. Pediatric additions While the AP-DRGs incorporated some of the pediatric modifications from the PM-DRGs (see chapter 1), the APR-DRGs incorporated the remaining significant pediatric modifications in the PM-DRGs. In addition, in conjunction with NACHRI, the APR-DRGs were reviewed with a national pediatric database. As a result of this review, additional APR-DRGs were created. For example, scoliosis (curvature of the back) is one of the primary reasons spinal fusions are performed on pediatric patients. Spinal fusions for scoliosis tend to be more complex than spinal fusions for other clinical reasons such as a herniated disk. Thus, the APR-DRG for spinal fusions was subdi- vided based on a principal diagnosis of scoliosis. Another example is the creation of an APR-DRG for major cardiothoracic repair of heart anomaly.
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24 Restructure newborn APR-DRGs The base APR-DRGs for newborns were completely restructured. Age was used instead of princi- pal diagnosis to define the newborn MDC; birthweight ranges were used as the starting point framework for newborn APR-DRGs; surgical APR-DRGs were created within each birthweight range; and medical hierarchies were created within birthweight ranges that have more than one medical APR-DRG. A medical hierarchy is necessary because newborns do not have a principal diagnosis in the usual sense. Most newborns have a live newborn status code as their principal diagnosis. This does not permit assignment to a medical APR-DRG based on principal diagnosis. Thus, it was necessary to create a medical hierarchy for newborns.
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  • Fall '18
  • Diagnosis-related group, DRGs

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