As summarized in table 27 there are nine different

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As summarized in table 2–7 there are nine different types of combinations of secondary diagnosis categories that will result in a minimum severity of illness subclass for a patient. For combination types 1 through 5, four significant secondary diagnoses are required in order to increase the severity of illness subclass of a patient. Two of the four secondary diagnoses must constitute one of the secondary diagnosis category combinations and must not have had their standard severity of illness level decreased as part of the Phase I severity level modifications. The addition of the third and fourth secondary diagnoses increases the likelihood that the specific combination of sec- ondary diagnosis categories represents a more extensive and severe disease process. Combination types 11, 13, and 15 only require a total of three significant secondary diagnoses, the two that make up the secondary diagnosis category combination and one additional second- ary diagnosis. This reflects that the secondary diagnosis category combination is sufficiently significant that only one additional secondary diagnosis is required. Combination types 11, 13, and 15 are new to version 20.0 of the APR-DRG system. Previous versions contained only types 1 through 6. A type 1 combination consists of two secondary diagnosis categories that contain major severity of illness level diagnoses, plus any third and fourth secondary diagnosis that is at least a major severity of illness level. When a type 1 combination occurs, the minimum patient severity of illness subclass is extreme. An example of a type 1 combination is a major bacterial infection (category 9) with a major hematological/immunological diagnosis (category 44). If a diagnosis from both these categories is present plus at least two other secondary diagnoses that are at least a major severity of illness level, then the minimum patient severity of illness subclass will be extreme. A type 2 combination is the same as a type one combination except that the two categories consist of a major severity of illness category and a moderate severity of illness category. An example of a type 2 combination is a major bacterial infection (category 9) and brain malignancy (category 11). A type 3 combination consists of two categories that contain moderate severity of illness level Table 2–7. Combinations of Secondary Diagnosis Categories Combination Type Combination of Categories Additional Secondary Diagnoses Required Minimum Severity of Illness 1 Specified combinations of two major categories At least two additional secondary diagnoses of major or higher Extreme (4) 2 Specified combinations of a major and moderate category At least two additional secondary diagnoses of major or higher Extreme (4) 3 Specified combinations of two moderate categories At least two additional secondary diagnoses of moderate or higher Major (3) 4 Specified combinations of a moderate and minor category At least two additional secondary diagnoses of moderate or higher Major (3) 5 Specified combinations of two
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  • Fall '18
  • Diagnosis-related group, DRGs

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