DRG and MDC.pdf

# Mortality secondary diagnoses except for certain

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mortality secondary diagnoses (except for certain secondary diagnoses for which this requirement if removed or modified Set the base risk of mortality subclass of the patient to the highest risk of mortality level of any of the secondary diagnoses PHASE I Determine the risk of mortality of each secondary diagnosis PHASE II Determine the base risk of mortality sub- class of the patient Eliminate secondary diagnoses that are associated with other secondary diagnoses Modify patient risk of mortality subclass based on the presence of specific combinations of: APR-DRG and principal diagnosis APR-DRG and age, or APR-DRG and principal diagnosis and age, or APR-DRG and birthweight and non-OR procedure APR-DRG and non-OR procedure APR-DRG and OR procedure APR-DRG and pairs of OR procedures APR-DRG for ECMO and presence/absence of certain OR procedures (not applicable) APR-DRG and principal diagnosis and non-OR procedures (not applicable) Combinations of categories of secondary diagnoses PHASE III Determine the final risk of mortality subclass of the patient Assign each secondary diagnosis its standard risk of mortality level Modify the standard risk of mortality level of each secondary diagnosis based on: Age APR-DRG and PDX APR-DRG Non-OR procedure Assign APR-DRG Compute the final patient severity of illness subclass based on the Phase III base patient severity of illness subclass and the Phase III severity of illness subclass modifications

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47 Phase I—Determining the risk of mortality level of each secondary diagnosis 1. Eliminate secondary diagnoses associated with the principal diagnosis This step is identical to the corresponding step in the determination of the severity of illness sub- class. If a secondary diagnosis is closely related to the principal diagnosis and does not add any distinguishing information, then the secondary diagnosis is completely excluded from the 18 step process to determine the patient’s risk of mortality subclass. 2. Assign each secondary diagnosis its standard risk of mortality level Each secondary diagnosis is assigned one of four distinct risk of mortality levels. In general, except for malignancies and certain extreme acute diseases such as acute renal failure, the risk of mortality level tends to be lower than the severity of illness level for the same diagnosis. Mortal- ity is relatively rare. There are a limited number of diagnoses that significantly increase the risk of mortality. For example, traumatic amputation of the arm, acute cholecystitis, and acute osteomy- elitis are all at a major severity of illness level since they represent serious diseases with significant loss of organ function. However, they present relatively low risk of mortality and there- fore are assigned to a minor risk of mortality level. Example of secondary diagnoses that would have an extreme risk of mortality are intracranial hemorrhage, acute vascular insufficiency of intestine, acute myocardial infarct, and acute renal failure.
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• Fall '18
• Diagnosis-related group, DRGs

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