In the instance of across mdc reroutings the

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and ROM levels. In the instance of Across MDC Reroutings, the technical approach is for the APR-DRG grouper to resequence the PDX and SDX as its first action step and then proceed through all of its regular steps—MDC assignment, APR-DRG assignment, and SOI and ROM level assignment. For exam- ple, if a patient has a PDX of hypovolemia (dehydration) and an SDX of gastroenteritis, the APR-DRG grouper resequences the PDX and SDX so that gastroenteritis becomes the PDX and the patient is assigned to MDC 6 (Diseases & Disorders of the Digestive System) and to the appropriate APR-DRG per the logic and specifications of MDC 6. Since gastroenteritis is already resequenced as the PDX, it will not contribute as a redundant SDX to the SOI and ROM levels. Hypovolemia, which is resequenced as the SDX, would contribute to the SOI and ROM levels if judged to be a significant comorbidity or complication by the APR-DRG system (which, in this case it is not). Note, the sequencing of PDX and SDX on the patient discharge record is not altered by any of these resequencing processes. Rather, the APR-DRG grouper is redesignating PDX and SDX for specified steps that are part of its logic. In the example of PDX hypovolemia and SDX gastroen- teritis, the APR-DRG grouper resequences PDX and SDX for grouping purposes, but when users examine their own discharge records, hypovolemia will still be the principal diagnosis. This also means that when users examine their patients in MDC 6 (Diseases & Disorders of the Digestive System) and especially APR-DRG 249 Non-Bacterial Gastroenteritis, Nausea & Vomiting, some of the patients will have a PDX of hypovolemia, which is ordinarily assigned to MDC 10 (Endo- crine, Nutritional & Metabolic Diseases and Disorders). Following is a list that summarizes the different types of logic used for the APR-DRG reroutings. There are three characters to the APR-DRG rerouting type number. Each character captures the following aspects of the rerouting logic: The first character refers to whether the rerouting occurs within or across MDCs. W = Within MDC Rerouting
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63 A = Across MDC Rerouting The second character refers to the combination of diagnostic, procedure and demographic factors used in rerouting (values 0–9 described earlier). The third character refers to special handling of SDXs, if any. P = Resequence SDX as PDX for new APR-DRG assignment and SOI/ROM purposes. S= Resequence SDX as PDX for SOI/ROM purposes (after assignment to new APR-DRG). X = SDX clarifies PDX; no special handling of SDX needed. Type C also includes where Age or Procedure clarify the APR-DRG assignment. The rerouting type numbers have no special significance in and of themselves. They are just a way to organize and explain the three elements to APR-DRG rerouting logic. The best way to fully understand the APR-DRG rerouting is to review specific examples.
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  • Fall '18
  • Diagnosis-related group, DRGs

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