This manual was written designed and produced by the

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—————————————————————————————————————————————————————————————————————————————————————— This manual was written, designed, and produced by the Clinical Research and Docu- mentation Departments of 3M Health Information Systems, Wallingford, Connecticut and Murray, Utah. Document number GRP–041 Version 20.0 07/03
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iii ACKNOWLEDGEMENTS The developement of the APR-DRGs, Version 20.0, involved the participation of many individual contributors. 3M HIS consultants Ruth Shaber, M.D., Warren Strauss, M.D., Stephen Wittenberg, M.D., David Earle, M.D., James Flink, M.D., James Slaughter, M.D., Robert Keller, M.D., Donald George, M.D., and Benjamin Gitterman, M.D. provided clinical input into the research. Data analysis support for the project was provided by Keith C. Mitchell, Enes Elia, Mona Bao, Julie-Anne Perry, and Oleg Kostenko. The software was produced by Ronald Mills and Laurence W. Gregg. It was tested by Susie Nickman and Carolyn Hogan. Assistance in the design and production of the APR-DRG Definitions Manual was provided by Sue Boucher, Kathy Blake, Marilyn Marino, and Darriell Rolka.
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v Table of Contents CHAPTER 1 HISTORY OF THE DEVELOPMENT OF THE DIAGNOSIS RELATED GROUPS (DRGS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 CHAPTER 2 DEVELOPMENT OF THE ALL PATIENT REFINED DIAGNOSIS RELATED GROUPS (APR-DRGS). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 CHAPTER 3 BACKGROUND AND EXPLANATION OF APPROACH FOR REROUTING LOGIC IN APR-DRG, VERSION 20.0 . . . . . . . . . . . . . . . . . . . . . . . . . . 57 APPENDIX A LIST OF ALL PATIENT REFINED DRGS, VERSION 20.0. . . . . . . . . . . . . . . . . . . . . . 69
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CHAPTER 1 1 History of the Development of the Diagnosis Related Groups (DRGs)
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3 HISTORY OF THE DEVELOPMENT OF THE DIAGNOSIS RELATED GROUPS (DRGS) Background The Diagnosis Related Groups (DRGs) are a patient classification scheme which provides a means of relating the type of patients a hospital treats (i.e., its case mix) to the costs incurred by the hospital. There are currently three major versions of the DRG in use: basic DRGs, All Patient DRGs, and All Patient Refined DRGs. The basic DRGs are used by the Centers for Medicare and Medicaid Services (CMS) for hospital payment for Medicare beneficiaries. The All Patient DRGs (AP-DRGs) are an expansion of the basic DRGs to be more representative of non-Medicare pop- ulations such as pediatric patients. The All Patient Refined DRGs (APR-DRG) incorporate severity of illness subclasses into the AP-DRGs. Since the APR-DRGs include both the CMS DRGs and the AP-DRGs, the development of all three versions of the DRGs will be reviewed. The design and development of the DRGs began in the late sixties at Yale University. The initial motivation for developing the DRGs was to create an effective framework for monitoring the qual- ity of care and the utilization of services in a hospital setting. The first large-scale application of the DRGs was in the late seventies in the State of New Jersey. The New Jersey State Depart- ment of Health used DRGs as the basis of a prospective payment system in which hospitals were reimbursed a fixed DRG specific amount for each patient treated. In 1982, the Tax Equity and Fis-
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  • Fall '18
  • Diagnosis-related group, DRGs

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