G major anomaly respiratory distress syndrome if

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MDC 15 medical hierarchy (e.g., major anomaly, respiratory distress syndrome). If medical patient in MDC 20 (Alcohol/Drug Use & Alcohol/Drug Induced Organic Mental Disorders) has a PDX or SDX from a list of cocaine abuse diagnoses, then assign patient to APR-DRG 774 Cocaine Abuse & Dependence and resequence the cocaine abuse diagnosis as the PDX for SOI/ROM purposes unless there is a PDX or SDX higher in the MDC 20 medical hierarchy (e.g., opioid abuse). MDC 20 patients are often admitted for multiple alcohol and drug abuse problems and so patients are assigned to a specific APR-DRG based upon a pre-existing medical hierarchy that examines all principal and secondary diagnoses. If medical patient in MDC 24 (Human Immunodeficiency Virus Infections) has a PDX of major HIV related condition and SDX of HIV Infection, then assign patient to APR-DRG 892 HIV With Major HIV Related Condition and resequence HIV Infection as the PDX for SOI/ROM purposes. The sequencing of PDX and SDX for HIV patients is somewhat ambiguous and so this approach assures consistency in assignment to APR-DRG cate- gory and SOI/ROM levels. Note, if there exists more than one secondary diagnosis from the specified diagnosis list for this type of rerouting logic, then the APR-DRG system provides additional selection logic for designa- tion of the PDX for SOI/ROM purposes. The selection logic is specific to each APR-DRG. In most instances, the logic selects the diagnosis with the highest severity level to capture the PDX that most fully describes the reason for hospitalization, e.g., intermediate coronary syndrome (unsta- ble angina) would be selected over coronary atherosclerosis NOS. The main exception to this approach is MDC 15 (Newborns & Other Neonates with Conditions Originating in the Perinatal Period) APR-DRGs. These APR-DRGs tend to be defined more broadly and can include patients with multiple problems at birth. In order to ensure that neonates with multiple problems have their most serious problems considered in the SOI/ROM algorithms, the diagnosis with the lowest severity is selected as the designated PDX (e.g., neonate with multiple anomalies).
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65 W1X: PDX and Age and Medical Æ Age clarifies PDX and assignment to new APR-DRG within same MDC. If medical patient in MDC 23 (Rehabilitation, Aftercare, Other Factors Influencing Health Status & Other Health Service Contacts) has PDX Aftercare NEC and Age < 90 days, then assign patient to APR-DRG 863 Neonatal Aftercare instead of APR-DRG 862 Other Aftercare & Convalescence. W3X: PDX and OR Procedure Æ PDX and OR Procedure together clarify APR-DRG assignment within same MDC in accordance with the MDC’s surgical hierarchy. If surgical patient in MDC 8 (Diseases & Disorders of the Musculoskeletal System and Connective Tissue) has a PDX of back/neck disorder and one of a designated set of mus- culoskeletal procedures not elsewhere classified (which includes back procedures), then reassign patient to APR-DRG 310 Intervertebral Disc Excision & Decompression unless the patient has another OR procedure that is higher in the MDC 8 surgical hierarchy.
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  • Fall '18
  • Diagnosis-related group, DRGs

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