17 establish a minimum severity of illness subclass

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17. Establish a minimum severity of illness subclass for the patient based on the presence of specific combinations of categories of secondary diagnoses The presence of certain combinations of secondary diagnoses has great clinical significance. The interaction of specific combinations of secondary diagnoses makes treatment more difficult and typically indicates a more extensive disease process. Therefore, a minimum patient severity of ill- ness subclass greater than minor is established if certain combinations of secondary diagnoses are present. The presence of multiple interacting diagnoses is characteristic of high severity of ill- ness patients. A subset of secondary diagnoses interact with each other causing patient severity of illness to be increased. All of the ICD-9-CM diagnosis codes were classified into either one of the 83 core secondary diagnosis categories applicable to all patients except MDC 15 (Newborns & Other Neonates with Conditions Originating in the Perinatal Period) or to one of the 21 second- ary diagnosis categories applicable to a subset of MDC 15. The 83 core secondary diagnosis categories are shown in table 2–5. Each of these categories represents a disease process and is further subdivided by severity of illness level. The full numbering of the categories includes the two digits shown in table 2–5 plus a third digit for the severity of illness level of the secondary diagnoses in the category. To illustrate, secondary diagnosis category 15 Cerebrovascular Diag- noses includes diagnoses that span all four severity levels so the full numbering and titling is: 151 Cerebrovascular Diagnoses (1), e.g., cerebral atherosclerosis; 152 Cerebrovascular Diagnoses (2), e.g., occlusion and stenosis of pre-cerebral artery without cerebral infarction; 153 Cere- brovascular Diagnoses (3), e.g., occlusion and stenosis of pre-cerebral artery with cerebral infarction; and 154 Cerebrovascular Diagnoses (4), e.g., cerebral thrombosis with cerebral infarc-
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40 tion. Not all secondary diagnosis categories contain four severity levels. Some describe a disease process that has only three severity levels (e.g., Ear, Nose & Throat; Eye) or only two severity levels (e.g., Asthma; Hypertension). Others describe a more singular disease process that has only one severity level (e.g., Coronary Bypass Graft Status, Acute Myocardial Infarct, Hypovolemia). Altogether, the secondary diagnosis categories together with severity level break- outs contain 240 categories. Table 2–5. Categories of Secondary Diagnoses Secondary Diagnosis Category 01 AMI–Subsequent/Unspecified 02 Abdominal Trauma 03 Abortion 04 Acute Myocardial Infarct 05 Alcohol & Drug Abuse 06 Arteries, Veins & Other Vascular DX 07 Asthma 08 Atrial Fibrillation 09 Bacterial Infections 10 Benign Neoplasm and CA in Situ 11 Brain Malignancy 12 Burn 13 CABG Status 14 Congestive Heart Failure 15 Cerebrovascular Diagnoses 16 Cardiac Diagnoses 17 Cardiac & Respiratory Arrest 18 Chest & Respiratory Trauma 19 Cardiovascular Device Malfunction 20 Hypertension 21 Child & Adult Abuse 22 Chronic Renal Failure 23 Cirrhosis 24
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  • Fall '18
  • Diagnosis-related group, DRGs

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