23 rehabilitation aftercare other factors influencing

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trauma, the patient is assigned to the appropriate tracheostomy AP-DRG. 23 Rehabilitation, Aftercare, Other Factors Influencing Health Status and Other Health Service Contacts 24 Human Immunodeficiency Virus (HIV) Infections 25 Multiple Significant Trauma Table 1–2. AP-DRG Hierarchy Exception Hierarchy MDC/AP-DRG Assignment Age less than 29 days Assign to MDC 15 Principal diagnosis of HIV or secondary diagnoses of HIV and principal diagnosis of HIV related condition Assign to MDC 24 Liver Transplant Assign to AP-DRG 480 Lung Transplant Assign to AP-DRG 795 Simultaneous Kidney/Pancreas Transplant Assign to AP-DRG 805 Heart Transplant Assign to AP-DRG 103 Kidney Transplant Assign to AP-DRG 302 Allogeneic Bone Marrow Transplant Assign to AP-DRG 803 Autologous Bone Marrow Transplant Assign to AP-DRG 804 Tracheostomy Assign to AP-DRG 482 or 483 Principal diagnosis of trauma and at least two significant traumas from different body sites Assign to MDC 25 Principal Diagnosis Assign to MDCs 1–14, 16–23 Table 1–1. Major Diagnostic Categories (continued)
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16 Pediatric and other AP-DRG modifications The AP-DRGs introduce many other changes to the CMS DRGs. Some of these primarily affect pediatric patients while others affect patients of all ages. The pediatric modifications include some of the recommendations originally developed by NACHRI. In the following areas either additional AP-DRGs were created or significant modifications were made: Pediatric ventricular shunts Pediatric cystic fibrosis Lead poisoning Spinal fusion Compulsive nutritional disorders Infant aftercare for weight gain High-risk obstetric care Tertiary aftercare for multiple trauma Acute leukemia Multiple channel cochlear implants Hemophilia factor VIII and IX diseases Traumatic stupor, coma, concussion and intracranial injuries Bronchopulmonary dysplasia Congenital anomalies Sickle cell crisis In addition, the AP-DRGs subdivide many of the pediatric groups based on CCs, whereas the CMS DRGs do not. The AP-DRGs also modified many of the basic components of the CMS DRGs. For example, diagnoses were deleted from the CC list (e.g., allergic urticaria), the CC exclusion list was modified (e.g., postoperative anemia is not a CC with a principal diagnosis of postoperative hemorrhage) and the surgical hierarchies were modified (e.g., Arthroscopy was moved lower in the surgical hierarchy for MDC 8). There are 653 AP-DRG in Version 18.0, two of which are error DRGs. There are 510 CMS DRGs in Version 20.0, two of which are error DRGs. Some of the DRG modifications originally developed in the AP-DRGs have subsequently been adopted in the CMS DRGs. For example, in Version 8.0 of the CMS DRGs, an HIV infection MDC was added. However, the CMS HIV infection MDC consists of three DRGs and does not discrimi- nate among HIV infection patients at the level of detail contained in the AP-DRGs.
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  • Fall '18
  • Diagnosis-related group, DRGs

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