The pdx spans several mdcs but the or procedure

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The PDX spans several MDCs but the OR procedure differentiates. For example, PDX abdominal pain (MDC 6) and hepatobiliary OR procedure (MDC 7). The PDX or the PDX and SDX together identify that the patient has diabetes with circulatory (MDC 5) and possibly other related manifestations (MDCs 1, 8, 9) and the patient receives a lower limb or toe amputation procedure. This is the most frequent and important surgical rerouting. To explain this last example further, diabetes is a complex disease with many manifestations, several of which relate to the possible need for lower limb or toe amputation. These patients may be admitted with many different principal diagnoses, including diabetes with circulatory manifesta- tion, diabetes with neuropathy, or diabetes with manifestations not elsewhere classified (includes skin ulcer, bone involvement in other disease, and osteomyelitis). They may also be admitted with principal diagnoses of peripheral vascular disease, gangrene, skin ulcer, or osteomyelitis and a secondary diagnosis of diabetes. All of these patients who receive a lower limb or toe amputation and who do not have another more defining surgical procedure (e.g., major cardiovascular proce- dure) are clinically similar patients and it is more helpful to group them together than to let them be dispersed across different MDCs and APR-DRGs. Following is a further description of the methodology for the APR-DRG reroutings. All of the reroutings have the same objective, to group together clinically similar patients. The exact logic
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61 and technical details vary from one rerouting to another. To make the reroutings easier to under- stand they are organized into various types or a typology. Methodology for APR-DRG Rerouting Logic As identified earlier, the assignment of patients to an MDC is usually very straightforward based upon the PDX. Likewise, the assignment to an APR-DRG is usually straightforward based upon the PDX for medical patients and OR procedure for surgical patients. Occasionally, the surgical APR-DRGs split into separate categories based upon PDX or non-OR procedure. There are situations however, where it is necessary to consider several different factors together to assign the patient to the most appropriate and useful MDC and APR-DRG. There are five differ- ent factors considered for this: PDX, SDX, OR procedure, non-OR procedure, and age. The entire logic and specifications for the APR-DRG reroutings contain three elements: 1. Whether the rerouting applies within MDC or across MDCs; 2. The combination of factors that define the rerouting; 3. Whether there is any special handling of SDXs, specifically, any resequencing of SDX and PDX for grouping purposes. There are ten specific combinations of factors used in the Version 20.0 APR-DRG rerouting logic.
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  • Fall '18
  • Diagnosis-related group, DRGs

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