For elderly patients age 69 years the risk of

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nephritis, and is increased from moderate to major for acidosis and hypotension. For elderly patients age >69 years, the risk of mortality level is increased from minor to moderate viral pneu- monia, mitral valve disorder, and anemia; and from moderate to major for streptococcal, staphylococcal, and other bacterial pneumonias; and from major to extreme for peritonitis. For elderly patients age >79 years, the risk of mortality level is increased from minor to moderate for fracture of femur or pelvis; and from moderate to major for pleural effusion. 4. Modify the standard risk of mortality level of a secondary diagnosis based on the APR-DRG and principal diagnosis The standard risk of mortality level for some secondary diagnoses may be modified depending on the APR-DRG and principal diagnosis of the patient. In version 20.0, this logic is applied only to APR-DRG 190 Acute Myocardial Infarct. In general, secondary diagnoses that are closely related to the principal diagnosis are excluded from the determination of the risk of mortality subclass. However, for a patient admitted for an acute anterior wall myocardial infarction, an acute antero- lateral myocardial infarction represents an extension of the acute anterior wall myocardial infarction. Therefore, the acute anterolateral myocardial infarction is not excluded and is assigned a risk of mortality level of moderate. 5. Modify the standard risk of mortality of a secondary diagnosis based on the APR-DRG The standard risk of mortality level for many secondary diagnoses is modified depending upon the APR-DRG to which the patient is assigned. Altogether, there are 1,474 modifications of the stan- dard risk of mortality level of secondary diagnosis depending on the APR-DRG. As with severity of illness, the APR-DRG specific modifications to the risk of mortality level of individual secondary diagnoses reflects the disease-specific nature of the determination of risk of mortality. For example, the risk of mortality level for secondary diagnoses is increased from minor to moder- ate for the following combinations of secondary diagnoses and APR-DRGs: right bundle branch block and APR-DRG for acute myocardial infarct; chronic obstructive lung disease and major chest and major cardiovascular surgery; hypovolemia and APR-DRGs for cancer, cardiovascular disease, and respiratory failure. The risk of mortality level for secondary diagnoses is increased from moderate to major for the following combinations of secondary diagnoses and APR-DRGs: acidosis and APR-DRGs for acute myocardial infarct, congestive heart failure, and septicemia; hypotension and APR-DRGs for respiratory failure, acute myocardial infarct, and liver and pan- creas disorders. There are also many APR-DRGs where the standard risk of mortality level for some secondary diagnoses is decreased, such as for secondary diagnoses that are closely related to the defini- tion of the APR-DRG. For example, the risk of mortality level is decreased from moderate to minor for secondary diagnosis of obstructive hydrocephalus in the APR-DRG for ventricular shunt pro- cedures, since the hydrocephalus is the underlying reason for performing the procedure. The risk
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  • Fall '18
  • Diagnosis-related group, DRGs

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