Hyponatremia Single SOI 2
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Hyponatremia Single SOI 2

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Hyponatremia Single SOI 2 Hyponatremia Single SOI 2 Document Transcript

  • 3M™ APR DRG Assignment Report Page 1 of 16 3M Health Information Systems 3M™ APR DRG Assignment Report APR DRG Version 26.1 Patient ID : - Sex : Female Age in Years : 65 Status : 1 - Home Days Mech Vent DMV 6 - No DMV (DMV) : Option : Grouper Results MDC : 6 - DISEASES AND DISORDERS OF THE DIGESTIVE SYSTEM All Patient Refined 253 - OTHER & UNSPECIFIED GASTROINTESTINAL DRG : HEMORRHAGE Severity of Illness : 2 - Moderate Patient Severity of Illness Risk of Mortality : 1 - Minor Patient Risk of Mortality Medical/Surgical DRG : Medical Return Code : 0 - DRG assigned Principal Diagnosis 5789 Gastrointest hemorr NOS (DRG) Diagnosis Affect DRG Affect SOI Affect ROM Compl of Care 5789 Yes Yes Yes No Secondary Diagnoses 41401 Crnry athrscl natve vssl 2761 Hyposmolality Diagnosis Affect DRG Affect SOI Affect ROM Compl of Care 41401 No No No No 2761 No Yes Yes No Procedures 9904 Packed cell transfusion Procedure OR Affect DRG Affect SOI Affect ROM 9904 No No No No APR DRG Assignment Patient PDX 5789 used for DRG and SOI/ROM assignment Phase 1 Advance to SOI Detail Advance to ROM Detail file://C:Documents and SettingsGAHERN001Local SettingsTempAPRAssignmentRepo... 5/7/2009
  • 3M™ APR DRG Assignment Report Page 2 of 16 Phase 1 Results MSL Steps 1-6 MML Steps 1-6 41401 1 1 2761 2 2 Phase 2 Advance to SOI Detail Advance to ROM Detail Phase 2 Results Steps 7-9 Maximum Severity level 2 Maximum Mortality level 1 Phase 3 Advance to SOI Detail Advance to ROM Detail Steps Phase 3 Results SOI ROM 10 PDX/DRG modification 2 1 11a DRG/Age modification 2 1 11b PDX/DRG/Age modification 2 1 11c DRG/BWT/Non-OR Proc modification - 1 12 DRG/Non-OR Proc modification 2 1 13 DRG/Proc modification 2 1 14 DRG/Multiple Proc modification 2 1 15 ECMO modification 2 - 16 PDX/DRG/Non-OR Proc modification 2 - 17 Multiple SDX modification 2 1 18 Final Severity of Illness/Risk of Mortality Subclass 2 1 Return to summary file://C:Documents and SettingsGAHERN001Local SettingsTempAPRAssignmentRepo... 5/7/2009
  • 3M™ APR DRG Assignment Report Page 3 of 16 APR DRG - Severity of Illness Detail Key: SSL = Standard Severity Level MSL = Modified Severity Level CSV = Category Subclass Value X = Excluded diagnosis D = Duplicate diagnosis Diagnosis Code SSL Group Category CSV PDX 5789 2 0 0 0 SDX 41401 1 519 161 1 SDX 2761 2 0 342 2 Phase 1 Results: Determine the Severity level of each individual secondary diagnosis. Step 1 : PDX/SDX Exclusions Eliminate secondary diagnoses that are closely related with the principal diagnosis. Step 2 : SDX Default Level Assign each secondary diagnosis to its standard severity level. Step 3 : SDX Modification by Age Modify the standard severity level of each secondary diagnosis based on patient age. Step 4 : SDX Modification by PDX and APR DRG Modify the standard severity level of each secondary diagnosis in specific APR DRG/PDX/SDX combinations. If the secondary diagnosis is closely related to the principal diagnosis. Step 5 : SDX Modification by APR DRG Modify the standard severity level of each secondary diagnosis. If the secondary diagnosis has a common presence in the APR DRG assigned. Step 6 : SDX Modification by non-OR procedure Modify the standard severity level of each secondary diagnosis. If a non-OR procedure indicates a more extensive disease process within that diagnosis. SOI - Steps Diagnosis 1 2 3 4 5 6 MSL 41401 0 1 1 1 1 1 1 2761 0 2 2 2 2 2 2 Return to summary file://C:Documents and SettingsGAHERN001Local SettingsTempAPRAssignmentRepo... 5/7/2009
  • 3M™ APR DRG Assignment Report Page 4 of 16 Phase 2 Results: Determine the Base Severity of Illness subclass of the Patient. Step 7A : SDX/SDX Exclusions Closely related secondary diagnoses are placed into groups together with clinically similar diagnoses. If more than one secondary diagnosis from the same group is present, then only the secondary diagnoses with the highest severity of illness is preserved. All other secondary diagnoses in the group are eliminated. Number of SDX Groups : 1 Group Count HiMSL 519 1 1 Step 7B : Specific/General SDX/SDX Exclusions Subsets of the groups in 7A are designated as "general secondary diagnosis groups" (GenSDX) or "specific secondary diagnosis groups" (SpecsSDX). Each specific secondary diagnosis group will have one or more general secondary diagnosis groups associated with it. If a diagnosis in a specific group is present, all diagnoses in the general groups associated with the specific group will be eliminated. The one exception is if the diagnosis in the general group creates an explicit secondary diagnosis combination in Step 17; when this occurs, both the specific and general groups are maintained. If the severity level of the diagnosis in the general group is higher than the severity level of the diagnosis in the specific group, the diagnosis in the general group is eliminated while the severity level of the diagnosis in the specific group is increased to be equal to the severity level of the diagnosis in the general group. Step 7C : General/General SDX/SDX Exclusions If there is no corresponding specific group diagnosis and there are diagnoses in multiple general groups present that would have been eliminated had the specific group been present, a hierarchy of general groups is used to eliminate all but one of the diagnoses in the general groups. If any of the severity levels of the diagnoses being eliminated is higher than the severity level of the general group that is highest in the general group hierarchy, the severity level of the diagnosis that is in the general group that is the highest in the hierarchy is increased to the severity level of the eliminated diagnosis with the highest severity level. MSL at end of Step 7 DXcode Final MSL 41401 1 2761 2 Step 8 : Initial Patient Subclass Compute a single overall base patient severity subclass value. The overall base patient severity of illness subclass is set equal to the highest severity of illness level of all the remaining secondary diagnoses. Number of SDXs with MSL equal to level 1 : 1 Number of SDXs with MSL equal to level 2 : 1 Number of SDXs with MSL equal to level 3 : 0 file://C:Documents and SettingsGAHERN001Local SettingsTempAPRAssignmentRepo... 5/7/2009
  • 3M™ APR DRG Assignment Report Page 5 of 16 Number of SDXs with MSL equal to level 4 : 0 Maximum Severity Subclass Value (8) : 2 Step 9 : Adjusted Patient Subclass Action : None Maximum Severity subclass (9) : 2 Return to summary Phase 3 Results: Determine the final Severity of Illness subclass of the patient. Step 10 : Subclass modification by PDX and APR DRG Compute a Modified Patient Severity Subclass based on the PDX/APR DRG combination. Modifications may be made to the severity of illness due to the clinical implications of the principal diagnosis combined with the APR DRG. The severity of illness subclass from Step 9 can be either increased or decreased based on the specific combinations of Principal Diagnosis and APR DRG. APR DRG/PDX not included in Step 10, set to value in Step 9 PDX/APR DRG Modified Patient Severity Subclass Value (10) : 2 Step 11A : Subclass modification by APR DRG and Age Compute a Modified Patient Severity Subclass based on the APR DRG/Age combination. The severity of illness subclass from Step 9 can be either increased or decreased based on the specific combinations of APR DRG and Age. APR DRG 253 not included in Step 11A, set to value in Step 9. APR DRG/AGE Severity Subclass Value (11A) : 2 Step 11B : Subclass modification by PDX, APR DRG and Age Compute a Modified Patient Severity Subclass based on the PDX/APR DRG combination within the patient age range. The severity of illness subclass from Step 9 can be either increased or decreased based on the specific combinations of PDX, APR DRG and Age. APR DRG / PDX not included in Step 11B, set to value in Step 9. PDX/APR DRG/AGE Severity Subclass Value (11B) : 2 Step 11C : Not applicable Step 12 : Subclass modification by APR DRG and non-OR procedure Compute a Modified Patient Severity Subclass based on a combination of the APR DRG and the presence of certain non-OR procedures which DO NOT affect APR DRG assignment. For some APR DRGs the presence of certain non-OR procedures indicates a more severely ill patient. file://C:Documents and SettingsGAHERN001Local SettingsTempAPRAssignmentRepo... 5/7/2009
  • 3M™ APR DRG Assignment Report Page 6 of 16 The severity of illness subclass from Step 9 can be either increased or decreased based on the specific combinations of APR DRG and non-OR procedures. If there is more than one non-OR procedure present that falls into this category, the non-OR procedure/APR DRG combination which results in the highest subclass is selected. APR DRG 253 not included in Step 12, set to value in Step 9. Non-OR/APR DRG Severity Subclass (12) : 2 Step 13 : Subclass modification by APR DRG and OR procedure Compute a Modified Patient Severity Subclass based on a combination of the APR DRG and the presence of certain OR procedures which affect APR DRG assignment. Within specific APR DRGs, some OR procedures are indicative of higher severity of illness relative to the other OR procedures in the APR DRG. Conversely, within specific APR DRGs, some OR procedures are indicative of lower severity of illness. The severity of illness subclass from Step 9 can be either increased or decreased based on the specific combinations of APR DRG and OR procedures. If there is more than one OR procedure present that falls into this category, the OR procedure/APR DRG combination which results in the highest subclass is selected. APR DRG 253 not included in Step 13, set to value in Step 9. OR Procedure/APR DRG Severity Subclass (13) : 2 Step 14 : Subclass modification by APR DRG and multiple procedures Compute a Modified Patient Severity Subclass based on the existence of an OR Procedure/Category combination. Within specific APR DRGs some pairs of OR procedures are indicative of higher severity of illness relative to the other patients in the APR DRG. There are specific areas where multiple procedures are a significant determinant of severity of illness. If one OR procedure category is listed for a specified APR DRG, then the patient subclass value from Step 9 is increased. If two OR procedure categories are listed but it does not define the APR DRG, then the patient subclass value from Step 9 is increased. APR DRG 253 not included in Step 14, set to value in Step 9. Procedure Category Pair Severity Subclass (14) : 2 Step 15 : Subclass modification for ECMO Compute a Modified Patient Severity Subclass based on a combination of APR DRG and the presence of certain specified procedures. This step is specific to the logic of how one APR DRG is defined, APR DRG 583 Neonate with ECMO. For this APR DRG, some neonates have a major OR procedure(s) performed which indicate a more severely ill patient. Those neonates who do not have a major OR procedure(s) performed are at a significantly lower severity of illness. If one or more major procedure(s) is present the highest subclass value will be selected. For neonates without a major procedure the severity of illness subclass value from Step 9 will decrease. file://C:Documents and SettingsGAHERN001Local SettingsTempAPRAssignmentRepo... 5/7/2009
  • 3M™ APR DRG Assignment Report Page 7 of 16 APR DRG 253 not included in Step 15, set to value in Step 9 OR procedure/APR DRG Severity Subclass (15) : 2 Step 16 : Subclass modification by APR DRG, PDX and non-OR procedure Compute a Modified Patient Severity Subclass based on the presence of certain non-OR procedure/PDX/APR DRG combinations. Within an APR DRG, specific principal diagnoses in combination with certain non-OR procedures indicate a more severely ill patient. If one of these combinations is present, the severity of illness subclass from Step 9 can be increased. This step applies to a limited number of patients, mostly cancer patients receiving chemotherapy or radiation therapy. APR DRG 253 not included in Step 16, set to value in Step 9. Non-OR/PDX/APR DRG Severity Subclass (16) : 2 Step 17 : Subclass modification for multiple SDXs Compute a Modified Patient Subclass Value (MPSV) based on the presence of specific combinations of categories of SDXs. The presence of certain combinations of secondary diagnoses has a great clinical significance, therefore, a minimum patient severity of illness subclass greater than minor (1) is established if certain combinations of secondary diagnoses are present. Each secondary diagnosis is assigned to a disease category which are defined with varying levels of severity of illness. An assignment process has been established to account for the interaction and increased severity of these situations. Any secondary diagnosis for which the MSL in Step 8 is less than the Category Subclass Value is excluded from this step. The table presented in Step 17 references secondary diagnosis categories and severity level combinations. The results of the analysis for multiple interacting diagnoses are presented in the table below. If a category combination is present, and the conditions for that combination type as listed in the table are met, then assign the modified patient severity subclass value as indicated in the table. If a category combination is present, and the conditions for that combination type as listed in the table are not met, then assign the modified patient severity subclass value from Step 9. Note : MDC 15 applies different logic for Step 17. If patients in APR DRGs 626 or 640 have multiple other problems, then a modified patient severity subclass of 3 is set. Combination Combination of SDX Additional Minimum Type Categories SDX Required Subclass 1 (3) + (3) Two (3)s 4 2 (3) + (2) Two (3)s 4 3 (2) + (2) Two (2)s 3 4 (2) + (1) Two (2)s 3 5 (1) + (1) Two (1)s 2 6 Combo Cats for None 3 Neonate APR DRGs file://C:Documents and SettingsGAHERN001Local SettingsTempAPRAssignmentRepo... 5/7/2009
  • 3M™ APR DRG Assignment Report Page 8 of 16 626 and 640 11 (3) + (3) One (3) 4 13 (2) + (2) One (2) 3 15 (1) + (1) One (1) 2 No combination selected in Step 17, set to value in Step 9. MPSV (17): 2 Step 18 : Final Patient Severity Subclass Compute a Final Patient Severity Subclass Value based on the following steps and hierarchy: Step 10 Modified PDX/APR DRG patient subclass Step 11A Modified APR DRG/Age patient subclass Step 11B Modified PDX/APR DRG/Age patient subclass Step 11C Not applicable Step 12 Modified non-OR procedure/APR DRG subclass Step 13 Modified OR procedure/APR DRG subclass Step 14 Modified OR procedure pair/APR DRG subclass Step 15 Modified ECMO/APR DRG subclass Step 16 Modified non-OR procedure/APR DRG/PDX/subclass Step 17 Modified patient severity subclass value (MPSV) from SDX category combinations The above 10 modified subclass results are used to compute the final subclass value based on the following hierarchy. In the hierarchy table, the base severity subclass refers to the subclass from Step 9. The maximum Phase III decrease means the maximum decrease of any Phase III step that decreases the severity subclass. The maximum Phase III increase means the maximum III step that increases the severity subclass. "Actual" increase or decrease means that the Step respectively increased or decreased the severity subclass. "Tried" increase or decrease means that the logic of the Step would have respectively increased or decreased the severity subclass but the severity subclass was at its respective maximum or minimum allowed by the Step. Tried Actual Value Actual Step Values Step 10 Modified PDX/APR DRG Subclass No No 2 Step 11A Modified APR DRG/Age Subclass No No 2 Step 11B Modified PDX/APR DRG/Age Subclass No No 2 Step 11C Not applicable Step 12 Modified non-OR/APR DRG Subclass No No 2 Step 13 Modified Procedure/APR DRG Subclass No No 2 Step 14 Modified Procedure Pair/APR DRG Subclass No No 2 Step 15 Modified ECMO/APR DRG Subclass No No 2 Step 16 Modified non-OR/APR DRG/PDX Subclass No No 2 Step 17 MPSV No No 2 Step Result Step Result Final Severity Subclass 15 Actual or Tried Decrease - - Base severity subclass file://C:Documents and SettingsGAHERN001Local SettingsTempAPRAssignmentRepo... 5/7/2009
  • 3M™ APR DRG Assignment Report Page 9 of 16 minus one Base severity subclass 13 Actual or Tried Decrease - - plus maximum Phase III severity increase Base severity subclass 13 Actual or Tried Decrease 12,14,16,17 Actual Increase minus maximum Phase III decrease plus one Base severity subclass 13 Actual or Tried Decrease - - minus maximum Phase III decrease Base severity subclass 10,12,14,17 Actual or Tried Decrease - - plus maximum Phase III increase Base severity subclass 10 Actual Decrease 11 Actual Increase minus maximum Phase III increase 10 Tried Decrease 11 Actual Increase Base severity subclass Base severity subclass 10 Actual or Tried Decrease - - minus maximum Phase III decrease Base severity subclass 11 Actual or Tried Increase - - plus maximum Phase III increase Base severity subclass 11 Actual or Tried Decrease - - minus maximum Phase III decrease Patient Severity of Illness Subclass Value : 2 Return to summary file://C:Documents and SettingsGAHERN001Local SettingsTempAPRAssignmentRepo... 5/7/2009
  • 3M™ APR DRG Assignment Report Page 10 of 16 APR DRG - Risk of Mortality Detail Key: SML = Standard Mortality Level MML = Modified Mortality Level CSV = Category Subclass Value X = Excluded diagnosis D = Duplicate diagnosis Diagnosis Code SML Group Category CSV PDX 5789 1 0 0 0 SDX 41401 1 519 161 1 SDX 2761 2 0 342 2 Phase 1 Results: Determine the Risk of Mortality level of each individual secondary diagnosis. Step 1 : PDX/SDX Exclusions Eliminate secondary diagnoses that are closely related with the principal diagnosis. Step 2 : SDX Default Level Assign each secondary diagnosis to its standard risk of mortality level. Step 3 : SDX Modification by Age Modify the standard risk of mortality level of each secondary diagnosis based on patient age. Step 4 : SDX Modification by PDX and APR DRG Modify the standard risk of mortality level of each secondary diagnosis in specific APR DRG/PDX/SDX combinations. If the secondary diagnosis is closely related to the principal diagnosis. Step 5 : SDX Modification by APR DRG Modify the standard risk of mortality level of each secondary diagnosis. If the secondary diagnosis has a common presence in the APR DRG assigned. Step 6 : SDX Modification by non-OR procedure Modify the standard risk of mortality level of each secondary diagnosis. If the non-OR procedure indicates a more extensive disease process within that diagnosis. ROM - Steps Diagnosis 1 2 3 4 5 6 MML 41401 0 1 1 1 1 1 1 2761 0 2 2 2 2 2 2 Return to summary file://C:Documents and SettingsGAHERN001Local SettingsTempAPRAssignmentRepo... 5/7/2009
  • 3M™ APR DRG Assignment Report Page 11 of 16 Phase 2 Results: Determine the base Risk of Mortality subclass of the patient. Step 7 A: SDX/SDX Exclusions Closely related secondary diagnoses are placed into groups together with clinically similar diagnoses. If more than one secondary diagnosis from the same group is present, then only the secondary diagnosis with the highest risk of mortality is preserved. All other secondary diagnoses in the group are eliminated. Number of SDX groups:1 Group Count HiMML 519 1 1 Step 7B : Specific/General SDX/SDX Exclusions Subsets of the groups in 7A are designated as "general secondary diagnosis groups" (GenSDX) or "specific secondary diagnosis groups" (SpecsSDX). Each specific secondary diagnosis group will have one or more general secondary diagnosis groups associated with it. If a diagnosis in a specific group is present, all diagnoses in the general groups associated with the specific group will be eliminated. The one exception is if the diagnosis in the general group creates an explicit secondary diagnosis combination in Step 17; when this occurs, both the specific and general groups are maintained. If the risk of mortality level of the diagnosis in the general group is higher than the risk of mortality level of the diagnosis in the specific group, the diagnosis in the general group is eliminated while the risk of mortality level of the diagnosis in the specific group is increased to be equal to the risk of mortality level of the diagnosis in the general group. Step 7C : General/General SDX/SDX Exclusions If there is no corresponding specific group diagnosis and there are diagnoses in multiple general groups present that would have been eliminated had the specific group been present, a hierarchy of general groups is used to eliminate all but one of the diagnoses in the general groups. If any of the risk of mortality levels of the diagnoses being eliminated is higher than the risk of mortality level of the general group that is highest in the general group hierarchy, the risk of mortality level of the diagnosis that is in the general group that is the highest in the hierarchy is increased to the risk of mortality level of the eliminated diagnosis with the highest risk of mortality level. MML at end of Step 7 DXcode Final MML 41401 1 2761 2 Step 8 : Initial Patient Subclass Compute a single overall base patient risk of mortality subclass value. The overall base patient risk of mortality subclass value is set equal to the highest risk of mortality level of all the remaining secondary diagnoses. Number of SDXs with MML equal to level 1 : 1 Number of SDXs with MML equal to level 2 : 1 file://C:Documents and SettingsGAHERN001Local SettingsTempAPRAssignmentRepo... 5/7/2009
  • 3M™ APR DRG Assignment Report Page 12 of 16 Number of SDXs with MML equal to level 3 : 0 Number of SDXs with MML equal to level 4 : 0 Maximum Risk of Mortality Subclass Value (8) : 2 Step 9 : Adjusted Patient Subclass If the Maximum Risk of Mortality Subclass is 2. Condition Action There are two or more secondary diagnosis at risk None of mortality level 2. There is only one secondary diagnosis at risk of None mortality level 2 and that diagnosis is on List E. There is none or only one secondary diagnosis at Subtract 1 risk of mortality level 2 Action : Subtract 1 Maximum Risk of Mortality Subclass (9) : 1 Return to summary Phase 3 Results: Determine the final Risk of Mortality subclass of the patient. Step 10 : Subclass modification by PDX and APR DRG Compute a Modified Patient Risk of Mortality Subclass based on the PDX/APR DRG combination. Modifications may be made to the risk of mortality due to the clinical implications of the principal diagnosis combined with the APR DRG. The risk of mortality subclass from Step 9 can be either increased or decreased based on the specific combinations of Principal Diagnosis and APR DRG. APR DRG /PDX not included in Step 10, set to value in Step 9. PDX/APR DRG Modified Patient Risk of Mortality Subclass Value (10) : 1 Step 11A : Subclass modification by APR DRG and Age Compute a Modified Patient Risk of Mortality Subclass based on the APR DRG/Age combination. The risk of mortality subclass from Step 9 can be either increased or decreased based on the specific combinations of APR DRG and Age. APR DRG 253 not included in Step 11A, set to value in Step 9. APR DRG/AGE Risk of Mortality Subclass Value (11A) : 1 Step 11B : Subclass modification by PDX, APR DRG and Age Compute a Modified Patient Risk of Mortality Subclass based on the PDX/APR DRG combination within the patient age range. The risk of mortality subclass from Step 9 can be either increased or decreased based on the specific combinations of PDX, APR DRG and Age. file://C:Documents and SettingsGAHERN001Local SettingsTempAPRAssignmentRepo... 5/7/2009
  • 3M™ APR DRG Assignment Report Page 13 of 16 APR DRG/PDX not included in Step 11B, set to value in Step 9. PDX/APR DRG/AGE RIsk of Mortality Subclass Value (11B) : 1 Subclass modification by APR DRG, Birth Weight and non-OR Step 11C : Procedure. Compute a Modified Patient Risk of Mortality Subclass based on the APR DRG/birth weight/non-OR procedures of the patient. The risk of mortality subclass from Step 9 can be either increased or decreased based on the specific combinations of APR DRG, birth weight and non-OR procedures. This step examines the relationship between APR DRG and birth weight and the presence/absence of non-OR procedures for extremely low birth weight neonates in MDC 15. APR DRG 253 not included in Step 11C, set to value in Step 9. APR DRG/Birth Weight/AGE Risk of Mortality Subclass Value(11C) : 1 Step 12 : Subclass modification by APR DRG and non-OR procedure Compute a Modified Patient Mortality Subclass based on a combination of the APR DRG and the presence of certain non-OR procedures which DO NOT affect APR DRG assignment. For some APR DRGs the presence of certain non-OR procedures indicates a more severely ill patient. The risk of mortality subclass from Step 9 can be either increased or decreased based on the specific combinations of APR DRG and non-OR procedures. If there is more than one non-OR procedure present that falls into this category, the non-OR procedure/APR DRG combination which results in the highest subclass is selected. APR DRG 253 not included in Step 12, set to value in Step 9. Non-OR/APR DRG Mortality Subclass (12) : 1 Step 13 : Subclass modification by APR DRG and OR procedure Compute a Modified Patient Risk of Mortality Subclass based on a combination of the APR DRG and the presence of certain OR procedures which affect APR DRG assignment. Within specific APR DRGs, some OR procedures are indicative of higher risk of mortality relative to the other OR procedures in the APR DRG. Conversely, within specific APR DRGs, some OR procedures are indicative of lower risk of mortality. The risk of mortality subclass from Step 9 can be either increased or decreased based on the specific combinations of APR DRG and OR procedures. If there is more than one OR procedure present that falls into this category, the OR procedure/APR DRG combination which results in the highest subclass is selected. APR DRG 253 not included in Step 13, set to value in Step 9. OR Procedure/APR DRG Risk of Mortality Subclass (13) : 1 Step 14 : Subclass modification by APR DRG and multiple procedures Compute a Modified Patient Risk of Mortality Subclass based on the existence file://C:Documents and SettingsGAHERN001Local SettingsTempAPRAssignmentRepo... 5/7/2009
  • 3M™ APR DRG Assignment Report Page 14 of 16 of an OR Procedure/Category combination. Within specific APR DRGs some pairs of OR procedures are indicative of higher risk of mortality relative to the other patients in the APR DRG. There are specific areas where multiple procedures are a significant determinant of risk of mortality. If one OR procedure category is listed for a specified APR DRG, then the patient subclass value from Step 9 is increased. If two OR procedure categories are listed but it does not define the APR DRG, then the patient subclass value from Step 9 is increased. APR DRG 253 not included in Step 14, set to value in Step 9. Procedure Category Pair Risk of Mortality Subclass (14) : 1 Step 15 : Not applicable Step 16 : Not applicable Step 17 : Subclass modification for multiple SDXs Compute a Modified Patient Subclass Value (MPSV) based on the presence of specific combinations of categories of SDXs. The presence of certain combinations of secondary diagnoses has great clinical significance, therefore, a minimum patient risk of mortality subclass greater than minor (1) is established if certain combinations of secondary diagnoses are present. Each secondary diagnosis is assigned to a disease category are defined with varying levels of risk of mortality. An assignment process has been established to account for the interaction and increased risk of mortality of these situations. Any secondary diagnosis for which the MML in Step 8 is less than the Category Subclass Value is excluded from this step. The table presented in Step 17 references secondary diagnosis categories and risk of mortality level combinations. The results of the analysis for multiple interacting diagnoses are presented in the table below. If a category combination is present, and the conditions for that combination type as listed in the table are met, then assign the modified patient risk of mortality subclass value as indicated in the table. If a category combination is present, and the conditions for that combination type as listed in the table are not met, then assign the modified patient risk of mortality subclass value from Step 9. Note: MDC 15 applies different logic for Step 17. If patients in APR DRGs 626 or 640 have multiple other problems, then a modified patient mortality subclass of 3 is set. Combination Combination of SDX Additional SDX Minimum Type Categories Required Subclass 1 (3) + (3) Two (3)s 4 2 (3) + (2) Two (3)s 4 3 (2) + (2) Two (2)s 3 4 (2) + (1) Two (2)s 3 5 (1) + (1) Two (1)s 2 11 (3) + (3) One (3) 4 13 (2) + (2) One (2) 3 15 (1) + (1) One (1) 2 No combination selected in Step 17, set to value in Step 9. MPSV (17) : 1 file://C:Documents and SettingsGAHERN001Local SettingsTempAPRAssignmentRepo... 5/7/2009
  • 3M™ APR DRG Assignment Report Page 15 of 16 Step 18 : Final Patient Risk of Mortality Subclass Compute a Final Patient Risk of Mortality Subclass value based on the following steps and hierarchy: Step 10 Modified PDX/APR DRG patient subclass Step 11A Modified APR DRG/Age patient subclass Step 11B Modified PDX/APR DRG/Age patient subclass Step 11C Modified APR DRG, Birth Weight and non-OR Procedure Step 12 Modified non-OR procedure/APR DRG subclass Step 13 Modified OR procedure/APR DRG subclass Step 14 Modified OR procedure pair/APR DRG subclass Step 15 Not applicable Step 16 Not applicable Step17 Modified patient mortality subclass value (MPSV) from SDX category combinations The above 10 modified subclass results are used to compute the final subclass value based on the following hierarchy. In the hierarchy table, the base risk of mortality subclass refers to the subclass from Step 9. The maximum Phase III decrease means the maximum decrease of Phase III step that decreases the risk of mortality subclass. The maximum Phase III increase means the maximum III step that increases the risk of mortality subclass. "Actual" increase or decrease means that the Step respectively increased or decreased the risk of mortality subclass. "Tried" increase or decrease means that the logic of the Step would have respectively increased or decreased the risk of mortality subclass but the risk of mortality subclass was at its respective maximum or minimum allowed by the Step. Tried Actual Value Actual Step Values Step 10 Modified PDX/APR DRG Subclass No No 1 Step 11A Modified APR DRG/Age Subclass No No 1 Step 11B Modified PDX/APR DRG/Age Subclass No No 1 Modified APR DRG, Birth Weight and non-OR Step 11C No No 1 Procedure subclass Step 12 Modified non-OR/APR DRG Subclass No No 1 Step 13 Modified Procedure/APR DRG Subclass No No 1 Step 14 Modified Procedure Pair/APR DRG Subclass No No 1 Step 15 Not applicable Step 16 Not applicable Step 17 MPSV No No 1 Final Risk of Mortality Step Result Step Result Subclass Base Risk of Mortality subclass plus maximum 11C Actual or Tried Decrease - - Phase III risk of mortality increase Base risk of mortality subclass plus maximum 13 Actual or Tried Decrease - - Phase III risk of mortality increase file://C:Documents and SettingsGAHERN001Local SettingsTempAPRAssignmentRepo... 5/7/2009
  • 3M™ APR DRG Assignment Report Page 16 of 16 Base risk of mortality subclass minus maximum 13 Actual Decrease 12,14,17 Actual Increase Phase III decrease plus one Base risk of mortality 13 Actual or Tried Decrease - - subclass minus maximum Phase III decrease Base risk of mortality 10,12,14,17 Actual or Tried Decrease - - subclass plus maximum Phase III increase Base risk of mortality subclass minus maximum 10 Actual Decrease 11A,11B Actual Increase Phase III increase plus one Base risk of mortality 10 Actual or Tried Decrease - - subclass minus maximum Phase III decrease Base risk of mortality 11A,11B Actual or Tried Increase - - subclass plus maximum Phase III increase Base risk of mortality 11A,11B Actual or Tried Decrease - - subclass minus maximum Phase III decrease Patient Risk of Mortality Subclass Value : 1 Return to summary file://C:Documents and SettingsGAHERN001Local SettingsTempAPRAssignmentRepo... 5/7/2009