The document discusses the Australian Refined Diagnosis Related Group (AR-DRG) patient classification scheme. It describes AR-DRG as grouping patients according to their clinical characteristics and resource use based on ICD-10-AM codes. The AR-DRG grouper applies demographic and clinical edits, and each AR-DRG has 4 alphanumeric characters determining a patient's length of stay and hospital payment.

1. AR-DRG
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2. AR-DRG
• Australian Refined Diagnosis Related Group
• Patient classification scheme
(based on ICD-10-AM codes)
• Group the patients treated in a hospital according to clinical
characteristics and resource use.
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3. • The AR-DRG grouper applies both
“Demographic" and “Clinical" edits.
• AR-DRG has 4 alpha-numeric characters.
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4. Length of
Stay
Payment
Primary
Diagnosis
Secondary
Diagnosis
Operating
Procedures
Adm. Data
Severity
Coding
Grouper
DRG
Payment
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5. AR-DRG
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6. AR-DRG
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7. AR-DRG
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8. Group of Patients
with Homogenous
Resources
Consumption
=
DRG
Patient Variables
Medical & Management
Decision Variables
gender, age,
main diagnosis, other
diagnoses, severity
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mix and intensity of
procedures, technologies
and human resource use

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10. What Impact Will ICD-10 Have On AR-DRG Payments?
Lack of ‘specificity’ for a certain diagnosis as
documented in the record, could have the potential of
not capturing the CC/MCC which could result in a
lower paying AR-DRG.
AR-DRG shifts could occur due to improper training
of the coding staff.
This incorrect code assignment could also potentially cause changes within
the AR-DRGs resulting in payment increases or decreases
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11. 35 Year-old Male w/ Pancreatitis
( Risk = $1,958)
Diagnoses K850 - Idiopathic acute pancreatitis
E803 - Defects of Catalase and Perioxidase
E162 - Hypoglycemia
DRG 439
Disorders of pancreas
exc. malignancy w CC
$6,144.60
Diagnoses K850 – Idiopathic acute pancreatitis
E889 – Metabolic disorder, unspecified
E162 – Hypoglycemia
DRG 440
Disorders of pancreas
exc. malignancy w/o
CC/MCC
$4,186.20
Revenue Impact
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