List of Globally Excluded APR DRGs

Transcription

1 Appendix F List of Globally Excluded APR DRGs THIS APPENDIX CONTAINS A LIST of each global exclusion, with a specification of the DRG number, description, and type. 159

2 Appendix F List of Globally Excluded APR DRGs 580 Neo, trans <5d not born here Neonatal admission 581 Neo, trans <5d born here Neonatal admission 583 Neonate with ECMO Neonatal admission 588 Neo bw <1500g w/maj proc Neonatal admission 589 Neo bw <500g Neonatal admission 591 Neo bw g wo maj proc Neonatal admission 593 Neo bw g wo maj proc Neonatal admission 602 Neo bw g w RDS/mj anm Neonatal admission 603 Neo bw g w/wo oth sig Neonatal admission 607 Neo bw g w RDS/mj anm Neonatal admission 608 Neo bw g w/wo oth sig Neonatal admission 609 Neo bw g w/maj proc Neonatal admission 611 Neo bw g w/maj anom Neonatal admission 612 Neo bw g w RDS/mj res Neonatal admission 613 Neo bw g perin infec Neonatal admission 614 Neo bw g w/wo oth sig Neonatal admission 621 Neo bw g w/maj anom Neonatal admission 622 Neo bw g w RDS/mj res Neonatal admission 623 Neo bw g perin infec Neonatal admission 625 Neo bw g oth sig dx Neonatal admission 630 Neo bw >2499g maj CV proc Neonatal admission 631 Neo bw >2499g oth maj proc Neonatal admission 633 Neo bw >2499g w/maj anom Neonatal admission 634 Neo bw >2499g w RDS/maj resp Neonatal admission 636 Neo bw >2499g perin infect Neonatal admission 639 Neo bw >2499g oth sig cond Neonatal admission 690 Acute leukemia Malignancy admission 691 Lymph/myelo/non-ac leuk Malignancy admission 692 Radiotherapy Malignancy admission 693 Chemotherapy Malignancy admission 770 Drug & alcohol abuse - LAMA Other globally excluded APR DRG 955 Pdx invalid as discharge dx Error APR DRG 956 Ungroupable Error APR DRG 160

3 Global exclusions by diagnosis In addition to the APR-DRG-based global exclusions, there are code level exclusions for admissions with principal or secondary diagnosis of chronic kidney disease stage V/end or renal dialysis status. The record type is OG. This section contains a list of those exclusions Mal hyp kid w cr kid V Ben hyp kid w cr kid V Hyp kid NOS w cr kid V Mal hy ht/kd st V w/o hf Mal hyp ht/kd stg V w hf Ben hy ht/kd st V w/o hf Ben hyp ht/kd stg V w hf Hy ht/kd NOS st V w/o hf Hyp ht/kd NOS st V w hf 5855 Chron kidney dis stage V 5856 End stage renal disease V4511 Renal dialysis status V4512 Noncmplnt w renal dialys V560 Renal dialysis encounter V561 Ft/adj xtrcorp dial cath V562 Fit/adj perit dial cath V5631 Hemodialysis testing V568 Dialysis encounter, NEC 164

4 Non-Event DRGs and Non-Event Discharge Statuses This section contains a list of Non-event DRGs with a specification of the DRG number and description. The Non-Event Exclusion section contains a list of procedure codes that qualify the Malignant Non-event DRGs as non-events. This section also contains a list of Non-event discharge statuses. Non-Event DRGs 110 Ear, nose, mouth, throat malig 136 Respiratory malignancy 240 Digestive malignancy 281 Maligncy-hepatobil & pancreas 343 Musculoskel malign & pathol fx 346 Connective tissue disorder 382 Malignant breast disorders 424 Oth endocrine disorders 442 Kidney/urinary trct proc-malig 461 Kidney/urinary tract malig 462 Nephritis & nephrosis 500 Malignancy, male reprod sys 530 Female repro syst malig 660 Maj hematologic/immunol dx 661 Coagulation/platelet disorder 663 Other anemia/blood disord 680 Maj proc lymph/hemat/oth neopl 681 Oth proc lymph/hemat/oth neopl 860 Rehabilitation 862 Oth aftercare & convales 863 Neonatal aftercare Non-event procedure codes 0010 Implant chemothera agent 0015 High-dose infusion IL IV infusion clofarabine 9220 Inf liquid brachy isotop 9221 Superficial radiation 9222 Orthovoltage radiation 9223 Radioisot teleradiother 9224 Teleradio using photons 9225 Electron teleradiotherap 9226 Particul teleradioth NEC 9227 Radioactive elem implant 9228 Isotope inject/instill 9229 Radiotherapeut proc NEC 9230 Stereo radiosurgery NOS 9231 Sing source radiosurgery 9232 Multisource radiosurgery 9233 Particulate radiosurgery 9239 Stereo radiosurgery NEC 9241 Intra-op electron rad rx 9925 Inject ca chemother NEC 9928 Immunotherapy as antineo Non-event diagnosis codes Hemochromatos-rbc trans Thlasema Hb-S w/o crisis Sickle cell disease NOS Hb-SS disease w/o crisis Hb-SS/hb-C dis w crisis Hb-SS/hb-C dis w/o crsis Hb-S dis w/o crisis NEC Non-event discharge statuses Skilled nursing facility Custodial/Supportive care Court/Law enfrc Hospice medical facility Swing bed Rehabilitation facility/unit Long term hospital Nursing facility Psych hospital or unit Transfer to another type of healthcare institution SNF w/medicare certification w/ planned acute care hosp inpt readmission 84 Custodial or supportive care w/planned acute care hosp inpt readmission 87 Court/law enfrc w/planned acute care hosp inpt readmission 89 Swing bed with a planned acute care inpt readmission 90 IRF including rehab distinct part units of hosp w/a planned acute care hosp inpt readmission 91 Long term care hosp w/planned acute care hosp inpt readmission 92 Nursing facility certified under Medicaid but not certified under Medicare w/planned acute care hospital inpt readmission 165

5 ICD-9-CM Codes Non-Event DRGs and Non-Event Discharge Statuses 93 Psychiatric hosp or psych distinct part unit of a hosp w/planned acute care hosp inpt readmission 95 Transfer to another type of health care institution not defined elsewhere in this code list w/a planned acute care hosp inpt readmission 166