3M APR DRG Grouper Modifications. v29.0

Transcription

1 v29.0 3

2 Copyright M. All rights reserved. GRP-105 This product contains material and information that is confidential and proprietary to 3M and its licensors. The use of this product is governed by a license agreement. Except as explicitly permitted in the license agreement or permitted in writing by 3M, no part of this product shall be: (i) reproduced, in whole or in part, by any electronic or mechanical means, (ii) disclosed or otherwise made available to, or accessible by, any third party (iii) sublicensed, leased, lent, or transferred to any third party, (iv) used for the benefit of any party other than the licensee, (v) disassembled, decrypted, decompiled, reverse-engineered, or (vi) used to create derivative works. This product includes commercial technical data and/or computer databases and/or commercial computer software and/or commercial computer software documentation, as applicable, which were developed exclusively at private expense by 3M, its subsidiaries, affiliates and licensors. Applicable FAR/DFARS restrictions, and associated license terms, apply to US Government use. 3M HIS can be contacted at 575 West Murray Boulevard, Murray, UT It is the policy of 3M Health Information Systems to improve products as new technology and software become available. Because of this, 3M HIS reserves the right to make changes in the specifications and materials contained herein without notice. All features, functions, and operations described herein may not be available in all locations. Consult your 3M HIS representative for the latest information. The example companies, organizations, people, addresses, places and events depicted in this document are fictitious and are included solely for the purposes of illustration. Any association with any real individual, company, organization, person, address place or event is unintended and should not be inferred. 3M complies with all applicable federal and state laws and regulations pertaining to patient privacy. If this product includes CPT or CPT Assistant, the following notices are applicable. CPT 2010 American Medical Association. All rights reserved. CPT Assistant American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. This product includes CPT and/or CPT Assistant which is commercial technical data and/or computer databases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 N. State Street, Chicago, Illinois, U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS (b)(2) (June 1995) and/or subject to the restrictions of DFARS (a) (June 1995) and DFARS (a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR (June 1987) and/or subject to the restricted rights provisions of FAR (June 1987) and FAR (June 1987), as applicable, and any applicable agency FAR Supplements, for non- Department of Defense Federal procurements. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. 3M is a trademark of 3M Company. APCfinder, APC Assurance, ChartFact, ChartFax, ChartID, ChartLocator, ChartQ, ChartRelease, ChartReserve, ChartScan, ChartScript, ChartScriptMD, ChartView, ClinTrac, Codefinder, DDSI, DisclosureTrac, DRG Assurance, DRGfinder, NetLinc, ProviderCV, RAAS DL, Solutions to Excellence, SyncStream, VoiceScript, and WebLinc are trademarks of 3M Company. Adobe, Acrobat, and Reader are registered trademarks of Adobe Systems Incorporated in the United States and/or other countries. Microsoft, Windows, Windows NT, Windows Vista, ActiveX, Visual Studio, MS-DOS, Microsoft Word, Word, and Internet Explorer are either trademarks or registered trademarks of Microsoft Corporation in the United States and/or other countries. z/os is a registered trademark of IBM Corporation in the United States and/or other countries. Pervasive,

3 Pervasive Software, Pervasive.SQL and Btrieve are registered trademarks of Pervasive Software Inc. in the United States and/or other countries. WinZip is a registered trademark of WinZip International LLC. Crystal Reports is a registered trademark of SAP. All rights reserved. Other products and services that are referred to in this document are or may be trademarks of their respective owners. This manual was written, designed, and produced by the Documentation Department of 3M Health Information Systems. October 2011

4

5 Table of Contents 3M APR DRG v29.0 Grouper Modifications... 7 Version... 7 New DRGs... 7 Deleted DRGs... 7 Revised DRG descriptions... 7 Discharge status changes... 7 Technical changes... 8 Procedure marking tie breaking logic... 8 APR DRG changes... 8 MDC 13: Diseases and Disorders of the Female Reproductive Systems... 8 MDC 16: Diseases and Disorders of Blood, Blood Forming Organs, and Immunological Disorders... 9 MDC 24: Human Immunodeficiency Virus Infections... 9 New diagnosis and procedure codes... 9 Existing diagnosis and procedure codes SOI step changes Admission DRG table changes Pre-existing table changes Complication of Care table changes Length of Stay to Identify Diagnosis POA Sep-2011 Page v

6

7 This document contains a brief description of the modifications made to the 3M APR DRG grouper since v28.0 that are effective with v29.0. Version The 3M APR DRG Software v29.0 replaces v28.0. The implementation date for v29.0 is effective 10/01/ /30/2012. New DRGs There are no new DRGs. Deleted DRGs There are no deleted DRGs. Revised DRG descriptions This release includes the following DRG description changes:. DRG Old description New description 142 Interstitial Lung Disease Interstitial and Alveolar Lung Diseases 1. Discharge status changes There are no new, deleted, or revised discharge statuses. Sep-2011 Page 7

8 Technical changes APR DRG v29.0 includes technical changes to grouping logic. Procedure marking tie breaking logic With APR DRG v29.0, there is new logic when two or more procedures on the record could impact the admission DRG assignment, the discharge DRG assignment, or both: If one of these procedures is in the first procedure position that procedure will be flagged with the following exceptions: If a single procedure designating a complete system is tied with a combination pair that also designated a complete system, the single procedure will be flagged regardless of position. If multiple combinations of lead/device pairs are tied then only one pair will be flagged regardless of position. If the two procedures tied are an OR and non-or, the OR will be flagged regardless of position. If none of the tied procedures is in the first procedure position, then the procedure with the lowest ASCII/index value will be flagged. This change is not retroactive to earlier versions. APR DRG changes There are no new or deleted APR DRGs. The following changes are effective with v29.0: MDC 13: Diseases and Disorders of the Female Reproductive Systems DRG 513 UTERINE & ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA DRG 532 MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS Add the following existing procedure to APR DRGs 513 and 532: Genital organ anom NEC Sep-2011 Page 8

9 MDC 16: Diseases and Disorders of Blood, Blood Forming Organs, and Immunological Disorders DRG 661 COAGULATION & PLATELET DISORDERS Add the following diagnoses to APR DRG 661 and remove from APR DRG 663: Prim hypercoagulable st Sec hypercoagulable st DRG 663 OTHER ANEMIA & DISORDERS OF BLOOD & BLOOD-FORMING ORGANS Remove the following diagnoses to APR DRG 663 and add to APR DRG 661: Prim hypercoagulable st Sec hypercoagulable st 5. MDC 24: Human Immunodeficiency Virus Infections DRG 890 HIV W MULTIPLE MAJOR HIV RELATED CONDITIONS DRG 892 HIV W MAJOR HIV RELATED CONDITION Add the following diagnosis to APR DRGs 890 and 892: Dementia w behavior dist 7. New diagnosis and procedure codes This release includes all new diagnoses and procedure codes that are valid as of 10/01//2011. Sep-2011 Page 9

10 Existing diagnosis and procedure codes This release includes the following changes to existing diagnosis codes. There are no changes for existing procedure codes. Add the following existing diagnosis to the HIV Category tables: 8. HIV CAT HIV CAT Description Dementia w behavior dist 13 Dementia and Encephalopathy 9. SOI step changes This release includes the following SOI step changes: Step 1 SOI Make the following changes to the following existing PDX/SDX combinations 10. SDX Description Add/Delete PDX Description 7467 Hypoplas left heart synd Delete 7461 Cong tricusp atres/sten 7467 Hypoplas left heart synd Delete 7462 Ebstein's anomaly 7467 Hypoplas left heart synd Delete Cong heart anomaly NEC 7467 Hypoplas left heart synd Delete 7469 Cong heart anomaly NOS 7467 Hypoplas left heart synd Delete Circulatory anomaly NEC 7467 Hypoplas left heart synd Delete 7597 Mult congen anomal NEC 7467 Hypoplas left heart synd Delete Specfied cong anomal NEC Cong heart anomaly NEC Add 7467 Hypoplas left heart synd 7469 Cong heart anomaly NOS Add 7467 Hypoplas left heart synd Step 2 SOI Change the SOI value for the following existing diagnosis code 11. DX Description V28 (from) V29 (to) 3109 Nonpsychot brain syn NOS 2 1 Sep-2011 Page 10

11 Step 5 SOI Make the following changes to existing diagnosis SDX Description Add/Delete DRG Description Dementia w/o behav dist Delete 757 Organic mental health disturbances Dementia w/o behav dist Delete 758 Childhood behavioral disorders Dementia w/o behav dist Delete 760 Other mental health disorders Dementia w/o behav dist Delete 890 HIV w multiple major HIV related conditions Dementia w/o behav dist Delete 892 HIV w major HIV related condition Dementia w/o behav dist Delete 893 HIV w multiple significant HIV related conditions Dementia w/o behav dist Delete 894 HIV w one signif HIV cond or w/o signif related cond Step 13 SOI Remove the following APR DRG/procedure combinations from the Step 13 logic for APR DRG v DRG Proc Value SOI /4 SOI /2 Add the following APR DRG/procedure combinations to the Step 13 logic for APR DRG v DRG Proc Value SOI /4 SOI /4 SOI /4 SOI /4 SOI /4 SOI /4 Sep-2011 Page 11

12 DRG Proc Value SOI /4 SOI /4 SOI /4 SOI /4 SOI /4 SOI /4 SOI /4 15. Admission DRG table changes See the APR DRG v29.0 Definitions Manual, Vol. 1, appendix F for details. Pre-existing table changes Add the following existing codes to the pre-existing table (all patients): Shiga toxin-producing Escherichia coli [E. coli] (STEC) O Other specified Shiga toxin-producing Escherichia coli [E. coli] (STEC) Shiga toxin-producing Escherichia coli [E. coli] (STEC), unspecified Other and unspecified Escherichia coli [E. coli] Unspecified malignant neoplasm of skin of lip Basal cell carcinoma of skin of lip Squamous cell carcinoma of skin of lip Other specified malignant neoplasm of skin of lip Unspecified malignant neoplasm of eyelid, including canthus Basal cell carcinoma of eyelid, including canthus Squamous cell carcinoma of eyelid, including canthus Other specified malignant neoplasm of eyelid, including canthus Unspecified malignant neoplasm of skin of ear and external auditory canal Sep-2011 Page 12

13 Basal cell carcinoma of skin of ear and external auditory canal Squamous cell carcinoma of skin of ear and external auditory canal Other specified malignant neoplasm of skin of ear and external auditory canal Unspecified malignant neoplasm of skin of other and unspecified parts of face Basal cell carcinoma of skin of other and unspecified parts of face Squamous cell carcinoma of skin of other and unspecified parts of face Other specified malignant neoplasm of skin of other and unspecified parts of face Unspecified malignant neoplasm of scalp and skin of neck Basal cell carcinoma of scalp and skin of neck Squamous cell carcinoma of scalp and skin of neck Other specified malignant neoplasm of scalp and skin of neck Unspecified malignant neoplasm of skin of trunk, except scrotum Basal cell carcinoma of skin of trunk, except scrotum Squamous cell carcinoma of skin of trunk, except scrotum Other specified malignant neoplasm of skin of trunk, except scrotum Unspecified malignant neoplasm of skin of upper limb, including shoulder Basal cell carcinoma of skin of upper limb, including shoulder Squamous cell carcinoma of skin of upper limb, including shoulder Other specified malignant neoplasm of skin of upper limb, including shoulder Unspecified malignant neoplasm of skin of lower limb, including hip Basal cell carcinoma of skin of lower limb, including hip Squamous cell carcinoma of skin of lower limb, including hip Other specified malignant neoplasm of skin of lower limb, including hip Unspecified malignant neoplasm of other specified sites of skin Basal cell carcinoma of other specified sites of skin Squamous cell carcinoma of other specified sites of skin Other specified malignant neoplasm of other specified sites of skin Unspecified malignant neoplasm of skin, site unspecified Basal cell carcinoma of skin, site unspecified Sep-2011 Page 13

14 Squamous cell carcinoma of skin, site unspecified Other specified malignant neoplasm of skin, site unspecified Thalassemia, unspecified Alpha thalassemia Beta thalassemia Delta-beta thalassemia Thalassemia minor Hemoglobin E-beta thalassemia Acquired hemophilia Antiphospholipid antibody with hemorrhagic disorder Other hemorrhagic disorder due to intrinsic circulating anticoagulants, antibodies, or inhibitors Dementia, unspecified, without behavioral disturbance Dementia, unspecified, with behavioral disturbance Corticobasal degeneration Lambert-Eaton syndrome, unspecified Lambert-Eaton syndrome in neoplastic disease Lambert-Eaton syndrome in other diseases classified elsewhere Open angle with borderline findings, high risk Primary angle closure without glaucoma damage Glaucoma stage, unspecified Mild stage glaucoma Moderate stage glaucoma Severe stage glaucoma Indeterminate stage glaucoma Vitreomacular adhesion Coronary atherosclerosis due to calcified coronary lesion Hypertrophic obstructive cardiomyopathy Other hypertrophic cardiomyopathy Respiratory conditions due to smoke inhalation Chronic pneumothorax Sep-2011 Page 14

15 Idiopathic interstitial pneumonia, not otherwise specified Idiopathic pulmonary fibrosis Respiratory bronchiolitis interstitial lung disease Idiopathic lymphoid interstitial pneumonia Cryptogenic organizing pneumonia Desquamative interstitial pneumonia Lymphangioleiomyomatosis Adult pulmonary Langerhans cell histiocytosis Neuroendocrine cell hyperplasia of infancy Pulmonary interstitial glycogenosis Surfactant mutations of the lung Alveolar capillary dysplasia with vein misalignment Other interstitial lung diseases of childhood Hepatopulmonary syndrome Inappropriate change in quantitative human chorionic gonadotropin (hcg) in early pregnancy Other abnormal products of conception Onset (spontaneous) of labor after 37 completed weeks of gestation but before 39 completed weeks gestation, with delivery by (planned) cesarean section, delivered, with or without mention of antepartum condition Onset (spontaneous) of labor after 37 completed weeks of gestation but before 39 completed weeks gestation, with delivery by (planned) cesarean section, delivered, with mention of postpartum complication Pilar cyst Trichilemmal cyst Pulmonary artery coarctation and atresia Pulmonary arteriovenous malformation Other anomalies of pulmonary artery and pulmonary circulation Solitary pulmonary nodule Other nonspecific abnormal finding of lung field Nonspecific reaction to tuberculin skin test without active tuberculosis Nonspecific reaction to cell mediated immunity measurement of gamma interferon antigen response without active tuberculosis Sep-2011 Page 15

16 V12.21 Personal history of gestational diabetes V12.29 Personal history of other endocrine, metabolic, and immunity disorders V12.55 Personal history of pulmonary embolism V13.81 Personal history of anaphylaxis V13.89 Personal history of other specified diseases V19.11 Family history of glaucoma V19.19 Family history of other specified eye disorder V23.42 Pregnancy with history of ectopic pregnancy V23.87 Pregnancy with inconclusive fetal viability V40.31 Wandering in diseases classified elsewhere V40.39 Other specified behavioral problem V54.82 Aftercare following explantation of joint prosthesis V58.68 Long term (current) use of bisphosphonates V87.02 Contact with and (suspected) exposure to uranium V88.21 Acquired absence of hip joint V88.22 Acquired absence of knee joint V88.29 Acquired absence of other joint 16. Complication of Care table changes Add the following new codes to the Complication of Care table: Postprocedural aspiration pneumonia Retained cholelithiasis following cholecystectomy Other digestive system complications Postoperative shock, unspecified Postoperative shock, cardiogenic Postoperative shock, septic Postoperative shock, other Sep-2011 Page 16

17 Bloodstream infection due to central venous catheter Local infection due to central venous catheter Acute infection following transfusion, infusion, or injection of blood and blood products Anaphylactic reaction due to administration of blood and blood products Anaphylactic reaction due to vaccination Anaphylactic reaction due to other serum Other serum reaction due to administration of blood and blood products Other serum reaction due to vaccination Other serum reaction 18. Length of Stay to Identify Diagnosis POA Add the following diagnoses to the Pneumonia when LOS <3 Days table: Influenza due to identified novel influenza A virus with other respiratory manifestations Influenza due to identified novel influenza A virus with other manifestations Add the following diagnoses to the Pneumonia when LOS <7 Days table: Influenza due to identified novel influenza A virus with pneumonia 21. Sep-2011 Page 17