All Medicaid (APR) DRG 2015

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Darleen Marsh
5 years ago
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1 All Medicaid (APR) DRG 2015 DRG DRG Description Avg. Charge 251 Abdominal Pain $9, Abortion w/o D&C, Aspiration Curettage or Hysterotomy $8, Acute & Subacute Endocarditis $13, Acute Anxiety & Delirium States $9, Acute Leukemia $14, Acute Major Eye Infections $16, Acute Myocardial Infarction $23, Alcohol Abuse & Dependence $16, Alcoholic Liver Disease $21, Allergic Reactions $10, Amputation of Lower Limb Except Toes $37, Anal Procedures $12, Angina Pectoris & Coronary Atherosclerosis $10, Appendectomy $15, Asthma $8, Bacterial & Tuberculous Infections of Nervous System $44, Bipolar Disorders $26, BPD & Oth Chronic Respiratory Dis Arising In Perinatal Period $5, Brain Contusion/Laceration & Compliated Skull FX, COMA < 1 HR OR No Coma $11, Breast Procedures Except Mastectomy $15, Bronchiolitis & RSV Pneumonia $9, Cardiac Arrest $27, Cardiac Arrhythmia & Conduction Disorders $12, Cardiac Catheterization for Ischemic Heart Disease $19, Cardiac Catheterization w/ Circ Disord Exc Ischemic Heart Disease $27, Cardiac Congenital & Valvular Disorders $14, Cardiomyopathy $12, Cellulitis & Other Bacterial Skin Infections $12, Cervical Spinal Fusion & Other Back/Neck Proc Exc Disc Excis/Decomp $24, Cesarean Delivery $11, Chemotherapy $10, Chest Pain $8, Childhood Behavioral Disorders $21, Cholecystectomy Except Laparoscopic $26, Chronic Obstructive Pulmonary Disease $13, Cleft Lip & Palate Repair $20, Coagulation & Platelet Disorders $26, Cocaine Abuse & Dependence $11, Concussion, Closed Skull FX Nos, Uncomplicated Intracranial Injury, Coma <1 Hr o $9, Connective Tissue Disorders $17, Contusion, Open Wound & Other Trauma To Skin & Subcutaneous Tissue $10, Craniotomy Except for Trauma $48, Craniotomy for Trauma $48, CVA & Precerebral Occulusion w/ Infarct $20,029.65

2 544 D&C, Aspiration Curettage or Hysterotomy For Obstetric Diagnoses $12, Degenerative Nervous System Disorders Exc Mult Sclerosis $17, Dental & Oral Diseases & Injuries $12, Depression Except Major Depressive Disorder $9, Diabetes $13, Digestive Malignancy $29, Dilation & Curettage For Non-Obstetric Procedures $13, Disorders of Pancreas Except Malignancy $16, Disorders of Personality & Impulse Control $8, Disorders of the Gallbladder & Biliary Tract $13, Diverticulitis & Diverticulosis $13, Dorsal & Lumbar Fusion Proc Except for Curvature of Back $47, Drug & Alcohol Abuse or Dependence, Left Against Medical Advice $11, Ear, Nose, Mouth Throat, Cranial/Facial Malignancies $25, Ectopic Pregnancy Procedure $12, Electrolyte Disorders Except Hypovolemia Related $16, Extensive Procedure Unrelated To Principal Diagnosis $48, Extracranial Vascular Procedures $26, Eye Disorders Except Major Infections $11, Eye Procedures Except Orbit $17, Facial Bone Procedures Except Major Cranial/Facial Bone Procedures $19, False Labor $6, Female Reproductive System Infections $11, Female Reproductive System Malignancy $23, Female Reproductive System Reconstructive Procedures $15, Fever $9, Foot & Toe Procedures $37, Fracture of Pelvis or Dislocation of Hip $12, Fracture or Dislocation Except Femur, Pelvis & Back $11, Fractures of Femur $8, Gastrointestinal Vascular Insufficiency $14, Hand & Wrist Procedures $16, Head Trauma w/ Coma > 1 Hr or Hemorrhage $21, Heart Failure $15, Hepatic Coma & Other Major Acute Liver Disorders $23, Hernia Procedures Except Inguinal, Femoral & Umbilical $22, Hip & Femur Procedures for Trauma Except Joint Replacement $48, Hip Joint Replacement $37, HIV W Major HIV Related Condition $18, HIV W Multiple Major HIV Related Conditions $41, HIV W Multiple Significant HIV Related Conditions $16, HIV W One Signif HIV Cond Or W/O Signif Related Cond $13, Hypertension $11, Hypovolemia & Related Electrolyte Disorders $9, Inborn Errors of Metabolism $16, Infections Of The Upper Respiratory Tract $9, Infectious & Parasitic Diseases Including HIV W O.R. Procedure $57,903.25

3 245 Inflammatory Bowel Disease $13, Inguinal, Femoral & Umbilical Hernia Procedures $13, Interstitial Lung Disease $20, Intervertebral Disc Excision & Decompression $15, Intestinal Obstruction $15, Intracranial Hemorrhage $26, Kidney & Urinary Tract Infections $12, Kidney & Urinary Tract Malignancy $36, Kidney & Urinary Tract Procedures for Malignancy $18, Kidney & Urinary Tract Procedures for Nonmalignancy $21, Knee & Lower Leg Procedures Except Foot $27, Knee Joint Replacement $28, Laparoscopic Cholecystectomy $19, Lymphatic & Other Malignancies & Neoplasms Of Uncertain Behavior $20, Lymphoma & Non-acute Leukemia $14, Major Biliary Tract Procedures $43, Major Chest & Respiratory Trauma $17, Major Cranial/Facial Bone Procedures $31, Major Depressive Disorders & Other/Unspecified Psychoses $13, Major Esophageal Disorders $19, Major Gastrointestinal & Peritoneal Infections $17, Major Hematologic/Immunologic Diag Exc Sickle Cell Crisis & Coagul $24, Major Larynx & Trachea Procedures $67, Major Male Pelvic Procedures $17, Major O.R. Procedures For Lymphatic/Hematopietic/Other Neoplasms $45, Major Pancreas, Liver & Shunt Procedures $69, Major Respiratory & Chest Procedures $42, Major Respiratory Infections & Inflammations $19, Major Skin Disorders $17, Major Small & Large Bowel Procedures $50, Major Stomach, Esophageal & Duodenal Procedures $52, Major Thoracic & Abdominal Vascular Procedures $24, Male Reproductive System Diagnoses Except Malignancy $11, Malfunction, Reaction & Comp of Cardiac or Vasc Device or Proc $19, Malfunction, Reaction & Comp of Orthopedic Device or Procedure $15, Malfunction, Reaction & Complic of Genitourinary Device Or Proc $16, Malfunction, Reaction & Complication Of G.I. Device Or Procedure $18, Malignancy of Hepatobiliary System & Pancreas $28, Malignancy, Male Reproductive System $13, Malignant Breast Disorders $25, Malnutrition, Failure To Thrive & Other Nutritional Disorders $13, Mastectomy Procedures $17, Menstrual & Other Female Reproductive System Disorders $9, Mental Illness Diagnosis W O.R. Procedure $9, Migraine & Other Headaches $10, Minor Small & Large Bowel Procedures $23, Minor Stomach, Esophageal & Duodenal Procedures $72,923.53

4 951 Moderately Extensive Procedure Unrelated To Principal Diagnosis $33, Multiple Sclerosis & Other Demyelinating Diseases $16, Multiple Significant Trauma W/O O.R. Procedure $14, Musculoskeletal & Other Procedures For Multiple Significant Trauma $53, Musculoskeletal Malignancy & Pathol Fractures D/T Muscskel Malig $18, Neonate BWT <1500G W Major Procedure $548, Neonate, Birthwt > 2499g W Congenital/Perinatal Infection $25, Neonate, Birthwt > 2499g W Other Significant Condition $32, Neonate, Birthwt > 2499g W Resp Dist Synd/Oth Maj Resp Cond $26, Neonate, Birthwt > 2499g w/ Major Anomaly $31, Neonate, Birthwt G w/ Resp Dist Synd/Oth Maj Resp Or Maj Anom $214, Neonate, Birthwt G W OR W/O Other Significant Condition $98, Neonate, Birthwt G W Congenital/Perinatal Infection $79, Neonate, Birthwt G W Major Anomaly $57, Neonate, Birthwt G W OR W/O Other Significant Condition $51, Neonate, Birthwt G W Congenital/Perinatal Infection $30, Neonate, Birthwt G W Other Significant Condition $35, Neonate, Birthwt G w/o Major Procedure $241, Neonate, Birthwt G w/o Major Procedure $234, Neonate, Bwt > 2499g, Normal Newborn Or Neonate W Other Problem $6, Neonate, BWT G W Resp Dist Synd/Oth Maj Resp Or Maj Anom $116, Neonate, BWT G W Resp Dist Synd/Oth Maj Resp Cond $80, Neonate, BWT G W Major Anomaly $24, Neonate, BWT G W Resp Dist Synd/Oth Maj Resp Cond $55, Neonate, BWT G, Normal Newborn Or Neonate W Other Problem $11, Neonate, Transferred <5 Days Old, Born Here $11, Nephritis & Nephrosis $21, Nervous System Malignancy $23, Non-Bacterial Gastroenteritis, Nausea & Vomiting $10, Non-bacterial Infections of Nervous System Exc Viral Meningitis $31, Nonextensive Procedure Unrelated To Principal Diagnosis $26, Nonspecific CVA & Precerebral Occlusion w/o Infarct $15, Nontraumatic Stupor & Coma $22, O.R. Procedure For Other Complications Of Treatment $16, Opioid Abuse & Dependence $12, Orbital Procedures $22, Organic Mental Health Disturbances $17, Osteomyelitis, Septic Arthritis & Other Musculoskeletal Infections $22, Other & Unspecified Gastrointestinal Hemorrhage $14, Other Aftercare & Convalescence $10, Other Anemia & Disorders Of Blood & Blood Forming Organs $12, Other Antepartum Diagnoses $10, Other Back & Neck Disorders, Fractures & Injuries $13, Other Bladder Procedures $48, Other Cardiothoracic Procedures $87, Other Circulatory System Diagnoses $14, Other Circulatory System Procedures $105,802.82

5 813 Other Complications of Treatment $11, Other Digestive System & Abdominal Procedures $31, Other Digestive System Diagnoses $13, Other Disorders of Nervous System $13, Other Disorders Of The Liver $15, Other Drug Abuse & Dependence $10, Other Ear, Nose, Mouth & Throat Procedures $15, Other Ear, Nose, Mouth,Throat & Cranial/Facial Diagnoses $10, Other Endocrine Disorders $15, Other Esophageal Disorders $9, Other Female Reproductive System & Related Procedures $14, Other Hepatobiliary, Pancreas & Abdominal Procedures $32, Other Infectious & Parasitic Diseases $11, Other Injury, Poisoning & Toxic Effect Diagnoses $11, Other Kidney & Urinary Tract Diagnoses, Signs & Symptoms $13, Other Kidney, Urinary Tract & Related Procedures $29, Other Major Head & Neck Procedures $68, Other Male Reproductive System & Related Procedures $22, Other Mental Health Disorders $9, Other Musculoskeletal System & Connective Tissue Diagnoses $12, Other Musculoskeletel System & Connective Tissue Procedures $22, Other Nervous System & Related Procedures $33, Other O.R. Proc For Obstetric Diagnoses Except Delivery Diagnoses $13, Other O.R. Procedures For Lymphatic/Hematopietic/Other Neoplasms $41, Other Pneumonia $13, Other Procedures for Endocrine, Nutrititional & Metabolic Disorders $25, Other Procedures of Blood & Blood Forming Organs $11, Other Respiratory & Chest Procedures $36, Other Respiratory Diagnosis Except Signs, Symptoms & Minor Diagnoses $14, Other Skin, Subcutaneous Tissue & Breast Disorders $10, Other Skin, Subcutaneous Tissue & Related Procedures $16, Other Vascular Procedures $42, Partial Thickness Burns W Or W/O Skin Graft $13, Pelvic Evisceration, Radical Hysterectectomy & Radical GYN Procs $16, Penis Procedures $14, Peptic Ulcer & Gastritis $10, Percutaneous Cardiovascular Procedures w/ AMI $35, Percutaneous Cardiovascular Procedures w/o AMI $28, Peripheral & Other Vascular Disorders $14, Peripheral, Cranial & Autonomic Nerve Disorders $13, Peritoneal Adhesiolysis $24, Pituitary & Adrenal Procedures $26, Poisoning Of Medicinal Agents $11, Post-Op,Post-Trauma, Other Device Infections W O.R. Procedure $34, Post-Operative, Post-Traumatic, Other Device Infections $19, Postpartum & Post Abortion Diagnoses w/o Procedure $9, Procedure W Diag Of Rehab, Aftercare Or Oth Contact W Health Service $20,324.27

6 403 Procedures for Obesity $18, Pulmonary Edema & Respiratory Failure $19, Pulmonary Embolism $21, Radiotherapy $26, Renal Dialysis Access Device Procedure Only $20, Renal Failure $18, Respiratory Malignancy $29, Respiratory System Diagnosis w/ Ventilator Support 96+ Hours $54, Respiratory System Signs, Symptoms & Other Diagnoses $9, Schizophrenia $11, Seizure $12, Septicemia & Disseminated Infections $29, Shoulder, Upper Arm & Forearm Procedures $30, Sickle Cell Anemia Crisis $13, Signs, Symptoms & Other Factors Influencing Health Status $12, Sinus & Mastoid Procedures $10, Skin Graft for Skin & Subcutaneous Tissue Diagnoses $28, Skin Graft, Except Hand, For Musculoskeletal & Connective Tissue Diagnoses $42, Skin Ulcers $14, Spinal Disorders & Injuries $16, Spinal Procedures $22, Splenectomy $29, Syncope & Collapse $10, Tendon, Muscle & Other Soft Tissue Procedures $22, Testes & Scrotal Procedures $9, Threatened Abortion $8, Thyroid, Parathyroid & Thyroglossal Procedures $12, Tonsill & Adenoid Procedures $9, Toxic Effects Of Non-Medicinal Substances $10, Tracheostomy W Long Term Mechanical Ventilation W Extensive Procedure $194, Tracheostomy W Long Term Mechanical Ventilation W/O Extensive Procedure $117, Transient Ischemia $13, Transurethral Prostatectomy $8, Urethral & Transurethral Procedures $13, Urinary Stones & Acquired Upper Urinary Tract Obstruction $9, Uterine & Adnexa Procedures For Leiomyoma $15, Uterine & Adnexa Procedures for Non-Malignancy Except Leiomyoma $14, Uterine & Adnexa Procedures for Non-ovarian & Non-adnexal Malig $17, Uterine & Adnexa Procedures for Ovarian & Adnexal Malignancy $35, Vaginal Delivery $9, Vaginal Delivery w/ Complicating Procedures Exc Sterilization &/or D&C $11, Vaginal Delivery w/ Sterilization &/or D&C $10, Ventricular Shunt Procedures $27, Vertigo & Other Labyrinth Disorders $9, Viral Illness $11, Viral Meningitis $10,936.41

APR-DRG Description Ave Charge

APR-DRG Description Ave Charge Abdominal Pain 16,500.25 2.8 6,000.09 Acute & Subacute Endocarditis 15,339.30 3.0 5,113.10 Acute Myocardial Infarction 17,687.46 2.6 6,802.87 Alcohol Abuse & Dependence 19,126.64 4.2 4,553.96 Alcoholic