v35 relative weights and alos - pennsylvania department … · 2018-03-01 · 0001 3 liver...

Relative Value, Average Length of Stay, High- and Low-Cost Outlier Threshold and Percentage Table For APR-DRG Grouper Version 35 Fee-for-Service Inpatient Claims Billed By Acute Care General Hospitals Enrolled In PA Medical Assistance

Threshold Percentage Threshold Percentage

0001 1 LIVER TRANSPLANT &/OR INTESTINAL TRANSPLANT 7.7856 6.19 30,000 100% 30,000 20%




0002 1 HEART &/OR LUNG TRANSPLANT 9.4066 9.27 30,000 100% 30,000 20%




0004 1 TRACHEOSTOMY W MV 96+ HOURS W EXTENSIVE PROCEDURE 5.5141 8.21 30,000 80% 30,000 20%




0005 1 TRACHEOSTOMY W MV 96+ HOURS W/O EXTENSIVE PROCEDURE 5.2964 16.12 30,000 80% 30,000 20%




0006 1 PANCREAS TRANSPLANT 6.3411 6.55 30,000 100% 30,000 20%




0007 1 ALLOGENEIC BONE MARROW TRANSPLANT 6.1057 1.93 30,000 100% 30,000 20%




0008 1 AUTOLOGOUS BONE MARROW TRANSPLANT 6.1057 8.58 30,000 100% 30,000 20%




0009 1 EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) 5.5141 7.00 30,000 80% 30,000 20%




0010 1 HEAD TRAUMA WITH DEEP COMA 1.6059 3.27 30,000 80% 30,000 20%


Relative

Weight

APR-

DRG

Severity

of Illness

(SOI) APR-DRG Description

Low-Cost Outlier Average

Length

of Stay

High-Cost Outlier

Effective October 1, 2017 based on date of discharge



Relative

Weight

APR-

DRG

Severity

of Illness



Length

of Stay

High-Cost Outlier



0020 1 CRANIOTOMY FOR TRAUMA 1.9384 4.46 30,000 80% 30,000 20%




0021 1 CRANIOTOMY EXCEPT FOR TRAUMA 2.2230 2.89 30,000 80% 30,000 20%




0022 1 VENTRICULAR SHUNT PROCEDURES 1.3618 1.97 30,000 80% 30,000 20%




0023 1 SPINAL PROCEDURES 1.5323 2.36 30,000 80% 30,000 20%




0024 1 EXTRACRANIAL VASCULAR PROCEDURES 1.2270 1.27 30,000 80% 30,000 20%




0026 1 OTHER NERVOUS SYSTEM & RELATED PROCEDURES 1.4089 1.90 30,000 80% 30,000 20%




0040 1 SPINAL DISORDERS & INJURIES 1.0760 2.66 30,000 80% 30,000 20%




0041 1 NERVOUS SYSTEM MALIGNANCY 0.8328 2.16 30,000 80% 30,000 20%







Relative

Weight

APR-

DRG

Severity

of Illness



Length

of Stay

High-Cost Outlier

0042 1 DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS 0.6616 3.12 30,000 80% 30,000 20%




0043 1 MULTIPLE SCLEROSIS & OTHER DEMYELINATING DISEASES 0.8587 3.00 30,000 80% 30,000 20%




0044 1 INTRACRANIAL HEMORRHAGE 0.9291 2.82 30,000 80% 30,000 20%




0045 1 CVA & PRECEREBRAL OCCLUSION W INFARCT 0.7986 2.21 30,000 80% 30,000 20%




0046 1 NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT 0.7822 1.87 30,000 80% 30,000 20%




0047 1 TRANSIENT ISCHEMIA 0.6534 1.57 30,000 80% 30,000 20%




0048 1 PERIPHERAL, CRANIAL & AUTONOMIC NERVE DISORDERS 0.6595 2.12 30,000 80% 30,000 20%




0049 1 BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM 1.0432 4.26 30,000 80% 30,000 20%




0050 1 NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITIS 0.7022 2.95 30,000 80% 30,000 20%



HR OR NO COMA

HR OR NO COMA

HR OR NO COMA

HR OR NO COMA



Relative

Weight

APR-

DRG

Severity

of Illness



Length

of Stay

High-Cost Outlier



0051 1 VIRAL MENINGITIS 0.6180 2.33 30,000 80% 30,000 20%




0052 1 ALTERATION IN CONSCIOUSNESS 0.6068 1.69 30,000 80% 30,000 20%




0053 1 SEIZURE 0.5682 1.89 30,000 80% 30,000 20%

0053 2 SEIZURE 0.6764 2.25 30,000 80% 30,000 20%

0053 3 SEIZURE 1.0194 3.18 30,000 80% 30,000 20%

0053 4 SEIZURE 2.6327 6.65 30,000 80% 30,000 20%

0054 1 MIGRAINE & OTHER HEADACHES 0.6105 1.95 30,000 80% 30,000 20%




0055 1 HEAD TRAUMA W COMA >1 HR OR HEMORRHAGE 0.7248 1.80 30,000 80% 30,000 20%




0056 1 BRAIN CONTUSION/LACERATION & COMPLICATED SKULL FX, COMA < 1 HR OR NO COMA 0.7267 1.74 30,000 80% 30,000 20%




0057 1 CONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 0.7206 1.31 30,000 80% 30,000 20%




0058 1 OTHER DISORDERS OF NERVOUS SYSTEM 0.6915 1.97 30,000 80% 30,000 20%







Relative

Weight

APR-

DRG

Severity

of Illness



Length

of Stay

High-Cost Outlier

0059 1 ANOXIC & OTHER SEVERE BRAIN DAMAGE 0.6844 2.45 30,000 80% 30,000 20%




0073 1 EYE PROCEDURES EXCEPT ORBIT 1.0084 1.75 30,000 80% 30,000 20%




0082 1 EYE DISORDERS EXCEPT MAJOR INFECTIONS 0.5419 1.78 30,000 80% 30,000 20%




0089 1 MAJOR CRANIAL/FACIAL BONE PROCEDURES 1.7868 1.76 30,000 80% 30,000 20%




0091 1 OTHER MAJOR HEAD & NECK PROCEDURES 1.8858 2.26 30,000 80% 30,000 20%




0092 1 FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL/FACIAL BONE PROCEDURES 1.2520 1.63 30,000 80% 30,000 20%




0095 1 CLEFT LIP & PALATE REPAIR 0.8715 1.33 30,000 80% 30,000 20%




0097 1 TONSIL & ADENOID PROCEDURES 0.5306 1.39 30,000 80% 30,000 20%




0098 1 OTHER EAR, NOSE, MOUTH & THROAT PROCEDURES 0.9287 1.68 30,000 80% 30,000 20%





Relative

Weight

APR-

DRG

Severity

of Illness



Length

of Stay

High-Cost Outlier



0110 1 EAR, NOSE, MOUTH, THROAT, CRANIAL/FACIAL MALIGNANCIES 0.7707 1.88 30,000 80% 30,000 20%




0111 1 VERTIGO & OTHER LABYRINTH DISORDERS 0.5694 1.65 30,000 80% 30,000 20%




0113 1 INFECTIONS OF UPPER RESPIRATORY TRACT 0.3624 1.61 30,000 80% 30,000 20%




0114 1 DENTAL DISEASES AND DISORDERS 0.5201 1.82 30,000 80% 30,000 20%




0115 1 OTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSES 0.5235 1.81 30,000 80% 30,000 20%




0120 1 MAJOR RESPIRATORY & CHEST PROCEDURES 1.9018 4.00 30,000 80% 30,000 20%




0121 1 OTHER RESPIRATORY & CHEST PROCEDURES 1.5605 2.50 30,000 80% 30,000 20%




0130 1 RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS 2.9507 9.58 30,000 80% 30,000 20%







Relative

Weight

APR-

DRG

Severity

of Illness



Length

of Stay

High-Cost Outlier

0131 1 CYSTIC FIBROSIS - PULMONARY DISEASE 1.4880 5.12 30,000 80% 30,000 20%




0132 1 BPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD 0.5888 2.49 30,000 80% 30,000 20%




0133 1 RESPIRATORY FAILURE 0.5093 1.72 30,000 80% 30,000 20%




0134 1 PULMONARY EMBOLISM 0.7025 2.77 30,000 80% 30,000 20%




0135 1 MAJOR CHEST & RESPIRATORY TRAUMA 0.7357 2.25 30,000 80% 30,000 20%




0136 1 RESPIRATORY MALIGNANCY 0.8906 2.46 30,000 80% 30,000 20%




0137 1 MAJOR RESPIRATORY INFECTIONS & INFLAMMATIONS 0.6825 3.19 30,000 80% 30,000 20%




0138 1 BRONCHIOLITIS & RSV PNEUMONIA 0.3193 1.80 30,000 80% 30,000 20%




0139 1 OTHER PNEUMONIA 0.4661 2.33 30,000 80% 30,000 20%

0139 2 OTHER PNEUMONIA 0.6569 3.11 30,000 80% 30,000 20%




Relative

Weight

APR-

DRG

Severity

of Illness



Length

of Stay

High-Cost Outlier

0139 3 OTHER PNEUMONIA 1.0382 4.49 30,000 80% 30,000 20%

0139 4 OTHER PNEUMONIA 2.0321 7.28 30,000 80% 30,000 20%

0140 1 CHRONIC OBSTRUCTIVE PULMONARY DISEASE 0.5409 2.50 30,000 80% 30,000 20%




0141 1 ASTHMA 0.4144 1.79 30,000 80% 30,000 20%

0141 2 ASTHMA 0.5935 2.42 30,000 80% 30,000 20%

0141 3 ASTHMA 0.8530 3.29 30,000 80% 30,000 20%

0141 4 ASTHMA 1.6890 4.26 30,000 80% 30,000 20%

0142 1 INTERSTITIAL LUNG DISEASE 0.7037 2.60 30,000 80% 30,000 20%




0143 1 OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS & MINOR DIAGNOSES 0.5325 2.24 30,000 80% 30,000 20%




0144 1 RESPIRATORY SIGNS, SYMPTOMS & MINOR DIAGNOSES 0.5303 1.79 30,000 80% 30,000 20%




0145 1 ACUTE BRONCHITIS AND RELATED SYMPTOMS 0.5070 1.76 30,000 80% 30,000 20%




0160 1 MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY 3.6029 3.67 30,000 80% 30,000 20%




0161 1 CARDIAC DEFIBRILLATOR & HEART ASSIST IMPLANT 4.2976 2.29 30,000 80% 30,000 20%







Relative

Weight

APR-

DRG

Severity

of Illness



Length

of Stay

High-Cost Outlier

0162 1 CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX 4.6973 6.17 30,000 80% 30,000 20%




0163 1 CARDIAC VALVE PROCEDURES W/O AMI OR COMPLEX PDX 3.9033 5.07 30,000 80% 30,000 20%




0165 1 CORONARY BYPASS W AMI OR COMPLEX PDX 4.0584 6.62 30,000 80% 30,000 20%




0166 1 CORONARY BYPASS W/O AMI OR COMPLEX PDX 3.3554 5.33 30,000 80% 30,000 20%




0167 1 OTHER CARDIOTHORACIC & THORACIC VASCULAR PROCEDURES 2.6009 3.60 30,000 80% 30,000 20%




0169 1 MAJOR ABDOMINAL VASCULAR PROCEDURES 1.8143 3.17 30,000 80% 30,000 20%




0170 1 PERMANENT CARDIAC PACEMAKER IMPLANT W AMI, HEART FAILURE OR SHOCK 2.5318 3.16 30,000 80% 30,000 20%




0171 1 PERM CARDIAC PACEMAKER IMPLANT W/O AMI, HEART FAILURE OR SHOCK 1.4366 2.18 30,000 80% 30,000 20%




0174 1 PERCUTANEOUS CORONARY INTERVENTION W AMI 2.0431 2.08 30,000 80% 30,000 20%





Relative

Weight

APR-

DRG

Severity

of Illness



Length

of Stay

High-Cost Outlier



0175 1 PERCUTANEOUS CORONARY INTERVENTION W/O AMI 2.0371 1.46 30,000 80% 30,000 20%




0176 1 CARDIAC PACEMAKER & DEFIBRILLATOR DEVICE REPLACEMENT 1.8654 2.25 30,000 80% 30,000 20%




0177 1 CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT 1.2586 2.09 30,000 80% 30,000 20%




0180 1 OTHER CIRCULATORY SYSTEM PROCEDURES 1.5230 2.88 30,000 80% 30,000 20%




0181 1 LOWER EXTREMITY ARTERIAL PROCEDURES 1.5871 2.20 30,000 80% 30,000 20%




0182 1 OTHER PERIPHERAL VASCULAR PROCEDURES 2.0282 1.78 30,000 80% 30,000 20%




0190 1 ACUTE MYOCARDIAL INFARCTION 0.8618 2.00 30,000 80% 30,000 20%




0191 1 CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE 0.9556 1.62 30,000 80% 30,000 20%







Relative

Weight

APR-

DRG

Severity

of Illness



Length

of Stay

High-Cost Outlier

0192 1 CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS 0.9996 1.70 30,000 80% 30,000 20%




0193 1 ACUTE & SUBACUTE ENDOCARDITIS 1.0111 4.30 30,000 80% 30,000 20%




0194 1 HEART FAILURE 0.5476 2.41 30,000 80% 30,000 20%

0194 2 HEART FAILURE 0.7096 3.11 30,000 80% 30,000 20%

0194 3 HEART FAILURE 1.0605 4.45 30,000 80% 30,000 20%

0194 4 HEART FAILURE 2.0885 7.38 30,000 80% 30,000 20%

0196 1 CARDIAC ARREST & SHOCK 0.5701 1.88 30,000 80% 30,000 20%




0197 1 PERIPHERAL & OTHER VASCULAR DISORDERS 0.5558 2.47 30,000 80% 30,000 20%




0198 1 ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS 0.5040 1.41 30,000 80% 30,000 20%




0199 1 HYPERTENSION 0.5186 1.64 30,000 80% 30,000 20%

0199 2 HYPERTENSION 0.6136 2.09 30,000 80% 30,000 20%

0199 3 HYPERTENSION 0.8729 3.04 30,000 80% 30,000 20%

0199 4 HYPERTENSION 2.3078 6.02 30,000 80% 30,000 20%

0200 1 CARDIAC STRUCTURAL & VALVULAR DISORDERS 0.6223 1.87 30,000 80% 30,000 20%




0201 1 CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS 0.4700 1.65 30,000 80% 30,000 20%





Relative

Weight

APR-

DRG

Severity

of Illness



Length

of Stay

High-Cost Outlier



0203 1 CHEST PAIN 0.5202 1.29 30,000 80% 30,000 20%

0203 2 CHEST PAIN 0.6075 1.61 30,000 80% 30,000 20%

0203 3 CHEST PAIN 0.7761 2.26 30,000 80% 30,000 20%

0203 4 CHEST PAIN 1.3712 3.76 30,000 80% 30,000 20%

0204 1 SYNCOPE & COLLAPSE 0.5784 1.68 30,000 80% 30,000 20%




0205 1 CARDIOMYOPATHY 0.5608 1.93 30,000 80% 30,000 20%

0205 2 CARDIOMYOPATHY 0.7140 2.41 30,000 80% 30,000 20%

0205 3 CARDIOMYOPATHY 1.0307 3.78 30,000 80% 30,000 20%

0205 4 CARDIOMYOPATHY 2.7419 8.06 30,000 80% 30,000 20%

0206 1 MALFUNCTION,REACTION,COMPLICATION OF CARDIAC/VASC DEVICE OR PROCEDURE 0.7817 1.73 30,000 80% 30,000 20%




0207 1 OTHER CIRCULATORY SYSTEM DIAGNOSES 0.5523 1.90 30,000 80% 30,000 20%




0220 1 MAJOR STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES 1.4153 2.53 30,000 80% 30,000 20%




0222 1 OTHER STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES 1.1323 1.80 30,000 80% 30,000 20%




0223 1 OTHER SMALL & LARGE BOWEL PROCEDURES 1.1830 3.66 30,000 80% 30,000 20%







Relative

Weight

APR-

DRG

Severity

of Illness



Length

of Stay

High-Cost Outlier

0224 1 PERITONEAL ADHESIOLYSIS 1.2425 4.35 30,000 80% 30,000 20%




0226 1 ANAL PROCEDURES 0.7346 2.03 30,000 80% 30,000 20%

0226 2 ANAL PROCEDURES 1.0205 3.03 30,000 80% 30,000 20%

0226 3 ANAL PROCEDURES 1.6829 5.21 30,000 80% 30,000 20%

0226 4 ANAL PROCEDURES 3.2666 10.54 30,000 80% 30,000 20%

0227 1 HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL & UMBILICAL 1.1217 2.40 30,000 80% 30,000 20%




0228 1 INGUINAL, FEMORAL & UMBILICAL HERNIA PROCEDURES 0.8473 1.67 30,000 80% 30,000 20%




0229 1 OTHER DIGESTIVE SYSTEM & ABDOMINAL PROCEDURES 1.1618 2.82 30,000 80% 30,000 20%




0230 1 MAJOR SMALL BOWEL PROCEDURES 1.4330 3.91 30,000 80% 30,000 20%




0231 1 MAJOR LARGE BOWEL PROCEDURES 1.5089 3.61 30,000 80% 30,000 20%




0232 1 GASTRIC FUNDOPLICATION 1.1600 1.61 30,000 80% 30,000 20%




0233 1 APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS 1.1860 2.54 30,000 80% 30,000 20%





Relative

Weight

APR-

DRG

Severity

of Illness



Length

of Stay

High-Cost Outlier



0234 1 APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS 0.8925 1.38 30,000 80% 30,000 20%




0240 1 DIGESTIVE MALIGNANCY 0.7526 2.52 30,000 80% 30,000 20%




0241 1 PEPTIC ULCER & GASTRITIS 0.6742 2.09 30,000 80% 30,000 20%




0242 1 MAJOR ESOPHAGEAL DISORDERS 0.6183 1.90 30,000 80% 30,000 20%




0243 1 OTHER ESOPHAGEAL DISORDERS 0.5872 1.59 30,000 80% 30,000 20%




0244 1 DIVERTICULITIS & DIVERTICULOSIS 0.5439 2.48 30,000 80% 30,000 20%




0245 1 INFLAMMATORY BOWEL DISEASE 0.6380 2.72 30,000 80% 30,000 20%




0246 1 GASTROINTESTINAL VASCULAR INSUFFICIENCY 0.6689 2.62 30,000 80% 30,000 20%







Relative

Weight

APR-

DRG

Severity

of Illness



Length

of Stay

High-Cost Outlier

0247 1 INTESTINAL OBSTRUCTION 0.5289 2.38 30,000 80% 30,000 20%




0248 1 MAJOR GASTROINTESTINAL & PERITONEAL INFECTIONS 0.5648 2.80 30,000 80% 30,000 20%




0249 1 OTHER GASTROENTERITIS, NAUSEA & VOMITING 0.4658 1.89 30,000 80% 30,000 20%




0251 1 ABDOMINAL PAIN 0.5317 1.80 30,000 80% 30,000 20%

0251 2 ABDOMINAL PAIN 0.6619 2.31 30,000 80% 30,000 20%

0251 3 ABDOMINAL PAIN 0.9228 3.16 30,000 80% 30,000 20%

0251 4 ABDOMINAL PAIN 2.0505 5.28 30,000 80% 30,000 20%

0252 1 MALFUNCTION, REACTION & COMPLICATION OF GI DEVICE OR PROCEDURE 0.6041 2.56 30,000 80% 30,000 20%




0253 1 OTHER & UNSPECIFIED GASTROINTESTINAL HEMORRHAGE 0.5889 2.13 30,000 80% 30,000 20%




0254 1 OTHER DIGESTIVE SYSTEM DIAGNOSES 0.5762 2.00 30,000 80% 30,000 20%




0260 1 MAJOR PANCREAS, LIVER & SHUNT PROCEDURES 1.6998 3.45 30,000 80% 30,000 20%




0261 1 MAJOR BILIARY TRACT PROCEDURES 1.4137 3.58 30,000 80% 30,000 20%





Relative

Weight

APR-

DRG

Severity

of Illness



Length

of Stay

High-Cost Outlier



0263 1 CHOLECYSTECTOMY 1.0666 1.98 30,000 80% 30,000 20%




0264 1 OTHER HEPATOBILIARY, PANCREAS & ABDOMINAL PROCEDURES 1.4264 3.25 30,000 80% 30,000 20%




0279 1 HEPATIC COMA & OTHER MAJOR ACUTE LIVER DISORDERS 0.5693 2.22 30,000 80% 30,000 20%




0280 1 ALCOHOLIC LIVER DISEASE 0.6128 2.16 30,000 80% 30,000 20%




0281 1 MALIGNANCY OF HEPATOBILIARY SYSTEM & PANCREAS 0.8273 2.51 30,000 80% 30,000 20%




0282 1 DISORDERS OF PANCREAS EXCEPT MALIGNANCY 0.5820 2.57 30,000 80% 30,000 20%




0283 1 OTHER DISORDERS OF THE LIVER 0.6123 2.32 30,000 80% 30,000 20%




0284 1 DISORDERS OF GALLBLADDER & BILIARY TRACT 0.6969 2.00 30,000 80% 30,000 20%







Relative

Weight

APR-

DRG

Severity

of Illness



Length

of Stay

High-Cost Outlier

0301 1 HIP JOINT REPLACEMENT 1.6634 2.93 30,000 80% 30,000 20%




0302 1 KNEE JOINT REPLACEMENT 1.5875 2.60 30,000 80% 30,000 20%




0303 1 DORSAL & LUMBAR FUSION PROC FOR CURVATURE OF BACK 4.9040 4.00 30,000 80% 30,000 20%




0304 1 DORSAL & LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK 2.9808 2.49 30,000 80% 30,000 20%




0305 1 AMPUTATION OF LOWER LIMB EXCEPT TOES 1.1247 4.12 30,000 80% 30,000 20%




0308 1 HIP & FEMUR FRACTURE REPAIRS 1.3550 3.55 30,000 80% 30,000 20%




0309 1 OTHER SIGNIFICANT HIP & FEMUR SURGERY 1.3714 2.25 30,000 80% 30,000 20%




0310 1 INTERVERTEBRAL DISC EXCISION & DECOMPRESSION 1.0189 1.51 30,000 80% 30,000 20%




0312 1 SKIN GRAFT, EXCEPT HAND, FOR MUSCULOSKELETAL & CONNECTIVE TISSUE DIAGNOSES 1.6798 3.23 30,000 80% 30,000 20%





Relative

Weight

APR-

DRG

Severity

of Illness



Length

of Stay

High-Cost Outlier



0313 1 KNEE & LOWER LEG PROCEDURES EXCEPT FOOT 1.1973 2.15 30,000 80% 30,000 20%




0314 1 FOOT & TOE PROCEDURES 1.0942 1.89 30,000 80% 30,000 20%




0315 1 SHOULDER, UPPER ARM & FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT 0.9868 1.53 30,000 80% 30,000 20%




0316 1 HAND & WRIST PROCEDURES 0.8592 1.79 30,000 80% 30,000 20%




0317 1 TENDON, MUSCLE & OTHER SOFT TISSUE PROCEDURES 0.9501 2.32 30,000 80% 30,000 20%




0320 1 OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES 1.0827 1.72 30,000 80% 30,000 20%




0321 1 CERVICAL SPINAL FUSION & OTHER BACK/NECK PROC EXC DISC EXCIS/DECOMP 1.7798 1.38 30,000 80% 30,000 20%




0322 1 SHOULDER and ELBOW JOINT REPLACEMENT 1.6243 1.57 30,000 80% 30,000 20%







Relative

Weight

APR-

DRG

Severity

of Illness



Length

of Stay

High-Cost Outlier

0340 1 FRACTURE OF FEMUR 0.5074 2.56 30,000 80% 30,000 20%




0341 1 FRACTURE OF PELVIS OR DISLOCATION OF HIP 0.5143 2.60 30,000 80% 30,000 20%




0342 1 FRACTURES & DISLOCATIONS EXCEPT FEMUR, PELVIS & BACK 0.5388 1.76 30,000 80% 30,000 20%




0343 1 MUSCULOSKELETAL MALIGNANCY & PATHOL FRACTURE D/T MUSCSKEL MALIG 0.8341 2.69 30,000 80% 30,000 20%




0344 1 OSTEOMYELITIS, SEPTIC ARTHRITIS & OTHER MUSCULOSKELETAL INFECTIONS 0.7763 3.32 30,000 80% 30,000 20%




0346 1 CONNECTIVE TISSUE DISORDERS 0.6943 2.51 30,000 80% 30,000 20%




0347 1 OTHER BACK & NECK DISORDERS, FRACTURES & INJURIES 0.6565 2.28 30,000 80% 30,000 20%




0349 1 MALFUNCTION, REACTION, COMPLIC OF ORTHOPEDIC DEVICE OR PROCEDURE 0.5483 1.75 30,000 80% 30,000 20%




0351 1 OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES 0.5593 1.97 30,000 80% 30,000 20%





Relative

Weight

APR-

DRG

Severity

of Illness



Length

of Stay

High-Cost Outlier



0361 1 SKIN GRAFT FOR SKIN & SUBCUTANEOUS TISSUE DIAGNOSES 1.4424 2.54 30,000 80% 30,000 20%




0362 1 MASTECTOMY PROCEDURES 1.3937 1.53 30,000 80% 30,000 20%




0363 1 BREAST PROCEDURES EXCEPT MASTECTOMY 1.0920 1.62 30,000 80% 30,000 20%




0364 1 OTHER SKIN, SUBCUTANEOUS TISSUE & RELATED PROCEDURES 0.8788 2.13 30,000 80% 30,000 20%




0380 1 SKIN ULCERS 0.6019 3.10 30,000 80% 30,000 20%

0380 2 SKIN ULCERS 0.7322 3.60 30,000 80% 30,000 20%

0380 3 SKIN ULCERS 1.0688 4.95 30,000 80% 30,000 20%

0380 4 SKIN ULCERS 2.2024 8.45 30,000 80% 30,000 20%

0381 1 MAJOR SKIN DISORDERS 0.4843 2.52 30,000 80% 30,000 20%




0382 1 MALIGNANT BREAST DISORDERS 0.6753 1.98 30,000 80% 30,000 20%




0383 1 CELLULITIS & OTHER SKIN INFECTIONS 0.4829 2.43 30,000 80% 30,000 20%







Relative

Weight

APR-

DRG

Severity

of Illness



Length

of Stay

High-Cost Outlier

0384 1 CONTUSION, OPEN WOUND & OTHER TRAUMA TO SKIN & SUBCUTANEOUS TISSUE 0.6147 1.52 30,000 80% 30,000 20%




0385 1 OTHER SKIN, SUBCUTANEOUS TISSUE & BREAST DISORDERS 0.4687 1.99 30,000 80% 30,000 20%




0401 1 ADRENAL PROCEDURES 1.5710 2.28 30,000 80% 30,000 20%




0403 1 PROCEDURES FOR OBESITY 1.3714 1.68 30,000 80% 30,000 20%




0404 1 THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES 0.8753 1.16 30,000 80% 30,000 20%




0405 1 OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL & METABOLIC DISORDERS 1.3612 2.45 30,000 80% 30,000 20%




0420 1 DIABETES 0.4459 2.04 30,000 80% 30,000 20%

0420 2 DIABETES 0.5734 2.23 30,000 80% 30,000 20%

0420 3 DIABETES 0.8672 3.30 30,000 80% 30,000 20%

0420 4 DIABETES 2.2179 6.97 30,000 80% 30,000 20%

0421 1 MALNUTRITION, FAILURE TO THRIVE & OTHER NUTRITIONAL DISORDERS 0.6727 2.20 30,000 80% 30,000 20%




0422 1 HYPOVOLEMIA & RELATED ELECTROLYTE DISORDERS 0.3592 1.67 30,000 80% 30,000 20%





Relative

Weight

APR-

DRG

Severity

of Illness



Length

of Stay

High-Cost Outlier



0423 1 INBORN ERRORS OF METABOLISM 0.6493 1.90 30,000 80% 30,000 20%




0424 1 OTHER ENDOCRINE DISORDERS 0.5429 2.04 30,000 80% 30,000 20%




0425 1 OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS 0.4495 1.96 30,000 80% 30,000 20%




0426 1 NON-HYPOVOLEMIC SODIUM DISORDERS 0.4424 1.79 30,000 80% 30,000 20%




0427 1 THYROID DISORDERS 0.5429 1.71 30,000 80% 30,000 20%




0440 1 KIDNEY TRANSPLANT 5.2699 4.25 30,000 100% 30,000 20%




0441 1 MAJOR BLADDER PROCEDURES 1.5540 3.45 30,000 80% 30,000 20%




0442 1 KIDNEY & URINARY TRACT PROCEDURES FOR MALIGNANCY 1.4330 2.67 30,000 80% 30,000 20%







Relative

Weight

APR-

DRG

Severity

of Illness



Length

of Stay

High-Cost Outlier

0443 1 KIDNEY & URINARY TRACT PROCEDURES FOR NONMALIGNANCY 1.2599 2.03 30,000 80% 30,000 20%




0444 1 RENAL DIALYSIS ACCESS DEVICE AND VESSEL REPAIR 1.3043 1.79 30,000 80% 30,000 20%




0445 1 OTHER BLADDER PROCEDURES 1.2677 1.73 30,000 80% 30,000 20%




0446 1 URETHRAL & TRANSURETHRAL PROCEDURES 0.7804 1.54 30,000 80% 30,000 20%




0447 1 OTHER KIDNEY, URINARY TRACT & RELATED PROCEDURES 1.2865 2.14 30,000 80% 30,000 20%




0461 1 KIDNEY & URINARY TRACT MALIGNANCY 0.5978 1.88 30,000 80% 30,000 20%




0462 1 NEPHRITIS & NEPHROSIS 0.4925 1.99 30,000 80% 30,000 20%




0463 1 KIDNEY & URINARY TRACT INFECTIONS 0.4811 2.25 30,000 80% 30,000 20%




0465 1 URINARY STONES & ACQUIRED UPPER URINARY TRACT OBSTRUCTION 0.5507 1.45 30,000 80% 30,000 20%





Relative

Weight

APR-

DRG

Severity

of Illness



Length

of Stay

High-Cost Outlier



0466 1 MALFUNCTION, REACTION, COMPLIC OF GENITOURINARY DEVICE OR PROC 0.5627 1.79 30,000 80% 30,000 20%




0468 1 OTHER KIDNEY & URINARY TRACT DIAGNOSES, SIGNS & SYMPTOMS 0.5422 2.03 30,000 80% 30,000 20%




0469 1 ACUTE KIDNEY INJURY 0.4966 2.17 30,000 80% 30,000 20%




0470 1 CHRONIC KIDNEY DISEASE 0.5243 1.84 30,000 80% 30,000 20%




0480 1 MAJOR MALE PELVIC PROCEDURES 1.3282 1.43 30,000 80% 30,000 20%




0482 1 TRANSURETHRAL PROSTATECTOMY 0.7161 1.51 30,000 80% 30,000 20%




0483 1 TESTES & SCROTAL PROCEDURES 0.8885 1.46 30,000 80% 30,000 20%




0484 1 OTHER MALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES 0.9824 2.02 30,000 80% 30,000 20%







Relative

Weight

APR-

DRG

Severity

of Illness



Length

of Stay

High-Cost Outlier

0500 1 MALIGNANCY, MALE REPRODUCTIVE SYSTEM 0.6079 1.73 30,000 80% 30,000 20%




0501 1 MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY 0.4946 2.10 30,000 80% 30,000 20%




0510 1 PELVIC EVISCERATION, RADICAL HYSTERECTOMY & OTHER RADICAL GYN PROCS 1.3437 1.87 30,000 80% 30,000 20%




0511 1 UTERINE & ADNEXA PROCEDURES FOR OVARIAN & ADNEXAL MALIGNANCY 1.3556 2.97 30,000 80% 30,000 20%




0512 1 UTERINE & ADNEXA PROCEDURES FOR NON-OVARIAN & NON-ADNEXAL MALIG 1.2052 1.72 30,000 80% 30,000 20%




0513 1 UTERINE & ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA 0.9213 1.62 30,000 80% 30,000 20%




0514 1 FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES 0.7588 1.25 30,000 80% 30,000 20%




0517 1 DILATION & CURETTAGE FOR NON-OBSTETRIC DIAGNOSES 0.7301 1.58 30,000 80% 30,000 20%




0518 1 OTHER FEMALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES 0.8696 1.79 30,000 80% 30,000 20%





Relative

Weight

APR-

DRG

Severity

of Illness



Length

of Stay

High-Cost Outlier



0519 1 UTERINE & ADNEXA PROCEDURES FOR LEIOMYOMA 0.9631 1.82 30,000 80% 30,000 20%




0530 1 FEMALE REPRODUCTIVE SYSTEM MALIGNANCY 0.6028 2.04 30,000 80% 30,000 20%




0531 1 FEMALE REPRODUCTIVE SYSTEM INFECTIONS 0.5383 2.25 30,000 80% 30,000 20%




0532 1 MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS 0.4696 1.49 30,000 80% 30,000 20%




0540 1 CESAREAN DELIVERY 0.5867 2.82 30,000 80% 30,000 20%




0541 1 VAGINAL DELIVERY W STERILIZATION &/OR D&C 0.5589 2.00 30,000 80% 30,000 20%




0542 1 VAGINAL DELIVERY W COMPLICATING PROCEDURES EXC STERILIZATION &/OR D&C 0.4145 2.03 30,000 80% 30,000 20%




0544 1 D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY FOR OBSTETRIC DIAGNOSES 0.5854 1.21 30,000 80% 30,000 20%







Relative

Weight

APR-

DRG

Severity

of Illness



Length

of Stay

High-Cost Outlier

0545 1 ECTOPIC PREGNANCY PROCEDURE 0.8382 1.40 30,000 80% 30,000 20%




0546 1 OTHER O.R. PROC FOR OBSTETRIC DIAGNOSES EXCEPT DELIVERY DIAGNOSES 0.6394 1.90 30,000 80% 30,000 20%




0560 1 VAGINAL DELIVERY 0.3462 1.90 30,000 80% 30,000 20%




0561 1 POSTPARTUM & POST ABORTION DIAGNOSES W/O PROCEDURE 0.2715 1.70 30,000 80% 30,000 20%




0563 1 THREATENED ABORTION 0.3110 1.80 30,000 80% 30,000 20%




0564 1 ABORTION W/O D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY 0.4065 1.19 30,000 80% 30,000 20%




0565 1 FALSE LABOR 0.1527 1.08 30,000 80% 30,000 20%

0565 2 FALSE LABOR 0.2173 1.32 30,000 80% 30,000 20%

0565 3 FALSE LABOR 0.3454 2.38 30,000 80% 30,000 20%

0565 4 FALSE LABOR 0.3801 2.62 30,000 80% 30,000 20%

0566 1 OTHER ANTEPARTUM DIAGNOSES 0.3287 1.65 30,000 80% 30,000 20%




0580 1 NEONATE, TRANSFERRED <5 DAYS OLD, NOT BORN HERE 0.2586 1.28 30,000 100% 30,000 20%





Relative

Weight

APR-

DRG

Severity

of Illness



Length

of Stay

High-Cost Outlier



0581 1 NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE 0.1030 1.15 30,000 100% 30,000 20%




0583 1 NEONATE W ECMO 8.9427 11.67 30,000 100% 30,000 20%

0583 2 NEONATE W ECMO 9.9363 12.96 30,000 100% 30,000 20%

0583 3 NEONATE W ECMO 18.6285 31.09 30,000 100% 30,000 20%

0583 4 NEONATE W ECMO 27.8558 52.69 30,000 100% 30,000 20%

0588 1 NEONATE BWT <1500G W MAJOR PROCEDURE 8.7763 29.57 30,000 100% 30,000 20%




0589 1 NEONATE BWT <500G 15.4097 69.06 30,000 100% 30,000 20%

0589 2 NEONATE BWT <500G 10.8091 80.77 30,000 100% 30,000 20%

0589 3 NEONATE BWT <500G 7.7322 82.97 30,000 100% 30,000 20%

0589 4 NEONATE BWT <500G 0.2628 3.04 30,000 100% 30,000 20%

0591 1 NEONATE BIRTHWT 500-749G W/O MAJOR PROCEDURE 9.2028 1.00 30,000 100% 30,000 20%








0602 1 NEONATE BWT 1000-1249G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM 4.1963 21.77 30,000 100% 30,000 20%




0603 1 NEONATE BIRTHWT 1000-1249G W OR W/O OTHER SIGNIFICANT CONDITION 2.4505 10.41 30,000 100% 30,000 20%







Relative

Weight

APR-

DRG

Severity

of Illness



Length

of Stay

High-Cost Outlier





0608 1 NEONATE BWT 1250-1499G W OR W/O OTHER SIGNIFICANT CONDITION 2.5886 15.69 30,000 100% 30,000 20%




0609 1 NEONATE BWT 1500-2499G W MAJOR PROCEDURE 4.0227 3.16 30,000 100% 30,000 20%




0611 1 NEONATE BIRTHWT 1500-1999G W MAJOR ANOMALY 2.2290 12.06 30,000 100% 30,000 20%




0612 1 NEONATE BWT 1500-1999G W RESP DIST SYND/OTH MAJ RESP COND 2.7506 16.33 30,000 100% 30,000 20%




0613 1 NEONATE BIRTHWT 1500-1999G W CONGENITAL/PERINATAL INFECTION 2.2679 14.16 30,000 100% 30,000 20%








0621 1 NEONATE BWT 2000-2499G W MAJOR ANOMALY 1.0613 5.46 30,000 100% 30,000 20%









Relative

Weight

APR-

DRG

Severity

of Illness



Length

of Stay

High-Cost Outlier



0623 1 NEONATE BWT 2000-2499G W CONGENITAL/PERINATAL INFECTION 1.4304 7.71 30,000 100% 30,000 20%




0625 1 NEONATE BWT 2000-2499G W OTHER SIGNIFICANT CONDITION 1.5800 9.41 30,000 100% 30,000 20%




0626 1 NEONATE BWT 2000-2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM 0.1626 2.42 30,000 100% 30,000 20%




0630 1 NEONATE BIRTHWT >2499G W MAJOR CARDIOVASCULAR PROCEDURE 2.4184 2.70 30,000 100% 30,000 20%




0631 1 NEONATE BIRTHWT >2499G W OTHER MAJOR PROCEDURE 1.3578 2.11 30,000 100% 30,000 20%




0633 1 NEONATE BIRTHWT >2499G W MAJOR ANOMALY 0.3015 2.32 30,000 100% 30,000 20%




0634 1 NEONATE, BIRTHWT >2499G W RESP DIST SYND/OTH MAJ RESP COND 0.5662 3.09 30,000 100% 30,000 20%




0636 1 NEONATE BIRTHWT >2499G W CONGENITAL/PERINATAL INFECTION 0.7753 4.52 30,000 100% 30,000 20%







Relative

Weight

APR-

DRG

Severity

of Illness



Length

of Stay

High-Cost Outlier

0639 1 NEONATE BIRTHWT >2499G W OTHER SIGNIFICANT CONDITION 0.4390 2.50 30,000 100% 30,000 20%




0640 1 NEONATE BIRTHWT >2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM 0.1142 1.92 30,000 100% 30,000 20%




0650 1 SPLENECTOMY 1.3809 2.73 30,000 80% 30,000 20%

0650 2 SPLENECTOMY 1.9766 4.15 30,000 80% 30,000 20%

0650 3 SPLENECTOMY 2.6652 6.42 30,000 80% 30,000 20%

0650 4 SPLENECTOMY 5.3361 12.19 30,000 80% 30,000 20%

0651 1 OTHER PROCEDURES OF BLOOD & BLOOD-FORMING ORGANS 1.1107 2.42 30,000 80% 30,000 20%




0660 1 MAJOR HEMATOLOGIC/IMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS & COAGUL 0.8128 2.55 30,000 80% 30,000 20%




0661 1 COAGULATION & PLATELET DISORDERS 0.9990 2.08 30,000 80% 30,000 20%




0662 1 SICKLE CELL ANEMIA CRISIS 0.6220 3.15 30,000 80% 30,000 20%




0663 1 OTHER ANEMIA & DISORDERS OF BLOOD & BLOOD-FORMING ORGANS 0.5344 1.83 30,000 80% 30,000 20%




0680 1 MAJOR O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS 1.6246 2.98 30,000 80% 30,000 20%





Relative

Weight

APR-

DRG

Severity

of Illness



Length

of Stay

High-Cost Outlier



0681 1 OTHER O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS 1.1837 2.02 30,000 80% 30,000 20%




0690 1 ACUTE LEUKEMIA 1.3759 3.29 30,000 80% 30,000 20%

0690 2 ACUTE LEUKEMIA 2.2717 5.03 30,000 80% 30,000 20%

0690 3 ACUTE LEUKEMIA 4.3524 10.72 30,000 80% 30,000 20%

0690 4 ACUTE LEUKEMIA 8.2669 22.18 30,000 80% 30,000 20%

0691 1 LYMPHOMA, MYELOMA & NON-ACUTE LEUKEMIA 1.1656 2.97 30,000 80% 30,000 20%




0692 1 RADIOTHERAPY 0.7877 2.43 30,000 80% 30,000 20%

0692 2 RADIOTHERAPY 1.6449 3.80 30,000 80% 30,000 20%

0692 3 RADIOTHERAPY 2.4109 5.92 30,000 80% 30,000 20%

0692 4 RADIOTHERAPY 4.4599 9.83 30,000 80% 30,000 20%

0694 1 LYMPHATIC & OTHER MALIGNANCIES & NEOPLASMS OF UNCERTAIN BEHAVIOR 0.7587 2.15 30,000 80% 30,000 20%




0695 1 CHEMOTHERAPY FOR ACUTE LEUKEMIA 0.6615 4.34 30,000 80% 30,000 20%




0696 1 OTHER CHEMOTHERAPY 0.8679 2.31 30,000 80% 30,000 20%




0710 1 INFECTIOUS & PARASITIC DISEASES INCLUDING HIV W O.R. PROCEDURE 1.1564 3.38 30,000 80% 30,000 20%







Relative

Weight

APR-

DRG

Severity

of Illness



Length

of Stay

High-Cost Outlier

0711 1 POST-OP, POST-TRAUMA, OTHER DEVICE INFECTIONS W O.R. PROCEDURE 1.1103 3.45 30,000 80% 30,000 20%




0720 1 SEPTICEMIA & DISSEMINATED INFECTIONS 0.5963 2.71 30,000 80% 30,000 20%




0721 1 POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS 0.6289 2.83 30,000 80% 30,000 20%




0722 1 FEVER 0.4702 1.99 30,000 80% 30,000 20%

0722 2 FEVER 0.6431 2.47 30,000 80% 30,000 20%

0722 3 FEVER 0.8685 3.20 30,000 80% 30,000 20%

0722 4 FEVER 1.7868 4.52 30,000 80% 30,000 20%

0723 1 VIRAL ILLNESS 0.4165 1.81 30,000 80% 30,000 20%

0723 2 VIRAL ILLNESS 0.5629 2.25 30,000 80% 30,000 20%

0723 3 VIRAL ILLNESS 0.9204 3.44 30,000 80% 30,000 20%

0723 4 VIRAL ILLNESS 3.2139 7.45 30,000 80% 30,000 20%

0724 1 OTHER INFECTIOUS & PARASITIC DISEASES 0.7234 3.14 30,000 80% 30,000 20%




0740 1 MENTAL ILLNESS DIAGNOSIS W O.R. PROCEDURE 1.4168 3.23 30,000 80% 30,000 20%




0750 1 SCHIZOPHRENIA 0.6623 6.22 30,000 80% 30,000 20%

0750 2 SCHIZOPHRENIA 0.7945 7.32 30,000 80% 30,000 20%

0750 3 SCHIZOPHRENIA 1.1614 9.11 30,000 80% 30,000 20%

0750 4 SCHIZOPHRENIA 2.3270 19.10 30,000 80% 30,000 20%

0751 1 MAJOR DEPRESSIVE DISORDERS & OTHER/UNSPECIFIED PSYCHOSES 0.3967 3.96 30,000 80% 30,000 20%





Relative

Weight

APR-

DRG

Severity

of Illness



Length

of Stay

High-Cost Outlier



0752 1 DISORDERS OF PERSONALITY & IMPULSE CONTROL 0.3396 3.13 30,000 80% 30,000 20%




0753 1 BIPOLAR DISORDERS 0.4316 4.26 30,000 80% 30,000 20%




0754 1 DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER 0.3189 3.00 30,000 80% 30,000 20%




0755 1 ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES 0.2866 2.59 30,000 80% 30,000 20%




0756 1 ACUTE ANXIETY & DELIRIUM STATES 0.4633 2.22 30,000 80% 30,000 20%




0757 1 ORGANIC MENTAL HEALTH DISTURBANCES 0.6849 5.65 30,000 80% 30,000 20%




0758 1 BEHAVIORAL DISORDERS 0.4521 4.13 30,000 80% 30,000 20%




0759 1 EATING DISORDERS 1.4404 6.52 30,000 80% 30,000 20%







Relative

Weight

APR-

DRG

Severity

of Illness



Length

of Stay

High-Cost Outlier

0760 1 OTHER MENTAL HEALTH DISORDERS 0.5638 3.82 30,000 80% 30,000 20%




0770 1 DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE 0.2524 1.68 30,000 80% 30,000 20%




0772 1 ALCOHOL & DRUG DEPENDENCE W REHAB OR REHAB/DETOX THERAPY 0.0000 0.00 0 0% 0 0%




0773 1 OPIOID ABUSE & DEPENDENCE 0.2996 3.09 30,000 80% 30,000 20%




0774 1 COCAINE ABUSE & DEPENDENCE 0.3792 2.26 30,000 80% 30,000 20%




0775 1 ALCOHOL ABUSE & DEPENDENCE 0.3679 2.48 30,000 80% 30,000 20%




0776 1 OTHER DRUG ABUSE & DEPENDENCE 0.3494 2.58 30,000 80% 30,000 20%




0792 1 EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT 1.0842 2.57 30,000 80% 30,000 20%




0793 1 MODERATELY EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT 1.0487 1.97 30,000 80% 30,000 20%





Relative

Weight

APR-

DRG

Severity

of Illness



Length

of Stay

High-Cost Outlier



0794 1 NON-EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT 1.0001 2.04 30,000 80% 30,000 20%




0810 1 HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION 0.5746 1.88 30,000 80% 30,000 20%




0811 1 ALLERGIC REACTIONS 0.3245 1.31 30,000 80% 30,000 20%




0812 1 POISONING OF MEDICINAL AGENTS 0.3753 1.39 30,000 80% 30,000 20%




0813 1 OTHER COMPLICATIONS OF TREATMENT 0.5980 1.97 30,000 80% 30,000 20%




0815 1 OTHER INJURY, POISONING & TOXIC EFFECT DIAGNOSES 0.5332 1.31 30,000 80% 30,000 20%




0816 1 TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES 0.5581 1.46 30,000 80% 30,000 20%




0817 1 OVERDOSE 0.4042 1.77 30,000 80% 30,000 20%

0817 2 OVERDOSE 0.5094 2.07 30,000 80% 30,000 20%

0817 3 OVERDOSE 0.8629 2.96 30,000 80% 30,000 20%

0817 4 OVERDOSE 2.1166 5.01 30,000 80% 30,000 20%




Relative

Weight

APR-

DRG

Severity

of Illness



Length

of Stay

High-Cost Outlier

0841 1 EXTENSIVE 3RD DEGREE BURNS W SKIN GRAFT 5.2328 15.31 30,000 100% 30,000 20%




0842 1 BURS W SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS 1.6398 3.69 30,000 100% 30,000 20%




0843 1 EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS W/O SKIN GRAFT 0.7998 3.00 30,000 100% 30,000 20%




0844 1 PARTIAL THICKNESS BURNS W/O SKIN GRAFT 0.5346 1.80 30,000 100% 30,000 20%




0850 1 PROCEDURE W DIAG OF REHAB, AFTERCARE OR OTH CONTACT W HEALTH SERVICE 1.6500 2.05 30,000 80% 30,000 20%




0860 1 REHABILITATION 0.9042 8.56 30,000 80% 30,000 20%

0860 2 REHABILITATION 1.2263 10.68 30,000 80% 30,000 20%

0860 3 REHABILITATION 1.6879 12.89 30,000 80% 30,000 20%

0860 4 REHABILITATION 2.2722 14.40 30,000 80% 30,000 20%

0861 1 SIGNS, SYMPTOMS & OTHER FACTORS INFLUENCING HEALTH STATUS 0.4680 1.91 30,000 80% 30,000 20%




0862 1 OTHER AFTERCARE & CONVALESCENCE 0.4537 4.20 30,000 80% 30,000 20%




0863 1 NEONATAL AFTERCARE 0.8345 1.00 30,000 80% 30,000 20%





Relative

Weight

APR-

DRG

Severity

of Illness



Length

of Stay

High-Cost Outlier



0890 1 HIV W MULTIPLE MAJOR HIV RELATED CONDITIONS 0.9947 4.58 30,000 80% 30,000 20%




0892 1 HIV W MAJOR HIV RELATED CONDITION 0.7745 4.07 30,000 80% 30,000 20%




0893 1 HIV W MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS 0.9217 2.74 30,000 80% 30,000 20%




0894 1 HIV W ONE SIGNIF HIV COND OR W/O SIGNIF RELATED COND 0.7104 2.60 30,000 80% 30,000 20%




0910 1 CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA 3.3301 3.46 30,000 80% 30,000 20%




0911 1 EXTENSIVE ABDOMINAL/THORACIC PROCEDURES FOR MULT SIGNIFICANT TRAUMA 1.8322 6.57 30,000 80% 30,000 20%




0912 1 MUSCULOSKELETAL & OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA 2.2153 5.27 30,000 80% 30,000 20%




0930 1 MULTIPLE SIGNIFICANT TRAUMA W/O O.R. PROCEDURE 0.8426 2.47 30,000 80% 30,000 20%







Relative

Weight

APR-

DRG

Severity

of Illness



Length

of Stay

High-Cost Outlier

0950 1 EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS 1.5442 2.47 30,000 80% 30,000 20%




0951 1 MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS 1.1334 2.27 30,000 80% 30,000 20%




0952 1 NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS 0.9389 2.05 30,000 80% 30,000 20%




0955 0 PRINCIPAL DIAGNOSIS INVALID AS DISCHARGE DIAGNOSIS 0.0000 0.00 0 0% 0 0%

0956 0 UNGROUPABLE 0.0000 0.00 0 0% 0 0%


v35 relative weights and alos - pennsylvania department … · 2018-03-01 · 0001 3 liver...

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