1 / 49

ICD-10-CM/PCS: APR DRG v.31 SDX Subclasses: SOI-ROM

www.pwc.com. ICD-10-CM/PCS: APR DRG v.31 SDX Subclasses: SOI-ROM. April 201 4. ICD-11: May 2017. icd10illustrated. Medicaid APR DRG. Arizona, October 1, 2014 District of Columbia Medicaid, October 1, 2014 (Replacing AP DRG). “Be” Browser. 2014 ICD-10-CM 2014 ICD-10-PCS. “Be” Browser.

mira-vang
Download Presentation

ICD-10-CM/PCS: APR DRG v.31 SDX Subclasses: SOI-ROM

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. www.pwc.com ICD-10-CM/PCS:APR DRG v.31SDX Subclasses: SOI-ROM April 2014

  2. ICD-11: May 2017

  3. icd10illustrated

  4. Medicaid APR DRG • Arizona, October 1, 2014 • District of Columbia Medicaid,October 1, 2014 (Replacing AP DRG)

  5. “Be” Browser 2014 ICD-10-CM 2014 ICD-10-PCS

  6. “Be” Browser Mouseover 2014 GEMs PCS Root Operation Definitions Create codetable from scratch

  7. ICD-10 APR v31 Definitions Manual Current changes on 3M website where download is also available. 3 Folders 6,844 files 493.3 MB fullcode_apr fullcode_rom fullcode_soi Open P0001.html

  8. Appendix G Step 17: SDX Assignment The presence of certain combinations of secondary diagnoses has great clinical significance. The interaction of specific combinations of secondary diagnoses make treatment more difficult and typically indicate a more extensive disease process. Therefore, a minimum patient severity of illness subclass is established if certain combinations of secondary diagnoses are present. The presence of multiple interacting diagnoses is characteristic of high severity of illness patients. A subset of secondary diagnoses will interact with each other causing patient severity of illness to be increased. The secondary diagnoses in each category are similar clinically and have the same standard severity of illness level. A separate set of diagnosis categories and combinations have been identified for newborns. Appendix G contains the definition of the secondary diagnosis categories. The ICD-10-CM codes in the secondary diagnosis categories are listed in code order with the associated secondary diagnosis category. The number used to identify the secondary diagnosis categories is arbitrary and has no specific meaning. The standard severity of illness level of the secondary diagnosis in each category is shown in parentheses.

  9. Phase II: Base SOI Subclass Highest SOI level of any SDX

  10. ICD-10 v31 - Secondary Diagnosis (fullcode_soi) • E860 Dehydration 917 Dehydration 2 • E860 Dehydration 511 Hypovolemia (1) 1 Newborn Diagnosis Categories - There’s a separate list of newborn diagnoses for Step 17

  11. ICD-10 v31 - Secondary Diagnosis (fullcode_soi) 61,999 ICD-10-CM diagnosis codes in Appendix G, (SOI) • Appendix G - SDX Patient Subclass (Step 17 Part 1): Secondary Diagnosis Category Assignment • The standard severity of illness level of the secondary diagnosis in each category is shown in parentheses

  12. Appendix G: SOI SDX: ICD-9-CM 13,403 ICD-9-CM diagnosis codes in Appendix G (v30 APR, SOI)

  13. Appendix G: SOI SDX, ICD-10-CM 61,999 ICD-10-CM diagnosis codes in Appendix G, (SOI)

  14. v31 - Secondary Diagnosis (fullcode_rom) • 61,999 diagnosis codes in Appendix F, (ROM) • Appendix F - SDX Patient Subclass • The standard risk of mortality level of the secondary diagnosis in each category is shown in parentheses

  15. Appendix F: ROM SDX

  16. Appendix F: ROM SDX, ICD-10-CM

  17. Same ICD-10-CM SDX:SOI vs. ROM Levels • 52,555 codes with equal level • 8,693 codes where SOI > ROM • 744 codes where SOI < ROM

  18. SOI < ROM (SDX) Examples R402343|Coma scale, best motor response, flexion withdrawal|3|4 R402344|Coma scale, best motor response, flexion withdrawal|3|4 R4181|Age-related cognitive decline|1|2 R54|Age-related physical debility|1|2 R64|Cachexia|2|3 413 C (Neoplasms) 61 S (Injury, poisoning) 53 T (Injury, poisoning) 47 O (Pregnancy, childbirth) 40 R (Symptoms, signs) 33 K (Digestive) 23 D (Neoplasms) 21 I (Circulatory) 15 G (Nervous) 11 A (Infectious) 8 Q (Congenital malformation) 5 F (Mental, Behavioral) 5 B (Infectious) 4 P (Perinatal) 2 N (Genitourinary) 2 J (Respiratory) 1 E (Endocrine) :1

  19. SOI < ROM (SDX): Example

  20. SOI < ROM (SDX): Example cancer cachexia

  21. SOI < ROM Highlights:SOI = minor (1), ROM = moderate (2)or (3) Example: C390, Malignant neoplasm of upper respiratory tract, part unspecified SOI = 1 ROM = 3 • Primary malignancy (C00 - C80) • Senile dementia (2900) • Alzheimer's disease (G30[0189]) • Hypertensive hrt dis NOS w/o HF (I119) • Alcoholic liver disease, unspec (K709) • CKD, Stage III (N183)

  22. Chapter 6 All ICD-10-CM diagnosis codes are listed in code order. Chapter 6 contains the standard severity of illness level for each ICD-10-CM code as well as any modifications to the standard severity of illness level made in steps 1-6.

  23. Chapter 6: Secondary Diagnosis Assignments (SOI) - Steps 1-6

  24. Chapter 6: Secondary Diagnosis Assignments (SOI)

  25. Chapter 6: Secondary Diagnosis Assignments, Step 6 Step 6: K50018 Crohn’s . . .1 / 3 subclass increment Secondary diagnosis of K50018 + any of 8 PCS codes, e.g., 3E0336Z Introduction of Nutritional into Periph Vein, Perc Approach

  26. Chapter 6: Step 6, Non-OR Codes • 503 - Pattern Match, Step_6 • 3 Character, Unique: ICD-10-PCS as Non-OR • 117 entries for ICD-10-PCS Pattern Match ( x / x) • 2,501 PCS codes 11 3E0 3 DU0 3 DB0 1 DUY 1 DG1 1 D81 7 5A1 3 DT0 3 D90 1 DU1 1 DFY 1 D7Y 6 0DH 3 DP0 3 D80 1 DTY 1 DF1 1 D71 4 D9Y 3 DM0 3 D70 1 DT1 1 DD1 1 D0Y 4 CW7 3 DH0 3 D00 1 DPY 1 DBY 1 D01 4 0D1 3 DG0 2 DVY 1 DMY 1 DB1 1 6A5 3 DWY 3 DF0 2 DHY 1 DM1 1 D91 1 5A0 3 DW0 3 DDY 1 DW1 1 DGY 1 D8Y 1 3E1 3 DV0 3 DD0 1 DV1 :

  27. Chapter 6: Step 6, Non-OR Codes • 2,633 ICD-10-PCS Codes as Non-OR (SOI) For example, 3E0[3456][03]6Z Introduction of Peripheral Vein (8 codes) 1/4

  28. Chapter 6: Secondary Diagnosis Assignments (ROM) - Step 6 Step 6: Secondary Diagnosis and Non-OR Procedure Index Step 6 identifies combinations of secondary diagnoses and non-OR procedures that modify the risk of mortality level of the secondary diagnosis. This step is listed as SDX/NON-OR PROC EXCEPTION.

  29. Chapter 6: Secondary Diagnosis Assignments, Steps (ROM) No Step 6 in Chapter 6, ROM

  30. Step 6, SOI vs. ROM What are the secondary diagnoses? What are the differences? Are the non-ORs the same?

  31. Step 6 SDX (SOI) 437 unique ICD-10-CM SDXs Most in G-K Range 65 G Diseases of the nervous system (G00-G99) 105 I Diseases of the circulatory system (I00-I99) 77 J Diseases of the respiratory system (J00-J99) 94 K Diseases of the digestive system (K00-K95)

  32. Step 6 SDX (SOI): “I” Circulatory Example: I69059 Hemiplegia . . . SDX of I69059 + Proc, any of 32 ICD-10-PCS codes = 1/3

  33. Step 6 SDX (SOI): “I” Non-OR 0DH64UZ - Insertion of feeding device into stomach, percutaneous endoscopic approach (PEG)

  34. Step 6 SDX (ROM) 33 unique ICD-10-CM SDXs 32 in “I” Circulatory 32 I Diseases of the circulatory system (I00-I99) 1 J Diseases of the respiratory system (J00-J99)

  35. Step 6 SDX (ROM) I0981 I2111 I221 I5022 I5033 I110 I2119 I222 I5023 I5041 I130 I2121 I228 I5023 I5042 I132 I2129 I229 I5031 I5043 I2101 I213 I499 I5032 I509 I2102 I214 I499 I5033 J9584 I2109 I220 I5021

  36. Step 6 Non-OR (ROM) For the 32 “I” SDXs: 5A02[12]10 Assistance, Cardiac (2 codes) 2/4 Implant of Pulsation Balloon

  37. Step 6 Non-OR (ROM) For the “J” SDX: J9584 Transfusion-related acute lung injury (TRALI)

  38. Chapter 8 (SOI) O.R. and Non-O.R. Procedure Assignments

  39. Step 12: APR DRG and Non-OR (SOI) 253 unique ICD-10-PCS codes, Non-OR (SOI) 33 D92 15 DG2 12 D02 6 DM2 2 02U 27 D72 13 0D1 9 DU2 5 GZB 1 3E1 21 DD2 12 DW2 8 3E0 5 5A0 1 0W3 21 DB2 12 DT2 7 5A1 3 D82 1 04L 19 0DH 12 DF2 6 DV2 2 0B1

  40. Step 12: D92 - Stereotactic Radiosurgery, D926DZZ

  41. Step 12: D92 - Stereotactic Radiosurgery, APR DRG 692 Increment APR-DRG 692 SOI from 1 / 2 D926DZZ,DRG/Non-OR Proc Modification

  42. Chapter 8 (ROM) O.R. and Non-O.R. Procedure Assignments *5A02110 Assistance with Cardiac Output using Balloon Pump, Intermittent *5A02210 Assistance with Cardiac Output using Balloon Pump, Continuous *5A1935Z Respiratory Ventilation, Less than 24 Consecutive Hours *5A1945Z Respiratory Ventilation, 24-96 Consecutive Hours *5A1955Z Respiratory Ventilation, Greater than 96 Consecutive Hours

  43. Chapter 8 (ROM) 133 APR DRGs, Increment 1 / 3 *5A1935Z Respiratory Ventilation, < 24 Consecutive Hrs 040 080 143 242 347 466 692 041 082 190 243 349 468 693 042 110 191 244 351 500 694 043 111 192 245 380 501 720 044 113 193 246 381 530 721 045 114 194 247 382 531 722 046 115 196 248 383 532 723 047 131 197 249 384 560 724 048 132 198 280 385 561 811 049 133 199 281 420 563 812 050 134 200 282 421 564 813 051 135 201 283 422 565 815 052 136 203 284 423 566 861 053 137 204 340 424 660 862 054 138 205 341 460 661 890 055 139 206 342 461 662 892 056 140 207 343 462 663 893 057 141 240 344 463 690 894 058 142 241 346 465 691 930 ICD-10-PCS Category for MV < 24 hours. Could this change now that there are three categories of MV Hrs?

  44. HCUPNET 2011: MV, 96.71 0

  45. Replication Problem: SDX = 99749 • 997.49 Other digestive system complications • Appendix G, SOI - 99749 | Gastrointestinal Diagnoses (1) • 2014 GEMs K913 |Postprocedural intestinal obstruction |Gastrointestinal Diagnoses (1) K9181|Oth intraoperative complications of dig sys |Gastrointestinal Diagnoses (1) K9182|Postprocedural hepatic failure |Gastrointestinal Diagnoses (1) K9183|Postprocedural hepatorenal syndrome |Gastrointestinal Diagnoses (1) K9189|Oth postprocedural complications and dis of dig sys |Gastrointestinal Diagnoses (1)

  46. K9182, Postprocedural hepatic failure

  47. K7200, Acute and subacute hepatic failure Appendix G, SOI K7200:Acute and subacute hepatic failure without coma |Gastrointestinal Diagnoses (4)

  48. Excludes 1 Highlighted - No Excludes1 with K9182, Postprocedural hepatic failure Add K7040, ROM changes from moderate (2) to major (3)

  49. Follow-up Tom Scholomiti, Director, AdvisoryPwC80 State StAlbany, NY 12207518-427-4453518-227-0371thomas.o.scholomiti@us.pwc.comor Text TSCHOLOM to 50500

More Related