IHCP announces changes to DRG grouper and inpatient ...

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IHCP ^bulletin INDIANA HEALTH COVERAGE PROGRAMS BT201559 AUGUST 18, 2015 ICD-10 Only 43 days remain until the implementation of ICD-10 on October 1, 2015. Are you ready? Page 1 of 3 IHCP announces changes to DRG grouper and inpatient hospital reimbursement rates The Indiana Health Coverage Programs (IHCP) has selected the 3M All-Patient Refined (APR) Diagnosis-Related Group (DRG), version 30, as the grouper for ICD-10 DRG assignment. The IHCP will move forward with the APR-DRG methodology on the federally mandated ICD-10 effective date of October 1, 2015. Public notice will be provided in the August 19, 2015, Indiana Register. All inpatient reimbursement rates and DRG weights communicated in this bulletin are effective for inpatient stays with discharge dates on or after October 1, 2015. The current AP-DRG grouper, version 18, will remain in place for inpatient stays with discharge dates before October 1, 2015. Billing procedures for inpatient hospital services have not changed. Please see the IHCP Provider Manual and IHCP provider bulletins and banner pages for specific billing instructions. For information about the APR-DRG software, contact 3M at 1-800- 367-2447 or visit 3M Health Information Systems on the 3M website at solutions.3m.com. Policy reminders Hospital Assessment Fee program The Hospital Assessment Fee (HAF) program remains in effect, as detailed in IHCP Bulletin BT201443. Inpatient stays of less than 24 hours Providers should continue to bill any inpatient stay that is less than 24 hours as an outpatient service. For exceptions to the 24-hour policy, please follow the guidance published in IHCP Banner Pages BR201515 and BR201524. Under the All-Patient (AP) DRG grouper, version 18, the following DRGs were exempt from the inpatient 24-hour policy because they were specific to one-day stays: DRG 637 – Neonate, died w/in one day of birth, born here DRG 638 – Neonate, died w/in one day of birth, not born here

Transcript of IHCP announces changes to DRG grouper and inpatient ...

Page 1: IHCP announces changes to DRG grouper and inpatient ...

IHCP ^bulletin INDIANA HEALTH COVERAGE PROGRAMS BT201559 AUGUST 18, 2015

ICD-10

Only 43 days remain until the implementation of ICD-10 on

October 1, 2015. Are you ready?

Page 1 of 3

IHCP announces changes to DRG grouper and inpatient hospital reimbursement rates The Indiana Health Coverage Programs (IHCP) has selected the 3M All-Patient Refined (APR) Diagnosis-Related Group

(DRG), version 30, as the grouper for ICD-10 DRG assignment. The IHCP will move forward with the APR-DRG

methodology on the federally mandated ICD-10 effective date of October 1, 2015. Public notice will be provided in the

August 19, 2015, Indiana Register.

All inpatient reimbursement rates and DRG weights communicated in

this bulletin are effective for inpatient stays with discharge dates on or

after October 1, 2015. The current AP-DRG grouper, version 18, will

remain in place for inpatient stays with discharge dates before October

1, 2015. Billing procedures for inpatient hospital services have not

changed. Please see the IHCP Provider Manual and IHCP provider

bulletins and banner pages for specific billing instructions.

For information about the APR-DRG software, contact 3M at 1-800-

367-2447 or visit 3M Health Information Systems on the 3M website at

solutions.3m.com.

Policy reminders

Hospital Assessment Fee program

The Hospital Assessment Fee (HAF) program remains in effect, as detailed in IHCP Bulletin BT201443.

Inpatient stays of less than 24 hours

Providers should continue to bill any inpatient stay that is less than 24 hours as an outpatient service. For exceptions to

the 24-hour policy, please follow the guidance published in IHCP Banner Pages BR201515 and BR201524.

Under the All-Patient (AP) DRG grouper, version 18, the following DRGs were exempt from the inpatient 24-hour policy

because they were specific to one-day stays:

DRG 637 – Neonate, died w/in one day of birth, born here

DRG 638 – Neonate, died w/in one day of birth, not born here

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ICD-10

There is no direct crosswalk between these two AP-DRGs and the new APR-DRG system. A neonate that expires within

one day of birth could be linked to any of the neonate APR-DRGs 580– 640 (all severity levels). The IHCP policy

regarding the expiration of a neonate within one day of birth has not changed with the introduction of the APR-DRG.

Providers are advised to continue to submit inpatient claims for this scenario. When the claim denies, to receive payment,

providers should then submit a request for administrative review of the claim per the instructions in Chapter 10 of the

IHCP Provider Manual, attaching documentation to support the inpatient claim.

DRGs exempt from the transfer reimbursement policies

As is current policy, DRGs relating to transfers of neonates less than 5 days old will continue to be exempt from the

transfer reimbursement policies. As such, APR-DRGs 580 – 581 (all severity levels) are exempt from the transfer

reimbursement policies.

Updated rates and relative weights

DRG base rate

The DRG base rate will be $3,471.25 for acute care hospital services. The DRG base rate for eligible children’s hospitals

will be $4,165.50. Providers eligible for the children’s hospital base rate will be notified individually of their eligibility.

Outlier threshold and cost-to-charge ratios

The threshold used to determine outlier payments will be updated to $51,425. Myers and Stauffer LC, the IHCP’s hospital

rate-setting contractor, will notify hospitals individually of their new global cost-to-charge ratio that is used to calculate

outlier payments. Low-volume IHCP providers, new IHCP providers, and most out-of-state providers will receive the

statewide median cost-to-charge ratio of 0.3965.

Level-of-care rates

Table 1 provides the level-of-care (LOC) per diem rates effective October 1, 2015.

Table 1 – LOC per diem rates effective October 1, 2015

Please note, DRG 757 will be paid at the psychiatric LOC rate unless billed with ICD-10 diagnosis codes F70-F79.

Claims that group to DRG 757, when billed with diagnosis codes F70-F79, will pay using the DRG payment methodology,

rather than the LOC per diem methodology.

Provider-specific per diem rates for providers classified as provider specialty 013 – Medicaid Long-Term Acute Care

(LTAC) Hospital will be communicated to qualifying providers individually by Myers & Stauffer.

Page 2 of 3

Service Per Diem Rate

Psychiatric LOC $408.50

Rehabilitation LOC $667.00

Burn/1 LOC $2,850.00

Burn/2 LOC $855.00

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ICD-10

Capital per diem rates

The capital per diem rate remains unchanged at $64.50.

Medical education rates

Myers and Stauffer will notify qualifying hospitals individually of their new

medical education per diem rates.

Relative weights and average lengths of stay

A complete list of new relative weights and average lengths of stay

(ALOS) associated with the new APR-DRG grouper, version 30, are listed in Table 2, attached to this bulletin. Please

note that each DRG has four severity levels (1 – Minor, 2 – Moderate, 3 – Major, and 4 – Extreme), which allow for more

detailed coding of the patient’s status.

Page 3 of 3

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APR-DRG, version 30 relative weights and ALOS 1 of 30

Table 2 – APR-DRG, version 30 relative weights and ALOS

effective October 1, 2015

DRG Description Relative Weight ALOS

001-1 Liver Transplant &/Or Intestinal Transplant 7.5587 11.0

001-2 Liver Transplant &/Or Intestinal Transplant 7.5587 11.4

001-3 Liver Transplant &/Or Intestinal Transplant 14.3853 13.3

001-4 Liver Transplant &/Or Intestinal Transplant 31.9119 34.8

002-1 Heart &/Or Lung Transplant 7.1430 15.0

002-2 Heart &/Or Lung Transplant 7.1430 15.0

002-3 Heart &/Or Lung Transplant 7.1430 15.2

002-4 Heart &/Or Lung Transplant 26.3287 37.5

003-1 Bone Marrow Transplant 5.5823 13.6

003-2 Bone Marrow Transplant 6.6749 24.6

003-3 Bone Marrow Transplant 6.6749 24.6

003-4 Bone Marrow Transplant 25.9768 49.6

004-1 Tracheostomy W Mv 96+ Hours W Extensive Procedure Or Ecmo 7.9399 18.5

004-2 Tracheostomy W Mv 96+ Hours W Extensive Procedure Or Ecmo 7.9399 18.5

004-3 Tracheostomy W Mv 96+ Hours W Extensive Procedure Or Ecmo 7.9399 18.5

004-4 Tracheostomy W Mv 96+ Hours W Extensive Procedure Or Ecmo 19.0663 39.2

005-1 Tracheostomy W Mv 96+ Hours W/O Extensive Procedure 5.9217 20.9

005-2 Tracheostomy W Mv 96+ Hours W/O Extensive Procedure 6.4864 20.9

005-3 Tracheostomy W Mv 96+ Hours W/O Extensive Procedure 7.0616 20.9

005-4 Tracheostomy W Mv 96+ Hours W/O Extensive Procedure 11.9831 30.4

006-1 Pancreas Transplant 6.8079 9.6

006-2 Pancreas Transplant 10.6976 9.6

006-3 Pancreas Transplant 10.6976 9.6

006-4 Pancreas Transplant 11.2055 11.0

020-1 Craniotomy For Trauma 2.7441 4.4

020-2 Craniotomy For Trauma 2.7441 4.4

020-3 Craniotomy For Trauma 4.2334 6.6

020-4 Craniotomy For Trauma 7.0691 14.5

021-1 Craniotomy Except For Trauma 2.3080 3.6

021-2 Craniotomy Except For Trauma 3.0776 4.6

021-3 Craniotomy Except For Trauma 5.4010 11.7

021-4 Craniotomy Except For Trauma 7.0480 16.5

022-1 Ventricular Shunt Procedures 2.0097 2.9

022-2 Ventricular Shunt Procedures 2.0198 3.8

022-3 Ventricular Shunt Procedures 3.0803 6.4

022-4 Ventricular Shunt Procedures 6.3003 11.7

023-1 Spinal Procedures 1.4679 2.4

023-2 Spinal Procedures 2.0045 3.9

023-3 Spinal Procedures 3.9233 7.2

023-4 Spinal Procedures 6.8425 14.6

024-1 Extracranial Vascular Procedures 1.5691 1.5

024-2 Extracranial Vascular Procedures 2.2659 2.3

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APR-DRG, version 30 relative weights and ALOS 2 of 30

Table 2 – APR-DRG, version 30 relative weights and ALOS

effective October 1, 2015

DRG Description Relative Weight ALOS

024-3 Extracranial Vascular Procedures 2.9253 5.6

024-4 Extracranial Vascular Procedures 5.0313 10.2

026-1 Other Nervous System & Related Procedures 1.4553 2.1

026-2 Other Nervous System & Related Procedures 3.1211 3.4

026-3 Other Nervous System & Related Procedures 3.1211 6.3

026-4 Other Nervous System & Related Procedures 4.5869 14.7

040-1 Spinal Disorders & Injuries 0.8106 2.7

040-2 Spinal Disorders & Injuries 1.0656 3.4

040-3 Spinal Disorders & Injuries 1.6861 5.2

040-4 Spinal Disorders & Injuries 2.6271 22.0

041-1 Nervous System Malignancy 0.8177 2.2

041-2 Nervous System Malignancy 0.9270 3.0

041-3 Nervous System Malignancy 1.4903 5.0

041-4 Nervous System Malignancy 2.3509 7.6

042-1 Degenerative Nervous System Disorders Exc Mult Sclerosis 0.5277 3.5

042-2 Degenerative Nervous System Disorders Exc Mult Sclerosis 1.1640 6.4

042-3 Degenerative Nervous System Disorders Exc Mult Sclerosis 1.1640 6.4

042-4 Degenerative Nervous System Disorders Exc Mult Sclerosis 2.7733 9.2

043-1 Multiple Sclerosis & Other Demyelinating Diseases 1.0736 4.0

043-2 Multiple Sclerosis & Other Demyelinating Diseases 1.3115 4.1

043-3 Multiple Sclerosis & Other Demyelinating Diseases 1.5231 5.3

043-4 Multiple Sclerosis & Other Demyelinating Diseases 4.1287 9.0

044-1 Intracranial Hemorrhage 0.6654 2.5

044-2 Intracranial Hemorrhage 2.0599 5.9

044-3 Intracranial Hemorrhage 2.0599 5.9

044-4 Intracranial Hemorrhage 2.0599 5.9

045-1 Cva & Precerebral Occlusion W Infarct 0.7931 2.7

045-2 Cva & Precerebral Occlusion W Infarct 1.2005 4.0

045-3 Cva & Precerebral Occlusion W Infarct 1.8045 6.2

045-4 Cva & Precerebral Occlusion W Infarct 3.8591 10.8

046-1 Nonspecific Cva & Precerebral Occlusion W/O Infarct 0.5770 1.8

046-2 Nonspecific Cva & Precerebral Occlusion W/O Infarct 1.0396 2.9

046-3 Nonspecific Cva & Precerebral Occlusion W/O Infarct 1.0396 3.7

046-4 Nonspecific Cva & Precerebral Occlusion W/O Infarct 1.7723 6.7

047-1 Transient Ischemia 0.5465 1.9

047-2 Transient Ischemia 0.7202 2.4

047-3 Transient Ischemia 0.8870 2.9

047-4 Transient Ischemia 1.2507 6.0

048-1 Peripheral, Cranial & Autonomic Nerve Disorders 0.7296 2.7

048-2 Peripheral, Cranial & Autonomic Nerve Disorders 0.8537 3.5

048-3 Peripheral, Cranial & Autonomic Nerve Disorders 1.4090 5.0

048-4 Peripheral, Cranial & Autonomic Nerve Disorders 2.1252 7.9

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Table 2 – APR-DRG, version 30 relative weights and ALOS

effective October 1, 2015

DRG Description Relative Weight ALOS

049-1 Bacterial & Tuberculous Infections Of Nervous System 0.8263 3.3

049-2 Bacterial & Tuberculous Infections Of Nervous System 1.7568 4.8

049-3 Bacterial & Tuberculous Infections Of Nervous System 2.2841 8.0

049-4 Bacterial & Tuberculous Infections Of Nervous System 3.9483 12.1

050-1 Non-Bacterial Infections Of Nervous System Exc Viral Meningitis 0.5474 2.9

050-2 Non-Bacterial Infections Of Nervous System Exc Viral Meningitis 1.0105 3.8

050-3 Non-Bacterial Infections Of Nervous System Exc Viral Meningitis 1.4985 6.0

050-4 Non-Bacterial Infections Of Nervous System Exc Viral Meningitis 4.5256 13.5

051-1 Viral Meningitis 0.4617 2.1

051-2 Viral Meningitis 1.0067 3.9

051-3 Viral Meningitis 1.2320 5.0

051-4 Viral Meningitis 4.5834 9.0

052-1 Nontraumatic Stupor & Coma 0.5217 1.7

052-2 Nontraumatic Stupor & Coma 0.7836 3.0

052-3 Nontraumatic Stupor & Coma 1.2146 4.2

052-4 Nontraumatic Stupor & Coma 2.2766 7.8

053-1 Seizure 0.5219 2.0

053-2 Seizure 0.6409 2.3

053-3 Seizure 0.8932 2.9

053-4 Seizure 2.2965 6.0

054-1 Migraine & Other Headaches 0.6681 2.5

054-2 Migraine & Other Headaches 0.7380 2.6

054-3 Migraine & Other Headaches 0.7672 2.9

054-4 Migraine & Other Headaches 1.7178 7.0

055-1 Head Trauma W Coma >1 Hr Or Hemorrhage 0.6360 2.0

055-2 Head Trauma W Coma >1 Hr Or Hemorrhage 0.9492 2.8

055-3 Head Trauma W Coma >1 Hr Or Hemorrhage 1.7905 5.8

055-4 Head Trauma W Coma >1 Hr Or Hemorrhage 4.0886 11.3

056-1 Brain Contusion/Laceration & Complicated Skull Fx, Coma < 1 Hr Or No Coma 0.6151 1.8

056-2 Brain Contusion/Laceration & Complicated Skull Fx, Coma < 1 Hr Or No Coma 0.7955 2.5

056-3 Brain Contusion/Laceration & Complicated Skull Fx, Coma < 1 Hr Or No Coma 1.3013 4.0

056-4 Brain Contusion/Laceration & Complicated Skull Fx, Coma < 1 Hr Or No Coma 3.3495 10.2

057-1 Concussion, Closed Skull Fx Nos, Uncomplicated Intracranial Injury, Coma < 1 Hr or No Coma 0.4934 1.6

057-2 Concussion, Closed Skull Fx Nos, Uncomplicated Intracranial Injury, Coma < 1 Hr or No Coma 0.7292 2.0

057-3 Concussion, Closed Skull Fx Nos, Uncomplicated Intracranial Injury, Coma < 1 Hr or No Coma 1.0932 3.1

057-4 Concussion, Closed Skull Fx Nos, Uncomplicated Intracranial Injury, Coma < 1 Hr or No Coma 2.5879 6.8

058-1 Other Disorders Of Nervous System 0.6622 2.4

058-2 Other Disorders Of Nervous System 0.9854 3.2

058-3 Other Disorders Of Nervous System 1.0206 4.0

058-4 Other Disorders Of Nervous System 2.1588 8.4

070-1 Orbital Procedures 1.0172 1.8

070-2 Orbital Procedures 1.2598 3.3

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Table 2 – APR-DRG, version 30 relative weights and ALOS

effective October 1, 2015

DRG Description Relative Weight ALOS

070-3 Orbital Procedures 1.7144 8.0

070-4 Orbital Procedures 1.9141 8.0

073-1 Eye Procedures Except Orbit 0.9772 2.4

073-2 Eye Procedures Except Orbit 0.9772 2.4

073-3 Eye Procedures Except Orbit 1.3873 3.0

073-4 Eye Procedures Except Orbit 1.8654 13.0

080-1 Acute Major Eye Infections 0.4154 2.1

080-2 Acute Major Eye Infections 0.5081 3.1

080-3 Acute Major Eye Infections 0.9124 5.3

080-4 Acute Major Eye Infections 0.9124 7.0

082-1 Eye Disorders Except Major Infections 0.5436 2.4

082-2 Eye Disorders Except Major Infections 0.6310 2.4

082-3 Eye Disorders Except Major Infections 0.9127 3.3

082-4 Eye Disorders Except Major Infections 0.9127 7.0

089-1 Major Cranial/Facial Bone Procedures 1.8485 1.9

089-2 Major Cranial/Facial Bone Procedures 2.7379 3.3

089-3 Major Cranial/Facial Bone Procedures 5.4772 7.9

089-4 Major Cranial/Facial Bone Procedures 6.2217 12.2

090-1 Major Larynx & Trachea Procedures 1.1154 6.0

090-2 Major Larynx & Trachea Procedures 3.3507 7.9

090-3 Major Larynx & Trachea Procedures 4.1787 9.7

090-4 Major Larynx & Trachea Procedures 7.9327 26.0

091-1 Other Major Head & Neck Procedures 1.3322 2.7

091-2 Other Major Head & Neck Procedures 2.2453 3.6

091-3 Other Major Head & Neck Procedures 4.7601 7.5

091-4 Other Major Head & Neck Procedures 6.4650 11.6

092-1 Facial Bone Procedures Except Major Cranial/Facial Bone Procedures 1.0263 1.6

092-2 Facial Bone Procedures Except Major Cranial/Facial Bone Procedures 1.6978 1.7

092-3 Facial Bone Procedures Except Major Cranial/Facial Bone Procedures 2.2470 3.6

092-4 Facial Bone Procedures Except Major Cranial/Facial Bone Procedures 4.2828 12.0

093-1 Sinus & Mastoid Procedures 1.1024 1.7

093-2 Sinus & Mastoid Procedures 1.4954 2.9

093-3 Sinus & Mastoid Procedures 2.1426 4.9

093-4 Sinus & Mastoid Procedures 2.6875 7.2

095-1 Cleft Lip & Palate Repair 0.6975 1.2

095-2 Cleft Lip & Palate Repair 0.7756 1.5

095-3 Cleft Lip & Palate Repair 1.3520 5.0

095-4 Cleft Lip & Palate Repair 1.5052 5.0

097-1 Tonsil & Adenoid Procedures 0.5684 1.6

097-2 Tonsil & Adenoid Procedures 0.7068 2.8

097-3 Tonsil & Adenoid Procedures 1.1216 3.1

097-4 Tonsil & Adenoid Procedures 1.9437 19.0

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Table 2 – APR-DRG, version 30 relative weights and ALOS

effective October 1, 2015

DRG Description Relative Weight ALOS

098-1 Other Ear, Nose, Mouth & Throat Procedures 0.7292 1.7

098-2 Other Ear, Nose, Mouth & Throat Procedures 1.2801 3.9

098-3 Other Ear, Nose, Mouth & Throat Procedures 1.5773 4.1

098-4 Other Ear, Nose, Mouth & Throat Procedures 3.3650 8.1

110-1 Ear, Nose, Mouth, Throat, Cranial/Facial Malignancies 0.7301 3.5

110-2 Ear, Nose, Mouth, Throat, Cranial/Facial Malignancies 0.7802 3.5

110-3 Ear, Nose, Mouth, Throat, Cranial/Facial Malignancies 1.1277 5.0

110-4 Ear, Nose, Mouth, Throat, Cranial/Facial Malignancies 1.9155 7.0

111-1 Vertigo & Other Labyrinth Disorders 0.4908 1.7

111-2 Vertigo & Other Labyrinth Disorders 0.5607 1.9

111-3 Vertigo & Other Labyrinth Disorders 0.7237 2.9

111-4 Vertigo & Other Labyrinth Disorders 0.7237 5.0

113-1 Infections Of Upper Respiratory Tract 0.3771 1.9

113-2 Infections Of Upper Respiratory Tract 0.5204 2.2

113-3 Infections Of Upper Respiratory Tract 0.8047 3.1

113-4 Infections Of Upper Respiratory Tract 1.7727 6.4

114-1 Dental & Oral Diseases & Injuries 0.5220 2.0

114-2 Dental & Oral Diseases & Injuries 0.6020 2.4

114-3 Dental & Oral Diseases & Injuries 0.9208 3.9

114-4 Dental & Oral Diseases & Injuries 1.2397 11.0

115-1 Other Ear, Nose, Mouth, Throat & Cranial/Facial Diagnoses 0.5350 2.3

115-2 Other Ear, Nose, Mouth, Throat & Cranial/Facial Diagnoses 0.7930 2.7

115-3 Other Ear, Nose, Mouth, Throat & Cranial/Facial Diagnoses 1.1275 3.7

115-4 Other Ear, Nose, Mouth, Throat & Cranial/Facial Diagnoses 1.8468 7.6

120-1 Major Respiratory & Chest Procedures 2.2382 4.9

120-2 Major Respiratory & Chest Procedures 2.9450 6.8

120-3 Major Respiratory & Chest Procedures 3.5345 9.5

120-4 Major Respiratory & Chest Procedures 6.2812 18.3

121-1 Other Respiratory & Chest Procedures 1.6114 3.3

121-2 Other Respiratory & Chest Procedures 1.9952 5.6

121-3 Other Respiratory & Chest Procedures 2.8326 7.5

121-4 Other Respiratory & Chest Procedures 7.1301 17.6

130-1 Respiratory System Diagnosis W Ventilator Support 96+ Hours 2.7262 9.0

130-2 Respiratory System Diagnosis W Ventilator Support 96+ Hours 3.0017 9.0

130-3 Respiratory System Diagnosis W Ventilator Support 96+ Hours 3.8734 11.1

130-4 Respiratory System Diagnosis W Ventilator Support 96+ Hours 5.5782 14.1

131-1 Cystic Fibrosis - Pulmonary Disease 1.4816 5.1

131-2 Cystic Fibrosis - Pulmonary Disease 1.4816 5.1

131-3 Cystic Fibrosis - Pulmonary Disease 2.4340 8.8

131-4 Cystic Fibrosis - Pulmonary Disease 3.4854 11.7

132-1 Bpd & Oth Chronic Respiratory Diseases Arising In Perinatal Period 0.5120 2.8

132-2 Bpd & Oth Chronic Respiratory Diseases Arising In Perinatal Period 0.6383 2.8

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Table 2 – APR-DRG, version 30 relative weights and ALOS

effective October 1, 2015

DRG Description Relative Weight ALOS

132-3 Bpd & Oth Chronic Respiratory Diseases Arising In Perinatal Period 0.9059 3.4

132-4 Bpd & Oth Chronic Respiratory Diseases Arising In Perinatal Period 1.1051 3.4

133-1 Pulmonary Edema & Respiratory Failure 0.4790 1.9

133-2 Pulmonary Edema & Respiratory Failure 1.0322 3.5

133-3 Pulmonary Edema & Respiratory Failure 1.4473 4.8

133-4 Pulmonary Edema & Respiratory Failure 2.1994 5.6

134-1 Pulmonary Embolism 0.8444 3.2

134-2 Pulmonary Embolism 1.0749 3.9

134-3 Pulmonary Embolism 1.5351 5.3

134-4 Pulmonary Embolism 2.1689 7.3

135-1 Major Chest & Respiratory Trauma 0.6215 2.2

135-2 Major Chest & Respiratory Trauma 1.1208 4.1

135-3 Major Chest & Respiratory Trauma 1.3130 5.2

135-4 Major Chest & Respiratory Trauma 1.7505 5.2

136-1 Respiratory Malignancy 0.5146 2.1

136-2 Respiratory Malignancy 1.0753 3.6

136-3 Respiratory Malignancy 1.6582 5.2

136-4 Respiratory Malignancy 1.8476 6.4

137-1 Major Respiratory Infections & Inflammations 0.7709 3.3

137-2 Major Respiratory Infections & Inflammations 1.0005 3.7

137-3 Major Respiratory Infections & Inflammations 1.8741 6.2

137-4 Major Respiratory Infections & Inflammations 2.6668 8.1

138-1 Bronchiolitis & Rsv Pneumonia 0.4695 2.3

138-2 Bronchiolitis & Rsv Pneumonia 0.6275 2.8

138-3 Bronchiolitis & Rsv Pneumonia 0.9205 4.3

138-4 Bronchiolitis & Rsv Pneumonia 2.6034 9.0

139-1 Other Pneumonia 0.4997 2.3

139-2 Other Pneumonia 0.7701 2.9

139-3 Other Pneumonia 1.3208 4.6

139-4 Other Pneumonia 2.1894 6.0

140-1 Chronic Obstructive Pulmonary Disease 0.6881 2.6

140-2 Chronic Obstructive Pulmonary Disease 0.8455 3.1

140-3 Chronic Obstructive Pulmonary Disease 1.1460 4.0

140-4 Chronic Obstructive Pulmonary Disease 2.2723 7.2

141-1 Asthma 0.4048 1.9

141-2 Asthma 0.5733 2.4

141-3 Asthma 1.0382 3.8

141-4 Asthma 1.4381 4.1

142-1 Interstitial & Alveolar Lung Diseases 0.4895 2.3

142-2 Interstitial & Alveolar Lung Diseases 0.9131 3.2

142-3 Interstitial & Alveolar Lung Diseases 1.0762 5.1

142-4 Interstitial & Alveolar Lung Diseases 1.9180 8.5

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Table 2 – APR-DRG, version 30 relative weights and ALOS

effective October 1, 2015

DRG Description Relative Weight ALOS

143-1 Other Respiratory Diagnoses Except Signs, Symptoms & Minor Diagnoses 0.6063 2.5

143-2 Other Respiratory Diagnoses Except Signs, Symptoms & Minor Diagnoses 0.8600 3.1

143-3 Other Respiratory Diagnoses Except Signs, Symptoms & Minor Diagnoses 1.3039 4.5

143-4 Other Respiratory Diagnoses Except Signs, Symptoms & Minor Diagnoses 1.6370 5.8

144-1 Respiratory Signs, Symptoms & Minor Diagnoses 0.6109 1.9

144-2 Respiratory Signs, Symptoms & Minor Diagnoses 0.6923 2.6

144-3 Respiratory Signs, Symptoms & Minor Diagnoses 0.8477 3.1

144-4 Respiratory Signs, Symptoms & Minor Diagnoses 1.4040 4.0

160-1 Major Cardiothoracic Repair Of Heart Anomaly 3.3408 5.5

160-2 Major Cardiothoracic Repair Of Heart Anomaly 3.3408 5.5

160-3 Major Cardiothoracic Repair Of Heart Anomaly 4.3104 7.6

160-4 Major Cardiothoracic Repair Of Heart Anomaly 9.6438 16.2

161-1 Cardiac Defibrillator & Heart Assist Implant 6.1784 3.2

161-2 Cardiac Defibrillator & Heart Assist Implant 6.1784 6.4

161-3 Cardiac Defibrillator & Heart Assist Implant 11.3999 13.1

161-4 Cardiac Defibrillator & Heart Assist Implant 39.5625 44.9

162-1 Cardiac Valve Procedures W Cardiac Catheterization 4.3275 7.8

162-2 Cardiac Valve Procedures W Cardiac Catheterization 4.9908 8.3

162-3 Cardiac Valve Procedures W Cardiac Catheterization 7.4764 15.0

162-4 Cardiac Valve Procedures W Cardiac Catheterization 9.7538 18.1

163-1 Cardiac Valve Procedures W/O Cardiac Catheterization 3.6571 6.5

163-2 Cardiac Valve Procedures W/O Cardiac Catheterization 4.9576 6.5

163-3 Cardiac Valve Procedures W/O Cardiac Catheterization 5.6073 8.5

163-4 Cardiac Valve Procedures W/O Cardiac Catheterization 12.1120 18.3

165-1 Coronary Bypass W Cardiac Cath Or Percutaneous Cardiac Procedure 3.2754 6.2

165-2 Coronary Bypass W Cardiac Cath Or Percutaneous Cardiac Procedure 4.9309 8.8

165-3 Coronary Bypass W Cardiac Cath Or Percutaneous Cardiac Procedure 5.6912 10.3

165-4 Coronary Bypass W Cardiac Cath Or Percutaneous Cardiac Procedure 11.3184 19.7

166-1 Coronary Bypass W/O Cardiac Cath Or Percutaneous Cardiac Procedure 3.5661 4.6

166-2 Coronary Bypass W/O Cardiac Cath Or Percutaneous Cardiac Procedure 3.6503 5.7

166-3 Coronary Bypass W/O Cardiac Cath Or Percutaneous Cardiac Procedure 4.5767 7.8

166-4 Coronary Bypass W/O Cardiac Cath Or Percutaneous Cardiac Procedure 6.6153 13.1

167-1 Other Cardiothoracic Procedures 2.6747 4.5

167-2 Other Cardiothoracic Procedures 3.2979 5.4

167-3 Other Cardiothoracic Procedures 3.7863 7.4

167-4 Other Cardiothoracic Procedures 6.4738 11.2

169-1 Major Thoracic & Abdominal Vascular Procedures 1.9076 3.2

169-2 Major Thoracic & Abdominal Vascular Procedures 2.8439 6.5

169-3 Major Thoracic & Abdominal Vascular Procedures 3.9182 7.4

169-4 Major Thoracic & Abdominal Vascular Procedures 6.6047 10.9

170-1 Permanent Cardiac Pacemaker Implant W Ami, Heart Failure or Shock 3.2699 3.9

170-2 Permanent Cardiac Pacemaker Implant W Ami, Heart Failure or Shock 3.2699 3.9

Page 11: IHCP announces changes to DRG grouper and inpatient ...

IHCP bulletin BT201559 AUGUST 18, 2015

APR-DRG, version 30 relative weights and ALOS 8 of 30

Table 2 – APR-DRG, version 30 relative weights and ALOS

effective October 1, 2015

DRG Description Relative Weight ALOS

170-3 Permanent Cardiac Pacemaker Implant W Ami, Heart Failure or Shock 3.2699 10.3

170-4 Permanent Cardiac Pacemaker Implant W Ami, Heart Failure or Shock 4.4341 11.0

171-1 Perm Cardiac Pacemaker Implant W/O Ami, Heart Failure Or Shock 1.9053 2.2

171-2 Perm Cardiac Pacemaker Implant W/O Ami, Heart Failure Or Shock 2.3711 2.8

171-3 Perm Cardiac Pacemaker Implant W/O Ami, Heart Failure Or Shock 2.3711 5.1

171-4 Perm Cardiac Pacemaker Implant W/O Ami, Heart Failure Or Shock 3.8110 9.2

173-1 Other Vascular Procedures 2.0483 2.4

173-2 Other Vascular Procedures 2.4657 3.2

173-3 Other Vascular Procedures 3.8110 6.8

173-4 Other Vascular Procedures 7.0286 16.7

174-1 Percutaneous Cardiovascular Procedures W Ami 1.9275 2.2

174-2 Percutaneous Cardiovascular Procedures W Ami 2.0585 2.6

174-3 Percutaneous Cardiovascular Procedures W Ami 2.7940 3.9

174-4 Percutaneous Cardiovascular Procedures W Ami 5.1092 9.3

175-1 Percutaneous Cardiovascular Procedures W/O Ami 2.1485 1.8

175-2 Percutaneous Cardiovascular Procedures W/O Ami 2.3604 2.5

175-3 Percutaneous Cardiovascular Procedures W/O Ami 2.6979 4.6

175-4 Percutaneous Cardiovascular Procedures W/O Ami 4.1156 7.5

176-1 Cardiac Pacemaker & Defibrillator Device Replacement 1.4678 2.7

176-2 Cardiac Pacemaker & Defibrillator Device Replacement 2.5604 2.7

176-3 Cardiac Pacemaker & Defibrillator Device Replacement 2.9579 3.5

176-4 Cardiac Pacemaker & Defibrillator Device Replacement 4.2011 12.0

177-1 Cardiac Pacemaker & Defibrillator Revision Except Device Replacement 1.0427 2.0

177-2 Cardiac Pacemaker & Defibrillator Revision Except Device Replacement 1.9490 4.5

177-3 Cardiac Pacemaker & Defibrillator Revision Except Device Replacement 2.1134 5.7

177-4 Cardiac Pacemaker & Defibrillator Revision Except Device Replacement 4.5068 12.8

180-1 Other Circulatory System Procedures 1.0204 2.8

180-2 Other Circulatory System Procedures 1.5046 4.5

180-3 Other Circulatory System Procedures 2.1024 7.2

180-4 Other Circulatory System Procedures 3.8966 12.4

190-1 Acute Myocardial Infarction 0.8778 2.0

190-2 Acute Myocardial Infarction 1.1734 3.0

190-3 Acute Myocardial Infarction 1.6425 4.0

190-4 Acute Myocardial Infarction 2.9029 7.6

191-1 Cardiac Catheterization W Circ Disord Exc Ischemic Heart Disease 0.9721 2.0

191-2 Cardiac Catheterization W Circ Disord Exc Ischemic Heart Disease 1.3665 3.8

191-3 Cardiac Catheterization W Circ Disord Exc Ischemic Heart Disease 1.7033 4.8

191-4 Cardiac Catheterization W Circ Disord Exc Ischemic Heart Disease 3.0184 8.5

192-1 Cardiac Catheterization For Ischemic Heart Disease 0.8702 2.0

192-2 Cardiac Catheterization For Ischemic Heart Disease 1.0005 2.3

192-3 Cardiac Catheterization For Ischemic Heart Disease 1.4867 4.1

192-4 Cardiac Catheterization For Ischemic Heart Disease 2.4132 6.7

Page 12: IHCP announces changes to DRG grouper and inpatient ...

IHCP bulletin BT201559 AUGUST 18, 2015

APR-DRG, version 30 relative weights and ALOS 9 of 30

Table 2 – APR-DRG, version 30 relative weights and ALOS

effective October 1, 2015

DRG Description Relative Weight ALOS

193-1 Acute & Subacute Endocarditis 1.0016 5.4

193-2 Acute & Subacute Endocarditis 1.0311 5.4

193-3 Acute & Subacute Endocarditis 1.5283 7.3

193-4 Acute & Subacute Endocarditis 2.2793 9.8

194-1 Heart Failure 0.5691 2.1

194-2 Heart Failure 0.8854 3.2

194-3 Heart Failure 1.3768 4.9

194-4 Heart Failure 3.3733 9.8

196-1 Cardiac Arrest 0.3640 1.8

196-2 Cardiac Arrest 0.4938 1.8

196-3 Cardiac Arrest 1.9578 4.7

196-4 Cardiac Arrest 2.2505 4.7

197-1 Peripheral & Other Vascular Disorders 0.8096 3.2

197-2 Peripheral & Other Vascular Disorders 0.9717 3.3

197-3 Peripheral & Other Vascular Disorders 1.5183 5.1

197-4 Peripheral & Other Vascular Disorders 1.9618 7.1

198-1 Angina Pectoris & Coronary Atherosclerosis 0.4924 1.5

198-2 Angina Pectoris & Coronary Atherosclerosis 0.5989 1.9

198-3 Angina Pectoris & Coronary Atherosclerosis 0.9389 2.6

198-4 Angina Pectoris & Coronary Atherosclerosis 1.5237 4.6

199-1 Hypertension 0.6297 2.3

199-2 Hypertension 0.6834 2.5

199-3 Hypertension 0.8775 3.4

199-4 Hypertension 1.7291 6.2

200-1 Cardiac Structural & Valvular Disorders 0.4386 1.6

200-2 Cardiac Structural & Valvular Disorders 0.5538 2.3

200-3 Cardiac Structural & Valvular Disorders 0.7906 3.9

200-4 Cardiac Structural & Valvular Disorders 5.5012 13.0

201-1 Cardiac Arrhythmia & Conduction Disorders 0.6239 2.1

201-2 Cardiac Arrhythmia & Conduction Disorders 0.8264 2.8

201-3 Cardiac Arrhythmia & Conduction Disorders 1.1048 3.6

201-4 Cardiac Arrhythmia & Conduction Disorders 2.9499 7.6

203-1 Chest Pain 0.4718 1.6

203-2 Chest Pain 0.5810 2.0

203-3 Chest Pain 0.9025 2.5

203-4 Chest Pain 0.9616 5.0

204-1 Syncope & Collapse 0.4623 1.8

204-2 Syncope & Collapse 0.6861 2.4

204-3 Syncope & Collapse 0.9766 3.5

204-4 Syncope & Collapse 1.6397 6.4

205-1 Cardiomyopathy 0.5204 1.9

205-2 Cardiomyopathy 0.8861 3.0

Page 13: IHCP announces changes to DRG grouper and inpatient ...

IHCP bulletin BT201559 AUGUST 18, 2015

APR-DRG, version 30 relative weights and ALOS 10 of 30

Table 2 – APR-DRG, version 30 relative weights and ALOS

effective October 1, 2015

DRG Description Relative Weight ALOS

205-3 Cardiomyopathy 0.8861 3.4

205-4 Cardiomyopathy 1.2891 11.0

206-1 Malfunction, Reaction, Complication Of Cardiac/Vasc Device or Procedure 0.5594 1.8

206-2 Malfunction, Reaction, Complication Of Cardiac/Vasc Device or Procedure 0.6300 2.6

206-3 Malfunction, Reaction, Complication Of Cardiac/Vasc Device or Procedure 1.4516 4.3

206-4 Malfunction, Reaction, Complication Of Cardiac/Vasc Device or Procedure 2.1060 8.0

207-1 Other Circulatory System Diagnoses 0.6846 2.5

207-2 Other Circulatory System Diagnoses 0.7317 2.7

207-3 Other Circulatory System Diagnoses 1.2374 4.1

207-4 Other Circulatory System Diagnoses 1.7596 5.4

220-1 Major Stomach, Esophageal & Duodenal Procedures 1.3993 3.3

220-2 Major Stomach, Esophageal & Duodenal Procedures 2.4628 6.4

220-3 Major Stomach, Esophageal & Duodenal Procedures 3.5590 10.0

220-4 Major Stomach, Esophageal & Duodenal Procedures 9.1261 21.4

221-1 Major Small & Large Bowel Procedures 1.6755 4.7

221-2 Major Small & Large Bowel Procedures 2.3238 7.0

221-3 Major Small & Large Bowel Procedures 3.6211 10.7

221-4 Major Small & Large Bowel Procedures 7.7288 19.8

222-1 Other Stomach, Esophageal & Duodenal Procedures 0.5352 1.9

222-2 Other Stomach, Esophageal & Duodenal Procedures 0.9330 3.8

222-3 Other Stomach, Esophageal & Duodenal Procedures 2.0467 5.9

222-4 Other Stomach, Esophageal & Duodenal Procedures 4.2618 13.9

223-1 Other Small & Large Bowel Procedures 1.2085 3.7

223-2 Other Small & Large Bowel Procedures 1.6748 5.1

223-3 Other Small & Large Bowel Procedures 2.2066 8.5

223-4 Other Small & Large Bowel Procedures 5.2375 22.5

224-1 Peritoneal Adhesiolysis 1.2053 4.0

224-2 Peritoneal Adhesiolysis 1.7584 5.4

224-3 Peritoneal Adhesiolysis 2.4280 10.2

224-4 Peritoneal Adhesiolysis 4.1704 14.5

225-1 Appendectomy 0.8278 1.7

225-2 Appendectomy 1.2160 3.8

225-3 Appendectomy 1.7975 5.8

225-4 Appendectomy 4.0382 12.2

226-1 Anal Procedures 0.9310 3.0

226-2 Anal Procedures 0.9450 3.0

226-3 Anal Procedures 1.7910 5.3

226-4 Anal Procedures 1.7910 10.0

227-1 Hernia Procedures Except Inguinal, Femoral & Umbilical 1.4090 2.9

227-2 Hernia Procedures Except Inguinal, Femoral & Umbilical 1.7122 4.0

227-3 Hernia Procedures Except Inguinal, Femoral & Umbilical 2.2649 6.9

227-4 Hernia Procedures Except Inguinal, Femoral & Umbilical 4.4738 11.0

Page 14: IHCP announces changes to DRG grouper and inpatient ...

IHCP bulletin BT201559 AUGUST 18, 2015

APR-DRG, version 30 relative weights and ALOS 11 of 30

Table 2 – APR-DRG, version 30 relative weights and ALOS

effective October 1, 2015

DRG Description Relative Weight ALOS

228-1 Inguinal, Femoral & Umbilical Hernia Procedures 0.5861 1.4

228-2 Inguinal, Femoral & Umbilical Hernia Procedures 0.9739 2.8

228-3 Inguinal, Femoral & Umbilical Hernia Procedures 1.4760 5.1

228-4 Inguinal, Femoral & Umbilical Hernia Procedures 3.4929 10.3

229-1 Other Digestive System & Abdominal Procedures 1.2261 3.7

229-2 Other Digestive System & Abdominal Procedures 1.9084 5.6

229-3 Other Digestive System & Abdominal Procedures 2.9917 9.6

229-4 Other Digestive System & Abdominal Procedures 4.5838 11.7

240-1 Digestive Malignancy 0.7864 3.6

240-2 Digestive Malignancy 1.0675 3.6

240-3 Digestive Malignancy 1.5381 5.2

240-4 Digestive Malignancy 1.9504 7.7

241-1 Peptic Ulcer & Gastritis 0.6231 2.4

241-2 Peptic Ulcer & Gastritis 0.8093 2.9

241-3 Peptic Ulcer & Gastritis 1.3030 4.2

241-4 Peptic Ulcer & Gastritis 2.3367 7.9

242-1 Major Esophageal Disorders 0.4606 1.8

242-2 Major Esophageal Disorders 0.8600 2.8

242-3 Major Esophageal Disorders 1.4395 4.2

242-4 Major Esophageal Disorders 2.2149 7.2

243-1 Other Esophageal Disorders 0.6156 2.0

243-2 Other Esophageal Disorders 0.7081 2.6

243-3 Other Esophageal Disorders 1.0825 3.6

243-4 Other Esophageal Disorders 2.1469 8.1

244-1 Diverticulitis & Diverticulosis 0.5738 2.5

244-2 Diverticulitis & Diverticulosis 0.8757 3.4

244-3 Diverticulitis & Diverticulosis 1.3008 5.1

244-4 Diverticulitis & Diverticulosis 2.4427 9.0

245-1 Inflammatory Bowel Disease 0.7580 3.0

245-2 Inflammatory Bowel Disease 0.8429 3.5

245-3 Inflammatory Bowel Disease 1.1974 4.1

245-4 Inflammatory Bowel Disease 1.9381 8.7

246-1 Gastrointestinal Vascular Insufficiency 0.7104 2.8

246-2 Gastrointestinal Vascular Insufficiency 1.2633 5.0

246-3 Gastrointestinal Vascular Insufficiency 1.2633 5.0

246-4 Gastrointestinal Vascular Insufficiency 2.4301 7.2

247-1 Intestinal Obstruction 0.6049 2.5

247-2 Intestinal Obstruction 0.7601 3.2

247-3 Intestinal Obstruction 1.2260 4.6

247-4 Intestinal Obstruction 2.0508 7.6

248-1 Major Gastrointestinal & Peritoneal Infections 0.8231 3.3

248-2 Major Gastrointestinal & Peritoneal Infections 0.9211 3.7

Page 15: IHCP announces changes to DRG grouper and inpatient ...

IHCP bulletin BT201559 AUGUST 18, 2015

APR-DRG, version 30 relative weights and ALOS 12 of 30

Table 2 – APR-DRG, version 30 relative weights and ALOS

effective October 1, 2015

DRG Description Relative Weight ALOS

248-3 Major Gastrointestinal & Peritoneal Infections 1.3874 5.0

248-4 Major Gastrointestinal & Peritoneal Infections 2.1462 9.2

249-1 Non-Bacterial Gastroenteritis, Nausea & Vomiting 0.4449 2.0

249-2 Non-Bacterial Gastroenteritis, Nausea & Vomiting 0.5538 2.3

249-3 Non-Bacterial Gastroenteritis, Nausea & Vomiting 0.9464 3.4

249-4 Non-Bacterial Gastroenteritis, Nausea & Vomiting 1.7118 6.5

251-1 Abdominal Pain 0.6210 2.5

251-2 Abdominal Pain 0.7314 2.7

251-3 Abdominal Pain 0.9992 3.6

251-4 Abdominal Pain 1.4600 5.5

252-1 Malfunction, Reaction & Complication Of Gi Device Or Procedure 0.5197 2.8

252-2 Malfunction, Reaction & Complication Of Gi Device Or Procedure 1.0742 3.8

252-3 Malfunction, Reaction & Complication Of Gi Device Or Procedure 1.0742 4.5

252-4 Malfunction, Reaction & Complication Of Gi Device Or Procedure 2.2207 8.0

253-1 Other & Unspecified Gastrointestinal Hemorrhage 0.5889 2.1

253-2 Other & Unspecified Gastrointestinal Hemorrhage 0.9036 3.2

253-3 Other & Unspecified Gastrointestinal Hemorrhage 1.3238 4.0

253-4 Other & Unspecified Gastrointestinal Hemorrhage 1.9939 6.3

254-1 Other Digestive System Diagnoses 0.6519 2.2

254-2 Other Digestive System Diagnoses 0.8152 2.9

254-3 Other Digestive System Diagnoses 1.3694 4.8

254-4 Other Digestive System Diagnoses 1.9928 6.8

260-1 Major Pancreas, Liver & Shunt Procedures 2.0324 4.1

260-2 Major Pancreas, Liver & Shunt Procedures 2.3898 4.6

260-3 Major Pancreas, Liver & Shunt Procedures 3.6464 8.8

260-4 Major Pancreas, Liver & Shunt Procedures 7.4300 18.3

261-1 Major Biliary Tract Procedures 1.2465 4.0

261-2 Major Biliary Tract Procedures 1.8619 5.9

261-3 Major Biliary Tract Procedures 2.7548 8.8

261-4 Major Biliary Tract Procedures 4.6991 15.3

262-1 Cholecystectomy Except Laparoscopic 1.0608 3.4

262-2 Cholecystectomy Except Laparoscopic 1.5958 4.5

262-3 Cholecystectomy Except Laparoscopic 2.0901 7.6

262-4 Cholecystectomy Except Laparoscopic 4.8450 15.0

263-1 Laparoscopic Cholecystectomy 1.0267 2.3

263-2 Laparoscopic Cholecystectomy 1.3075 3.5

263-3 Laparoscopic Cholecystectomy 1.9450 5.3

263-4 Laparoscopic Cholecystectomy 5.5832 14.8

264-1 Other Hepatobiliary, Pancreas & Abdominal Procedures 1.3284 3.7

264-2 Other Hepatobiliary, Pancreas & Abdominal Procedures 1.4635 4.2

264-3 Other Hepatobiliary, Pancreas & Abdominal Procedures 2.3292 7.2

264-4 Other Hepatobiliary, Pancreas & Abdominal Procedures 5.2069 14.7

Page 16: IHCP announces changes to DRG grouper and inpatient ...

IHCP bulletin BT201559 AUGUST 18, 2015

APR-DRG, version 30 relative weights and ALOS 13 of 30

Table 2 – APR-DRG, version 30 relative weights and ALOS

effective October 1, 2015

DRG Description Relative Weight ALOS

279-1 Hepatic Coma & Other Major Acute Liver Disorders 0.4575 2.3

279-2 Hepatic Coma & Other Major Acute Liver Disorders 0.7823 3.0

279-3 Hepatic Coma & Other Major Acute Liver Disorders 1.2880 4.7

279-4 Hepatic Coma & Other Major Acute Liver Disorders 3.4075 9.9

280-1 Alcoholic Liver Disease 0.4562 2.2

280-2 Alcoholic Liver Disease 0.7631 2.9

280-3 Alcoholic Liver Disease 1.3292 4.7

280-4 Alcoholic Liver Disease 3.1972 8.4

281-1 Malignancy Of Hepatobiliary System & Pancreas 0.5384 2.7

281-2 Malignancy Of Hepatobiliary System & Pancreas 1.0699 3.7

281-3 Malignancy Of Hepatobiliary System & Pancreas 1.3869 4.5

281-4 Malignancy Of Hepatobiliary System & Pancreas 1.6877 6.3

282-1 Disorders Of Pancreas Except Malignancy 0.6878 2.9

282-2 Disorders Of Pancreas Except Malignancy 0.8559 3.4

282-3 Disorders Of Pancreas Except Malignancy 1.4530 5.0

282-4 Disorders Of Pancreas Except Malignancy 3.1315 10.6

283-1 Other Disorders Of The Liver 0.4877 1.7

283-2 Other Disorders Of The Liver 0.7656 2.8

283-3 Other Disorders Of The Liver 1.0216 3.7

283-4 Other Disorders Of The Liver 2.3376 7.4

284-1 Disorders Of Gallbladder & Biliary Tract 0.7440 2.5

284-2 Disorders Of Gallbladder & Biliary Tract 0.9945 3.3

284-3 Disorders Of Gallbladder & Biliary Tract 1.2791 4.3

284-4 Disorders Of Gallbladder & Biliary Tract 2.3222 8.4

301-1 Hip Joint Replacement 2.4426 3.2

301-2 Hip Joint Replacement 2.5834 3.2

301-3 Hip Joint Replacement 3.2704 3.6

301-4 Hip Joint Replacement 3.5572 10.3

302-1 Knee Joint Replacement 2.3578 2.8

302-2 Knee Joint Replacement 2.6522 3.3

302-3 Knee Joint Replacement 3.2402 4.7

302-4 Knee Joint Replacement 4.0771 10.7

303-1 Dorsal & Lumbar Fusion Proc For Curvature Of Back 4.5572 4.0

303-2 Dorsal & Lumbar Fusion Proc For Curvature Of Back 8.6419 4.6

303-3 Dorsal & Lumbar Fusion Proc For Curvature Of Back 8.6419 7.2

303-4 Dorsal & Lumbar Fusion Proc For Curvature Of Back 11.6646 12.4

304-1 Dorsal & Lumbar Fusion Proc Except For Curvature Of Back 4.4786 2.9

304-2 Dorsal & Lumbar Fusion Proc Except For Curvature Of Back 4.6918 3.5

304-3 Dorsal & Lumbar Fusion Proc Except For Curvature Of Back 8.1115 7.5

304-4 Dorsal & Lumbar Fusion Proc Except For Curvature Of Back 9.5061 14.1

305-1 Amputation Of Lower Limb Except Toes 0.8421 3.7

305-2 Amputation Of Lower Limb Except Toes 1.8874 6.4

Page 17: IHCP announces changes to DRG grouper and inpatient ...

IHCP bulletin BT201559 AUGUST 18, 2015

APR-DRG, version 30 relative weights and ALOS 14 of 30

Table 2 – APR-DRG, version 30 relative weights and ALOS

effective October 1, 2015

DRG Description Relative Weight ALOS

305-3 Amputation Of Lower Limb Except Toes 2.6395 8.9

305-4 Amputation Of Lower Limb Except Toes 4.1842 14.3

308-1 Hip & Femur Procedures For Trauma Except Joint Replacement 1.5126 3.3

308-2 Hip & Femur Procedures For Trauma Except Joint Replacement 1.8623 4.1

308-3 Hip & Femur Procedures For Trauma Except Joint Replacement 2.5003 5.9

308-4 Hip & Femur Procedures For Trauma Except Joint Replacement 3.3837 9.7

309-1 Hip & Femur Procedures For Non-Trauma Except Joint Replacement 1.5395 2.8

309-2 Hip & Femur Procedures For Non-Trauma Except Joint Replacement 2.0339 3.7

309-3 Hip & Femur Procedures For Non-Trauma Except Joint Replacement 2.2412 6.4

309-4 Hip & Femur Procedures For Non-Trauma Except Joint Replacement 4.5287 12.8

310-1 Intervertebral Disc Excision & Decompression 1.0312 1.6

310-2 Intervertebral Disc Excision & Decompression 1.6571 3.3

310-3 Intervertebral Disc Excision & Decompression 2.1242 5.8

310-4 Intervertebral Disc Excision & Decompression 4.1021 11.9

312-1 Skin Graft, Except Hand, For Musculoskeletal & Connective Tissue Diagnosis 1.4776 3.2

312-2 Skin Graft, Except Hand, For Musculoskeletal & Connective Tissue Diagnosis 2.0841 6.5

312-3 Skin Graft, Except Hand, For Musculoskeletal & Connective Tissue Diagnosis 3.7528 12.4

312-4 Skin Graft, Except Hand, For Musculoskeletal & Connective Tissue Diagnosis 9.9758 43.0

313-1 Knee & Lower Leg Procedures Except Foot 1.3529 2.4

313-2 Knee & Lower Leg Procedures Except Foot 2.1026 4.0

313-3 Knee & Lower Leg Procedures Except Foot 3.3011 6.8

313-4 Knee & Lower Leg Procedures Except Foot 4.1812 11.2

314-1 Foot & Toe Procedures 0.9522 2.2

314-2 Foot & Toe Procedures 1.5054 4.6

314-3 Foot & Toe Procedures 2.2199 6.6

314-4 Foot & Toe Procedures 3.2321 11.5

315-1 Shoulder, Upper Arm & Forearm Procedures 0.8558 1.8

315-2 Shoulder, Upper Arm & Forearm Procedures 1.9112 2.6

315-3 Shoulder, Upper Arm & Forearm Procedures 2.9989 5.6

315-4 Shoulder, Upper Arm & Forearm Procedures 3.8569 9.9

316-1 Hand & Wrist Procedures 0.7403 1.8

316-2 Hand & Wrist Procedures 1.0556 2.8

316-3 Hand & Wrist Procedures 1.8317 5.1

316-4 Hand & Wrist Procedures 1.8317 20.0

317-1 Tendon, Muscle & Other Soft Tissue Procedures 1.2120 3.3

317-2 Tendon, Muscle & Other Soft Tissue Procedures 1.2120 4.0

317-3 Tendon, Muscle & Other Soft Tissue Procedures 2.2286 6.7

317-4 Tendon, Muscle & Other Soft Tissue Procedures 4.3804 16.4

320-1 Other Musculoskeletal System & Connective Tissue Procedures 0.9309 1.8

320-2 Other Musculoskeletal System & Connective Tissue Procedures 1.6475 3.7

320-3 Other Musculoskeletal System & Connective Tissue Procedures 2.0782 6.3

320-4 Other Musculoskeletal System & Connective Tissue Procedures 4.4433 14.0

Page 18: IHCP announces changes to DRG grouper and inpatient ...

IHCP bulletin BT201559 AUGUST 18, 2015

APR-DRG, version 30 relative weights and ALOS 15 of 30

Table 2 – APR-DRG, version 30 relative weights and ALOS

effective October 1, 2015

DRG Description Relative Weight ALOS

321-1 Cervical Spinal Fusion & Other Back/Neck Proc Exc Disc Excis/Decomp 2.1926 1.5

321-2 Cervical Spinal Fusion & Other Back/Neck Proc Exc Disc Excis/Decomp 2.9843 2.6

321-3 Cervical Spinal Fusion & Other Back/Neck Proc Exc Disc Excis/Decomp 4.3188 5.6

321-4 Cervical Spinal Fusion & Other Back/Neck Proc Exc Disc Excis/Decomp 6.3153 12.1

340-1 Fracture Of Femur 0.3814 2.1

340-2 Fracture Of Femur 0.6629 2.1

340-3 Fracture Of Femur 0.7332 3.6

340-4 Fracture Of Femur 1.1283 3.9

341-1 Fracture Of Pelvis Or Dislocation Of Hip 0.4117 2.6

341-2 Fracture Of Pelvis Or Dislocation Of Hip 0.7703 2.8

341-3 Fracture Of Pelvis Or Dislocation Of Hip 0.7703 4.0

341-4 Fracture Of Pelvis Or Dislocation Of Hip 1.8673 7.6

342-1 Fractures & Dislocations Except Femur, Pelvis & Back 0.4371 1.8

342-2 Fractures & Dislocations Except Femur, Pelvis & Back 0.5517 2.7

342-3 Fractures & Dislocations Except Femur, Pelvis & Back 1.1531 3.9

342-4 Fractures & Dislocations Except Femur, Pelvis & Back 2.1602 8.1

343-1 Musculoskeletal Malignancy & Pathol Fracture D/T Muscskel Malig 0.7647 3.0

343-2 Musculoskeletal Malignancy & Pathol Fracture D/T Muscskel Malig 0.8656 3.7

343-3 Musculoskeletal Malignancy & Pathol Fracture D/T Muscskel Malig 1.9547 6.6

343-4 Musculoskeletal Malignancy & Pathol Fracture D/T Muscskel Malig 2.2316 8.8

344-1 Osteomyelitis, Septic Arthritis & Other Musculoskeletal Infections 0.5565 2.9

344-2 Osteomyelitis, Septic Arthritis & Other Musculoskeletal Infections 1.2482 4.6

344-3 Osteomyelitis, Septic Arthritis & Other Musculoskeletal Infections 1.8982 6.9

344-4 Osteomyelitis, Septic Arthritis & Other Musculoskeletal Infections 2.3690 12.0

346-1 Connective Tissue Disorders 0.6881 2.7

346-2 Connective Tissue Disorders 1.3167 4.5

346-3 Connective Tissue Disorders 1.3468 5.1

346-4 Connective Tissue Disorders 3.2476 11.0

347-1 Other Back & Neck Disorders, Fractures & Injuries 0.7576 2.7

347-2 Other Back & Neck Disorders, Fractures & Injuries 1.0018 3.4

347-3 Other Back & Neck Disorders, Fractures & Injuries 1.2666 5.0

347-4 Other Back & Neck Disorders, Fractures & Injuries 2.3198 8.6

349-1 Malfunction, Reaction, Complic Of Orthopedic Device Or Procedure 0.4541 1.8

349-2 Malfunction, Reaction, Complic Of Orthopedic Device Or Procedure 0.6527 3.2

349-3 Malfunction, Reaction, Complic Of Orthopedic Device Or Procedure 1.0259 5.1

349-4 Malfunction, Reaction, Complic Of Orthopedic Device Or Procedure 2.3198 10.3

351-1 Other Musculoskeletal System & Connective Tissue Diagnoses 0.7019 2.3

351-2 Other Musculoskeletal System & Connective Tissue Diagnoses 0.8514 2.8

351-3 Other Musculoskeletal System & Connective Tissue Diagnoses 1.3023 3.7

351-4 Other Musculoskeletal System & Connective Tissue Diagnoses 1.9560 7.9

361-1 Skin Graft For Skin & Subcutaneous Tissue Diagnoses 1.2238 2.9

361-2 Skin Graft For Skin & Subcutaneous Tissue Diagnoses 1.4845 4.6

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IHCP bulletin BT201559 AUGUST 18, 2015

APR-DRG, version 30 relative weights and ALOS 16 of 30

Table 2 – APR-DRG, version 30 relative weights and ALOS

effective October 1, 2015

DRG Description Relative Weight ALOS

361-3 Skin Graft For Skin & Subcutaneous Tissue Diagnoses 3.6888 11.3

361-4 Skin Graft For Skin & Subcutaneous Tissue Diagnoses 4.0904 18.3

362-1 Mastectomy Procedures 1.2223 1.8

362-2 Mastectomy Procedures 1.4770 2.0

362-3 Mastectomy Procedures 2.1720 4.6

362-4 Mastectomy Procedures 2.1720 6.0

363-1 Breast Procedures Except Mastectomy 0.9098 1.8

363-2 Breast Procedures Except Mastectomy 1.6583 2.9

363-3 Breast Procedures Except Mastectomy 2.0764 4.5

363-4 Breast Procedures Except Mastectomy 2.0764 11.0

364-1 Other Skin, Subcutaneous Tissue & Related Procedures 0.7318 2.5

364-2 Other Skin, Subcutaneous Tissue & Related Procedures 1.3437 4.3

364-3 Other Skin, Subcutaneous Tissue & Related Procedures 2.4048 8.6

364-4 Other Skin, Subcutaneous Tissue & Related Procedures 3.2662 12.0

380-1 Skin Ulcers 0.6438 3.2

380-2 Skin Ulcers 1.1509 4.4

380-3 Skin Ulcers 1.3517 5.0

380-4 Skin Ulcers 2.0672 10.7

381-1 Major Skin Disorders 0.4406 2.4

381-2 Major Skin Disorders 0.8016 4.2

381-3 Major Skin Disorders 1.0187 4.9

381-4 Major Skin Disorders 2.9038 15.0

382-1 Malignant Breast Disorders 0.3749 3.0

382-2 Malignant Breast Disorders 0.6470 3.1

382-3 Malignant Breast Disorders 0.9494 4.5

382-4 Malignant Breast Disorders 1.6307 5.9

383-1 Cellulitis & Other Bacterial Skin Infections 0.5648 2.5

383-2 Cellulitis & Other Bacterial Skin Infections 0.8487 3.5

383-3 Cellulitis & Other Bacterial Skin Infections 1.3867 5.2

383-4 Cellulitis & Other Bacterial Skin Infections 1.9289 8.1

384-1 Contusion, Open Wound & Other Trauma To Skin & Subcutaneous Tissue 0.5617 1.7

384-2 Contusion, Open Wound & Other Trauma To Skin & Subcutaneous Tissue 0.7204 2.6

384-3 Contusion, Open Wound & Other Trauma To Skin & Subcutaneous Tissue 0.9916 3.8

384-4 Contusion, Open Wound & Other Trauma To Skin & Subcutaneous Tissue 1.5057 6.3

385-1 Other Skin, Subcutaneous Tissue & Breast Disorders 0.5641 2.4

385-2 Other Skin, Subcutaneous Tissue & Breast Disorders 0.8109 3.3

385-3 Other Skin, Subcutaneous Tissue & Breast Disorders 1.4090 5.4

385-4 Other Skin, Subcutaneous Tissue & Breast Disorders 1.6926 7.3

401-1 Pituitary & Adrenal Procedures 1.4525 2.6

401-2 Pituitary & Adrenal Procedures 1.7983 2.7

401-3 Pituitary & Adrenal Procedures 3.2974 6.4

401-4 Pituitary & Adrenal Procedures 8.3501 24.0

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IHCP bulletin BT201559 AUGUST 18, 2015

APR-DRG, version 30 relative weights and ALOS 17 of 30

Table 2 – APR-DRG, version 30 relative weights and ALOS

effective October 1, 2015

DRG Description Relative Weight ALOS

403-1 Procedures For Obesity 1.8089 2.2

403-2 Procedures For Obesity 2.2438 2.7

403-3 Procedures For Obesity 2.2438 3.6

403-4 Procedures For Obesity 5.0041 11.3

404-1 Thyroid, Parathyroid & Thyroglossal Procedures 0.7487 1.6

404-2 Thyroid, Parathyroid & Thyroglossal Procedures 1.0801 1.6

404-3 Thyroid, Parathyroid & Thyroglossal Procedures 2.1504 4.6

404-4 Thyroid, Parathyroid & Thyroglossal Procedures 2.1740 18.0

405-1 Other Procedures For Endocrine, Nutritional & Metabolic Disorders 1.3796 2.9

405-2 Other Procedures For Endocrine, Nutritional & Metabolic Disorders 1.7246 5.4

405-3 Other Procedures For Endocrine, Nutritional & Metabolic Disorders 2.0274 5.9

405-4 Other Procedures For Endocrine, Nutritional & Metabolic Disorders 4.5117 12.9

420-1 Diabetes 0.5394 2.4

420-2 Diabetes 0.6736 2.5

420-3 Diabetes 1.0920 3.7

420-4 Diabetes 3.1638 7.9

421-1 Malnutrition, Failure To Thrive & Other Nutritional Disorders 0.6686 2.7

421-2 Malnutrition, Failure To Thrive & Other Nutritional Disorders 0.7045 3.2

421-3 Malnutrition, Failure To Thrive & Other Nutritional Disorders 1.2013 5.0

421-4 Malnutrition, Failure To Thrive & Other Nutritional Disorders 1.9258 8.7

422-1 Hypovolemia & Related Electrolyte Disorders 0.3884 1.9

422-2 Hypovolemia & Related Electrolyte Disorders 0.5600 2.3

422-3 Hypovolemia & Related Electrolyte Disorders 1.1398 3.8

422-4 Hypovolemia & Related Electrolyte Disorders 1.6043 6.3

423-1 Inborn Errors Of Metabolism 0.7528 2.7

423-2 Inborn Errors Of Metabolism 0.7528 2.7

423-3 Inborn Errors Of Metabolism 0.7528 3.2

423-4 Inborn Errors Of Metabolism 2.9480 27.0

424-1 Other Endocrine Disorders 0.5384 2.1

424-2 Other Endocrine Disorders 0.8424 3.0

424-3 Other Endocrine Disorders 0.9968 4.7

424-4 Other Endocrine Disorders 2.5802 10.7

425-1 Electrolyte Disorders Except Hypovolemia Related 0.4495 2.0

425-2 Electrolyte Disorders Except Hypovolemia Related 0.6667 2.6

425-3 Electrolyte Disorders Except Hypovolemia Related 0.9506 3.4

425-4 Electrolyte Disorders Except Hypovolemia Related 1.7451 6.8

440-1 Kidney Transplant 3.4374 5.0

440-2 Kidney Transplant 3.4374 6.3

440-3 Kidney Transplant 7.2947 8.1

440-4 Kidney Transplant 11.3063 16.2

441-1 Major Bladder Procedures 1.6549 4.3

441-2 Major Bladder Procedures 2.4922 8.0

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IHCP bulletin BT201559 AUGUST 18, 2015

APR-DRG, version 30 relative weights and ALOS 18 of 30

Table 2 – APR-DRG, version 30 relative weights and ALOS

effective October 1, 2015

DRG Description Relative Weight ALOS

441-3 Major Bladder Procedures 3.7250 9.1

441-4 Major Bladder Procedures 6.2597 17.5

442-1 Kidney & Urinary Tract Procedures For Malignancy 1.0983 2.0

442-2 Kidney & Urinary Tract Procedures For Malignancy 1.7284 3.9

442-3 Kidney & Urinary Tract Procedures For Malignancy 2.3251 6.9

442-4 Kidney & Urinary Tract Procedures For Malignancy 5.1488 12.7

443-1 Kidney & Urinary Tract Procedures For Nonmalignancy 0.9834 2.2

443-2 Kidney & Urinary Tract Procedures For Nonmalignancy 1.4154 2.6

443-3 Kidney & Urinary Tract Procedures For Nonmalignancy 2.0537 5.7

443-4 Kidney & Urinary Tract Procedures For Nonmalignancy 4.0480 11.4

444-1 Renal Dialysis Access Device Procedure Only 0.9836 1.8

444-2 Renal Dialysis Access Device Procedure Only 1.3003 3.0

444-3 Renal Dialysis Access Device Procedure Only 2.8604 8.5

444-4 Renal Dialysis Access Device Procedure Only 3.9340 13.0

445-1 Other Bladder Procedures 0.7856 1.7

445-2 Other Bladder Procedures 1.0904 2.5

445-3 Other Bladder Procedures 1.1982 6.1

445-4 Other Bladder Procedures 3.0093 11.1

446-1 Urethral & Transurethral Procedures 0.7776 1.9

446-2 Urethral & Transurethral Procedures 0.7843 1.9

446-3 Urethral & Transurethral Procedures 1.6616 4.3

446-4 Urethral & Transurethral Procedures 2.5245 9.5

447-1 Other Kidney, Urinary Tract & Related Procedures 1.2211 1.8

447-2 Other Kidney, Urinary Tract & Related Procedures 1.3832 2.5

447-3 Other Kidney, Urinary Tract & Related Procedures 2.2847 7.3

447-4 Other Kidney, Urinary Tract & Related Procedures 4.1628 11.3

460-1 Renal Failure 0.6502 2.8

460-2 Renal Failure 0.9804 3.3

460-3 Renal Failure 1.2246 4.3

460-4 Renal Failure 2.7524 7.7

461-1 Kidney & Urinary Tract Malignancy 0.4242 1.9

461-2 Kidney & Urinary Tract Malignancy 0.5879 2.6

461-3 Kidney & Urinary Tract Malignancy 0.9416 4.8

461-4 Kidney & Urinary Tract Malignancy 1.8235 7.6

462-1 Nephritis & Nephrosis 0.4113 1.6

462-2 Nephritis & Nephrosis 0.7591 3.3

462-3 Nephritis & Nephrosis 1.0267 4.5

462-4 Nephritis & Nephrosis 1.5475 13.0

463-1 Kidney & Urinary Tract Infections 0.4957 2.3

463-2 Kidney & Urinary Tract Infections 0.6632 2.8

463-3 Kidney & Urinary Tract Infections 0.9586 3.9

463-4 Kidney & Urinary Tract Infections 1.3494 6.5

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IHCP bulletin BT201559 AUGUST 18, 2015

APR-DRG, version 30 relative weights and ALOS 19 of 30

Table 2 – APR-DRG, version 30 relative weights and ALOS

effective October 1, 2015

DRG Description Relative Weight ALOS

465-1 Urinary Stones & Acquired Upper Urinary Tract Obstruction 0.5482 1.5

465-2 Urinary Stones & Acquired Upper Urinary Tract Obstruction 0.7042 2.2

465-3 Urinary Stones & Acquired Upper Urinary Tract Obstruction 1.1242 3.3

465-4 Urinary Stones & Acquired Upper Urinary Tract Obstruction 1.6819 6.5

466-1 Malfunction, Reaction, Complic Of Genitourinary Device Or Proc 0.4244 1.7

466-2 Malfunction, Reaction, Complic Of Genitourinary Device Or Proc 0.9607 3.5

466-3 Malfunction, Reaction, Complic Of Genitourinary Device Or Proc 1.2985 4.9

466-4 Malfunction, Reaction, Complic Of Genitourinary Device Or Proc 1.9262 7.4

468-1 Other Kidney & Urinary Tract Diagnoses, Signs & Symptoms 0.6070 2.2

468-2 Other Kidney & Urinary Tract Diagnoses, Signs & Symptoms 0.8685 3.1

468-3 Other Kidney & Urinary Tract Diagnoses, Signs & Symptoms 1.3277 4.8

468-4 Other Kidney & Urinary Tract Diagnoses, Signs & Symptoms 2.1535 7.4

480-1 Major Male Pelvic Procedures 1.3338 2.6

480-2 Major Male Pelvic Procedures 1.4181 2.6

480-3 Major Male Pelvic Procedures 2.0760 4.4

480-4 Major Male Pelvic Procedures 2.6085 12.0

481-1 Penis Procedures 0.7001 1.7

481-2 Penis Procedures 1.3544 2.4

481-3 Penis Procedures 2.0481 6.0

481-4 Penis Procedures 3.4074 17.0

482-1 Transurethral Prostatectomy 0.6066 1.8

482-2 Transurethral Prostatectomy 0.7642 2.3

482-3 Transurethral Prostatectomy 1.4578 5.3

482-4 Transurethral Prostatectomy 3.0895 11.5

483-1 Testes & Scrotal Procedures 0.6722 1.6

483-2 Testes & Scrotal Procedures 0.9689 3.4

483-3 Testes & Scrotal Procedures 2.1715 11.0

483-4 Testes & Scrotal Procedures 3.1231 16.0

484-1 Other Male Reproductive System & Related Procedures 0.6862 2.0

484-2 Other Male Reproductive System & Related Procedures 1.5263 3.1

484-3 Other Male Reproductive System & Related Procedures 1.6284 3.4

484-4 Other Male Reproductive System & Related Procedures 2.0994 13.0

500-1 Malignancy, Male Reproductive System 0.4654 2.9

500-2 Malignancy, Male Reproductive System 0.6790 2.9

500-3 Malignancy, Male Reproductive System 0.9162 4.4

500-4 Malignancy, Male Reproductive System 1.5100 11.0

501-1 Male Reproductive System Diagnoses Except Malignancy 0.3965 2.1

501-2 Male Reproductive System Diagnoses Except Malignancy 0.8512 3.8

501-3 Male Reproductive System Diagnoses Except Malignancy 0.8512 4.0

501-4 Male Reproductive System Diagnoses Except Malignancy 1.5996 7.7

510-1 Pelvic Evisceration, Radical Hysterectomy & Other Radical Gyn Procs 1.3429 2.8

510-2 Pelvic Evisceration, Radical Hysterectomy & Other Radical Gyn Procs 1.9681 3.7

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IHCP bulletin BT201559 AUGUST 18, 2015

APR-DRG, version 30 relative weights and ALOS 20 of 30

Table 2 – APR-DRG, version 30 relative weights and ALOS

effective October 1, 2015

DRG Description Relative Weight ALOS

510-3 Pelvic Evisceration, Radical Hysterectomy & Other Radical Gyn Procs 2.1783 5.2

510-4 Pelvic Evisceration, Radical Hysterectomy & Other Radical Gyn Procs 7.8918 18.0

511-1 Uterine & Adnexa Procedures For Ovarian & Adnexal Malignancy 1.4431 3.1

511-2 Uterine & Adnexa Procedures For Ovarian & Adnexal Malignancy 2.0222 5.5

511-3 Uterine & Adnexa Procedures For Ovarian & Adnexal Malignancy 2.4291 7.2

511-4 Uterine & Adnexa Procedures For Ovarian & Adnexal Malignancy 5.6380 18.0

512-1 Uterine & Adnexa Procedures For Non-Ovarian & Non-Adnexal Malig 1.0786 2.6

512-2 Uterine & Adnexa Procedures For Non-Ovarian & Non-Adnexal Malig 1.7012 3.5

512-3 Uterine & Adnexa Procedures For Non-Ovarian & Non-Adnexal Malig 1.9911 5.3

512-4 Uterine & Adnexa Procedures For Non-Ovarian & Non-Adnexal Malig 3.6830 10.1

513-1 Uterine & Adnexa Procedures For Non-Malignancy Except Leiomyoma 0.8068 1.9

513-2 Uterine & Adnexa Procedures For Non-Malignancy Except Leiomyoma 1.1237 2.5

513-3 Uterine & Adnexa Procedures For Non-Malignancy Except Leiomyoma 2.0398 4.0

513-4 Uterine & Adnexa Procedures For Non-Malignancy Except Leiomyoma 3.6819 15.0

514-1 Female Reproductive System Reconstructive Procedures 0.7770 1.1

514-2 Female Reproductive System Reconstructive Procedures 0.8689 1.4

514-3 Female Reproductive System Reconstructive Procedures 1.3048 2.9

514-4 Female Reproductive System Reconstructive Procedures 1.5480 12.0

517-1 Dilation & Curettage For Non-Obstetric Diagnoses 0.7175 1.9

517-2 Dilation & Curettage For Non-Obstetric Diagnoses 0.7983 2.1

517-3 Dilation & Curettage For Non-Obstetric Diagnoses 1.3050 4.7

517-4 Dilation & Curettage For Non-Obstetric Diagnoses 1.3050 6.0

518-1 Other Female Reproductive System & Related Procedures 0.7941 1.9

518-2 Other Female Reproductive System & Related Procedures 1.0394 3.0

518-3 Other Female Reproductive System & Related Procedures 2.0313 5.6

518-4 Other Female Reproductive System & Related Procedures 4.0830 12.0

519-1 Uterine & Adnexa Procedures For Leiomyoma 0.8855 2.1

519-2 Uterine & Adnexa Procedures For Leiomyoma 0.9726 2.7

519-3 Uterine & Adnexa Procedures For Leiomyoma 1.8936 5.2

519-4 Uterine & Adnexa Procedures For Leiomyoma 3.3742 14.0

530-1 Female Reproductive System Malignancy 0.5679 2.3

530-2 Female Reproductive System Malignancy 0.6685 3.1

530-3 Female Reproductive System Malignancy 1.0782 4.6

530-4 Female Reproductive System Malignancy 2.2347 8.8

531-1 Female Reproductive System Infections 0.6517 2.5

531-2 Female Reproductive System Infections 0.8574 2.9

531-3 Female Reproductive System Infections 0.8574 4.3

531-4 Female Reproductive System Infections 1.7690 8.9

532-1 Menstrual & Other Female Reproductive System Disorders 0.6995 2.4

532-2 Menstrual & Other Female Reproductive System Disorders 0.6995 2.4

532-3 Menstrual & Other Female Reproductive System Disorders 0.7736 3.2

532-4 Menstrual & Other Female Reproductive System Disorders 0.7909 7.0

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IHCP bulletin BT201559 AUGUST 18, 2015

APR-DRG, version 30 relative weights and ALOS 21 of 30

Table 2 – APR-DRG, version 30 relative weights and ALOS

effective October 1, 2015

DRG Description Relative Weight ALOS

540-1 Cesarean Delivery 0.7284 2.7

540-2 Cesarean Delivery 0.9249 3.4

540-3 Cesarean Delivery 1.2703 4.7

540-4 Cesarean Delivery 2.5022 8.1

541-1 Vaginal Delivery W Sterilization &/Or D&C 0.6858 2.1

541-2 Vaginal Delivery W Sterilization &/Or D&C 0.7584 2.4

541-3 Vaginal Delivery W Sterilization &/Or D&C 0.7609 2.4

541-4 Vaginal Delivery W Sterilization &/Or D&C 1.1542 11.0

542-1 Vaginal Delivery W Complicating Procedures Exc Sterilization &/Or D&C 0.5552 2.2

542-2 Vaginal Delivery W Complicating Procedures Exc Sterilization &/Or D&C 0.8527 2.7

542-3 Vaginal Delivery W Complicating Procedures Exc Sterilization &/Or D&C 0.9426 6.0

542-4 Vaginal Delivery W Complicating Procedures Exc Sterilization &/Or D&C 1.0903 6.0

544-1 D&C, Aspiration Curettage Or Hysterotomy For Obstetric Diagnoses 0.5992 1.4

544-2 D&C, Aspiration Curettage Or Hysterotomy For Obstetric Diagnoses 0.6204 1.7

544-3 D&C, Aspiration Curettage Or Hysterotomy For Obstetric Diagnoses 1.0671 3.7

544-4 D&C, Aspiration Curettage Or Hysterotomy For Obstetric Diagnoses 3.6737 12.0

545-1 Ectopic Pregnancy Procedure 0.7559 1.7

545-2 Ectopic Pregnancy Procedure 0.8749 2.0

545-3 Ectopic Pregnancy Procedure 1.1697 2.7

545-4 Ectopic Pregnancy Procedure 1.2373 4.0

546-1 Other O.R. Proc For Obstetric Diagnoses Except Delivery Diagnoses 0.7662 2.4

546-2 Other O.R. Proc For Obstetric Diagnoses Except Delivery Diagnoses 0.8323 2.9

546-3 Other O.R. Proc For Obstetric Diagnoses Except Delivery Diagnoses 1.4286 5.0

546-4 Other O.R. Proc For Obstetric Diagnoses Except Delivery Diagnoses 1.8842 12.0

560-1 Vaginal Delivery 0.5184 2.1

560-2 Vaginal Delivery 0.5849 2.3

560-3 Vaginal Delivery 0.8051 3.1

560-4 Vaginal Delivery 1.7239 9.0

561-1 Postpartum & Post Abortion Diagnoses W/O Procedure 0.4206 2.1

561-2 Postpartum & Post Abortion Diagnoses W/O Procedure 0.5578 2.4

561-3 Postpartum & Post Abortion Diagnoses W/O Procedure 0.9088 3.5

561-4 Postpartum & Post Abortion Diagnoses W/O Procedure 1.3520 4.6

563-1 Preterm Labor 0.5605 2.6

563-2 Preterm Labor 0.9097 3.6

563-3 Preterm Labor 0.9097 3.6

563-4 Preterm Labor 1.0174 37.0

564-1 Abortion W/O D&C, Aspiration Curettage Or Hysterotomy 0.3826 1.3

564-2 Abortion W/O D&C, Aspiration Curettage Or Hysterotomy 0.3897 1.3

564-3 Abortion W/O D&C, Aspiration Curettage Or Hysterotomy 0.5739 2.0

564-4 Abortion W/O D&C, Aspiration Curettage Or Hysterotomy 0.6536 5.0

565-1 False Labor 0.1190 1.1

565-2 False Labor 0.2965 4.0

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IHCP bulletin BT201559 AUGUST 18, 2015

APR-DRG, version 30 relative weights and ALOS 22 of 30

Table 2 – APR-DRG, version 30 relative weights and ALOS

effective October 1, 2015

DRG Description Relative Weight ALOS

565-3 False Labor 0.2976 4.0

565-4 False Labor 0.2976 4.0

566-1 Other Antepartum Diagnoses 0.4722 2.0

566-2 Other Antepartum Diagnoses 0.6088 2.7

566-3 Other Antepartum Diagnoses 0.8267 3.5

566-4 Other Antepartum Diagnoses 1.3961 5.2

580-1 Neonate, Transferred <5 Days Old, Not Born Here 0.2677 0.0

580-2 Neonate, Transferred <5 Days Old, Not Born Here 0.3127 0.0

580-3 Neonate, Transferred <5 Days Old, Not Born Here 0.4146 0.0

580-4 Neonate, Transferred <5 Days Old, Not Born Here 1.0830 0.0

581-1 Neonate, Transferred < 5 Days Old, Born Here 0.2277 0.0

581-2 Neonate, Transferred < 5 Days Old, Born Here 0.3249 0.0

581-3 Neonate, Transferred < 5 Days Old, Born Here 0.3897 0.0

581-4 Neonate, Transferred < 5 Days Old, Born Here 0.4594 0.0

583-1 Neonate W Ecmo 13.2384 18.5

583-2 Neonate W Ecmo 13.2384 18.5

583-3 Neonate W Ecmo 13.2384 18.5

583-4 Neonate W Ecmo 35.5479 38.8

588-1 Neonate Bwt <1500G W Major Procedure 13.9439 44.3

588-2 Neonate Bwt <1500G W Major Procedure 13.9439 44.3

588-3 Neonate Bwt <1500G W Major Procedure 13.9439 61.5

588-4 Neonate Bwt <1500G W Major Procedure 21.7558 61.5

589-1 Neonate Bwt <500G Or Ga <24 Weeks 9.4470 20.8

589-2 Neonate Bwt <500G Or Ga <24 Weeks 9.4470 20.8

589-3 Neonate Bwt <500G Or Ga <24 Weeks 2.7642 20.8

589-4 Neonate Bwt <500G Or Ga <24 Weeks 0.2201 3.0

591-1 Neonate Birthwt 500-749G W/O Major Procedure 4.3942 13.0

591-2 Neonate Birthwt 500-749G W/O Major Procedure 5.1769 34.2

591-3 Neonate Birthwt 500-749G W/O Major Procedure 12.7116 34.2

591-4 Neonate Birthwt 500-749G W/O Major Procedure 16.7559 73.6

593-1 Neonate Birthwt 750-999G W/O Major Procedure 0.3696 5.0

593-2 Neonate Birthwt 750-999G W/O Major Procedure 8.2282 50.4

593-3 Neonate Birthwt 750-999G W/O Major Procedure 13.0584 54.8

593-4 Neonate Birthwt 750-999G W/O Major Procedure 14.0898 55.4

602-1 Neonate Bwt 1000-1249G W Resp Dist Synd/Oth Maj Resp Or Maj Anom 4.7536 33.0

602-2 Neonate Bwt 1000-1249G W Resp Dist Synd/Oth Maj Resp Or Maj Anom 7.8458 46.1

602-3 Neonate Bwt 1000-1249G W Resp Dist Synd/Oth Maj Resp Or Maj Anom 11.4358 59.2

602-4 Neonate Bwt 1000-1249G W Resp Dist Synd/Oth Maj Resp Or Maj Anom 14.7444 69.5

603-1 Neonate Birthwt 1000-1249G W Or W/O Other Significant Condition 3.6279 24.5

603-2 Neonate Birthwt 1000-1249G W Or W/O Other Significant Condition 6.2931 32.7

603-3 Neonate Birthwt 1000-1249G W Or W/O Other Significant Condition 8.6622 40.5

603-4 Neonate Birthwt 1000-1249G W Or W/O Other Significant Condition 15.9843 50.0

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IHCP bulletin BT201559 AUGUST 18, 2015

APR-DRG, version 30 relative weights and ALOS 23 of 30

Table 2 – APR-DRG, version 30 relative weights and ALOS

effective October 1, 2015

DRG Description Relative Weight ALOS

607-1 Neonate Bwt 1250-1499G W Resp Dist Synd/Oth Maj Resp Or Maj Anom 3.3982 23.3

607-2 Neonate Bwt 1250-1499G W Resp Dist Synd/Oth Maj Resp Or Maj Anom 5.8023 34.9

607-3 Neonate Bwt 1250-1499G W Resp Dist Synd/Oth Maj Resp Or Maj Anom 8.9838 47.0

607-4 Neonate Bwt 1250-1499G W Resp Dist Synd/Oth Maj Resp Or Maj Anom 10.6918 47.0

608-1 Neonate Bwt 1250-1499G W Or W/O Other Significant Condition 3.6635 18.4

608-2 Neonate Bwt 1250-1499G W Or W/O Other Significant Condition 4.8283 29.6

608-3 Neonate Bwt 1250-1499G W Or W/O Other Significant Condition 5.6459 30.1

608-4 Neonate Bwt 1250-1499G W Or W/O Other Significant Condition 7.6884 39.0

609-1 Neonate Bwt 1500-2499G W Major Procedure 3.9128 17.0

609-2 Neonate Bwt 1500-2499G W Major Procedure 3.9985 22.0

609-3 Neonate Bwt 1500-2499G W Major Procedure 8.6866 34.3

609-4 Neonate Bwt 1500-2499G W Major Procedure 14.5608 49.1

611-1 Neonate Birthwt 1500-1999G W Major Anomaly 4.4756 23.7

611-2 Neonate Birthwt 1500-1999G W Major Anomaly 4.4756 24.0

611-3 Neonate Birthwt 1500-1999G W Major Anomaly 6.5933 28.8

611-4 Neonate Birthwt 1500-1999G W Major Anomaly 6.9497 28.8

612-1 Neonate Bwt 1500-1999G W Resp Dist Synd/Oth Maj Resp Cond 2.6175 16.6

612-2 Neonate Bwt 1500-1999G W Resp Dist Synd/Oth Maj Resp Cond 4.7518 26.4

612-3 Neonate Bwt 1500-1999G W Resp Dist Synd/Oth Maj Resp Cond 6.2011 33.0

612-4 Neonate Bwt 1500-1999G W Resp Dist Synd/Oth Maj Resp Cond 7.2620 33.0

613-1 Neonate Birthwt 1500-1999G W Congenital/Perinatal Infection 2.5367 15.4

613-2 Neonate Birthwt 1500-1999G W Congenital/Perinatal Infection 5.2046 30.6

613-3 Neonate Birthwt 1500-1999G W Congenital/Perinatal Infection 5.4160 30.6

613-4 Neonate Birthwt 1500-1999G W Congenital/Perinatal Infection 5.5341 30.6

614-1 Neonate Bwt 1500-1999G W Or W/O Other Significant Condition 1.7028 8.3

614-2 Neonate Bwt 1500-1999G W Or W/O Other Significant Condition 3.3631 19.6

614-3 Neonate Bwt 1500-1999G W Or W/O Other Significant Condition 4.0511 23.2

614-4 Neonate Bwt 1500-1999G W Or W/O Other Significant Condition 4.6113 28.7

621-1 Neonate Bwt 2000-2499G W Major Anomaly 0.7950 8.0

621-2 Neonate Bwt 2000-2499G W Major Anomaly 2.5803 14.5

621-3 Neonate Bwt 2000-2499G W Major Anomaly 4.0996 18.7

621-4 Neonate Bwt 2000-2499G W Major Anomaly 6.1267 25.0

622-1 Neonate Bwt 2000-2499G W Resp Dist Synd/Oth Maj Resp Cond 1.6726 7.9

622-2 Neonate Bwt 2000-2499G W Resp Dist Synd/Oth Maj Resp Cond 2.9898 16.0

622-3 Neonate Bwt 2000-2499G W Resp Dist Synd/Oth Maj Resp Cond 4.1726 21.3

622-4 Neonate Bwt 2000-2499G W Resp Dist Synd/Oth Maj Resp Cond 5.2515 21.3

623-1 Neonate Bwt 2000-2499G W Congenital/Perinatal Infection 1.6389 10.0

623-2 Neonate Bwt 2000-2499G W Congenital/Perinatal Infection 1.7455 11.5

623-3 Neonate Bwt 2000-2499G W Congenital/Perinatal Infection 2.7904 17.2

623-4 Neonate Bwt 2000-2499G W Congenital/Perinatal Infection 3.8436 34.0

625-1 Neonate Bwt 2000-2499G W Other Significant Condition 1.9697 10.5

625-2 Neonate Bwt 2000-2499G W Other Significant Condition 2.8600 16.5

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IHCP bulletin BT201559 AUGUST 18, 2015

APR-DRG, version 30 relative weights and ALOS 24 of 30

Table 2 – APR-DRG, version 30 relative weights and ALOS

effective October 1, 2015

DRG Description Relative Weight ALOS

625-3 Neonate Bwt 2000-2499G W Other Significant Condition 2.8832 17.1

625-4 Neonate Bwt 2000-2499G W Other Significant Condition 3.1219 35.0

626-1 Neonate Bwt 2000-2499G, Normal Newborn Or Neonate W Other Problem 0.3661 2.6

626-2 Neonate Bwt 2000-2499G, Normal Newborn Or Neonate W Other Problem 0.7159 3.7

626-3 Neonate Bwt 2000-2499G, Normal Newborn Or Neonate W Other Problem 1.4804 7.8

626-4 Neonate Bwt 2000-2499G, Normal Newborn Or Neonate W Other Problem 1.4804 9.0

630-1 Neonate Birthwt >2499G W Major Cardiovascular Procedure 2.8710 4.1

630-2 Neonate Birthwt >2499G W Major Cardiovascular Procedure 2.9118 4.1

630-3 Neonate Birthwt >2499G W Major Cardiovascular Procedure 6.9255 19.4

630-4 Neonate Birthwt >2499G W Major Cardiovascular Procedure 16.7090 25.6

631-1 Neonate Birthwt >2499G W Other Major Procedure 1.2514 2.3

631-2 Neonate Birthwt >2499G W Other Major Procedure 3.1235 12.1

631-3 Neonate Birthwt >2499G W Other Major Procedure 4.2959 17.3

631-4 Neonate Birthwt >2499G W Other Major Procedure 13.7065 47.6

633-1 Neonate Birthwt >2499G W Major Anomaly 0.4574 2.6

633-2 Neonate Birthwt >2499G W Major Anomaly 1.6582 6.9

633-3 Neonate Birthwt >2499G W Major Anomaly 3.9229 15.2

633-4 Neonate Birthwt >2499G W Major Anomaly 5.5235 15.2

634-1 Neonate, Birthwt >2499G W Resp Dist Synd/Oth Maj Resp Cond 0.8636 4.5

634-2 Neonate, Birthwt >2499G W Resp Dist Synd/Oth Maj Resp Cond 2.1783 9.7

634-3 Neonate, Birthwt >2499G W Resp Dist Synd/Oth Maj Resp Cond 3.7565 14.5

634-4 Neonate, Birthwt >2499G W Resp Dist Synd/Oth Maj Resp Cond 6.7909 26.0

636-1 Neonate Birthwt >2499G W Congenital/Perinatal Infection 1.0277 5.7

636-2 Neonate Birthwt >2499G W Congenital/Perinatal Infection 1.4276 7.5

636-3 Neonate Birthwt >2499G W Congenital/Perinatal Infection 1.9351 9.9

636-4 Neonate Birthwt >2499G W Congenital/Perinatal Infection 3.1753 24.0

639-1 Neonate Birthwt >2499G W Other Significant Condition 0.8892 4.1

639-2 Neonate Birthwt >2499G W Other Significant Condition 1.6161 7.5

639-3 Neonate Birthwt >2499G W Other Significant Condition 1.6161 7.5

639-4 Neonate Birthwt >2499G W Other Significant Condition 3.0888 8.7

640-1 Neonate Birthwt >2499G, Normal Newborn Or Neonate W Other Problem 0.2650 2.1

640-2 Neonate Birthwt >2499G, Normal Newborn Or Neonate W Other Problem 0.3356 2.3

640-3 Neonate Birthwt >2499G, Normal Newborn Or Neonate W Other Problem 0.6112 3.3

640-4 Neonate Birthwt >2499G, Normal Newborn Or Neonate W Other Problem 0.6112 23.0

650-1 Splenectomy 1.2017 2.6

650-2 Splenectomy 1.7021 4.0

650-3 Splenectomy 2.3684 6.7

650-4 Splenectomy 5.8211 11.6

651-1 Other Procedures Of Blood & Blood-Forming Organs 0.9768 2.3

651-2 Other Procedures Of Blood & Blood-Forming Organs 1.4411 3.9

651-3 Other Procedures Of Blood & Blood-Forming Organs 2.2982 6.5

651-4 Other Procedures Of Blood & Blood-Forming Organs 11.7957 34.0

Page 28: IHCP announces changes to DRG grouper and inpatient ...

IHCP bulletin BT201559 AUGUST 18, 2015

APR-DRG, version 30 relative weights and ALOS 25 of 30

Table 2 – APR-DRG, version 30 relative weights and ALOS

effective October 1, 2015

DRG Description Relative Weight ALOS

660-1 Major Hematologic/Immunologic Diag Exc Sickle Cell Crisis & Coagul 0.5612 2.3

660-2 Major Hematologic/Immunologic Diag Exc Sickle Cell Crisis & Coagul 0.9068 3.5

660-3 Major Hematologic/Immunologic Diag Exc Sickle Cell Crisis & Coagul 1.7304 6.0

660-4 Major Hematologic/Immunologic Diag Exc Sickle Cell Crisis & Coagul 3.7469 10.1

661-1 Coagulation & Platelet Disorders 0.7941 2.1

661-2 Coagulation & Platelet Disorders 1.4609 3.6

661-3 Coagulation & Platelet Disorders 1.8392 3.8

661-4 Coagulation & Platelet Disorders 3.4060 13.0

662-1 Sickle Cell Anemia Crisis 0.7026 3.6

662-2 Sickle Cell Anemia Crisis 0.9259 4.5

662-3 Sickle Cell Anemia Crisis 1.4556 6.7

662-4 Sickle Cell Anemia Crisis 3.0460 11.1

663-1 Other Anemia & Disorders Of Blood & Blood-Forming Organs 0.5881 2.3

663-2 Other Anemia & Disorders Of Blood & Blood-Forming Organs 0.7250 2.7

663-3 Other Anemia & Disorders Of Blood & Blood-Forming Organs 0.9981 3.3

663-4 Other Anemia & Disorders Of Blood & Blood-Forming Organs 2.2110 6.8

680-1 Major O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms 1.4682 3.1

680-2 Major O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms 1.8798 4.6

680-3 Major O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms 3.5223 9.5

680-4 Major O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms 6.7235 18.2

681-1 Other O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms 1.1281 3.1

681-2 Other O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms 1.3527 3.7

681-3 Other O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms 3.6467 9.5

681-4 Other O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms 5.9174 17.4

690-1 Acute Leukemia 0.8145 2.8

690-2 Acute Leukemia 1.5493 4.3

690-3 Acute Leukemia 4.5360 12.8

690-4 Acute Leukemia 6.0345 14.1

691-1 Lymphoma, Myeloma & Non-Acute Leukemia 0.9304 2.8

691-2 Lymphoma, Myeloma & Non-Acute Leukemia 1.0261 3.7

691-3 Lymphoma, Myeloma & Non-Acute Leukemia 1.6969 6.3

691-4 Lymphoma, Myeloma & Non-Acute Leukemia 3.1483 9.2

692-1 Radiotherapy 0.6060 4.5

692-2 Radiotherapy 1.2261 4.5

692-3 Radiotherapy 2.9264 10.0

692-4 Radiotherapy 3.3476 24.0

693-1 Chemotherapy 0.6701 2.2

693-2 Chemotherapy 0.9711 3.4

693-3 Chemotherapy 2.0545 6.5

693-4 Chemotherapy 5.1198 18.4

694-1 Lymphatic & Other Malignancies & Neoplasms Of Uncertain Behavior 0.4641 1.9

694-2 Lymphatic & Other Malignancies & Neoplasms Of Uncertain Behavior 0.7054 3.0

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IHCP bulletin BT201559 AUGUST 18, 2015

APR-DRG, version 30 relative weights and ALOS 26 of 30

Table 2 – APR-DRG, version 30 relative weights and ALOS

effective October 1, 2015

DRG Description Relative Weight ALOS

694-3 Lymphatic & Other Malignancies & Neoplasms Of Uncertain Behavior 1.1738 4.9

694-4 Lymphatic & Other Malignancies & Neoplasms Of Uncertain Behavior 2.1986 7.5

710-1 Infectious & Parasitic Diseases Including Hiv W O.R. Procedure 1.4449 4.2

710-2 Infectious & Parasitic Diseases Including Hiv W O.R. Procedure 1.4449 5.2

710-3 Infectious & Parasitic Diseases Including Hiv W O.R. Procedure 3.2721 9.7

710-4 Infectious & Parasitic Diseases Including Hiv W O.R. Procedure 7.9176 19.2

711-1 Post-Op, Post-Trauma, Other Device Infections W O.R. Procedure 1.3902 3.7

711-2 Post-Op, Post-Trauma, Other Device Infections W O.R. Procedure 1.8513 5.4

711-3 Post-Op, Post-Trauma, Other Device Infections W O.R. Procedure 3.1466 8.8

711-4 Post-Op, Post-Trauma, Other Device Infections W O.R. Procedure 7.6409 18.9

720-1 Septicemia & Disseminated Infections 0.5856 2.7

720-2 Septicemia & Disseminated Infections 1.0287 3.9

720-3 Septicemia & Disseminated Infections 1.6903 5.5

720-4 Septicemia & Disseminated Infections 3.5502 8.5

721-1 Post-Operative, Post-Traumatic, Other Device Infections 0.7272 2.8

721-2 Post-Operative, Post-Traumatic, Other Device Infections 1.0972 4.1

721-3 Post-Operative, Post-Traumatic, Other Device Infections 1.5380 5.9

721-4 Post-Operative, Post-Traumatic, Other Device Infections 2.9290 10.0

722-1 Fever 0.4071 2.0

722-2 Fever 0.5873 2.6

722-3 Fever 0.9508 3.1

722-4 Fever 1.3024 4.6

723-1 Viral Illness 0.4261 2.1

723-2 Viral Illness 0.5475 2.4

723-3 Viral Illness 0.7995 3.6

723-4 Viral Illness 2.4119 8.2

724-1 Other Infectious & Parasitic Diseases 0.8103 3.8

724-2 Other Infectious & Parasitic Diseases 0.9994 3.9

724-3 Other Infectious & Parasitic Diseases 1.6596 6.3

724-4 Other Infectious & Parasitic Diseases 2.6911 9.8

740-1 Mental Illness Diagnosis W O.R. Procedure LOC LOC

740-2 Mental Illness Diagnosis W O.R. Procedure LOC LOC

740-3 Mental Illness Diagnosis W O.R. Procedure LOC LOC

740-4 Mental Illness Diagnosis W O.R. Procedure LOC LOC

750-1 Schizophrenia LOC LOC

750-2 Schizophrenia LOC LOC

750-3 Schizophrenia LOC LOC

750-4 Schizophrenia LOC LOC

751-1 Major Depressive Disorders & Other/Unspecified Psychoses LOC LOC

751-2 Major Depressive Disorders & Other/Unspecified Psychoses LOC LOC

751-3 Major Depressive Disorders & Other/Unspecified Psychoses LOC LOC

751-4 Major Depressive Disorders & Other/Unspecified Psychoses LOC LOC

Page 30: IHCP announces changes to DRG grouper and inpatient ...

IHCP bulletin BT201559 AUGUST 18, 2015

APR-DRG, version 30 relative weights and ALOS 27 of 30

Table 2 – APR-DRG, version 30 relative weights and ALOS

effective October 1, 2015

DRG Description Relative Weight ALOS

752-1 Disorders Of Personality & Impulse Control LOC LOC

752-2 Disorders Of Personality & Impulse Control LOC LOC

752-3 Disorders Of Personality & Impulse Control LOC LOC

752-4 Disorders Of Personality & Impulse Control LOC LOC

753-1 Bipolar Disorders LOC LOC

753-2 Bipolar Disorders LOC LOC

753-3 Bipolar Disorders LOC LOC

753-4 Bipolar Disorders LOC LOC

754-1 Depression Except Major Depressive Disorder LOC LOC

754-2 Depression Except Major Depressive Disorder LOC LOC

754-3 Depression Except Major Depressive Disorder LOC LOC

754-4 Depression Except Major Depressive Disorder LOC LOC

755-1 Adjustment Disorders & Neuroses Except Depressive Diagnos LOC LOC

755-2 Adjustment Disorders & Neuroses Except Depressive Diagnos LOC LOC

755-3 Adjustment Disorders & Neuroses Except Depressive Diagnos LOC LOC

755-4 Adjustment Disorders & Neuroses Except Depressive Diagnos LOC LOC

756-1 Acute Anxiety & Delirium States LOC LOC

756-2 Acute Anxiety & Delirium States LOC LOC

756-3 Acute Anxiety & Delirium States LOC LOC

756-4 Acute Anxiety & Delirium States LOC LOC

757-1 Organic Mental Health Disturbances 0.6570 6.7

757-2 Organic Mental Health Disturbances 0.6570 6.7

757-3 Organic Mental Health Disturbances 1.0600 10.0

757-4 Organic Mental Health Disturbances 1.3246 10.0

758-1 Childhood Behavioral Disorders LOC LOC

758-2 Childhood Behavioral Disorders LOC LOC

758-3 Childhood Behavioral Disorders LOC LOC

758-4 Childhood Behavioral Disorders LOC LOC

759-1 Eating Disorders LOC LOC

759-2 Eating Disorders LOC LOC

759-3 Eating Disorders LOC LOC

759-4 Eating Disorders LOC LOC

760-1 Other Mental Health Disorders LOC LOC

760-2 Other Mental Health Disorders LOC LOC

760-3 Other Mental Health Disorders LOC LOC

760-4 Other Mental Health Disorders LOC LOC

770-1 Drug & Alcohol Abuse Or Dependence, Left Against Medical Advice 0.2836 2.0

770-2 Drug & Alcohol Abuse Or Dependence, Left Against Medical Advice 0.3654 2.0

770-3 Drug & Alcohol Abuse Or Dependence, Left Against Medical Advice 0.5340 2.0

770-4 Drug & Alcohol Abuse Or Dependence, Left Against Medical Advice 0.5340 10.0

772-1 Alcohol & Drug Dependence W Rehab Or Rehab/Detox Therapy 0.3768 3.0

772-2 Alcohol & Drug Dependence W Rehab Or Rehab/Detox Therapy 0.4320 8.5

Page 31: IHCP announces changes to DRG grouper and inpatient ...

IHCP bulletin BT201559 AUGUST 18, 2015

APR-DRG, version 30 relative weights and ALOS 28 of 30

Table 2 – APR-DRG, version 30 relative weights and ALOS

effective October 1, 2015

DRG Description Relative Weight ALOS

772-3 Alcohol & Drug Dependence W Rehab Or Rehab/Detox Therapy 0.5931 10.3

772-4 Alcohol & Drug Dependence W Rehab Or Rehab/Detox Therapy 2.9960 13.0

773-1 Opioid Abuse & Dependence 0.4488 3.2

773-2 Opioid Abuse & Dependence 0.5249 3.5

773-3 Opioid Abuse & Dependence 0.6879 3.5

773-4 Opioid Abuse & Dependence 0.8304 8.0

774-1 Cocaine Abuse & Dependence 0.3272 2.3

774-2 Cocaine Abuse & Dependence 0.4959 3.1

774-3 Cocaine Abuse & Dependence 0.7578 3.6

774-4 Cocaine Abuse & Dependence 0.7578 10.0

775-1 Alcohol Abuse & Dependence 0.4873 3.1

775-2 Alcohol Abuse & Dependence 0.5901 3.1

775-3 Alcohol Abuse & Dependence 1.1813 4.1

775-4 Alcohol Abuse & Dependence 2.3491 8.9

776-1 Other Drug Abuse & Dependence 0.4371 3.3

776-2 Other Drug Abuse & Dependence 0.4892 3.3

776-3 Other Drug Abuse & Dependence 0.7070 3.5

776-4 Other Drug Abuse & Dependence 1.4375 6.4

791-1 O.R. Procedure For Other Complications Of Treatment 1.4535 2.7

791-2 O.R. Procedure For Other Complications Of Treatment 2.0984 4.7

791-3 O.R. Procedure For Other Complications Of Treatment 2.5002 7.5

791-4 O.R. Procedure For Other Complications Of Treatment 5.9577 15.7

811-1 Allergic Reactions 0.2666 1.3

811-2 Allergic Reactions 0.4280 1.5

811-3 Allergic Reactions 0.7959 2.9

811-4 Allergic Reactions 2.0951 6.3

812-1 Poisoning Of Medicinal Agents 0.4702 1.6

812-2 Poisoning Of Medicinal Agents 0.5199 1.8

812-3 Poisoning Of Medicinal Agents 0.8380 2.6

812-4 Poisoning Of Medicinal Agents 1.9320 4.5

813-1 Other Complications Of Treatment 0.7007 2.5

813-2 Other Complications Of Treatment 0.8270 3.1

813-3 Other Complications Of Treatment 1.3023 4.2

813-4 Other Complications Of Treatment 2.3743 7.9

815-1 Other Injury, Poisoning & Toxic Effect Diagnoses 0.5043 1.5

815-2 Other Injury, Poisoning & Toxic Effect Diagnoses 0.5488 2.2

815-3 Other Injury, Poisoning & Toxic Effect Diagnoses 0.8817 3.1

815-4 Other Injury, Poisoning & Toxic Effect Diagnoses 2.7134 6.0

816-1 Toxic Effects Of Non-Medicinal Substances 0.4724 1.7

816-2 Toxic Effects Of Non-Medicinal Substances 0.5702 2.1

816-3 Toxic Effects Of Non-Medicinal Substances 0.8999 2.7

816-4 Toxic Effects Of Non-Medicinal Substances 2.2436 5.9

Page 32: IHCP announces changes to DRG grouper and inpatient ...

IHCP bulletin BT201559 AUGUST 18, 2015

APR-DRG, version 30 relative weights and ALOS 29 of 30

Table 2 – APR-DRG, version 30 relative weights and ALOS

effective October 1, 2015

DRG Description Relative Weight ALOS

841-1 Extensive 3Rd Degree Burns W Skin Graft LOC LOC

841-2 Extensive 3Rd Degree Burns W Skin Graft LOC LOC

841-3 Extensive 3Rd Degree Burns W Skin Graft LOC LOC

841-4 Extensive 3Rd Degree Burns W Skin Graft LOC LOC

842-1 Full Thickness Burns W Skin Graft LOC LOC

842-2 Full Thickness Burns W Skin Graft LOC LOC

842-3 Full Thickness Burns W Skin Graft LOC LOC

842-4 Full Thickness Burns W Skin Graft LOC LOC

843-1 Extensive 3Rd Degree Or Full Thickness Burns W/O Skin Graft LOC LOC

843-2 Extensive 3Rd Degree Or Full Thickness Burns W/O Skin Graft LOC LOC

843-3 Extensive 3Rd Degree Or Full Thickness Burns W/O Skin Graft LOC LOC

843-4 Extensive 3Rd Degree Or Full Thickness Burns W/O Skin Graft LOC LOC

844-1 Partial Thickness Burns W Or W/O Skin Graft LOC LOC

844-2 Partial Thickness Burns W Or W/O Skin Graft LOC LOC

844-3 Partial Thickness Burns W Or W/O Skin Graft LOC LOC

844-4 Partial Thickness Burns W Or W/O Skin Graft LOC LOC

850-1 Procedure W Diag Of Rehab, Aftercare Or Oth Contact W Health Service 1.2924 2.0

850-2 Procedure W Diag Of Rehab, Aftercare Or Oth Contact W Health Service 1.6123 3.3

850-3 Procedure W Diag Of Rehab, Aftercare Or Oth Contact W Health Service 2.5006 9.3

850-4 Procedure W Diag Of Rehab, Aftercare Or Oth Contact W Health Service 15.3272 58.0

860-1 Rehabilitation LOC LOC

860-2 Rehabilitation LOC LOC

860-3 Rehabilitation LOC LOC

860-4 Rehabilitation LOC LOC

861-1 Signs, Symptoms & Other Factors Influencing Health Status 0.5510 2.2

861-2 Signs, Symptoms & Other Factors Influencing Health Status 0.6841 2.5

861-3 Signs, Symptoms & Other Factors Influencing Health Status 1.0892 3.7

861-4 Signs, Symptoms & Other Factors Influencing Health Status 1.4686 5.5

862-1 Other Aftercare & Convalescence 0.3105 2.1

862-2 Other Aftercare & Convalescence 0.5229 4.9

862-3 Other Aftercare & Convalescence 0.8971 8.4

862-4 Other Aftercare & Convalescence 1.6229 12.6

863-1 Neonatal Aftercare 1.8708 11.0

863-2 Neonatal Aftercare 2.7549 19.0

863-3 Neonatal Aftercare 4.9000 28.0

863-4 Neonatal Aftercare 11.1197 45.0

890-1 Hiv W Multiple Major Hiv Related Conditions 1.4448 5.6

890-2 Hiv W Multiple Major Hiv Related Conditions 1.4448 5.6

890-3 Hiv W Multiple Major Hiv Related Conditions 1.4792 5.6

890-4 Hiv W Multiple Major Hiv Related Conditions 4.3558 12.1

892-1 Hiv W Major Hiv Related Condition 0.3766 2.8

892-2 Hiv W Major Hiv Related Condition 1.0085 3.6

Page 33: IHCP announces changes to DRG grouper and inpatient ...

IHCP bulletin BT201559 AUGUST 18, 2015

APR-DRG, version 30 relative weights and ALOS 30 of 30

Table 2 – APR-DRG, version 30 relative weights and ALOS

effective October 1, 2015

DRG Description Relative Weight ALOS

892-3 Hiv W Major Hiv Related Condition 1.4180 4.7

892-4 Hiv W Major Hiv Related Condition 2.2391 7.8

893-1 Hiv W Multiple Significant Hiv Related Conditions 0.9234 4.5

893-2 Hiv W Multiple Significant Hiv Related Conditions 0.9979 4.5

893-3 Hiv W Multiple Significant Hiv Related Conditions 1.2647 4.5

893-4 Hiv W Multiple Significant Hiv Related Conditions 1.5483 20.0

894-1 Hiv W One Signif Hiv Cond Or W/O Signif Related Cond 0.5336 2.4

894-2 Hiv W One Signif Hiv Cond Or W/O Signif Related Cond 0.7538 3.1

894-3 Hiv W One Signif Hiv Cond Or W/O Signif Related Cond 1.0366 4.3

894-4 Hiv W One Signif Hiv Cond Or W/O Signif Related Cond 1.0366 6.0

910-1 Craniotomy For Multiple Significant Trauma 3.4965 7.9

910-2 Craniotomy For Multiple Significant Trauma 3.4965 7.9

910-3 Craniotomy For Multiple Significant Trauma 4.5985 7.9

910-4 Craniotomy For Multiple Significant Trauma 6.3519 8.6

911-1 Extensive Abdominal/Thoracic Procedures For Mult Significant Trauma 2.0349 5.8

911-2 Extensive Abdominal/Thoracic Procedures For Mult Significant Trauma 2.0349 5.8

911-3 Extensive Abdominal/Thoracic Procedures For Mult Significant Trauma 2.8338 6.1

911-4 Extensive Abdominal/Thoracic Procedures For Mult Significant Trauma 6.2590 9.9

912-1 Musculoskeletal & Other Procedures For Multiple Significant Trauma 2.6876 5.5

912-2 Musculoskeletal & Other Procedures For Multiple Significant Trauma 3.4056 5.5

912-3 Musculoskeletal & Other Procedures For Multiple Significant Trauma 5.7918 8.3

912-4 Musculoskeletal & Other Procedures For Multiple Significant Trauma 10.7564 15.8

930-1 Multiple Significant Trauma W/O O.R. Procedure 0.9518 3.7

930-2 Multiple Significant Trauma W/O O.R. Procedure 1.1503 3.7

930-3 Multiple Significant Trauma W/O O.R. Procedure 2.1349 5.8

930-4 Multiple Significant Trauma W/O O.R. Procedure 4.0683 10.3

950-1 Extensive Procedure Unrelated To Principal Diagnosis 1.5400 3.0

950-2 Extensive Procedure Unrelated To Principal Diagnosis 2.7285 4.6

950-3 Extensive Procedure Unrelated To Principal Diagnosis 4.0835 9.6

950-4 Extensive Procedure Unrelated To Principal Diagnosis 6.3437 18.4

951-1 Moderately Extensive Procedure Unrelated To Principal Diagnosis 0.9950 2.7

951-2 Moderately Extensive Procedure Unrelated To Principal Diagnosis 1.4793 3.7

951-3 Moderately Extensive Procedure Unrelated To Principal Diagnosis 3.0809 8.0

951-4 Moderately Extensive Procedure Unrelated To Principal Diagnosis 6.7749 17.2

952-1 Nonextensive Procedure Unrelated To Principal Diagnosis 1.0373 2.3

952-2 Nonextensive Procedure Unrelated To Principal Diagnosis 1.4409 4.2

952-3 Nonextensive Procedure Unrelated To Principal Diagnosis 2.4274 7.6

952-4 Nonextensive Procedure Unrelated To Principal Diagnosis 3.6692 12.5