Secondary Effects of APR‐DRG Assignments - acdis.org · •CMS adopted the DRG system in the...

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1 This is the Full Title of a Session Secondary Effects of APR‐DRG Assignments Candace Blankenship, BSN, RN, CCDS Clinical Documentation Improvement Specialist Johns Hopkins Health System Maryland ACDIS Baltimore, MD 2018 Copyright, HCPro, an H3.Group division of Simplify Compliance LLC. All rights reserved. These materials may not be copied without written permission.

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Transcript of Secondary Effects of APR‐DRG Assignments - acdis.org · •CMS adopted the DRG system in the...

1

ThisistheFullTitleofaSession

SecondaryEffectsofAPRDRGAssignments

CandaceBlankenship,BSN,RN,CCDSClinicalDocumentationImprovementSpecialistJohnsHopkinsHealthSystemMarylandACDISBaltimore,MD

2018 Copyright, HCPro, an H3.Group division of Simplify Compliance LLC. All rights reserved. These materials may not be copied without written permission.

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LearningObjectives

Atthecompletionofthiseducationalactivity,thelearnerwillbeableto: Identifythecodingtoolsembeddedinthe3M encoder IdentifythreewaysAPRDRGcodinginteractswithinthepatientcodingprofile

BuildspecificcodingprofilesforthemajorprimaryDRGsintheirpractice

DiscussandeducatetheirpeersinqualityandfinanceregardingthenuancesofROMscoringintheAPRDRGsystem

2018 Copyright, HCPro, an H3.Group division of Simplify Compliance LLC. All rights reserved. These materials may not be copied without written permission.

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2018 Copyright, HCPro, an H3.Group division of Simplify Compliance LLC. All rights reserved. These materials may not be copied without written permission.

4

PollingQuestion#1

WhoherelovesAPRDRG? HeckyeahIdo! Loveisastrongword.Maybelike? Notme!

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WhyWeUseAPRDRG

2018 Copyright, HCPro, an H3.Group division of Simplify Compliance LLC. All rights reserved. These materials may not be copied without written permission.

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OurHistory

TheDRGsystem CreatedatYaleUniversityinthe1970sbyRobertFetterandJohnThompson

Contained467groups Usedtodescribediagnosesandconditionsandtheirsubgroups(thinkCHF,acuteCHF,andacutesystolicCHF)

ThegoalofthisprogramwastomovetheU.S.fromacostbasedtoaproductbasedreimbursementsystem

Savage,Leah(Ed.).(2017).PediatricCDI:BuildingBlocksforSuccess.Middleton,MA:HCPro.

2018 Copyright, HCPro, an H3.Group division of Simplify Compliance LLC. All rights reserved. These materials may not be copied without written permission.

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OurHistory

CMSadoptedtheDRGsystemintheearly1980sandsplititinto2groups:MSDRGandAPDRG MSDRG

UsedtobillandreimburseforservicesrenderedtotheMedicarerecipient

TheMSDRGsystemrequiresthattheindividualMedicarepatientbeassignedadiagnosiscodethatdescribestheprincipalreasonforthehospitaladmission,whichthentriggerstheassignmentofarelativereimbursementweight(RW)andalengthofstay(LOS)parameter

TheMSDRGcodingsystemallowsthehospitaltofurtherdescribetheMedicarepatientforreimbursementpurposesifaMCCorCCoccurssometimeduringtheadmission

Savage,Leah(Ed.).(2017).PediatricCDI:BuildingBlocksforSuccess.Middleton,MA:HCPro.

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OurHistory

MSDRG293 HFw/oMCC/CC RW0.6618 ALOS3.0

MSDRG293 HFw/CC RW0.9574 ALOS4.3

MSDRG293 HFw/MCC RW1.4796 ALOS5.8

2018 Copyright, HCPro, an H3.Group division of Simplify Compliance LLC. All rights reserved. These materials may not be copied without written permission.

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OurHistory

APRDRG Createdthroughacollaborationbetween3MHealthInformationSystemsandtheNationalAssociationofChildrensHospitalsandRelatedInstitutions(NACHRI)

ThegoalofthiscollaborationwastoexpandtheoldAPDRGcodingsystemtoincludediagnosesandconditionsthatwerespecifictopediatricpatientpopulations

APRDRGconsidersthepatientsage,sex,birthweight,dischargestatus,primarycauseforadmission,andasmanysecondarydiagnosesthatareneededtodescribethepatientscurrentstateofhealth*

*Medicareonlyacceptslines225fromyourcodingprofileSavage,Leah(Ed.).(2017).PediatricCDI:BuildingBlocksforSuccess.Middleton,MA:HCPro.

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OurHistory

APRDRG(cont.) JustlikeMSDRG,theAPRDRGsystemassignsarelative

reimbursementandaLOSparameter,butitalsoassignsaseverityofillness(SOI)andariskofmortality(ROM)score

TheSOIandROMarescoredbyseveritylevel: 1 Minor 2 Moderate 3 Major 4 Extreme

TheSOIandROMthatiscalculatedbytheAPRDRGsystemprovidesawaytomeasurethehealthcareproviderscomplicatedpatientpopulation

Savage,Leah(Ed.).(2017).PediatricCDI:BuildingBlocksforSuccess.Middleton,MA:HCPro.

2018 Copyright, HCPro, an H3.Group division of Simplify Compliance LLC. All rights reserved. These materials may not be copied without written permission.

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OurHistory

ThepatientscoresintheAPRDRGsystem:APRDRG194 HF RW1.8244 LOS8.76

SOI4 ROM4

EndStageCHFAcuteonchronicsystolicheartfailure,cardiogenicshock,NSTEMI2,NSVT,mixedacidbasebalance,CKD4

ThepatientscoresintheMSDRGsystem:MSDRG293 HFw/MCC RW1.4796 LOS5.8

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TheAPRDRGEncoder

InaRelationship

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TheAPRDRGEncoder

194 HeartFailure

MDAPRDRGandMDCInformation

Clicktoopenallofyour+boxestochangethemtoboxes

3MAPRDRGReportPOASOI/ROMDischargeSOI/ROMLogicPaths

AdvancedSessionReportMSDRGAPRDRGAnalyzerSummaryDiagnosisCodeDetailProcedureCodeDetail

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TheAPRDRGEncoder

I5023 Acuteonchronicsystolicheartfailure

DiagnosisCodeDetail

Codebook CodingCl CodingHB CDI HCC

TheselectedcodeCodealsoExcludesnotesOthercodesinthatsubgroup

AnyCodingClinic thatmentionstheselecteddxcode

ICD10focusedOtherdxsDefinitions

Clinicaldocumentationconcepts

HierarchicalConditionCategory

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TheAPRDRGEncoder

AddDiagnosis

AddProcedure

Codebook

DirectCode

DRGOptions

Analyze

Complete

Diagnosissuggestionstoconsider

MSRP

IfyouleaveyourNosologyMessages/Editsboxopen,thereisalotlessclickingonthisbutton

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TheHierarchyofSecondaryDiagnosesintheAPRDRGEncoder

SecondaryDiagnosisWiththeHighest

Rank

SecondaryDiagnosesThatImpactSOI/ROM

TheRemainingSecondaryDiagnosesThatHaveNoImpactonSOI/ROM

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TheAPRDRGEncoder

SOI ROM CODE

P P I5023 Acuteonchronicsystolicheartfailure

3 3 N179 Acutekidneyfailure

2 3 R64 Cachexia

1 1 E785 Hyperlipidemia

1 1 Z66 DNR

TheSOIandROMscoresareunderlinedTheSOIandROMscoreswillIMPACT theprincipalDRGscore

OnlytheROMscoreisunderlinedOnlytheROMscorewill IMPACTtheprincipalDRGscoreTheSOIscorewillNOTimpacttheprincipalDRGscore

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IMPACT

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ThisIsYourONETHING!

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APRDRGCodingProfilesUsedinThisPresentation Allofthecodingprofilesusea>70yearoldpatient

demographic. AllofthecodingprofileswerebuilttofocusontheROM

levelscoring. Therulesforlevelassignmentusedinthispresentationcan

beappliedtoSOIlevelscoringaswell. Iusedabbreviationsinthecodingprofilestosavespace,so

whenyouseeAKI,Iintendforyoutothinkacutekidneyinjury.Donotqueryme!

Ididnotlistcombinationcodes(hypertensiveheartdisease)inthepresentationscodingprofiles,buttheywereincludedwhenItestedthesescenarios.ThecombinationcodesdonotaddvaluetotheSOIorROM,buttheydobetterdescribethecomplexityofthepatient.

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ItsNotYou,ItsMe

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Itsallaboutrelationships.

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1.TheRelationshipBetweenthePatientsAgeandtheAssignedROMLevel

SOI ROM 3yearoldfemale

3 4 A419Sepsis

2 2 J189Pneumonia

4 3 N179AKI

3 4 R6521Severesepsis

withshock

SOI ROM 40yearoldfemale

3 3 A419Sepsis

2 2 J189Pneumonia

3 4 R6521Severesepsis

withshock

3 3 N179AKI

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1.TheRelationshipBetweenthePatientsAgeandtheAssignedROMLevel

SOI ROM 40yearoldfemale

3 3 A419Sepsis

2 2 J189Pneumonia

3 4 R6521Severesepsis

withshock

3 2 N179AKI

SOI ROM 64yearoldfemale

3 3 A419Sepsis

2 2 J189Pneumonia

3 4 R6521Severesepsis

withshock

3 2 N179AKI

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1.TheRelationshipBetweenthePatientsAgeandtheAssignedROMLevel

SOI ROM 64yearoldfemale

3 3 A419Sepsis

2 2 J189Pneumonia

3 3 R6521Severesepsis

withshock

3 2 N179AKI

SOI ROM 65yearoldfemale

3 4 A419Sepsis

2 3 J189Pneumonia

3 4 R6521Severesepsis

withshock

3 3 N179AKI

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1.TheRelationshipBetweenthePatientsAgeandtheAssignedROMLevel

SOI ROM 104yearoldfemale

3 4 A419Sepsis

2 3 J189Pneumonia

3 4 R6521Severesepsis

withshock

3 3 N179AKI

SOI ROM 65yearoldfemale

3 4 A419Sepsis

2 3 J189Pneumonia

3 4 R6521Severesepsis

withshock

3 3 N179AKI

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TheimpactofageisseenmoreintheROMlevelthanitisfortheSOIlevel

65yearsofage Afib,COPD,nephritis,acidosis,

hypotension >69yearsofage Viralpneumonia,mitralvalve

disorder,anemia,specifiedbacterialpneumonia,peritonitis

>79yearsofage Fractureoffemurorpelvis,pleuraleffusion

1.TheRelationshipBetweenthePatientsAgeandtheAssignedROMLevel

3MAllPatientRefinedDiagnosisRelatedGroups(APRDRG)MethodologyReview,Version35,Oct2017

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AIDS

ESRD

Medicareisnotjustfortheelderly.

Youngeradultswithpermanentdisabilities

1.TheRelationshipBetweenthePatientsAgeandtheAssignedROMLevel

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2.TheRelationshipBetweentheAssignedSOIandROMLevelsforEachSecondaryDiagnosis

Ingeneral,theassignedSOIlevelwillbehigherthantheassignedROMlevel.

Therearesomeexceptions:Acidosis SOI2 ROM3DOE SOI1 ROM3Oliguria SOI2ROM4Hypotension SOI2ROM3

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3.TheRelationshipBetweenthePrincipalDiagnosisandROM

SOI ROM

2 2 I2109 STEMI

3MAllPatientRefinedDiagnosisRelatedGroups(APRDRG)MethodologyReview,Version35,Oct2017

SOI ROM

2 2 J9601Acuterespfailure

SOI ROM

2 2 S225XXA Flailchest

SOI ROM

2 4 I711Ruptured aorticaneurysm

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4.TheRelationshipBetweenaSpecificPrincipalDiagnosisandaSecondaryDiagnosis

SOI ROM

3 3 A419 Sepsis,unsporganism

3 3 I5023AonCsys CHF

3 3 N179 AKI

2 3 J189Pneumonia

2 2 Dehydration

X X R6520Severesepsisw/oshock

SOI ROM

4 4 I5023AonCsys CHF

4 4 R6520Severesepsisw/oshock

3 3 N179 AKI

3 3 J189Pneumonia

2 3 Dehydration

3 3 A419 Sepsis,unsporganism

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AcutesystolicCHF Pleuraleffusion

Newborn Malignant DuetoSLE Duetoheartfailure Other/unspecifiedThecodingpathwayforpleuraleffusiondirectsyoubacktotheCHFcodingpathway.

5.TheRelationshipBetweenthePrincipalDiagnosisandanAssociatedSecondaryDiagnosis

3MAllPatientRefinedDiagnosisRelatedGroups(APRDRG)MethodologyReview,Version35,Oct2017

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5.TheRelationshipBetweenthePrincipalDiagnosisandanAssociatedSecondaryDiagnosis

Thereisanexceptiontothisrule:

APRDRG190AcuteMyocardialInfarction

ExtensionofaSTEMI

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6.TheRelationshipBetweenTwoSecondaryDiagnoses

SOI ROM

3 3 A419 Sepsis,unsporganism

3 3 I5023AonCsys CHF

3 3 N179 AKI

2 3 J189Pneumonia

X X R6520Severesepsisw/oshock

SOI ROM

3 4 A419 Sepsis,unsporganism

3 3 I5023AonCsys CHF

3 3 N179 AKI

2 3 J189Pneumonia

2 2 Dehydration

X X R6520Severesepsisw/oshock

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7.TheRelationshipBetweenSecondaryDiagnosesintheSameGroup

SOI ROM

2 1 J441COPDexacerbation

3 2 J9611Chrrespfailure

SOI ROM

3 3 J441COPDexacerbation

4 4 J9622AonCrespfailure

3 2 J9611Chrrespfailure

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7.TheRelationshipBetweenSecondaryDiagnosesintheSameGroup

SOI ROM

3 3 J441COPDexacerbation

4 4 J9601Acrespfailure

SOI ROM

3 2 J441COPDexacerbation

4 4 J9622AonCrespfailure

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WhenRulesConverge

SOI ROM

3 2 S066X94 TraumaticsubarachnoidhemorrhagewithLOC,initial

4 4 I4901Vfib

4 4 I469Cardiac arrest

3 3 I472Vtach

X X S065X9ATraumaticsubduralhemorrhage withLOC,initial

1 1 Z95810PresenceofAICD

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7.TheRelationshipBetweenSecondaryDiagnosesintheSameGroup

SOI ROM

2 2 I5023 AonCsysHF

3 3 N179AKI

SOI ROM

2 2 I5023Aon CsysHF

2 4 R34Anuriaandoliguria

3 3 N179AKI

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8.TheRelationshipBetweenROMLevelandNonORProcedures

SOI ROM

2 2 I2109 STEMIanterior

SOI ROM

3 4 I2109 STEMIanterior

5A02210 IABP

*SOI

*ROM

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9.TheRelationshipBetweenROMandZCodes

SOI ROM

2 1 I5023AonCsysHF

3 2 Z95811 Presenceofheartassistdevice

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10.TheRelationshipBetweenthePrincipalDiagnosisandtheORProcedure

SOI ROM

1 1 N08GlomerularD/O

0TT10ZZ Resectionofleftkidney

SOI ROM

3 3 N08GlomerularD/O

0TT20ZZResectionofboth kidneys*SOI*ROM

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10.TheRelationshipBetweenthePrincipalDiagnosisandtheORProcedure

SOI ROM

2 1 I25110CADw/angina

1 2 I352AI w/AS

0211093CABGx2

SOI ROM

2 2 I25110CADw/angina

1 2 I352AIw/AS

0211093CABGx2*SOI*ROM

X2RF032AVR*ROM

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10.TheRelationshipBetweenthePrincipalDiagnosisandtheORProcedure

SOI ROM

4 4 I2109 STEMI

3 3 N179AKI

5A02210IABP*SOI*ROM

SOI ROM

3 3 I2109STEMI

3 3 N179 AKI

5A02210 IABP*SOI*ROM

0212093CABGAffectssecondaryDRG

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APRDRGMATHforSecondaryDiagnoses

DONTPANIC

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SOI ROM

3 3 I5023AonCsysHF

4 4 J9601Acrespfailure

SOI ROM

4 4 I5023 AonCsysHF

4 4 J9601Ac respfailure

4 4 I21A1NSTEMI2

3MAllPatientRefinedDiagnosisRelatedGroups(APRDRG)MethodologyReview,Version35,Oct2017

4 + 4 = 4

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SOI ROM

3 3 I5023AonCsysHF

4 4 I21A1NSTEMI2

3 3 N179AKI

SOI ROM

4 4 I5023 AonCsysHF

4 4 I21A1 NSTEMI2

3 3 N179AKI

3 3 I472NSVT

3MAllPatientRefinedDiagnosisRelatedGroups(APRDRG)MethodologyReview,Version35,Oct2017

4 + 3 + 3 = 4

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3MAllPatientRefinedDiagnosisRelatedGroups(APRDRG)MethodologyReview,Version35,Oct2017

SOI ROM

4 3 I5023AonCsysHF

4 3 I330Acuteinfectiveendocarditis

4 3 E43 Unspsevereproteinmalnutrition

3 3 L89154 Pressureulcerstage4

SOI ROM

2 3 I5023AonCsysHF

4 3 I330 Acuteinfectiveendocarditis

4 3 E43 Unspsevereproteinmalnutrition

3 3 L89154 Pressureulcerstage4

3 3 N179 AKI

3 3 3 3+ + + = 4

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3MAllPatientRefinedDiagnosisRelatedGroups(APRDRG)MethodologyReview,Version35,Oct2017

ROM4

4 +4 =4

4 +3 +3 =4

3 +3 +3 +3 =4

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SOI ROM

3 2 I5023AonCsysHF

4 4 I21A1NSTEMI2

SOI ROM

3 3 I5023 AonCsysHF

4 4 I21A1 NSTEMI2

3 3 N179AKI

3MAllPatientRefinedDiagnosisRelatedGroups(APRDRG)MethodologyReview,Version35,Oct2017

4 + 3 = 3

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SOI ROM

2 2 I5023AonCsysHF

3 3 I472NSVT

SOI ROM

3 3 I5023Aon CsysHF

3 3 I472NSVT

3 3 N179AKI

3MAllPatientRefinedDiagnosisRelatedGroups(APRDRG)MethodologyReview,Version35,Oct2017

3 + 3 = 3

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3MAllPatientRefinedDiagnosisRelatedGroups(APRDRG)MethodologyReview,Version35,Oct2017

SOI ROM

2 2 I5023AonCsysHF

2 3 E872 Acidosis

1 2 K760 Fattyliver

SOI ROM

2 3 I5023AonCsysHF

2 3 E872 Acidosis

1 2 K760Fattyliver

1 2 N183CKD3

3 + 2 + 2 = 3

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51

3MAllPatientRefinedDiagnosisRelatedGroups(APRDRG)MethodologyReview,Version35,Oct2017

ROM3

4 +3 =3

3 +3 =3

3 +2 +2 =3

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3MAllPatientRefinedDiagnosisRelatedGroups(APRDRG)MethodologyReview,Version35,Oct2017

SOI ROM

3 2 I5023AonCsysHF

4 4 I21A1NSTEMI2

4 = 2

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3MAllPatientRefinedDiagnosisRelatedGroups(APRDRG)MethodologyReview,Version35,Oct2017

SOI ROM

2 2 I5023AonCsysHF

2 3 E872 Acidosis

1 2 K760 Fattyliver

3 + 2 = 2

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ROM 2

4 =2

3 +2 =2

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EndStageCHFROMCodingProfile

MCC 4 +3 4 +4 4+3+3

Acute corpulmonale X

CVA X

Acute endocarditis X

AMI X

NSTEMI2 X

PE X

Aspiration pneumonia X

Respiratory failure X

AKIwithATN X

Cardiogenic shock X

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APR_DRG Analysis

DRG 194Heart Failure

Weight 1.8244

ALOS 8.76

SOI 4Extreme

ROM 4 Extreme

MS_DRG Analysis

DRG 293Heart Failure&Shock(withMCC)

Weight 1.4796

ALOS 5.8

PrincipalDiagnosis

I5023Acuteonchronicsystolic(congestive)heartfailure

SecondaryDx SOI ROM

R570Cardiogenic shock 4Extreme 4Extreme

I472Ventriculartachycardia 3Major 3Major

E874 Mixeddisorderofacidbase 3Major 3Major

I272OthersecondarypulmHTN 2Mod 2Mod

E878Otherd/oofelectrolytebal 2Mod 2Mod

K761 Chronicpassivelivercong 1 Minor 2 Mod

N183 CKD,stage3(moderate) 1 Minor 2 Mod

E871 Hypoosmoandhyponatrem 2Mod 1Minor

E8342Hypomagnesemia 2Mod 1Minor

I255 Ischemiccardiomyopathy 2Mod 1 Minor

I248Other formsofacuteischheartdz

1Minor 2Mod

R5381Othermalaise 1Minor 1Minor

R600Localizededema 1Minor 1Minor

CHFNYSEClass4D

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57

HeresaStory

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CODINGPROFILE

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Thankyou.Questions?

[email protected]

Inordertoreceiveyourcontinuingeducationcertificate(s)forthisprogram,youmustcompletetheonlineevaluation.Thelinkcanbefoundinthecontinuingeducationsectionatthefrontoftheprogramguide.

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ICD10Code DiagnosisDescription

ICD10Code DiagnosisDescription

E872 Acidosis I110 HypertensiveheartdiseasewheartfailureD684 Acquiredcoagulationfactordeficiency I959 Hypotension,unspecifiedK353 Acuteappendicitiswithlocalizedperitonitis J84112 IdiopathicpulmonaryfibrosisT7611XA Adultphysicalabuse,suspected,initial C9201 Leukemia,acutemyeloblastic,inremissionF1029 Alcoholdependwalcoholinduceddisorder C9590 Leukemia,unspecnotachievedremissionF1019 Alcoholusewalcoholinduceddisorder D6862 LupusanticoagulantsyndromeD62 Anemia,acuteposthemorrhagic A6920 Lymedisease,unspecifiedD6481 Anemiaduetoantineoplasticchemo F331 Majordepressivedis,recurrent,moderateI728 Aneurysmofspecifiedartery CXXXX Malignantneoplasms,primary/metastaticR0681 Apnea,NEC K592 Neurogenicbowel,NECR188 Ascites E6601 Obesity,morbidJ45901 Asthma,unspedifiedwithacuteexacerbation I6603 Occlu/stenosbilatmiddlecerebralarteriesI4891 Atrialfibrillation R34 OliguriaZ68.XX BMI>40 F1120 Opioiddependence,uncomplicatedG540 Brachialplexusdisorders M86622 Osteomyelitis,chronic,lefthumerusR64 Cachexia K560 ParalyticileusK8051 Calculous,bileduct G822X ParaplegiaI429 Cardiomyopathy,unspecified M84453A PathologicalfracturesL03311 Cellulitisofabdominalwall K766 PortalhypertensionK812 Cholecystitis,acutewchroniccholecystitis F0781 PostconcussionalsyndromeN18X Chronickidneydisease,stage4,stage5 L89XXX Pressureulcerextremities

ICD10Code DiagnosisDescription

ICD10Code DiagnosisDescription

K630 Abscessofintestine F332 Majordepressdis,recurseverewopsychoticN179 Acutekidneyfailure,unspecified E440 Malnutrition,moderateE873 Alkalosis E46 Malnutrition,unspecifiedG931 Anoxicbraindamage,notelsewhereclassified E8411 MeconiumileusincysticfibrosisR180 Ascites,malignant D709 Neutropenia,unspecifiedI442 Atrioventricularblock,complete K859X Pancreatitis,acuteK5521 AVMintestine,withhemorrhage D61818 PancytopeniaR7881 Bacteremia I309 Pericarditis,acuteK831 Bileductobstruction J90 Pleuraleffusion,notelsewhereclassifiedA047 C.Diff J910 Pleuraleffusion,malignantI671 Cerebralaneurysmnonruptured J18X Pneumonia,unspecifedorganismI63XXX Cerebralinfarct,unspecifiedprecerebralartery J12X Pneumonia,viralI63032 Cerebralinfrct,d/tthrombsisleftcarotidartery L89XXX Pressureulcers:back,buttock,hip,sacrumK830 Cholangitis L89XXX Pressureulcers:othersites,stage4K80XX Cholecystitis,acutewithGBstone G8250 Quadriplegia,unspecifiedI50XX Congestiveheartfailure,acute J9611 Respiratoryfailure,chronicEXXXXX Diabeticketoacidosiswocoma A419 Sepsis,unspecifiedorganismI82XXX Embolism&thrombosis,acute E222 SIADHG9340 Encephalopathy T86XX TransplantcomplicationsK250 Gastriculcer,acutewithhemorrhage K260 Ulcer,duodenal,acutewithhemorrhageK2901 Gastritis,acutewithbleeding K437 VentralherniawithgangreneK2931 Gastritis,chronicsuperficial,withbleeding I472 VentriculartachycardiaD8981X Graftversushostdisease J129 Viralpneumonia,unspecifiedI5021 Heartfailure(congestive)systolicacute ZCodes:K920 Hematemesis Z7682 AwaitingorgantransplantstatusG919 Hydrocephalus,unspecified Z430 EncounterforattentiontotracheostomyD693 Immunethrombocytopenicpurpura Z94XX Organtransplantstatusexckidney&boneJ849 Interstitialpulmonarydisease,unspecified Z95811 PresenceofheartassistdeviceK5660 Intestinalobstruction Z930 Tracheostomystatus

K750 Abscessofliver J9851 MediastinitisI21XX AcuteMI K650 PeritonitisN170 Acutetubularnecrosis(ATN) J690 Pneumonia,aspirationT8601 Bonemarrowtransplantrejection J15X Pneumonia,bacterialG935 Braincompression J96XX Respiratoryfailure,acuteG936 Cerebraledema J121 RespiratorysyncytialviruspneumoniaI63031 Cerebralinfrcd/tthrombosisrightcarotidartery A41XX Sepsis,staph,hemophilus,e.Coli,pseudomonasI63XXX Cerebralinfarct,mostarteries R57X ShockD65 Disseminatedintravascularcoagulation(DIC) R6511 SIRSofnoninfectoriginwithacorgandysfuncJ100X Fluduetoothidentfluviruswfpneumonia I22X SubsequentMIK767 Hepatorenalsyndrome K26X Ulcergastric,acutewithperforationK55X Infarctorischemia,intestine I49XX Ventricularfibrillation/flutterE43 Malnutrition,severe Z9911 Dependenceonrespirator(vent)status

DiagnosesbySeverityLevelAPRDRGV34SeverityLevel3Conditions(Moderate)

SeverityLevel4Conditions(Severe)