APR DRG Classification Data Elements MDC (Major Diagnostic Category) Base APR DRG (316 base APR DRG categories) Four Severity of Illness Subclasses* Subclass Severity 1 Minor 2 Moderate 3 Major 4 Extreme Four Risk of Mortality Subclasses * Severity subclasses have APR DRG weights for each subclass. APR DRGs are first classified into major diagnostic categories, followed by base APR DRGs These are the components of APR DRG adjusted data for both Severity of Illness (how sick one is) and Risk of Mortality (how likely one is to die). Major Diagnostic Category APR DRG SOI Subclass ROM Subclass

Underlying Principle of 3M™ APR DRGs Severity of illness (SOI) and risk of mortality (ROM) are dependent on the patient’s underlying problem. High severity of illness and risk of mortality are characterized by multiple serious diseases and the interaction among those diseases. A few slides to explain the very basics of All Patient Refined DRGs. First and foremost, the underlying principle of APR DRGs is that the severity of illness and risk of mortality of a patient are dependent on the underlying problems that the patient brings with them. A high severity of illness and a high risk of mortality are characterized by multiple serious underlying diseases, and how those diseases interact with each other. For example – Severity of Illness: A Knee replacement patient due to sports injuries with no chronic diseases versus a knee replacement patient over 65 with heart disease, hypertension, and diabetes. For example – Risk of Mortality: An infection patient who is also immune-suppressed and due to other diseases is more severely ill, is at a much higher risk of dying than a patient admitted with an infection and a broken arm Should these patients be compared to each other as equals when evaluating length of stay or mortality?

3M™ APR DRG Assignment is Driven by: Principal diagnosis Procedures performed All secondary diagnoses Age Gender

Example of Progression of Severity of Illness Subclass Secondary Diagnosis of Diabetes Mellitus 1 Minor Uncomplicated Diabetes (250.0x) 2 Moderate Diabetes with Renal Manifestation (250.4x) 3 Major Diabetes with Ketoacidosis (250.1x) 4 Severe Diabetes with Hyperosmolar Coma (250.2x) The calculation of SOI and ROM involves 18 steps over 3 phases. The initial step is to assign the standard or default SOI level to each individual secondary diagnosis. The next 17 steps apply logic to calculate the overall patient SOI. For example, secondary diagnosis are compared to each other and the principal diagnosis for duplication. APR DRG assignment and the patient’s age are evaluated, and other other criteria are applied. Here is an example of the standard or default SOI assignment for some diabetes codes.

Example of Progression of Risk of Mortality Subclass Secondary Diagnosis of Cardiac Arrhythmias 1 Minor Premature beats (427.60) 2 Moderate Sinoatrial Node Dysfunction (427.81) 3 Major Paroxysmal Ventricular Tachycardia (427.1) 4 Severe Ventricular Fibrillation (427.41) And here is an example of the standard ROM level for cardiac codes. For example, premature beats are not necessarily life threatening while ventricular fibrillation could certainly result in death. ROM is calculated separately and distinctly from SOI codes.

SOI and ROM are Independent The severity of illness and risk of mortality subclass are calculated separately and may be different from each other. Severity of Illness is a weight base ROM is based on many factors including age & gender ROM = 1 Low risk of mortality Major severity of illness SOI = 3 Acute Cholecystitis Example: Acute Cholecystitis (Gall bladder attack) Patient is severely ill, organ is in extreme state of decomposition However, we have a very effective intervention that does not pose a high risk of death to the patient.