Comparison of Differences in CMS DRG Version 30 and APR DRG Version Top Ranking Delivery Groupings by Charges for Massachusetts HDD CMS DRG CMS Version 30 DRG 766 Cesarean section wo CCMCC ID: 705127
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Slide1
If I want to
identify
potential delivery records, which DRG is the best for me?Slide2
Comparison of Differences in
CMS DRG Version 30 and APR DRG Version Top Ranking Delivery Groupings by Charges for Massachusetts HDD
CMS DRGCMS Version 30 DRG766Cesarean section w/o CC/MCC775Vaginal delivery w/o complicating diagnoses765Cesarean section w CC/MCC774Vaginal delivery w complicating diagnoses767Vaginal delivery w sterilization &/or D&C776Postpartum & post abortion diagnoses w/o O.R. procedure781Other antepartum diagnoses w medical complications794Neonate w other significant problems982Extensive O.R. procedure unrelated to principal diagnosis w CC782Other antepartum diagnoses w/o medical complications768Vaginal delivery w O.R. proc except steril &/or D&C792Prematurity w/o major problems789Neonates, died or transferred to another acute care facility791Prematurity w major problems793Full term neonate w major problems769Postpartum & post abortion diagnoses w O.R. procedure
APR DRGAPR DRG* Version 30 DRG540Cesarean delivery560Vaginal delivery541Vaginal delivery w sterilization &/or D&C561Postpartum & post abortion diagnoses w/o procedure566Other antepartum diagnoses640Neonate birthwt >2499g, normal newborn or neonate w other problem542Vaginal delivery w complicating procedures exc sterilization &/or D&C950Extensive procedure unrelated to principal diagnosis625Neonate bwt 2000-2499g w other significant condition614Neonate bwt 1500-1999g w or w/o other significant condition546Other O.R. proc for obstetric diagnoses except delivery diagnoses639Neonate birthwt >2499g w other significant condition633Neonate birthwt >2499g w major anomaly544D&C, aspiration curettage or hysterotomy for obstetric diagnoses626Neonate bwt 2000-2499g, normal newborn or neonate w other problem621Neonate bwt 2000-2499g w major anomaly580Neonate, transferred <5 days old, not born here
*
Note
: APR DRG includes additional Subclass
groupings by Category for
Severity of Illness
and
Risk of Mortality Slide3
PDX V3000: Single liveborn, born in hospital, delivered without mention of cesarean section
Admission age in days: 0
Discharge status: HomeBirthweight: 500G
Case 1Case 2Case 3Case 4DescriptionSecondary Diagnoses 748.4748.4770.8748.4770.8753.0Congenital Cystic LungRespiratory Failure of NBRenal Agenesis
CMS DRG
APR DRG 391591 Subclass 1390591 Subclass 2389591Subclass 3389591 Subclass 4Normal Newborn/ Newborn with other significant problems/Full Term Neonate w/ Maj. Prob. Neonate, birth weight 500-749G, without major procedureCMS DRGAPR DRG0.25600.11340.28922.63200.643012.89010.643023.1141Payment weights**
*
Source: Lisa Lyons, An Overview of 3MTM All Patient Refined Diagnostic Related Groups (3M APR DRG), July 13, 2012, 3M HIS** Payment weights are budget neutral and computed from a national database
Comparison of CMS-DRG to APR-DRG for 4 Single Liveborn Cases*Slide4
Comparison of CMS-DRG to APR-DRG for Preterm Infant*
* Source: All Patient Refined DRGs, a Methodology Overview, 2006, 3M HIS, https://msmedicaid.acs-inc.com/trainingMaterials/MSAPR-Methodology.pdf