Final Report - Table of AR-DRG v8.0 splitting logic

Appendix 2: AR-DRG Version 8.0 Splitting Logic

Note: The ECCS of each episode is rounded to the nearest multiple of 0.5 before being evaluated against the splitting thresholds.

ADRG

Code IHPA report Description

801 OR Procedures Unrelated to Principal Diagnosis

960 Ungroupable

961 Unacceptable Principal Diagnosis

963 Neonatal Diagnosis Not Consistent W Age/Weight

A01 Liver Transplant

A03 Lung or Heart-Lung Transplant

A05 Heart Transplant

A06 Tracheostomy and/or Ventilation >=96hours

A07 Allogeneic Bone Marrow Transplant

A08 Autologous Bone Marrow Transplant

A09 Kidney Transplant

A10 Insertion of Ventricular Assist Device

A11 Insertion of Implantable Spinal Infusion Device

A12 Insertion of Neurostimulator Device

A40 ECMO

B01 Ventricular Shunt Revision

B02 Cranial Procedures

B03 Spinal Procedures

B04 Extracranial Vascular Procedures

B05 Carpal Tunnel Release

B06

Procedures for Cerebral Palsy, Muscular Dystrophy and

Neuropathy

DRG Count

3

1

1

1

2

1

2

2

1

3

1

1

3

1

3

3

2

2

2

1

3

AR-DRG V8.0 Specifications

Splitting Logic

If (ECCS >= 3.5) then 801A; else if (ECCS >= 2.0) then 801B; else 801C

960Z

961Z

963Z

A01Z

A03Z

A05Z

If (ECCS >= 4.5) then A06A; else if (ECCS >= 2.5) then A06B; else A06C

If (age_years <= 16) or (ECCS >= 4.0) then A07A; else A07B

If (ECCS >= 2.5) then A08A; else A08B

If (age_years <= 16) or (ECCS >= 3.0) then A09A; else A09B

A10Z


A12Z


If (ECCS >= 3.0) then B01A; else B01B

If (ECCS >= 3.5) then B02A; else if (ECCS >= 2.0) then B02B; else B02C



B05Z


Appendix 2 – AR-DRG Version 8.0 Splitting Logic - Development of the Australian Refined Diagnosis Related Groups V8.0 – Final Report 31 October 2014 1

B41

B62 Apheresis

B64 Delirium

B65 Cerebral Palsy

B69

B70

B71

B76 Seizures

B77 Headaches

B78 Intracranial Injuries

ADRG

Code

B07

IHPA report Description

Cranial or Peripheral Nerve and Other Nervous System

Procedures

B40 Plasmapheresis W Neurological Disease, Sameday

Telemetric EEG Monitoring

B42 Nervous System Disorders W Ventilator Support

B60 Acute Paraplegia and Quadriplegia W or W/O OR Procedures

B61 Spinal Cord Conditions W or W/O OR Procedures

B63 Dementia and Other Chronic Disturbances of Cerebral Function

B66 Nervous System Neoplasms

B67 Degenerative Nervous System Disorders

B68 Multiple Sclerosis and Cerebellar Ataxia

TIA and Precerebral Occlusion

Stroke and Other Cerebrovascular Disorders

Cranial and Peripheral Nerve Disorders

B72 Nervous System Infection Except Viral Meningitis

B73 Viral Meningitis

B74 Nontraumatic Stupor and Coma

B75 Febrile Convulsions

DRG Count

2

1

1

2

2

2

1

2

2

2

2

3

2

2

4

2

2

1

2

1

2

2

3


Splitting Logic


B40Z

B41Z




B62Z








If (los <= 4) and (sep_mode = '01') then B70D; else if (ECCS >= 4.0) then B70A; else if (ECCS >= 2.5) then B70B; else B70C



B73Z


B75Z



If (los <= 4) and (sep_mode = '01') then B78C; else if (ECCS >= 3.0) then B78A; else B78B


DRG Count

2

2

2

3


Splitting Logic





2

2

1

2

2

1

1

1

1

1

2

1

2

1

2

3

1

3

1

2

If (ECCS >= 1.0) then C01A; else C01B

C02Z



C05Z

C10Z

C11Z

C12Z

C13Z


C15Z

C16Z




If (ECCS >= 3.5) then C63A; else if (ECCS >= 1.0) then C63B; else C63C

D01Z

If (ECCS >= 3.0) then D02A; else if (ECCS >= 2.0) then D02B; else D02C

D03Z

If (ECCS >= 2.0) then D04A; else D04B

ADRG

Code

B79 Skull Fractures

B80 Other Head Injuries


B81 Other Disorders of the Nervous System

B82

Chronic and Unspecified Paraplegia/Quadriplegia W or W/O OR

Procedures

C01 Procedures for Penetrating Eye Injury

C02 Enucleations and Orbital Procedures

C03 Retinal Procedures

C04 Major Corneal, Scleral and Conjunctival Procedures

C05 Dacryocystorhinostomy

C10 Strabismus Procedures

C11 Eyelid Procedures

C12 Other Corneal, Scleral and Conjunctival Procedures

C13 Lacrimal Procedures

C14 Other Eye Procedures

C15 Glaucoma and Complex Cataract Procedures

C16 Lens Procedures

C60 Acute and Major Eye Infections

C61 Neurological and Vascular Disorders of the Eye

C62 Hyphaema and Medically Managed Trauma to the Eye

C63 Other Disorders of the Eye

D01 Cochlear Implant

D02 Head and Neck Procedures

D03 Surgical Repair for Cleft Lip and Palate Disorders

D04 Maxillo Surgery


2

2

3

2

2

3

2

2

2

2

2

2

2

2

2

1

1

2

DRG Count

1

1

2

1

1

1

2


Splitting Logic

D05Z

D06Z

D10Z

D11Z


D13Z


D15Z

D40Z









If (ECCS >= 4.5) then E01A; else if (ECCS >= 2.5) then E01B; else E01C

If (ECCS >= 3.5) then E02A; else if (ECCS >= 1.0) then E02B; else E02C

If (ECCS >= 2.5) then E40A; else E40B






ADRG


D05 Parotid Gland Procedures

D06 Sinus and Complex Middle Ear Procedures

D10 Nasal Procedures

D11 Tonsillectomy and Adenoidectomy

D12 Other Ear, Nose, Mouth and Throat Procedures

D13 Myringotomy W Tube Insertion

D14 Mouth and Salivary Gland Procedures

D15 Mastoid Procedures

D40 Dental Extractions and Restorations

D60 Ear, Nose, Mouth and Throat Malignancy

D61 Dysequilibrium

D62 Epistaxis

D63 Otitis Media and Upper Respiratory Infections

D64 Laryngotracheitis and Epiglottitis

D65 Nasal Trauma and Deformity

D66 Other Ear, Nose, Mouth and Throat Disorders

D67 Oral and Dental Disorders

E01 Major Chest Procedures

E02 Other Respiratory System OR Procedures

E40 Respiratory System Disorders W Ventilator Support

E41 Respiratory System Disorders W Non-Invasive Ventilation

E42 Bronchoscopy

E60 Cystic Fibrosis

E61 Pulmonary Embolism

E62 Respiratory Infections and Inflammations


ADRG AR-DRG V8.0 Specifications

Code

E63 Sleep Apnoea


E64 Pulmonary Oedema and Respiratory Failure

E65 Chronic Obstructive Airways Disease

E66 Major Chest Trauma

E67 Respiratory Signs and Symptoms

E68 Pneumothorax

E69 Bronchitis and Asthma

DRG Count

2

2

2

2

2

2

2

Splitting Logic








E70

E71

E72

Whooping Cough and Acute Bronchiolitis

Respiratory Neoplasms

Respiratory Problems Arising from Neonatal Period

2

2

1

2

2

3

2



E72Z

If (ECCS >= 3.5) then E73A; else if (ECCS >= 2.0) then E73B; else E73C E73 Pleural Effusion

E74

E75

E76

Interstitial Lung Disease

Other Respiratory System Disorders

Respiratory Tuberculosis




If (ECCS >= 2.5) then F01A; else F01B F01 Implantation and Replacement of AICD, Total System

F02 Other AICD Procedures

F03

F04

Cardiac Valve Procedures W CPB Pump W Invasive Cardiac

Investigation

Cardiac Valve Procedures W CPB Pump W/O Invasive Cardiac

Investigation

F05 Coronary Bypass W Invasive Cardiac Investigation

F06 Coronary Bypass W/O Invasive Cardiac Investigation

2

1

2

3

2

2

F02Z

If (ECCS >= 2.5) then F03A; else F03B

If (ECCS >= 4.0) then F04A; else if (ECCS >= 2.0) then F04B; else F04C



F07 Other Cardiothoracic/Vascular Procedures W CPB Pump

F08 Major Reconstructive Vascular Procedures W/O CPB Pump

F09 Other Cardiothoracic Procedures W/O CPB Pump

F10 Interventional Coronary Procedures, Admitted for AMI

3

3

3

2






F62

F63

Heart Failure and Shock

Venous Thrombosis

ADRG

Code

F11


Amputation, Except Upper Limb and Toe, for Circulatory

Disorders

F12 Implantation and Replacement of Pacemaker, Total System

F13 Amputation, Upper Limb and Toe, for Circulatory Disorders

F14

F15

F16

Vascular Procedures, Except Major Reconstruction, W/O CPB

Pump

Interventional Coronary Procedures, Not Admitted for AMI W

Stent Implantation

Interventional Coronary Procedures, Not Admitted for AMI W/O

Stent Implantation

F17 Insertion and Replacement of Pacemaker Generator

F18 Other Pacemaker Procedures

F19 Trans-Vascular Percutaneous Cardiac Intervention

F20 Vein Ligation and Stripping

F21 Other Circulatory System OR Procedures

F40 Circulatory Disorders W Ventilator Support

F41

F42

Circulatory Disorders, Admitted for AMI W Invasive Cardiac

Investigative Procs

Circulatory Disorders, Not Admitted for AMI W Invasive Cardiac

Investig Procs

F43 Circulatory Disorders W Non-Invasive Ventilation

F60

Circulatory Disorders, Admitted for AMI W/O Invasive Cardiac

Investigative Procs

F61 Infective Endocarditis

2

2

3

DRG Count

2


Splitting Logic





2


2


2

2

2

1

3

2

2




F20Z




2


2

2


If (los <= 4) and (sep_mode = '01') then F60B; else F60A

2

3

2


If (los <= 4) and (sep_mode = '01') then F62C; else if (ECCS >= 3.0) then F62A; else F62B



3

2

2

2

1

2

3

2

3

2

2

3

3

2

3

2

2

3

DRG Count

3

2

2

2

2

2

2


Splitting Logic












If (ECCS >= 4.0) then G01A; else if (ECCS >= 2.5) then G01B; else G01C




If (ECCS >= 2.5) then G05A; else G05B

G06Z









ADRG


F64 Skin Ulcers in Circulatory Disorders

F65 Peripheral Vascular Disorders

F66 Coronary Atherosclerosis

F67 Hypertension

F68 Congenital Heart Disease

F69 Valvular Disorders

F72 Unstable Angina

F73 Syncope and Collapse

F74 Chest Pain

F75 Other Circulatory Disorders

F76 Arrhythmia, Cardiac Arrest and Conduction Disorders

G01 Rectal Resection

G02 Major Small and Large Bowel Procedures

G03 Stomach, Oesophageal and Duodenal Procedures

G04 Peritoneal Adhesiolysis

G05 Minor Small and Large Bowel Procedures

G06 Pyloromyotomy

G07 Appendicectomy

G10 Hernia Procedures

G11 Anal and Stomal Procedures

G12 Other Digestive System OR Procedures

G46 Complex Endoscopy

G47 Gastroscopy

G48 Colonoscopy

G60 Digestive Malignancy


3

2

2

2

2

3

3

2

2

2

1

3

3

3

2

2

2

3

DRG Count

2

2

2

2

2

2

3


Splitting Logic







If (ECCS >= 4.5) then H01A; else if (ECCS >= 2.0) then H01B; else H01C

If (ECCS >= 2.5) then H02A; else H02B












If (ECCS >= 1.0) then I01A; else I01B

If (ECCS >= 4.0) then I02A; else if (ECCS >= 2.0) then I02B; else I02C




I06Z

ADRG


G61 Gastrointestinal Haemorrhage

G64 Inflammatory Bowel Disease

G65 Gastrointestinal Obstruction

G66 Abdominal Pain and Mesenteric Adenitis

G67 Oesophagitis and Gastroenteritis

G70 Other Digestive System Disorders

H01 Pancreas, Liver and Shunt Procedures

H02 Major Biliary Tract Procedures

H05 Hepatobiliary Diagnostic Procedures

H06 Other Hepatobiliary and Pancreas OR Procedures

H07 Open Cholecystectomy

H08 Laparoscopic Cholecystectomy

H40 Endoscopic Procedures for Bleeding Oesophageal Varices

H43 ERCP Procedures

H60 Cirrhosis and Alcoholic Hepatitis

H61 Malignancy of Hepatobiliary System and Pancreas

H62 Disorders of Pancreas, Except Malignancy

H63 Other Disorders of Liver

H64 Disorders of the Biliary Tract

I01 Bilateral and Multiple Major Joint Procedures of Lower Limb

I02

I03

Microvascular Tissue Transfers or Skin Grafts, Excluding Hand

Hip Replacement

I04

I05

I06

Knee Replacement

Other Joint Replacement

Spinal Fusion for Deformity


Code

I07

I08

I09

I10

I11

I12

I13

I15

I16

I17

I18

I19

I20

I21

I23

I24

I25

I27

I28

I29

I30

I31

I32

Soft Tissue Procedures

Hand Procedures

ADRG


Amputation

Other Hip and Femur Procedures

Spinal Fusion

Other Back and Neck Procedures

Limb Lengthening Procedures

Miscellaneous Musculoskeletal Procs for Infection/Inflammation of Bone and Joint

Humerus, Tibia, Fibula and Ankle Procedures

Cranio-Facial Surgery

Other Shoulder Procedures

Maxillo-Facial Surgery

Other Knee Procedures

Other Elbow and Forearm Procedures

Other Foot Procedures

Local Excision and Removal of Internal Fixation Devices of Hip and Femur

Local Excision and Removal of Internal Fixation Devices, Except

Hip and Femur

Arthroscopy

Bone and Joint Diagnostic Procedures Including Biopsy

Other Musculoskeletal Procedures

Knee Reconstructions, and Revisions of Reconstructions

Revision of Hip Replacement

Revision of Knee Replacement

DRG Count

1

2

3

2

1

3

2

2

2

2

1

2

2

1

2

2

3

1

2

2

1

3

2



I16Z





I21Z


Splitting Logic

I07Z




I11Z







I29Z

I30Z




I67

I68

I69

I71

I72

I73

I74

Code

I40

I60

I61

I63

I64

I65

I66

I79

I80

I81

I82

I75

I76

I77

I78

J01

J06

ADRG


Infusions for Musculoskeletal Disorders, Sameday

Femoral Shaft Fractures

Distal Femoral Fractures

Sprains, Strains and Dislocations of Hip, Pelvis and Thigh

Osteomyelitis

Musculoskeletal Malignant Neoplasms

Inflammatory Musculoskeletal Disorders

Septic Arthritis

Non-surgical Spinal Disorders

Bone Diseases and Arthropathies

Other Musculotendinous Disorders

Specific Musculotendinous Disorders

Aftercare of Musculoskeletal Implants or Prostheses

Injuries to Forearm, Wrist, Hand and Foot

Injuries to Shoulder, Arm, Elbow, Knee, Leg and Ankle

Other Musculoskeletal Disorders

Fractures of Pelvis

Fractures of Neck of Femur

Pathological Fractures

Femoral Fractures, Transferred to Acute Facility <2 Days

Musculoskeletal Injuries, Sameday

Other Sameday Treatment for Musculoskeletal Disorders

Microvascular Tissue Transfers for Skin, Subcutaneous Tissue &

Breast Disorders

Major Procedures for Breast Disorders

2

2

2

2

2

2

2

DRG Count

1

1

2

2

2

2

3

1

1

2

1

2

2

2

3

2


Splitting Logic

I40Z

I60Z


















I80Z

I81Z

I82Z

If (ECCS >= 2.5) then J01A; else J01B

2 If (ECCS >= 3.0) then J06A; else J06B


DRG Count

2

3

1

2


Splitting Logic


If (ECCS >= 3.5) then J08A; else if (ECCS >= 2.0) then J08B; else J08C

J09Z


2

1

3

3

2

2

2

2

2

2

1

3

2

2

2

1

2

2

2

2




J14Z









If (ECCS >= 3.5) then K01A; else if (ECCS >= 2.0) then K01B; else K01C

If (ECCS >= 3.0) then K02A; else K02B

K03Z



K08Z



ADRG

Code

J07

J08

J09

J10

J11

J12

J13

J14

J60

J62

J63


Minor Procedures for Breast Disorders

Other Skin Grafts and Debridement Procedures

Perianal and Pilonidal Procedures

Plastic OR Procedures for Skin, Subcutaneous Tissue and Breast

Disorders

Other Skin, Subcutaneous Tissue and Breast Procedures

Lower Limb Procedures W Ulcer or Cellulitis

Lower Limb Procedures W/O Ulcer or Cellulitis

J64

J65

J67

J68

Major Breast Reconstructions

Skin Ulcers

Malignant Breast Disorders

Non-Malignant Breast Disorders

Cellulitis

Trauma to Skin, Subcutaneous Tissue and Breast

Minor Skin Disorders

Major Skin Disorders

J69 Skin Malignancy

K01 OR Procedures for Diabetic Complications

K02 Pituitary Procedures

K03 Adrenal Procedures

K05 Parathyroid Procedures

K06 Thyroid Procedures

K08 Thyroglossal Procedures

K09 Other Endocrine, Nutritional and Metabolic OR Procedures

K10 Revisional and Open Bariatric Procedures


1

1

2

3

3

2

3

2

2

3

2

2

2

3

2

2

1

2

1

3

2

ADRG

L08

L09

L40

L41

L42

L60

L61

L62

L63


K11 Major Laparoscopic Bariatric Procedures

K12 Other Bariatric Procedures

K13

Plastic OR Procedures for Endocrine, Nutritional and Metabolic

Disorders

K40 Endoscopic and Investigative Procedures for Metabolic Disorders

K60 Diabetes

K61 Severe Nutritional Disturbance

K62 Miscellaneous Metabolic Disorders

K63 Inborn Errors of Metabolism

K64 Endocrine Disorders

L02

L03

Operative Insertion of Peritoneal Catheter for Dialysis

Kidney, Ureter and Major Bladder Procedures for Neoplasm

L04

L05

L06

L07

Kidney, Ureter and Major Bladder Procedures for Non-Neoplasm

Transurethral Prostatectomy for Urinary Disorder

Minor Bladder Procedures

Other Transurethral Procedures

Urethral Procedures

Other Procedures for Kidney and Urinary Tract Disorders

Ureteroscopy

Cystourethroscopy for Urinary Disorder, Sameday

ESW Lithotripsy

Kidney Failure

Haemodialysis

Kidney and Urinary Tract Neoplasms

Kidney and Urinary Tract Infections

DRG Count

2

2

1


Splitting Logic



K13Z




If (ECCS >= 3.5) then K62A; else if (ECCS >= 2.0) then K62B; else K62C



If (ECCS >= 2.5) then L02A; else L02B

If (ECCS >= 3.5) then L03A; else if (ECCS >= 2.0) then L03B; else L03C







L40Z

L41Z

L42Z


L61Z




ADRG

Code

L64

L65


Urinary Stones and Obstruction

Kidney and Urinary Tract Signs and Symptoms

L66

L67

Urethral Stricture

Other Kidney and Urinary Tract Disorders

L68 Peritoneal Dialysis

M01 Major Male Pelvic Procedures

M02 Transurethral Prostatectomy for Reproductive System Disorder

M03 Penis Procedures

M04 Testes Procedures

M05 Circumcision

M06 Other Male Reproductive System OR Procedures

M40

Cystourethroscopy for Male Reproductive System Disorder,

Sameday

M60 Male Reproductive System Malignancy

M61 Benign Prostatic Hypertrophy

M62 Male Reproductive System Inflammation

M63 Male Sterilisation Procedures

M64 Other Male Reproductive System Disorders

N01 Pelvic Evisceration and Radical Vulvectomy

N04 Hysterectomy for Non-Malignancy

N05

Oophorectomy and Complex Fallopian Tube Procedures for Non-

Malignancy

N06 Female Reproductive System Reconstructive Procedures

N07 Other Uterus and Adnexa Procedures for Non-Malignancy

N08

Endoscopic and Laparoscopic Procedures, Female Reproductive

System

DRG Count

2

2

1

3

1

2

2

2

1

1

2

1

2

2

2

1

2

2

2

2

2

2

1

Splitting Logic



L66Z


L68Z

If (ECCS >= 2.5) then M01A; else M01B



M04Z

M05Z


M40Z





M63Z


If (ECCS >= 2.5) then N01A; else N01B





N08Z


ADRG


N09 Other Vagina, Cervix and Vulva Procedures

N10 Diagnostic Curettage and Diagnostic Hysteroscopy

N11 Other Female Reproductive System OR Procedures

N12 Uterus and Adnexa Procedures for Malignancy

N60 Female Reproductive System Malignancy

N61 Female Reproductive System Infections

N62 Menstrual and Other Female Reproductive System Disorders

O01 Caesarean Delivery

O02 Vaginal Delivery W OR Procedures

O03 Ectopic Pregnancy

O04 Postpartum and Post Abortion W OR Procedures

O05 Abortion W OR Procedures

O60 Vaginal Delivery

O61 Postpartum and Post Abortion W/O OR Procedures

O63 Abortion W/O OR Procedures

O66 Antenatal and Other Obstetric Admissions

P01

Neonate W Sig OR Proc or Vent>=96hrs, Died or Transfer to

Acute Facility <5 Days

P02 Cardiothoracic and Vascular Procedures for Neonates

P03

P04

Neonate, AdmWt 1000-1499g W Significant OR Procedure or

Ventilation >=96hours



P05



P06 Neonate, AdmWt >=2500g W Significant OR Procedure or

3

2

2

1

2

2

3

2

2

DRG Count

1

1

2

2

2

3

2

1


Splitting Logic

N09Z

N10Z


If (ECCS >= 4.0) then N12A; else if (ECCS >= 2.0) then N12B; else N12C




If (ECCS >= 4.5) then O01A; else if (ECCS >= 2.0) then O01B; else O01C

If (ECCS >= 3.5) then O02A; else O02B



O05Z

If (ECCS >= 4.0) then O60A; else if (ECCS >= 2.0) then O60B; else O60C




P01Z

1

2

P02Z

If (ECCS >= 2.5) then P03A; else P03B

2


2

2






P07 Neonate, AdmWt <750g W Significant OR Procedure

P08 Neonate, AdmWt 750-999g W Significant OR Procedure

P60

Neonate W/O Sig OR or Vent>=96hrs, Died or Transferred to

Acute Facility <5Days

P61 Neonate, AdmWt <750g W/O Significant OR Procedure

P62 Neonate, AdmWt 750-999g W/O Significant OR Procedure

P63

P64

P65

P66

P67

P68

Neonate, AdmWt 1000-1249g W/O Significant OR Procedure or








Neonate, AdmWt >=2500g W/O Sig OR Proc/Vent>=96hrs, <37

Completed Wks Gestation

Neonate, AdmWt >=2500g W/O Sig OR Proc/Vent>=96hrs, >=37

Completed Wks Gestation

Q01 Splenectomy

ADRG

Q02 Blood and Immune System Disorders W Other OR Procedures

Q60 Reticuloendothelial and Immunity Disorders

Q61 Red Blood Cell Disorders

Q62 Coagulation Disorders

R01

R02

R03

Lymphoma and Leukaemia W Major OR Procedures

Other Neoplastic Disorders W Major OR Procedures

Lymphoma and Leukaemia W Other OR Procedures

DRG Count

1

1

2

1

2

2

2

4

4

4

4

3

3

2

2

2

3

2

2

P07Z

P08Z


P61Z


Splitting Logic




If (ECCS >= 4.5) then P65A; else if (ECCS >= 3.5) then P65B; else if (ECCS >= 2.5) then P65C; else P65D




If (ECCS >= 3.5) then Q01A; else Q01B



If (ECCS >= 2.5) then Q61A; else if (ECCS >= 1.0) then Q61B; else Q61C


If (ECCS >= 2.0) then R01A; else R01B

If (ECCS >= 4.0) then R02A; else if (ECCS >= 2.5) then R02B; else R02C



2

2

2

2

2

2

2

2

2

2

2

3

1

2

2

1

3

2

DRG Count

2

2

1

3

2

3

3


Splitting Logic





R63Z

If (ECCS >= 6.0) then S65A; else if (ECCS >= 2.5) then S65B; else S65C

If (ECCS >= 3.0) then T01A; else if (ECCS >= 2.0) then T01B; else T01C

T40Z


If (ECCS >= 2.5) then T61A; else T61B




U40Z

If (ECCS >= 1.0) then U60A; else U60B









If (ECCS >= 3.0) then V60A; else V60B


ADRG


R04 Other Neoplastic Disorders W Other OR Procedures

R60 Acute Leukaemia

R61 Lymphoma and Non-Acute Leukaemia

R62 Other Neoplastic Disorders

R63 Chemotherapy

S65 Human Immunodeficiency Virus

T01 Infectious and Parasitic Diseases W OR Procedures

T40 Infectious and Parasitic Diseases W Ventilator Support

T60 Septicaemia

T61 Postoperative and Post-Traumatic Infections

T62 Fever of Unknown Origin

T63 Viral Illnesses

T64 Other Infectious and Parasitic Diseases

U40 Mental Health Treatment W ECT, Sameday

U60 Mental Health Treatment W/O ECT, Sameday

U61 Schizophrenia Disorders

U62 Paranoia and Acute Psychotic Disorders

U63 Major Affective Disorders

U64 Other Affective and Somatoform Disorders

U65 Anxiety Disorders

U66 Eating and Obsessive-Compulsive Disorders

U67 Personality Disorders and Acute Reactions

U68 Childhood Mental Disorders

V60 Alcohol Intoxication and Withdrawal

V61 Drug Intoxication and Withdrawal


ADRG


V62 Alcohol Use and Dependence

V63 Opioid Use and Dependence

V64 Other Drug Use and Dependence

V65 Treatment for Alcohol Disorders, Sameday

V66 Treatment for Drug Disorders, Sameday

W01

W02

Ventilation, Tracheostomy and Cranial Procedures for Multiple

Significant Trauma

Hip, Femur and Lower Limb Procedures for Multiple Significant

Trauma

W03 Abdominal Procedures for Multiple Significant Trauma

W04 Multiple Significant Trauma W Other OR Procedures

W60

Multiple Significant Trauma, Died or Transferred to Acute Facility

<5 Days

W61 Multiple Significant Trauma W/O OR Procedures

X02

Microvascular Tissue Transfer and Skin Grafts for Injuries to

Hand

X04 Other Procedures for Injuries to Lower Limb

X05 Other Procedures for Injuries to Hand

X06 Other Procedures for Other Injuries

X07 Skin Grafts for Injuries Excluding Hand

X40

Injuries, Poisoning and Toxic Effects of Drugs W Ventilator

Support

X60 Injuries

X61 Allergic Reactions

X62 Poisoning/Toxic Effects of Drugs and Other Substances

X63 Sequelae of Treatment

DRG Count

2

1

1

1

1

3


Splitting Logic


V63Z

V64Z

V65Z

V66Z

If (ECCS >= 3.5) then W01A; else if (ECCS >= 2.0) then W01B; else W01C

2

1

2

2

2

2

2

2

3

3

2

2

2

2

2

If (ECCS >= 3.0) then W02A; else W02B

W03Z




If (ECCS >= 3.5) then X02A; else X02B



If (ECCS >= 3.5) then X06A; else if (ECCS >= 2.0) then X06B; else X06C

If (ECCS >= 3.5) then X07A; else if (ECCS >= 2.0) then X07B; else X07C







ADRG


X64 Other Injuries, Poisonings and Toxic Effects

Y01

Ventilation or Tracheostomy for Burns or OR Proc for Severe Full

Thickness Burns

Y02 Skin Grafts for Other Burns

Y03 Other OR Procedures for Other Burns

Y60 Burns, Transferred to Acute Facility <5 Days

Y61 Severe Burns

Y62 Other Burns

Z01 Other Contacts W Health Services W OR Procedures

Z40 Other Contacts W Health Services W Endoscopy, Sameday

Z60 Rehabilitation

Z61 Signs and Symptoms

Z63 Other Follow Up After Surgery or Medical Care

Z64 Other Factors Influencing Health Status

Z65

Congenital Anomalies and Problems Arising from Neonatal

Period

Z66 Sleep Disorders

2

3

2

1

2

2

3

1

2

2

1

1

DRG Count

2

1


Splitting Logic


Y01Z

If (ECCS >= 3.5) then Y02A; else if (ECCS >= 2.0) then Y02B; else Y02C

If (ECCS >= 2.5) then Y03A; else Y03B

Y60Z

Y61Z

If (ECCS >= 3.0) then Y62A; else Y62B

If (ECCS >= 3.0) then Z01A; else Z01B

Z40Z


If (ECCS >= 2.5) then Z61A; else if (ECCS >= 1.0) then Z61B; else Z61C



Z65Z

1 Z66Z


Final Report - Table of AR-DRG v8.0 splitting logic

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