AR-DRG V9.0 Final Report - IHPA



AR-DRG Version 9.0 - Final Report1 December 2016Prepared for the Independent Hospital Pricing AuthorityThis page intentionally left blankContentsContenti TOC \o "1-2" \h \z \u Glossary of Abbreviations PAGEREF _Toc468204652 \h iiiExecutive Summary PAGEREF _Toc468204653 \h 1Overview PAGEREF _Toc468204654 \h 11.Introduction PAGEREF _Toc468204655 \h 31.1.Background PAGEREF _Toc468204656 \h 31.2 Governance and consultation process PAGEREF _Toc468204657 \h 32.Overview of AR-DRG Version 9.0 PAGEREF _Toc468204658 \h 53.Development of the work program PAGEREF _Toc468204659 \h 84.Review process and outcomes PAGEREF _Toc468204660 \h 10Statistical Analysis PAGEREF _Toc468204661 \h 10Data preparation PAGEREF _Toc468204662 \h 104.1Review of Pre MDC ADRGs PAGEREF _Toc468204663 \h 114.2Review of Pre MDC A06 Tracheostomy and/or Ventilation >=96 hours PAGEREF _Toc468204664 \h 134.3ADRGs using Pre MDC reassignment logic PAGEREF _Toc468204665 \h 144.4ADRGs in the ‘Other’ partition PAGEREF _Toc468204666 \h 164.5ADRGs using administrative variables in their definition PAGEREF _Toc468204667 \h 204.6ADRGs with a lack of clinical distinctiveness PAGEREF _Toc468204668 \h 235.Splitting ADRGs PAGEREF _Toc468204669 \h 245.1 Splitting models PAGEREF _Toc468204670 \h 255.2Splitting selection process PAGEREF _Toc468204671 \h 285.3Splitting outcome PAGEREF _Toc468204672 \h 296.Public Submissions PAGEREF _Toc468204673 \h 317.Overall statistical performance of AR-DRG Version 9.0 PAGEREF _Toc468204674 \h 318.Conclusion PAGEREF _Toc468204675 \h 32Appendix A: V9.0 ADRG DescriptionsA PAGEREF _Toc468204676 \h 1Appendix B: V9.0 DRG DescriptionsB PAGEREF _Toc468204677 \h 1List of Tables TOC \h \z \c "Table" Table 1: New/Deleted ADRGs for AR-DRG Version 9.0 PAGEREF _Toc466365297 \h 5Table 2: Number of ADRGs and DRGs in AR-DRG V8.0 and V9.0 PAGEREF _Toc466365298 \h 7Table 3: ADRGs removed from Pre MDC with newly created ADRGs PAGEREF _Toc466365299 \h 12Table 4: ADRGs removed from Pre MDC PAGEREF _Toc466365300 \h 13Table 5: Replacement of A06 PAGEREF _Toc466365301 \h 14Table 6: Changes to ADRGs using Pre MDC reassignment logic PAGEREF _Toc466365302 \h 15Table 7: ADRGs in the ‘Other’ partition being removed PAGEREF _Toc466365303 \h 18Table 8: ADRGs in the ‘Other’ partition being revised PAGEREF _Toc466365304 \h 18Table 9: Retained ADRGs from the ‘Other’ partition PAGEREF _Toc466365305 \h 19Table 10: ADRGs with administrative variables removed from the definition PAGEREF _Toc466365306 \h 21Table 11: ADRG with administrative variable revised PAGEREF _Toc466365307 \h 21Table 12: Retained ADRGs using administrative variables PAGEREF _Toc466365308 \h 22Table 13: ADRGs lacking clinical distinctiveness PAGEREF _Toc466365309 \h 23Table 14: Splitting criteria and thresholds PAGEREF _Toc466365310 \h 24Table 15: ADRG groups for splitting decisions PAGEREF _Toc466365312 \h 28Table 16: Comparison of number of DRGs V8.0 vs V9.0 PAGEREF _Toc466365313 \h 30Glossary of AbbreviationsAbbreviationDescriptionABFActivity Based FundingACCDAustralian Consortium for Classification DevelopmentACHIAustralian Classification of Health InterventionsACSAustralian Coding StandardsADRG(s)Adjacent Diagnosis Related GroupsAIHWAustralian Institute of Health and WelfareAMIAcute Myocardial InfarctionAPCAdmitted Patient CareAR-DRGAustralian Refined Diagnosis Related GroupsCCAGClassification Clinical Advisory GroupCLIPClassification Information PortalCVCoefficient of VariationDCLDiagnosis Complexity LevelDRG(s)Diagnosis Related GroupsDTGDRG Technical GroupECCEpisode Clinical ComplexityECCSEpisode Clinical Complexity ScoreECMOExtracorporeal Membrane OxygenationECTElectroconvulsive TherapyEDEmergency DepartmentEEGElectroencephalogramERCPEndoscopic Retrograde Cholangio-PancreatographyESWExtracorporeal shock waveGIGeneral InterventionHIVHuman Immunodeficiency VirusHMVHours of Mechanical VentilationICDInternational Classification of DiseasesICD-10-AMInternational Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian ModificationICD-10-AM/ACHI/ACSInternational Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification, the Australian Classification of Health Interventions and the Australian Coding StandardsIHPAIndependent Hospital Pricing AuthorityITGICD Technical GroupMDCMajor Diagnostic CategoryNCCHNational Centre for Classification in HealthNHCDCNational Hospital Cost Data CollectionNMDSNational Minimum DatasetNon ORNon Operating RoomOROperating RoomPAPricing AuthorityPCAPrincipal Clinical AdvisorPDxPrincipal diagnosisProcProcedureRIDReduction in DevianceSISpecific InterventionVVersionWWithW/OWithoutWSUWestern Sydney UniversityExecutive SummaryOverviewThis report presents the results of the project to develop the Australian-Refined Diagnosis Related Groups (AR-DRG) Version 9.0. A new case complexity methodology, known as the Episode Clinical Complexity (ECC) Model, was implemented into the classification in AR-DRG Version 8.0, where the major revision was at the end class, or Diagnosis Related Group (DRG) level. The structural component of the classification was left unchanged during this development cycle. The work program for Version 9.0 primarily focused on a review at this higher level of the classification, utilising the improvements made to the classification in Version 8.0 with the improvement in the calculation of case complexity. The Australian Consortium for Classification Development (ACCD) consulted extensively with both the Classifications Clinical Advisory Group (CCAG) and the DRG Technical Group (DTG) in developing the work program and then developing proposals, reviewing the results of comprehensive investigations and statistical analyses, and determining the final recommendations for consideration by the Pricing Authority (PA).A systematic review was undertaken which incorporated the Pre Major Diagnostic Category (Pre MDC) Adjacent Diagnosis Related Groups (ADRGs) and other selected ADRGs, including those in the ‘Other’ partition within the Major Diagnostic Categories (MDCs), those using administrative variables in their definition, and two ADRGs specifically identified as lacking clinical distinctiveness. The work program also incorporated the review of public submissions, and proposals as highlighted through modifications arising from the concurrent International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification, the Australian Classification of Health Interventions and the Australian Coding Standards (ICD-10-AM/ACHI/ACS) Tenth Edition development work undertaken by ACCD. The development work for AR-DRG Version 9.0 followed the Principles for Construction of AR-DRGs that were developed for Version 8.0.The final result was a slight decrease in the number of ADRGs and DRGs, reduced by seven and four respectively with a similar overall statistical performance as in AR-DRG Version 8.0. Significant changes include:Refinement to the classification of episodes previously grouping to A06 Tracheostomy and/or Ventilation >=96 hours, with its replacement by three new ADRGs, providing an increase in DRGs from three to eight.Improvements to the clinical coherency of the classification, including the removal of human immunodeficiency virus (HIV) as a condition that previously overrode the principal diagnosis (PDx) in the grouping logic.Reduction in the use of administrative variables (e.g. length of stay) to define ADRGs.Simplification in the structure of the classification with the removal of the ‘Other’ partition. The structural changes implemented in Version 9.0 build on the improvements implemented at the end class in Version 8.0, and provide an updated and streamlined framework on which to base future development work. IntroductionACCD is contracted by the Commonwealth of Australia as represented by the Independent Hospital Pricing Authority (IHPA) to maintain, develop and improve the AR-DRG Classification System. The consortium is led by the University of Sydney’s National Centre for Classification in Health (NCCH) in collaboration with Western Sydney University (WSU) and KPMG.There are two major components of the AR-DRG Classification system:ICD-10-AM/ACHI/ACS, andThe AR-DRG classification.1.1 BackgroundFollowing the completion of ICD-10-AM/ACHI/ACS Ninth Edition and AR-DRG Version 8.0 (both released in July 2015), the AR-DRG Classification System development work has continued, to deliver ICD-10-AM/ACHI/ACS Tenth Edition and AR-DRG Version 9.0 both scheduled for release in July 2017.The major focus of the AR-DRG Version 9.0 development has been at the ADRG level. This work was a progression from the development and implementation of the ECC model in Version 8.0 where the major changes were at the end class, or DRG level, with the ADRG structure unchanged. In addition, the momentum behind a systematic review of ADRGs had been building for some years and a range of issues with the current system had been identified both by public submissions and input from various expert groups, committees and stakeholders. 1.2 Governance and consultation processThe PA has the overall governance role and is responsible for the effective and efficient performance of IHPA’s functions. The final decision on the AR-DRG Classification System rests with the PA.ACCD’s governance arrangements, endorsed by IHPA, include management of the following advisory and technical groups to ensure appropriate communication channels:ICD Technical Group (ITG): advice in regard to the refinement and development of ICD-10-AM/ACHI/ACS.DRG Technical Group (DTG): advice in regard to the refinement and development of AR-AG: to facilitate broad canvassing of clinical opinion to ensure that there is likely to be general acceptance of the developed proposals.The DTG includes representatives from Australian state and territory health authorities as well as the New Zealand Ministry of Health, Australian Private Hospitals Association, Catholic Health Australia, Private Healthcare Australia, Australian Government Department of Health, IHPA and the National Hospital Cost Data Collection (NHCDC) Advisory Committee. The ICD Technical Group and CCAG also have representatives attending DTG meetings.Clinical and technical advice for AR-DRG Version 9.0 content was provided by CCAG, DTG, and the ACCD’s Principal Clinical Advisor (PCA), who in turn consult widely with their peers and within their jurisdictions and organisations.In addition, a public consultation process on the major changes proposed for AR-DRG Version 9.0 was undertaken during the period 1 to 31 August 2016. The comments received were considered in the final determination of changes to be implemented for Version 9.0.The principles for construction of the AR-DRG classification included in the ACCD report of 31 October 2014 have been followed in developing AR-DRG Version 9.0.Overview of AR-DRG Version 9.0There are a total of 399 ADRGs in AR-DRG Version 9.0 with 396 non-error ADRGs and three error ADRGs (960 Ungroupable, 961 Unacceptable Principal Diagnosis and 963 Neonatal Diagnosis Not Consistent W Age/Weight), representing a net decrease of seven ADRGs (see REF _Ref466300194 \h \* MERGEFORMAT Appendix A: V9.0 ADRG Descriptions). There are eight newly created ADRGs (some of which resulted from the combining or splitting of Version 8.0 ADRGs) and 15 deleted ADRGs (some of which were combined or split into new ADRGs) (see REF _Ref466281011 \h \* MERGEFORMAT Table 1). Eight Pre MDC ADRGs were retained, with all but one of these (A40 ECMO) moving into their natural MDC, and so have been renumbered to align with the MDC where they are now placed.Table SEQ Table \* ARABIC 1: New/Deleted ADRGs for AR-DRG Version 9.0New/Deleted ADRGsDescriptionNew ADRGs (Total = 8)A13 Ventilation >=336 hours (arising from deletion of A06)A14 Ventilation >=96 hours & <336 hours (arising from deletion of A06)A15 Tracheostomy (arising from deletion of A06)B83 Acute Paraplegia and Quadriplegia and Spinal Cord Conditions (arising from combining of B60 and B61)E77 Bronchiectasis (newly created to separate these episodes from E65)F24 Interventional Coronary Procs, Not Adm for AMI (arising from the combining of F15 & F16)H65 Bleeding Oesophageal Varices (arising from the deletion of H40)I33 Hip Replacement for Non-Trauma (newly created to separate these episodes from I03)New/Deleted ADRGsDescriptionDeleted ADRGs (Total – 15)A06 Tracheostomy and/or Ventilation >=96 hours (split into A13, A14, A15)A11 Insertion of Implantable Spinal Infusion DeviceA12 Insertion of Neurostimulator DeviceB60 Acute Paraplegia and Quadriplegia W or W/O OR Procedures (combined with B61 into newly created B83)B61 Spinal Cord Conditions W or W/O OR Procedures (combined with B60 into newly created B83)F15 Interventional Coronary Procs, Not Adm for AMI, W Stent Implant (combined with F16 into newly created F24)F16 Interventional Coronary Procs, Not Adm for AMI, W/O Stent Implant (combined with F15 into newly created F24)H40 Endoscopic Procedures for Bleeding Oesophageal Varices (medical ADRG H65 created) H43 ERCP ProceduresI40 Infusions for Musculoskeletal DisordersI81 Musculoskeletal InjuriesI82 Other Sameday Treatment for Musculoskeletal DisordersS65 Human Immunodeficiency VirusV65 Treatment for Alcohol Disorders, SamedayV66 Treatment for Drug Disorders, SamedayOf the 399 ADRGs in AR-DRG Version 9.0, 87 have no split (Z), 225 have one split (A,B), 82 have two splits (A, B, C) and five have three splits (A, B, C, D). A comparison of the number of ADRGs and DRGs between AR-DRG Version 8.0 and Version 9.0 is provided in REF _Ref466282015 \h \* MERGEFORMAT Table 2 (refer to Appendix B for full listing of Version 9.0 DRGs). Table SEQ Table \* ARABIC 2: Number of ADRGs and DRGs in AR-DRG V8.0 and V9.0 LINK Excel.Sheet.12 "Book1" "Sheet1!R3C1:R9C5" \a \f 5 \h \* MERGEFORMAT Number of DRGs in ADRGNumber of ADRGs V8.0Number of ADRGs V9.0Number of DRGs V8.0Number of DRGs V9.01858785872246225492450370822102464552020Total406399807803Development of the work programThe AR-DRG classification hinges on two successive levels of classification: MDCs further subdivided by ADRGs which seek to group clinically similar conditions, and DRGs which further subdivide ADRGs according to complexity (as calculated by the ECC Score (ECCS)). The development of Version 8.0 used a data driven approach to the splitting of ADRGs into component DRGs, based on measured relative resource use as a proxy for clinical complexity. The ECC model determines the relative use of each and every diagnosis (including the PDx) in each episode, in the context of the ADRG, and then identifies ‘splits’ into the end classes, or DRGs. The resulting DRGs were better matched to complexity than earlier versions, providing the platform to effectively review and improve the classification at the ADRG level.The Version 9.0 work program was initially sourced from clinical recommendations provided by the CCAG, and then in consultation with DTG and IHPA committees. Extensive investigation and data analysis was undertaken on each of the recommendations to provide the technical information to inform the decisions, made in consultation with both CCAG and the DTG. Specific ADRGs were selected for review as part of the Version 9.0 development because: many current ADRGs appear to work well and can safely be left as they arean incremental approach, targeting specific problems, minimises disruption as new AR-DRG versions are introduced. In consultation with CCAG and DTG, the following groups of ADRGs were included for review:Pre MDC ADRGsADRGs using Pre MDC processing logicADRGs in the ‘Other’ partition ADRGs using administrative variables in their definitionADRGs with a lack of clinical distinctiveness.The work program also included:the review of DRG public submissions, including submissions that had been held over from previous development cycles and those submitted to ACCD through the ACCD Classification Information Portal (CLIP) prior to the close off date (31 May 2016)proposals as highlighted through modifications arising from the concurrent ICD-10-AM/ACHI/ACS Tenth Edition development work.Review process and outcomesStatistical AnalysisComprehensive analysis was undertaken on all proposals to determine the episode movements and measure the impact on performance, both at an overall classification level and for blocks of episodes. Data preparationThe modelling and analysis work for AR-DRG Version 9.0 drew upon the latest acute admitted episode data available to ACCD, including the Admitted Patient Collection (APC) managed by the Australian Institute of Health and Welfare (AIHW) and the NHCDC managed by IHPA.The primary source of cost data was the latest three years of data from the NHCDC (2011/12 to 2013/14). The business rules for data exclusions (i.e. removal of certain episodes and certain codes) were generally consistent with those used for V8.0. All episode costs reported in the NHCDC were used, except those reported within the depreciation and Emergency Department (ED) cost buckets. The ED costs were unsuitable to use for the purpose of the classification development as there were inconsistencies in this data item across the different years’ data sets. The costs were adjusted to the 2013/14 value, using the health price index published by the AIHW.Similar to the development of Version 8.0, the ability to include private sector data in the modelling work, and to address issues raised by private sector representatives was constrained by the absence of private hospital cost data. In order to manage this data limitation, the three years APC data (2010-11 to 2012-13) was used to compare clinical profiles between public and private hospital patients as required. 4.1 Review of Pre MDC ADRGsPre MDC ADRGs fall into two groups:The ADRGs which have been created to group very high cost treatment, such as organ transplant.The ADRG which groups together all episodes that include a very high cost service as a component of their care (notably prolonged ventilation in A06 which is covered in section REF _Ref466300427 \r \h 0 below).In these episodes, the care provided is used to group the episodes rather than the patient condition. The outcome is that the Pre MDC ADRGs can include patients with a variety of conditions. In Pre MDC processing, the PDx is overridden. The 11 Pre MDC ADRGs in Version 8.0 were all reviewed to determine if it was still appropriate to separate out these episodes on the basis of the care provided, given that in accordance with the principles underlying the development, the classification should be based as far as possible on patient characteristics (notably diagnoses or main intervention).Outcomes:A selection of the Pre MDC ADRGs were considered to appropriately define episodes according to the treatment provided and so have been retained as a group. As the PDx for each of these was predominately located in a particular MDC, new ADRGs have been created in the appropriate MDCs (using the same logic, i.e. the episode will group to that ADRG regardless of the PDx) (see REF _Ref481415707 \h Table 3). These ADRGs are placed at the top of the Intervention partition hierarchy within the MDCs.Table SEQ Table \* ARABIC 3: ADRGs removed from Pre MDC with newly created ADRGsV8.0 Pre MDC ADRGTitleChanges for AR-DRG Version 9.0A01Liver transplantRemoved from Pre MDC with new ADRG (H09) created in MDC 07 Diseases and Disorders of the Hepatobiliary System and Pancreas A03Lung or Heart-Lung TransplantRemoved from Pre MDC with new ADRG (E03) created in MDC 04 Diseases and Disorders of the Respiratory System A05Heart transplantRemoved from Pre MDC with new ADRG (F23) created in MDC 05 Diseases and Disorders of the Circulatory System A07Allogeneic Bone Marrow TransplantRemoved from Pre MDC with new ADRG (R05) created in MDC 17 Neoplastic Disorders A08Autologous bone marrow transplantRemoved from Pre MDC with new ADRG (R06) created in MDC 17 Neoplastic Disorders A09Kidney transplantRemoved from Pre MDC with new ADRG (L10) created in MDC 11 Diseases and Disorders of the Kidney and Urinary Tract A10Insertion of Ventricular Assist DeviceRemoved from Pre MDC with new ADRG (F22) created in MDC 05 Diseases and Disorders of the Circulatory System Outcome:Two Pre MDC ADRGs were removed (see REF _Ref466283505 \h \* MERGEFORMAT Table 4), as the frequencies and costs did not warrant the existence of a Pre MDC, and the episodes were considered to be more appropriately grouped to MDCs according to the PDx. Thus these episodes will be spread across a range of MDCs. Table SEQ Table \* ARABIC 4: ADRGs removed from Pre MDCV8.0 Pre MDC ADRGTitleChanges for AR-DRG Version 9.0A11Insertion of Implantable Spinal Infusion DeviceRemoved with episodes grouping to MDCs according to the PDX, and then to ADRGs according to the intervention code(s) A12Insertion of Neurostimulator DeviceRemoved with episodes grouping to MDCs according to the PDX, and then to ADRGs according to the intervention code(s) Outcome:A40 ECMO has been retained as a Pre MDC ADRG, given the high cost and wide range of PDx spread across a range of MDCs, and the small number of specialist sites providing this treatment.4.2 Review of Pre MDC A06 Tracheostomy and/or Ventilation >=96?hoursThe Pre MDC ADRG A06 Tracheostomy and/or Ventilation >=96hours was identified by IHPA as a priority for review for Version 9.0. Pre MDC processing for A06 groups all episodes together that involve a tracheostomy being performed or continuous ventilatory support >=96 hours, regardless of the PDx. This results in a grouping of a wide range of conditions as the PDx of these high cost episodes are not considered in ADRG allocation. Several options were discussed. CCAG advised that the tracheostomy episodes could constitute a separate ADRG. No satisfactory proposal was identified that would allow the remaining episodes to be spread across other MDCs. Additional analyses demonstrated that improvements could be made to the current grouping logic to further classify the episodes into more homogenous categories. Outcome: A06 has been replaced with three new ADRGs within the Pre MDCs, separating out longer term ventilatory episodes (>= 2 weeks) and tracheostomy episodes, resulting in an increase from three DRGs (A06A, A06B, A06C) to eight DRGs across the new ADRGs (refer REF _Ref466284145 \h \* MERGEFORMAT Table 5). The grouping of episodes into A13 or A14 will be determined from the ACHI code 13882-02 [569] Management of continuous ventilation support >= 96 hours and also the Hours of Mechanical Ventilation (HMV) data item from the National Minimum Dataset (NMDS). Episodes will be assigned to A13 where the ventilation hours are >=336 hours. All other episodes will group to A14.Table SEQ Table \* ARABIC 5: Replacement of A06V8.0 Pre MDC ADRGTitleChanges for AR-DRG Version 9.0A06Tracheostomy and/or Ventilation >=96hoursReplace A06 with three new ADRGs:A13 Ventilation >=336 hours (2 weeks) (2 DRGS)A14 Ventilation >=96 and <336 hours (3 DRGs)A15 Tracheostomy (3 DRGs)ACCD has highlighted that consideration may be given to a future review of the proposed Pre MDC ADRGs A13 and A14 to provide additional clinical distinctiveness.4.3ADRGs using Pre MDC reassignment logicIn addition to separating out very high cost ADRGs, Pre MDC processing also changes MDCs where the MDC is not defined exclusively on the basis of the PDx, including in MDC 01 (paraplegia and quadriplegia), MDC 15 (newborns and other neonates), MDC 18 (HIV) and MDC 21 (multiple significant trauma). Of the ADRGs using Pre MDC reassignment, paraplegia and quadriplegia (MDC 01) and HIV (MDC 18) were selected for review as part of the Version 9.0 development work, to determine if it was still appropriate to separate out these episodes given the advances in treatment and management of these conditions that had occurred over recent years. Pre MDC reassignment groups episodes with a PDx of HIV (or an HIV related PDx) and those with an additional diagnosis of HIV to MDC 18 Infectious and Parasitic Diseases. Pre MDC reassignment also groups episodes that include a diagnosis of paraplegia, quadriplegia or specific spinal conditions to one of three medical ADRGs that are at the top of the hierarchy in MDC 01 Diseases and Disorders of the Nervous System, regardless of the PDx or any surgical procedures. Outcomes: Given the changes in the clinical management of HIV, it was determined that these episodes should be classified according to the PDx, which is often a manifestation of the HIV (see REF _Ref466284454 \h \* MERGEFORMAT Table 6). This removes MDC 18 Infectious and Parasitic Diseases HIV from the classification.While the paraplegia/quadriplegia episodes were seen as a complex cohort, there was a large variation in cost distribution, and it was determined that the paraplegia/quadriplegia diagnosis should not override the PDx for surgical episodes as they were better defined by the surgical intervention and thus need to be reclassified to their MDC (see REF _Ref466284454 \h \* MERGEFORMAT Table 6).Table SEQ Table \* ARABIC 6: Changes to ADRGs using Pre MDC reassignment logicV8.0 ADRGChanges for AR-DRG Version 9.0S65 – HIVRemove the Pre MDC logic used for HIV and the ADRG S65 Human Immunodeficiency Virus and allocate HIV related episodes to their ‘natural’ MDC according to the PDxEpisodes with a PDx of HIV to group to ADRG T64 Other Infectious and Parasitic DiseasesB60 - Acute Paraplegia and Quadriplegia W or W/O OR ProceduresB61 - Spinal Cord Conditions W or W/O OR Procedures B82 - Chronic and Unspecified Paraplegia/Quadriplegia W or W/O OR ProceduresSurgical (Operating room [OR]) episodes including a diagnosis of paraplegia/quadriplegia to be removed from the Pre MDC reassignment and assigned to the MDC based on the PDx and then the relevant ADRG based on the interventionMedical episodes with a diagnosis of paraplegia/quadriplegia continue to group to the three ADRGs, with these ADRGs moved to the top of the medical partition in MDC 01B60 and B61 have been combined into a new ADRG due to the low number of episodes grouping to these ADRGs (B83 Acute Paraplegia and Quadriplegia and Spinal Cord Conditions) and B82 has been renamed Chronic and Unspecified Paraplegia/Quadriplegia4.4 ADRGs in the ‘Other’ partition The AR-DRG classification is broadly categorised into MDCs which are generally based on a single body system or aetiology associated with a particular clinical specialty. Within each MDC the ADRGs have clinically meaningful classes generally defined by the PDx or intervention codes. The ADRGs are subdivided into three separate partitions within the MDCs:Surgical: the episode needs to include at least one OR procedure‘Other’: the episode does not include an OR procedure, but includes at least one Non Operating Room (NonOR) procedure considered significant for the MDCMedical: the episode does not include an OR procedure or a locally significant NonOR procedure.As defined in the AR-DRG Definitions Manual Version 8.0, OR procedures are ‘those interventions that are considered significant for all MDCs’, and NonOR procedures are ‘interventions that are considered significant by the classification for only some MDCs’. Generally, the ‘Other’ partition includes non-surgical interventions or some type of ventilator support, however the definition of NonOR procedures only relates to their use in the classification and is not a true clinical definition. Interventions identified as NonOR may actually take place in operating rooms. There is variation in the nature of episodes allocated to the ‘Other’ partition, with some interventions arguably surgical in nature, while others are now ambulatory procedures.All the ADRGs in the ‘Other’ partitions were reviewed to determine whether they should be revised or disaggregated and also, if retained, whether the two different types of interventions could be preserved, noting the outcome of this was a change in name to the Intervention partition to encompass the expanded range of interventions.Outcomes:The Surgical and Other partitions have both been included in a newly created Intervention partition (includes ADRGs with the numeric characters 01 to 59), with the Medical partition being retained as for V8.0 (ADRGs with the numeric characters 60 to 99).OR procedures have been renamed as General Interventions (GIs) and Non OR procedures as Specific Interventions (SIs).The Intervention partition includes ADRGs that are defined by:the presence of GIs - identifiable as those ADRGs with the numeric characters 00 to 39 e.g. B05 Carpal Tunnel Release (formerly comprising the Surgical partition); andthe presence of SIs - identifiable as those ADRGs with the numeric characters 40 to 59, e.g. B41 Telemetric EEG Monitoring (formerly comprising the Other partition). Two ADRGs from the ‘Other’ partition have been disaggregated (see REF _Ref466368177 \h \* MERGEFORMAT Table 7), as the episodes were considered to be better defined by the PDx, rather than the intervention.Table SEQ Table \* ARABIC 7: ADRGs in the ‘Other’ partition being removedV8.0 ADRGTitleChanges for AR-DRG Version 9.0H43 ERCP proceduresRemoved with episodes dispersing according to the PDx (in the Medical partition)H40 Endoscopic procedures for bleeding oesophageal varicesRemoved, with a new ADRG H65 Bleeding oesophageal varices created in the Medical partitionOutcome:Two ADRGs from the ‘Other’ partition have been retained (moving into the Intervention partition), but with some revisions as outlined below (see REF _Ref466289375 \h \* MERGEFORMAT Table 8). Table SEQ Table \* ARABIC 8: ADRGs in the ‘Other’ partition being revisedV8.0 ADRGTitleChanges for AR-DRG Version 9.0F41 Circulatory Disorders, Adm for AMI W Invasive Cardiac ProcsAblation procedures removed from this ADRG, and added to F10 Interventional Coronary Procedures, Admitted for AMI (issue of inappropriate placement of ablation procedures highlighted by IHPA)F42Circulatory Disorders, Not Adm for AMI W Invasive Cardiac ProcsAblation procedures removed from this ADRG, and added to the combined F15/F16 (issue of inappropriate placement of ablation procedures highlighted by IHPA)Outcomes:An additional change was made to ADRGs in the Surgical partition with the combining of F15 Interventional Coronary Procedures, Not admitted for AMI W Stent Implantation and F16 Interventional Coronary Procedures, Not Admitted for AMI W/O Stent Implantation, thereby removing the with/without stent variable.A number of ADRGs in the ‘Other’ partition used administrative variables in their definitions, and these are addressed in item REF _Ref466295934 \n \h \* MERGEFORMAT 0.For the ADRGs in the ‘Other’ partition without administrative variables, there are 16 that have been retained without any changes (see REF _Ref466289549 \h \* MERGEFORMAT Table 9), and have been moved into the Intervention partition.Table SEQ Table \* ARABIC 9: Retained ADRGs from the ‘Other’ partitionV8.0 ADRGTitleChanges for AR-DRG Version 9.0B41Telemetric EEG MonitoringRetained - in the Intervention partitionB42Nervous System Disorders W Ventilator SupportRetained - in the Intervention partitionD40Dental Extractions and RestorationsRetained - in the Intervention partitionE40Respiratory System Disorders W Ventilator SupportRetained - in the Intervention partitionE41Respiratory System Disorders W Non-invasive VentilationRetained - in the Intervention partitionE42BronchoscopyRetained - in the Intervention partitionF40Circulatory Disorders W Ventilator SupportRetained - in the Intervention partitionF43Circulatory Disorders W Non-Invasive VentilationRetained - in the Intervention partitionG46Complex endoscopyRetained - in the Intervention partitionG47GastroscopyRetained - in the Intervention partitionG48ColonoscopyRetained - in the Intervention partitionK40Endoscopic and Investigative Procedures for Metabolic DisordersRetained - in the Intervention partitionL40UreteroscopyRetained - in the Intervention partitionL42ESW lithotripsyRetained - in the Intervention partitionT40Infectious and Parasitic Diseases W Ventilator SupportRetained - in the Intervention partitionX40Injuries, Poisoning and Toxic Effects of Drugs W Ventilator SupportRetained - in the Intervention partition4.5 ADRGs using administrative variables in their definition AR-DRG Version 8.0 contained 16 ADRGs that use administrative variables in their definition, with 11 using a sameday variable, three using died/transferred, and two using transferred. Following the implementation of the ECC model in Version 8.0, there is significantly less reliance on administrative variables to split ADRGs, with increased regard to the clinical attributes of the patient. Selected ADRGs using administrative variables in their definition were reviewed to determine whether these variables were still required, including those in the ‘Other’ partition. Mental health ADRGs were not included in the review given the development work being undertaken by IHPA on the classification of mental health episodes. Similarly neonatal ADRGs were excluded as there have been recommendations by Neonatologists to classify neonates using gestational age rather than birth weight, which would require a new data item to be implemented in the NMDS and is out of the scope for classification development at this stage.Outcome:A number of ADRGs using administrative variables were considered to be more appropriately defined using clinical variables only, and these have been revised with the administrative variables removed from the grouping logic (see REF _Ref474232709 \h \* MERGEFORMAT Table 10). In some cases this removed the ADRG from the classification, as all episodes moved to ADRGs in the Medical partition.Table SEQ Table \* ARABIC 10: ADRGs with administrative variables removed from the definitionV8.0 ADRGTitleChanges for AR-DRG Version 9.0I40Infusions for musculoskeletal disorders, samedayRemoval of sameday logic, which removes the ADRG, distributing episodes to medical ADRGs according to the PDxI81Musculoskeletal injuries, samedayRemoval of sameday logic, which removes the ADRG, distributing episodes to medical ADRGs according to the PDxI82Other sameday treatment for musculoskeletal disordersRemoval of sameday logic, which removes the ADRG, distributing episodes to medical ADRGs according to the PDxV65Treatment for alcohol disorders, samedayRemoval of sameday logic - which removes the ADRG, distributing episodes to medical ADRGs according to the PDxV66Treatment for drug disorders, samedayRemoval of sameday logic - which removes the ADRG, distributing episodes to medical ADRGs according to the PDxZ40Other contacts w health services w endoscopy, samedayRemoval of sameday logic - ADRG retained in the Intervention partitionOutcome:The administrative variable has been retained for one ADRG, but the definition used in the grouping logic has been revised (see REF _Ref466296443 \h \* MERGEFORMAT Table 11). Table SEQ Table \* ARABIC 11: ADRG with administrative variable revisedV8.0 ADRGTitleChanges for AR-DRG Version 9.0W60 Multiple sig trauma, died or transferred to acute facility <5 daysRemoval of ‘died’ from the definition as this variable was not required given the implementation of the ECCS to measure clinical complexity – ADRG retained in the Medical partitionOutcome:For the ADRGs using administrative variables, there are nine that have been retained without any changes (P01 and P60 have been updated with new terminology for OR procedure) (see REF _Ref466296585 \h \* MERGEFORMAT Table 12). Table SEQ Table \* ARABIC 12: Retained ADRGs using administrative variablesV8.0 ADRGTitleChanges for AR-DRG Version 9.0B40Plasmapheresis W Neurological Disease, SamedayRetained - in the Intervention partitionI80Femoral Fractures, Transferred to Acute Facility <2 DaysRetained - in the Medical PartitionL41Cystourethroscopy for urinary disorder, samedayRetained - in the Intervention partitionM40Cystourethroscopy for male reproductive system disorder, samedayRetained - in the Intervention partitionP01Neonate W sig GI/vent>=96 hours, died or transferred to acute facilityRetained - in the Intervention partitionP60Neonate W/O sig GI/vent>=96 hours, died or transferred to acute facilityRetained - in the Medical partitionU40Mental Health Treatment with ECT, SamedayRetained - in the Intervention partitionU60Mental Health Treatment W/O ECT, SamedayRetained - in the Medical partitionY60Burns, transferred to acute facility <5daysRetained - in the Medical partition4.6 ADRGs with a lack of clinical distinctiveness In consultation with CCAG, two ADRGs were highlighted for review as there was a lack of heterogeneity noted in the PDx.I03 Hip replacement was highlighted as having two distinct patient cohorts, these being hip replacement episodes with a trauma PDx and those with other medical PDx, such as osteoarthritis. E65 Chronic Obstructive Airways Disease was reviewed as it was noted that episodes with a PDx of bronchiectasis should be classified separately.Outcome:New ADRGs were created in order to separate the clinically distinct episodes (see REF _Ref466297022 \h \* MERGEFORMAT Table 13).Table SEQ Table \* ARABIC 13: ADRGs lacking clinical distinctivenessV8.0 ADRGTitleChanges for AR-DRG Version 9.0I03Hip replacementI33 Hip Replacement, Non- traumatic created for hip replacement episodes with a non-trauma PDx, such as osteoarthritis, and I03 renamed as Hip Replacement, Trauma E65 Chronic Obstructive Airways DiseaseE77 Bronchiectasis created for episodes with a PDx of bronchiectasis – separating these from the other medical PDx in E65 The outcome of the changes to the ADRGs was a decrease in the total number from 406 in Version 8.0 to 399 in Version 9.0. Splitting ADRGsFollowing the finalisation and merging of all the ADRG revisions and other modifications arising from the work program, the final stage of development for the AR-DRG classification is the splitting of the ADRGs into DRGs (the end classes). This process firstly required the recalculation of the Diagnosis Complexity Level (DCL) matrix with the proposed modifications for Version 9.0. The DCL matrix includes all the weights given to each diagnosis for each ADRG.The splitting process determines the number of ADRGs that have one DRG only (Z) or are split into two, three or four DRGs (A, B, C, D), and also the ECCS value used to create the split where applicable. The splitting criteria used for AR-DRG Version 8.0 were retained for use for Version 9.0 (see REF _Ref466368267 \h \* MERGEFORMAT Table 14). Table SEQ Table \* ARABIC 14: Splitting criteria and thresholdsCriterion*DescriptionThreshold1aMinimum episodes per DRG200 per year1bMinimum cost per DRG$1M per year1cMinimum percentage of ADRG episodes per DRG10%2aMinimum absolute change in mean cost between consecutive DRGs ** $3,7002bMinimum relative change in mean cost between consecutive DRGs2.03aMaximum relative increase in the coefficient of variation (CV) of DRGs compared to ADRG1.34aMinimum increase in the reduction in deviance (RID) from best performing partition with one less DRG across initially generated candidate models5%* Each criterion must be satisfied (except where either 2(a) or 2(b) apply)** Consecutive DRGs are DRGs in increasing order of mean costThese criteria have not been observed in all cases of splitting within previous AR-DRG versions. Similarly there are examples in Version 9.0 where the proposed number of end classes do not meet all criteria when:there was a need to retain stability across versions of the classification and/or a clinical argument was made to retain the number of end classes; andthe proposed number of DRGs or end classes just ‘failed’ to meet the criteria (e.g. most exceptions were made because the RID gain was close to 5%).5.1 Splitting modelsThe use of the splitting criteria, with the application of minimum thresholds, facilitates the derivation of various splitting models that can then be compared to select the preferred model. As in AR-DRG Version 8.0, complexity (i.e. ECCS) is the preferred splitting mechanism for Version 9.0 in all but 6 ADRGs, namely:R05 and L10 (previously A07 and A09 in Version 8.0) which use ECCS and ageB70, B78, F62 which use ECCS and transferF60 which uses transfer onlyFollowing CCAG advice, these six ADRGs remain unchanged in the use of non-complexity (or non-ECCS) splitting variables from Version 8.0.A comprehensive process for splitting model selection was developed and considered for each ADRG in Version 9.0 with comparisons made to Version 8.0 to reconsider areas of the classification that contained forced splits in Version 8.0 and to ensure stability of the classification over time. The following models were considered:Legacy modelsModel A:AR‐DRG V8.0 accepted modelMay not always satisfy splitting criteriaMay use non‐ECCS splitting variablesModel B:AR‐DRG V8.0 optimum model Satisfies all splitting criteria (or has no splits).Uses ECCS alone as a splitting variableNew ModelsModel 0Uses AR-DRG V8.0 splitting logicUses new AR-DRG V9.0 DCL matrixSimilar to Model A (i.e. it may not always satisfy splitting criteria and can use non-ECCS splitting variables).Model 1: (new optimum model):Satisfies all splitting criteria (or has no splits)Uses ECCS alone as the splitting variableMay or may not have the same number of splits as in AR‐DRG V8.0Similar to Model BModel 2: (with a forced additional split)Number of splits is as in Model 1 plus 1, but limited to 4At least one splitting criterion is not satisfied as a consequence of a forced additional splitUses ECCS alone as the splitting variableModel 3: (only applicable to 6 ADRGs using non‐ECCS variables, as in AR-DRG V8.0)Uses non‐ECCS splitting variablesSatisfies all splitting criteriaModel 4: (with a forced additional split; only for the 6 ADRGs using non‐ECCS variables, as in V8.0)Number of splits is as in Model 3 plus 1, but limited to 4At least one splitting criterion is not satisfied as a consequence of a forced additional splitFor ease of comparison to AR-DRG Version 8.0, Models A and B were developed. Model A applied the accepted and implemented logic of Version 8.0 while Model B was the optimum splitting option that met all splitting criteria and thresholds with the largest RID and uses ECCS only as a splitting variable. Models A and B were very important options to consider (along with Models 1-4) especially in relation to the consistency of using ECCS as a splitting variable over time. Where Model 1 and Model B had the same number of splits, rejection of forced splits in AR-DRG Version 9.0 was common (i.e. forced splits implemented in Version 8.0 were generally not maintained in Version 9.0). Both Models A and B were run on three years of data (2009/10-2011/12) using the Version 8.0 DCL matrix. When Model 1 was run on the latest three years of data and the new Version 9.0 DCL matrix, it was labeled as Model 0.For all ADRGs, two base splitting options (Models 1 and 2) using ECCS alone were derived under Version 9.0. Model 1 was the optimum splitting model as it met all the splitting criteria and thresholds with the largest RID. Model 2 forced the number of DRGs to be one more than that of Model 1.For those ADRGs (n = 6) that use non-complexity splitting variables, Models 3 and 4 were produced incorporating these variables (i.e. age and mode of separation). Model 3 identified the best splitting option using these variables and Model 4 presented an option that forced the number of DRGs to be one more than that of Model 3.Generally, Model 1 is the default splitting model as it satisfies all criteria and uses ECCS alone. However, Model 0 (no change from Version 8.0) has been preferred on many occasions if the change in ADRG logic produced a small percentage gain in RID. Most Version 9.0 ADRGs maintain the logic of Version 8.0 (i.e. Model 0) and is to be expected in those ADRGs with no splits. A model other than the default may also be selected in some circumstances based on statistical performance/description, clinical coherence and other special factors that have applied in a previous version.5.2Splitting selection processAs set out in Table 15, to streamline the splitting selection process, the ADRGs were categorised into groups, each with a general approach for selecting the preferred model (with the exception of ADRGs where the number of DRGs decreased). Thresholds of 2% and 3% were introduced to prevent the acceptance of spurious changes. In consultation with DTG, the preferred splitting model was determined for each ADRG, with the ACCD proposed model selected in all but 20 ADRGs.Most exceptions were made because the RID gain for the second split was close to 5% and these marginal cases were considered in conjunction with other information including size and stability. Splits for O01 and O60 were retained at the current number to reflect the large number of episodes and the consequent substantial implications of change. A review of criteria may be warranted in ADRGs of this nature with large numbers of episodes.Table SEQ Table \* ARABIC 15: ADRG groups for splitting decisionsGroupSubgroupNo of ADRGsDefaultNo changeNo change211Model 0New or substantial changes in ADRG compositionNew8Model 1Substantial changes – exceeding ±20% of episodes due to regrouping11Model 1Same number of splits, changed optimal ECCS splitting valueModel 0 pass all criteria, RID gain < 3%*63Model 0Model 0 pass all criteria, RID gain >=3%*9Model 1Model 0 do not pass all criteria, RID gain < 2%*18Model 0Model 0 do not pass all criteria, RID gain >=2%*6Model 1Number of DRGs increaseNo. DRGs +125Model 1Number of DRGs decreaseNo. DRGs -131Case by case reviewECCS-plus or Non-ECCS ADRGECCS-plus or Non-ECCS ADRG6Model 0NeonatesNo change to be implemented11Model 05.3Splitting outcomeBoth CCAG and DTG input was sought to determine final model selection. Broadly speaking Model 1 was the default preferred splitting model for each ADRG. However, to maintain stability within the classification, Model 0 was the preferred splitting model if the change in ADRG logic produced a small gain in RID%, or if there were special factors that require the preservation of a status quo.When there was justification to reject either Model 1 or Model 0 (e.g. statistical performance/description, clinical coherence and any special factors that have applied to that ADRG in previous AR-DRG versions) Model 2 was selected. The final outcome of the splitting decisions resulted in a decrease in the total number of ADRGs, from 807 in Version 8.0 to 803 in Version 9.0. A comparison of the number of splits between versions is shown in see .Table 16: Comparison of number of DRGs V8.0 vs V9.0?n/aV8.0 ADRGs??V8.0 ADRGs??V8.0 ADRGs??V8.0 ADRGs??V9.0?n/aN=1N=2N=3N=4TotalV9.0N=170170087V9.0N=2920570225V9.0N=301959082V9.0N=400055V9.0Total79241665399Public SubmissionsAll public submissions were reviewed by ACCD’s PCA and DTG and where required, further input was sought from CCAG. A number of modifications have been made to the classification arising from issues highlighted in public submissions. These revisions are primarily related to:Episodes grouping to ADRG 801 GIs unrelated to principal diagnosis (where a GI is not related to a PDx in the MDC that the episode is assigned to it will group to ADRG 801).Inappropriate grouping outcomes due to the GI/SI status of intervention codes.Other public submission issues were addressed by the outcomes of the work program, including:Lack of clinical distinctiveness for episodes with a PDx of bronchiectasisInappropriate grouping of surgical episodes with a code of paraplegia/quadriplegia.Overall statistical performance of AR-DRG Version 9.0The overall statistical performance of AR-DRG Version 9.0 is a RID of 65.3% compared to AR-DRG Version 8.0 which was 65.6%. The change in overall statistical performance of the classification should be understood within the context that the major improvements in Version 9.0 have been at ADRG level that was primarily driven by the clinical coherence principle.? In particular the removal of sameday ADRGs had a decreasing effect on the indices of performance, offset by?the disaggregation of ADRG A06. ConclusionThe changes in AR-DRG Version 9.0 are primarily at the ADRG level, with some ADRGs being removed, replaced, relocated or redefined, and some new ADRGs being created. The revisions have been made in consideration of the most appropriate clinical definition for the group of episodes, including whether the episodes should be defined by the PDx, the intervention or the care provided (such as mechanical ventilation). This determined the placement of the ADRGs within either the Pre MDCs, or the Intervention or Medical partitions, and also whether the use of administrative variables in the definition remained appropriate. All decisions were made in consultation with the ACCD advisory and technical groups and expert advisors, and were informed by comprehensive statistical analysis undertaken by ACCD. There has been a slight decrease in the number of ADRGs and DRGs in Version 9.0 as a result of the revisions implemented. Improvements include a reduction in the number of ADRGs using administrative variables, increased granularity in the classification of the high cost episodes involving long term mechanical ventilation, streamlining of the classification structure, and clinical currency.The Version 9.0 development work at the structural level has utilised the improved clinical complexity methodology implemented in Version 8.0 with the ECC model, and this latest version facilitates a future work program targeting specific areas of the classification within the enhanced MDC/ADRG/DRG structure.Appendix A: V9.0 ADRG DescriptionsADRGV9.0 ADRG Descriptions801GIs Unrelated to Principal Diagnosis960Ungroupable961Unacceptable Principal Diagnosis963Neonatal Diagnosis Not Consistent W Age/WeightA13Ventilation >=336hoursA14Ventilation >=96hours & <336hoursA15TracheostomyA40ECMOB01Ventricular Shunt RevisionB02Cranial ProceduresB03Spinal ProceduresB04Extracranial Vascular ProceduresB05Carpal Tunnel ReleaseB06Procedures for Cerebral Palsy, Muscular Dystrophy and NeuropathyB07Cranial or Peripheral Nerve and Other Nervous System ProceduresB40Plasmapheresis W Neurological Disease, SamedayB41Telemetric EEG MonitoringB42Nervous System Disorders W Ventilator SupportB62ApheresisB63Dementia and Other Chronic Disturbances of Cerebral FunctionB64DeliriumB65Cerebral PalsyB66Nervous System NeoplasmsB67Degenerative Nervous System DisordersB68Multiple Sclerosis and Cerebellar AtaxiaB69TIA and Precerebral OcclusionB70Stroke and Other Cerebrovascular DisordersB71Cranial and Peripheral Nerve DisordersB72Nervous System Infection Except Viral MeningitisB73Viral MeningitisB74Nontraumatic Stupor and ComaB75Febrile ConvulsionsB76SeizuresB77HeadachesB78Intracranial InjuriesB79Skull FracturesB80Other Head InjuriesB81Other Disorders of the Nervous SystemB82Chronic and Unspecified Paraplegia/QuadriplegiaB83Acute Paraplegia and Quadriplegia and Spinal Cord ConditionsC01Procedures for Penetrating Eye InjuryC02Enucleations and Orbital ProceduresC03Retinal ProceduresC04Major Corneal, Scleral and Conjunctival ProceduresC05DacryocystorhinostomyC10Strabismus ProceduresC11Eyelid ProceduresC12Other Corneal, Scleral and Conjunctival ProceduresC13Lacrimal ProceduresC14Other Eye ProceduresC15Glaucoma and Complex Cataract ProceduresC16Lens ProceduresC60Acute and Major Eye InfectionsC61Neurological and Vascular Disorders of the EyeC62Hyphaema and Medically Managed Trauma to the EyeC63Other Disorders of the EyeD01Cochlear ImplantD02Head and Neck ProceduresD03Surgical Repair for Cleft Lip and Palate DisordersD04Maxillo SurgeryD05Parotid Gland ProceduresD06Sinus and Complex Middle Ear ProceduresD10Nasal ProceduresD11Tonsillectomy and AdenoidectomyD12Other Ear, Nose, Mouth and Throat ProceduresD13Myringotomy W Tube InsertionD14Mouth and Salivary Gland ProceduresD15Mastoid ProceduresD40Dental Extractions and RestorationsD60Ear, Nose, Mouth and Throat MalignancyD61DysequilibriumD62EpistaxisD63Otitis Media and Upper Respiratory InfectionsD64Laryngotracheitis and EpiglottitisD65Nasal Trauma and DeformityD66Other Ear, Nose, Mouth and Throat DisordersD67Oral and Dental DisordersE01Major Chest ProceduresE02Other Respiratory System GIsE03Lung or Heart-Lung TransplantE40Respiratory System Disorders W Ventilator SupportE41Respiratory System Disorders W Non-Invasive VentilationE42BronchoscopyE60Cystic FibrosisE61Pulmonary EmbolismE62Respiratory Infections and InflammationsE63Sleep ApnoeaE64Pulmonary Oedema and Respiratory FailureE65Chronic Obstructive Airways DiseaseE66Major Chest TraumaE67Respiratory Signs and SymptomsE68PneumothoraxE69Bronchitis and AsthmaE70Whooping Cough and Acute BronchiolitisE71Respiratory NeoplasmsE72Respiratory Problems Arising from Neonatal PeriodE73Pleural EffusionE74Interstitial Lung DiseaseE75Other Respiratory System DisordersE76Respiratory TuberculosisE77BronchiectasisF01Implantation and Replacement of AICD, Total SystemF02Other AICD ProceduresF03Cardiac Valve Procedures W CPB Pump W Invasive Cardiac InvestigationF04Cardiac Valve Procedures W CPB Pump W/O Invasive Cardiac InvestigationF05Coronary Bypass W Invasive Cardiac InvestigationF06Coronary Bypass W/O Invasive Cardiac InvestigationF07Other Cardiothoracic/Vascular Procedures W CPB PumpF08Major Reconstructive Vascular Procedures W/O CPB PumpF09Other Cardiothoracic Procedures W/O CPB PumpF10Interventional Coronary Procedures, Admitted for AMIF11Amputation, Except Upper Limb and Toe, for Circulatory DisordersF12Implantation and Replacement of Pacemaker, Total SystemF13Amputation, Upper Limb and Toe, for Circulatory DisordersF14Vascular Procedures, Except Major Reconstruction, W/O CPB PumpF17Insertion and Replacement of Pacemaker GeneratorF18Other Pacemaker ProceduresF19Trans-Vascular Percutaneous Cardiac InterventionF20Vein Ligation and StrippingF21Other Circulatory System GIsF22Insertion of Artificial Heart DeviceF23Heart TransplantF24Interventional Coronary Procedures, Not Admitted for AMIF40Circulatory Disorders W Ventilator SupportF41Circulatory Disorders, Admitted for AMI W Invasive Cardiac Investigative ProcsF42Circulatory Disorders, Not Admitted for AMI W Invasive Cardiac Investig ProcsF43Circulatory Disorders W Non-Invasive VentilationF60Circulatory Disorders, Admitted for AMI W/O Invasive Cardiac Investigative ProcsF61Infective EndocarditisF62Heart Failure and ShockF63Venous ThrombosisF64Skin Ulcers in Circulatory DisordersF65Peripheral Vascular DisordersF66Coronary AtherosclerosisF67HypertensionF68Congenital Heart DiseaseF69Valvular DisordersF72Unstable AnginaF73Syncope and CollapseF74Chest PainF75Other Circulatory DisordersF76Arrhythmia, Cardiac Arrest and Conduction DisordersG01Rectal ResectionG02Major Small and Large Bowel ProceduresG03Stomach, Oesophageal and Duodenal ProceduresG04Peritoneal AdhesiolysisG05Minor Small and Large Bowel ProceduresG06PyloromyotomyG07AppendicectomyG10Hernia ProceduresG11Anal and Stomal ProceduresG12Other Digestive System GIsG46Complex endoscopyG47GastroscopyG48ColonoscopyG60Digestive MalignancyG61Gastrointestinal HaemorrhageG64Inflammatory Bowel DiseaseG65Gastrointestinal ObstructionG66Abdominal Pain and Mesenteric AdenitisG67Oesophagitis and GastroenteritisG70Other Digestive System DisordersH01Pancreas, Liver and Shunt ProceduresH02Major Biliary Tract ProceduresH05Hepatobiliary Diagnostic ProceduresH06Other Hepatobiliary and Pancreas GIsH07Open CholecystectomyH08Laparoscopic CholecystectomyH09Liver TransplantH60Cirrhosis and Alcoholic HepatitisH61Malignancy of Hepatobiliary System and PancreasH62Disorders of Pancreas, Except MalignancyH63Other Disorders of LiverH64Disorders of the Biliary TractH65Bleeding Oesophageal VaricesI01Bilateral and Multiple Major Joint Procedures of Lower LimbI02Microvascular Tissue Transfers or Skin Grafts, Excluding HandI03Hip Replacement for TraumaI04Knee ReplacementI05Other Joint ReplacementI06Spinal Fusion for DeformityI07AmputationI08Other Hip and Femur ProceduresI09Spinal FusionI10Other Back and Neck ProceduresI11Limb Lengthening ProceduresI12Miscellaneous Musculoskeletal Procs for Infection/Inflammation of Bone and JointI13Humerus, Tibia, Fibula and Ankle ProceduresI15Cranio-Facial SurgeryI16Other Shoulder ProceduresI17Maxillo-Facial SurgeryI18Other Knee ProceduresI19Other Elbow and Forearm ProceduresI20Other Foot ProceduresI21Local Excision and Removal of Internal Fixation Devices of Hip and FemurI23Local Excision and Removal of Internal Fixation Devices, Except Hip and FemurI24ArthroscopyI25Bone and Joint Diagnostic Procedures Including BiopsyI27Soft Tissue ProceduresI28Other Musculoskeletal ProceduresI29Knee Reconstructions, and Revisions of ReconstructionsI30Hand ProceduresI31Revision of Hip ReplacementI32Revision of Knee ReplacementI33Hip Replacement for Non-TraumaI60Femoral Shaft FracturesI61Distal Femoral FracturesI63Sprains, Strains and Dislocations of Hip, Pelvis and ThighI64OsteomyelitisI65Musculoskeletal Malignant NeoplasmsI66Inflammatory Musculoskeletal DisordersI67Septic ArthritisI68Non-surgical Spinal DisordersI69Bone Diseases and ArthropathiesI71Other Musculotendinous DisordersI72Specific Musculotendinous DisordersI73Aftercare of Musculoskeletal Implants or ProsthesesI74Injuries to Forearm, Wrist, Hand and FootI75Injuries to Shoulder, Arm, Elbow, Knee, Leg and AnkleI76Other Musculoskeletal DisordersI77Fractures of PelvisI78Fractures of Neck of FemurI79Pathological FracturesI80Femoral Fractures, Transferred to Acute Facility <2 DaysJ01Microvascular Tissue Transfers for Skin, Subcutaneous Tissue & Breast DisordersJ06Major Procedures for Breast DisordersJ07Minor Procedures for Breast DisordersJ08Other Skin Grafts and Debridement ProceduresJ09Perianal and Pilonidal ProceduresJ10Plastic GIs for Skin, Subcutaneous Tissue and Breast DisordersJ11Other Skin, Subcutaneous Tissue and Breast ProceduresJ12Lower Limb Procedures W Ulcer or CellulitisJ13Lower Limb Procedures W/O Ulcer or CellulitisJ14Major Breast ReconstructionsJ60Skin UlcersJ62Malignant Breast DisordersJ63Non-Malignant Breast DisordersJ64CellulitisJ65Trauma to Skin, Subcutaneous Tissue and BreastJ67Minor Skin DisordersJ68Major Skin DisordersJ69Skin MalignancyK01GIs for Diabetic ComplicationsK02Pituitary ProceduresK03Adrenal ProceduresK05Parathyroid ProceduresK06Thyroid ProceduresK08Thyroglossal ProceduresK09Other Endocrine, Nutritional and Metabolic GIsK10Revisional and Open Bariatric ProceduresK11Major Laparoscopic Bariatric ProceduresK12Other Bariatric ProceduresK13Plastic GIs for Endocrine, Nutritional and Metabolic DisordersK40Endoscopic and Investigative Procedures for Metabolic DisordersK60DiabetesK61Severe Nutritional DisturbanceK62Miscellaneous Metabolic DisordersK63Inborn Errors of MetabolismK64Endocrine DisordersL02Operative Insertion of Peritoneal Catheter for DialysisL03Kidney, Ureter and Major Bladder Procedures for NeoplasmL04Kidney, Ureter and Major Bladder Procedures for Non-NeoplasmL05Transurethral Prostatectomy for Urinary DisorderL06Minor Bladder ProceduresL07Other Transurethral ProceduresL08Urethral ProceduresL09Other Procedures for Kidney and Urinary Tract DisordersL10Kidney TransplantL40UreteroscopyL41Cystourethroscopy for Urinary Disorder, SamedayL42ESW LithotripsyL60Kidney FailureL61HaemodialysisL62Kidney and Urinary Tract NeoplasmsL63Kidney and Urinary Tract InfectionsL64Urinary Stones and ObstructionL65Kidney and Urinary Tract Signs and SymptomsL66Urethral StrictureL67Other Kidney and Urinary Tract DisordersL68Peritoneal DialysisM01Major Male Pelvic ProceduresM02Transurethral Prostatectomy for Reproductive System DisorderM03Penis ProceduresM04Testes ProceduresM05CircumcisionM06Other Male Reproductive System GIsM40Cystourethroscopy for Male Reproductive System Disorder, SamedayM60Male Reproductive System MalignancyM61Benign Prostatic HypertrophyM62Male Reproductive System InflammationM63Male Sterilisation ProceduresM64Other Male Reproductive System DisordersN01Pelvic Evisceration and Radical VulvectomyN04Hysterectomy for Non-MalignancyN05Oophorectomy and Complex Fallopian Tube Procedures for Non-MalignancyN06Female Reproductive System Reconstructive ProceduresN07Other Uterus and Adnexa Procedures for Non-MalignancyN08Endoscopic and Laparoscopic Procedures, Female Reproductive SystemN09Other Vagina, Cervix and Vulva ProceduresN10Diagnostic Curettage and Diagnostic HysteroscopyN11Other Female Reproductive System GIsN12Uterus and Adnexa Procedures for MalignancyN60Female Reproductive System MalignancyN61Female Reproductive System InfectionsN62Menstrual and Other Female Reproductive System DisordersO01Caesarean DeliveryO02Vaginal Delivery W GIsO03Ectopic PregnancyO04Postpartum and Post Abortion W GIsO05Abortion W GIsO60Vaginal DeliveryO61Postpartum and Post Abortion W/O GIsO63Abortion W/O GIsO66Antenatal and Other Obstetric AdmissionsP01Neonate W Sig GI or Vent>=96hrs, Died or Transfer to Acute Facility <5 DaysP02Cardiothoracic and Vascular Procedures for NeonatesP03Neonate, AdmWt 1000-1499g W Significant GI or Ventilation >=96hoursP04Neonate, AdmWt 1500-1999g W Significant GI or Ventilation >=96hoursP05Neonate, AdmWt 2000-2499g W Significant GI or Ventilation >=96hoursP06Neonate, AdmWt >=2500g W Significant GI or Ventilation >=96hoursP07Neonate, AdmWt <750g W Significant GIP08Neonate, AdmWt 750-999g W Significant GIP60Neonate W/O Sig GI or Vent>=96hrs, Died or Transferred to Acute Facility <5DaysP61Neonate, AdmWt <750g W/O Significant GIP62Neonate, AdmWt 750-999g W/O Significant GIP63Neonate, AdmWt 1000-1249g W/O Significant GI or Ventilation >=96hoursP64Neonate, AdmWt 1250-1499g W/O Significant GI or Ventilation >=96hoursP65Neonate, AdmWt 1500-1999g W/O Significant GI or Ventilation >=96hoursP66Neonate, AdmWt 2000-2499g W/O Significant GI or Ventilation >=96hoursP67Neonate, AdmWt >=2500g W/O Sig GI/Vent>=96hrs, <37 Completed Wks GestationP68Neonate, AdmWt >=2500g W/O Sig GI/Vent>=96hrs, >=37 Completed Wks GestationQ01SplenectomyQ02Blood and Immune System Disorders W Other GIsQ60Reticuloendothelial and Immunity DisordersQ61Red Blood Cell DisordersQ62Coagulation DisordersR01Lymphoma and Leukaemia W Major GIsR02Other Neoplastic Disorders W Major GIsR03Lymphoma and Leukaemia W Other GIsR04Other Neoplastic Disorders W Other GIsR05Allogeneic Bone Marrow TransplantR06Autologous Bone Marrow TransplantR60Acute LeukaemiaR61Lymphoma and Non-Acute LeukaemiaR62Other Neoplastic DisordersR63ChemotherapyT01Infectious and Parasitic Diseases W GIsT40Infectious and Parasitic Diseases W Ventilator SupportT60SepticaemiaT61Postoperative InfectionsT62Fever of Unknown OriginT63Viral IllnessesT64Other Infectious and Parasitic DiseasesU40Mental Health Treatment W ECT, SamedayU60Mental Health Treatment W/O ECT, SamedayU61Schizophrenia DisordersU62Paranoia and Acute Psychotic DisordersU63Major Affective DisordersU64Other Affective and Somatoform DisordersU65Anxiety DisordersU66Eating and Obsessive-Compulsive DisordersU67Personality Disorders and Acute ReactionsU68Childhood Mental DisordersV60Alcohol Intoxication and WithdrawalV61Drug Intoxication and WithdrawalV62Alcohol Use and DependenceV63Opioid Use and DependenceV64Other Drug Use and DependenceW01Ventilation, Tracheostomy and Cranial Procedures for Multiple Significant TraumaW02Hip, Femur and Lower Limb Procedures for Multiple Significant TraumaW03Abdominal Procedures for Multiple Significant TraumaW04Multiple Significant Trauma W Other GIsW60Multiple Significant Trauma, Transferred to Acute Facility <5 DaysW61Multiple Significant Trauma W/O GIsX02Microvascular Tissue Transfer and Skin Grafts for Injuries to HandX04Other Procedures for Injuries to Lower LimbX05Other Procedures for Injuries to HandX06Other Procedures for Other InjuriesX07Skin Grafts for Injuries Excluding HandX40Injuries, Poisoning and Toxic Effects of Drugs W Ventilator SupportX60InjuriesX61Allergic ReactionsX62Poisoning/Toxic Effects of Drugs and Other SubstancesX63Sequelae of TreatmentX64Other Injuries, Poisonings and Toxic EffectsY01Ventilation or Tracheostomy for Burns or GI for Severe Full Thickness BurnsY02Skin Grafts for Other BurnsY03Other GIs for Other BurnsY60Burns, Transferred to Acute Facility <5 DaysY61Severe BurnsY62Other BurnsZ01Other Contacts W Health Services W GIsZ40Other Contacts W Health Services W EndoscopyZ60RehabilitationZ61Signs and SymptomsZ63Other Follow Up After Surgery or Medical CareZ64Other Factors Influencing Health StatusZ65Congenital Anomalies and Problems Arising from Neonatal PeriodZ66Sleep DisordersAppendix B: V9.0 DRG DescriptionsDRGV9.0 DRG Descriptions801AGIs Unrelated to Principal Diagnosis, Major Complexity801BGIs Unrelated to Principal Diagnosis, Intermediate Complexity801CGIs Unrelated to Principal Diagnosis, Minor Complexity960ZUngroupable961ZUnacceptable Principal Diagnosis963ZNeonatal Diagnosis Not Consistent W Age/WeightA13AVentilation >=336hours, Major ComplexityA13BVentilation >=336hours, Minor ComplexityA14AVentilation >=96hours & <336hours, Major ComplexityA14BVentilation >=96hours & <336hours, Intermediate ComplexityA14CVentilation >=96hours & <336hours, Minor ComplexityA15ATracheostomy, Major ComplexityA15BTracheostomy, Intermediate ComplexityA15CTracheostomy, Minor ComplexityA40ZECMOB01ZVentricular Shunt RevisionB02ACranial Procedures, Major ComplexityB02BCranial Procedures, Intermediate ComplexityB02CCranial Procedures, Minor ComplexityB03ASpinal Procedures, Major ComplexityB03BSpinal Procedures, Intermediate ComplexityB03CSpinal Procedures, Minor ComplexityB04AExtracranial Vascular Procedures, Major ComplexityB04BExtracranial Vascular Procedures, Intermediate ComplexityB04CExtracranial Vascular Procedures, Minor ComplexityB05ZCarpal Tunnel ReleaseB06AProcedures for Cerebral Palsy, Muscular Dystrophy and Neuropathy, Major CompB06BProcedures for Cerebral Palsy, Muscular Dystrophy and Neuropathy, Interm CompB06CProcedures for Cerebral Palsy, Muscular Dystrophy and Neuropathy, Minor CompB07ACranial or Peripheral Nerve and Other Nervous System Procedures, Major CompB07BCranial or Peripheral Nerve and Other Nervous System Procedures, Minor CompB40ZPlasmapheresis W Neurological Disease, SamedayB41ATelemetric EEG Monitoring, Major ComplexityB41BTelemetric EEG Monitoring, Minor ComplexistyB42ANervous System Disorders W Ventilator Support, Major ComplexityB42BNervous System Disorders W Ventilator Support, Intermediate ComplexityB42CNervous System Disorders W Ventilator Support, Minor ComplexityB62ZApheresisB63ADementia and Other Chronic Disturbances of Cerebral Function, Major ComplexityB63BDementia and Other Chronic Disturbances of Cerebral Function, Minor ComplexityB64ADelirium, Major ComplexityB64BDelirium, Minor ComplexityB65ZCerebral PalsyB66ANervous System Neoplasms, Major ComplexityB66BNervous System Neoplasms, Minor ComplexityB67ADegenerative Nervous System Disorders, Major ComplexityB67BDegenerative Nervous System Disorders, Intermediate ComplexityB67CDegenerative Nervous System Disorders, Minor ComplexityB68AMultiple Sclerosis and Cerebellar Ataxia, Major ComplexityB68BMultiple Sclerosis and Cerebellar Ataxia, Minor ComplexityB69ATIA and Precerebral Occlusion, Major ComplexityB69BTIA and Precerebral Occlusion, Minor ComplexityB70AStroke and Other Cerebrovascular Disorders, Major ComplexityB70BStroke and Other Cerebrovascular Disorders, Intermediate ComplexityB70CStroke and Other Cerebrovascular Disorders, Minor ComplexityB70DStroke and Other Cerebrovascular Disorders, Transferred <5 DaysB71ACranial and Peripheral Nerve Disorders, Major ComplexityB71BCranial and Peripheral Nerve Disorders, Minor ComplexityB72ANervous System Infection Except Viral Meningitis, Major ComplexityB72BNervous System Infection Except Viral Meningitis, Minor ComplexityB73AViral Meningitis, Major ComplexityB73BViral Meningitis, Minor ComplexityB74ANontraumatic Stupor and Coma, Major ComplexityB74BNontraumatic Stupor and Coma, Minor ComplexityB75ZFebrile ConvulsionsB76ASeizures, Major ComplexityB76BSeizures, Minor ComplexityB77AHeadaches, Major ComplexityB77BHeadaches, Minor ComplexityB78AIntracranial Injuries, Major ComplexityB78BIntracranial Injuries, Minor ComplexityB78CIntracranial Injuries, Transferred <5 DaysB79ASkull Fractures, Major ComplexityB79BSkull Fractures, Minor ComplexityB80AOther Head Injuries, Major ComplexityB80BOther Head Injuries, Minor ComplexityB81AOther Disorders of the Nervous System, Major ComplexityB81BOther Disorders of the Nervous System, Minor ComplexityB82AChronic & Unspec Para/Quadriplegia, Major ComplexityB82BChronic & Unspec Para/Quadriplegia, Intermediate ComplexityB82CChronic & Unspec Para/Quadriplegia, Minor ComplexityB83AAcute Paraplegia and Quadriplegia and Spinal Cord Conditions, Major ComplexityB83BAcute Paraplegia and Quadriplegia and Spinal Cord Conditions, Interm CompB83CAcute Paraplegia and Quadriplegia and Spinal Cord Conditions, Minor ComplexityC01AProcedures for Penetrating Eye Injury, Major ComplexityC01BProcedures for Penetrating Eye Injury, Minor ComplexityC02AEnucleations and Orbital Procedures, Major ComplexityC02BEnucleations and Orbital Procedures, Minor ComplexityC03ARetinal Procedures, Major ComplexityC03BRetinal Procedures, Minor ComplexityC04AMajor Corneal, Scleral and Conjunctival Procedures, Major ComplexityC04BMajor Corneal, Scleral and Conjunctival Procedures, Minor ComplexityC05ZDacryocystorhinostomyC10ZStrabismus ProceduresC11ZEyelid ProceduresC12AOther Corneal, Scleral and Conjunctival Procedures, Major ComplexityC12BOther Corneal, Scleral and Conjunctival Procedures, Minor ComplexityC13ZLacrimal ProceduresC14AOther Eye Procedures, Major ComplexityC14BOther Eye Procedures, Minor ComplexityC15ZGlaucoma and Complex Cataract ProceduresC16ZLens ProceduresC60AAcute and Major Eye Infections, Major ComplexityC60BAcute and Major Eye Infections, Minor ComplexityC61ANeurological and Vascular Disorders of the Eye, Major ComplexityC61BNeurological and Vascular Disorders of the Eye, Minor ComplexityC62AHyphaema and Medically Managed Trauma to the Eye, Major ComplexityC62BHyphaema and Medically Managed Trauma to the Eye, Minor ComplexityC63AOther Disorders of the Eye, Major ComplexityC63BOther Disorders of the Eye, Minor ComplexityD01ZCochlear ImplantD02AHead and Neck Procedures, Major ComplexityD02BHead and Neck Procedures, Minor ComplexityD03ASurgical Repair for Cleft Lip and Palate Disorders, Major ComplexityD03BSurgical Repair for Cleft Lip and Palate Disorders, Minor ComplexityD04AMaxillo Surgery, Major ComplexityD04BMaxillo Surgery, Minor ComplexityD05ZParotid Gland ProceduresD06ZSinus and Complex Middle Ear ProceduresD10ZNasal ProceduresD11ZTonsillectomy and AdenoidectomyD12AOther Ear, Nose, Mouth and Throat Procedures, Major ComplexityD12BOther Ear, Nose, Mouth and Throat Procedures, Minor ComplexityD13ZMyringotomy W Tube InsertionD14AMouth and Salivary Gland Procedures, Major ComplexityD14BMouth and Salivary Gland Procedures, Minor ComplexityD15ZMastoid ProceduresD40ZDental Extractions and RestorationsD60AEar, Nose, Mouth and Throat Malignancy, Major ComplexityD60BEar, Nose, Mouth and Throat Malignancy, Minor ComplexityD61ADysequilibrium, Major ComplexityD61BDysequilibrium, Minor ComplexityD62AEpistaxis, Major ComplexityD62BEpistaxis, Minor ComplexityD63AOtitis Media and Upper Respiratory Infections, Major ComplexityD63BOtitis Media and Upper Respiratory Infections, Minor ComplexityD64ALaryngotracheitis and Epiglottitis, Major ComplexityD64BLaryngotracheitis and Epiglottitis, Minor ComplexityD65ANasal Trauma and Deformity, Major ComplexityD65BNasal Trauma and Deformity, Minor ComplexityD66AOther Ear, Nose, Mouth and Throat Disorders, Major ComplexityD66BOther Ear, Nose, Mouth and Throat Disorders, Minor ComplexityD67AOral and Dental Disorders, Major ComplexityD67BOral and Dental Disorders, Minor ComplexityE01AMajor Chest Procedures, Major ComplexityE01BMajor Chest Procedures, Intermediate ComplexityE01CMajor Chest Procedures, Minor ComplexityE02AOther Respiratory System GIs, Major ComplexityE02BOther Respiratory System GIs, Intermediate ComplexityE02COther Respiratory System GIs, Minor ComplexityE03ZLung or Heart-Lung TransplantE40ARespiratory System Disorders W Ventilator Support, Major ComplexityE40BRespiratory System Disorders W Ventilator Support, Minor ComplexityE41ARespiratory System Disorders W Non-Invasive Ventilation, Major ComplexityE41BRespiratory System Disorders W Non-Invasive Ventilation, Minor ComplexityE42ABronchoscopy, Major ComplexityE42BBronchoscopy, Intermediate ComplexityE42CBronchoscopy, Minor ComplexityE60ACystic Fibrosis, Major ComplexityE60BCystic Fibrosis, Minor ComplexityE61APulmonary Embolism, Major ComplexityE61BPulmonary Embolism, Minor ComplexityE62ARespiratory Infections and Inflammations, Major ComplexityE62BRespiratory Infections and Inflammations, Minor ComplexityE63ASleep Apnoea, Major ComplexityE63BSleep Apnoea, Minor ComplexityE64APulmonary Oedema and Respiratory Failure, Major ComplexityE64BPulmonary Oedema and Respiratory Failure, Minor ComplexityE65AChronic Obstructive Airways Disease, Major ComplexityE65BChronic Obstructive Airways Disease, Minor ComplexityE66AMajor Chest Trauma, Major ComplexityE66BMajor Chest Trauma, Intermediate ComplexityE66CMajor Chest Trauma, Minor ComplexityE67ARespiratory Signs and Symptoms, Major ComplexityE67BRespiratory Signs and Symptoms, Minor ComplexityE68APneumothorax, Major ComplexityE68BPneumothorax, Minor ComplexityE69ABronchitis and Asthma, Major ComplexityE69BBronchitis and Asthma, Minor ComplexityE70AWhooping Cough and Acute Bronchiolitis, Major ComplexityE70BWhooping Cough and Acute Bronchiolitis, Minor ComplexityE71ARespiratory Neoplasms, Major ComplexityE71BRespiratory Neoplasms, Minor ComplexityE72ZRespiratory Problems Arising from Neonatal PeriodE73APleural Effusion, Major ComplexityE73BPleural Effusion, Intermediate ComplexityE73CPleural Effusion, Minor ComplexityE74AInterstitial Lung Disease, Major ComplexityE74BInterstitial Lung Disease, Minor ComplexityE75AOther Respiratory System Disorders, Major ComplexityE75BOther Respiratory System Disorders, Minor ComplexityE76ZRespiratory TuberculosisE77ABronchiectasis, Major ComplexityE77BBronchiectasis, Minor ComplexityF01AImplantation and Replacement of AICD, Total System, Major ComplexityF01BImplantation and Replacement of AICD, Total System, Minor ComplexityF02ZOther AICD ProceduresF03ACardiac Valve Procedures W CPB Pump W Invasive Cardiac Investigation, Major CompF03BCardiac Valve Procedures W CPB Pump W Invasive Cardiac Investigation, Minor CompF04ACardiac Valve Procedures W CPB Pump W/O Invasive Cardiac Invest, Major CompF04BCardiac Valve Procedures W CPB Pump W/O Invasive Cardiac Invest, Interm CompF04CCardiac Valve Procedures W CPB Pump W/O Invasive Cardiac Invest, Minor CompF05ACoronary Bypass W Invasive Cardiac Investigation, Major ComplexityF05BCoronary Bypass W Invasive Cardiac Investigation, Minor ComplexityF06ACoronary Bypass W/O Invasive Cardiac Investigation, Major ComplexityF06BCoronary Bypass W/O Invasive Cardiac Investigation, Intermediate ComplexityF06CCoronary Bypass W/O Invasive Cardiac Investigation, Minor ComplexityF07AOther Cardiothoracic/Vascular Procedures W CPB Pump, Major ComplexityF07BOther Cardiothoracic/Vascular Procedures W CPB Pump, Minor ComplexityF08AMajor Reconstructive Vascular Procedures W/O CPB Pump, Major ComplexityF08BMajor Reconstructive Vascular Procedures W/O CPB Pump, Intermediate ComplexityF08CMajor Reconstructive Vascular Procedures W/O CPB Pump, Minor ComplexityF09AOther Cardiothoracic Procedures W/O CPB Pump, Major ComplexityF09BOther Cardiothoracic Procedures W/O CPB Pump, Intermediate ComplexityF09COther Cardiothoracic Procedures W/O CPB Pump, Minor ComplexityF10AInterventional Coronary Procedures, Admitted for AMI, Major ComplexityF10BInterventional Coronary Procedures, Admitted for AMI, Minor ComplexityF11AAmputation, Except Upper Limb and Toe, for Circulatory Disorders, Major CompF11BAmputation, Except Upper Limb and Toe, for Circulatory Disorders, Minor CompF12AImplantation and Replacement of Pacemaker, Total System, Major ComplexityF12BImplantation and Replacement of Pacemaker, Total System, Minor ComplexityF13AAmputation, Upper Limb and Toe, for Circulatory Disorders, Major ComplexityF13BAmputation, Upper Limb and Toe, for Circulatory Disorders, Minor ComplexityF14AVascular Procedures, Except Major Reconstruction, W/O CPB Pump, Major ComplexityF14BVascular Procedures, Except Major Reconstruction, W/O CPB Pump, Interm CompF14CVascular Procedures, Except Major Reconstruction, W/O CPB Pump, Minor ComplexityF17AInsertion and Replacement of Pacemaker Generator, Major ComplexityF17BInsertion and Replacement of Pacemaker Generator, Minor ComplexityF18ZOther Pacemaker ProceduresF19ATrans-Vascular Percutaneous Cardiac Intervention, Major ComplexityF19BTrans-Vascular Percutaneous Cardiac Intervention, Minor ComplexityF20ZVein Ligation and StrippingF21AOther Circulatory System GIs, Major ComplexityF21BOther Circulatory System GIs, Intermediate ComplexityF21COther Circulatory System GIs, Minor ComplexityF22ZInsertion of Artificial Heart DeviceF23ZHeart TransplantF24AInterventional Coronary Procs, Not Adm for AMI, Major CompF24BInterventional Coronary Procs, Not Adm for AMI, Minor CompF40ACirculatory Disorders W Ventilator Support, Major ComplexityF40BCirculatory Disorders W Ventilator Support, Minor ComplexityF41ACirculatory Disorders, Adm for AMI W Invasive Cardiac Inves Proc, Major CompF41BCirculatory Disorders, Adm for AMI W Invasive Cardiac Inves Proc, Minor CompF42ACirculatory Dsrds, Not Adm for AMI W Invasive Cardiac Inves Proc, Major CompF42BCirculatory Dsrds, Not Adm for AMI W Invasive Cardiac Inves Proc, Minor CompF43ACirculatory Disorders W Non-Invasive Ventilation, Major ComplexityF43BCirculatory Disorders W Non-Invasive Ventilation, Minor ComplexityF60ACirculatory Dsrd, Adm for AMI W/O Invas Card Inves ProcF60BCirculatory Dsrd, Adm for AMI W/O Invas Card Inves Proc, Transf <5 DaysF61AInfective Endocarditis, Major ComplexityF61BInfective Endocarditis, Intermediate ComplexityF61CInfective Endocarditis, Minor ComplexityF62AHeart Failure and Shock, Major ComplexityF62BHeart Failure and Shock, Minor ComplexityF62CHeart Failure and Shock, Transferred <5 DaysF63AVenous Thrombosis, Major ComplexityF63BVenous Thrombosis, Minor ComplexityF64ASkin Ulcers in Circulatory Disorders, Major ComplexityF64BSkin Ulcers in Circulatory Disorders, Intermediate ComplexityF64CSkin Ulcers in Circulatory Disorders, Minor ComplexityF65APeripheral Vascular Disorders, Major ComplexityF65BPeripheral Vascular Disorders, Minor ComplexityF66ACoronary Atherosclerosis, Major ComplexityF66BCoronary Atherosclerosis, Minor ComplexityF67AHypertension, Major ComplexityF67BHypertension, Minor ComplexityF68ZCongenital Heart DiseaseF69AValvular Disorders, Major ComplexityF69BValvular Disorders, Minor ComplexityF72AUnstable Angina, Major ComplexityF72BUnstable Angina, Minor ComplexityF73ASyncope and Collapse, Major ComplexityF73BSyncope and Collapse, Minor ComplexityF74AChest Pain, Major ComplexityF74BChest Pain, Minor ComplexityF75AOther Circulatory Disorders, Major ComplexityF75BOther Circulatory Disorders, Intermediate ComplexityF75COther Circulatory Disorders, Minor ComplexityF76AArrhythmia, Cardiac Arrest and Conduction Disorders, Major ComplexityF76BArrhythmia, Cardiac Arrest and Conduction Disorders, Minor ComplexityG01ARectal Resection, Major ComplexityG01BRectal Resection, Intermediate ComplexityG01CRectal Resection, Minor ComplexityG02AMajor Small and Large Bowel Procedures, Major ComplexityG02BMajor Small and Large Bowel Procedures, Intermediate ComplexityG02CMajor Small and Large Bowel Procedures, Minor ComplexityG03AStomach, Oesophageal and Duodenal Procedures, Major ComplexityG03BStomach, Oesophageal and Duodenal Procedures, Intermediate ComplexityG03CStomach, Oesophageal and Duodenal Procedures, Minor ComplexityG04APeritoneal Adhesiolysis, Major ComplexityG04BPeritoneal Adhesiolysis, Intermediate ComplexityG04CPeritoneal Adhesiolysis, Minor ComplexityG05AMinor Small and Large Bowel Procedures, Major ComplexityG05BMinor Small and Large Bowel Procedures, Minor ComplexityG06ZPyloromyotomyG07AAppendicectomy, Major ComplexityG07BAppendicectomy, Minor ComplexityG10AHernia Procedures, Major ComplexityG10BHernia Procedures, Minor ComplexityG11AAnal and Stomal Procedures, Major ComplexityG11BAnal and Stomal Procedures, Minor ComplexityG12AOther Digestive System GIs, Major ComplexityG12BOther Digestive System GIs, Intermediate ComplexityG12COther Digestive System GIs, Minor ComplexityG46AComplex endoscopy, Major ComplexityG46BComplex endoscopy, Minor ComplexityG47AGastroscopy, Major ComplexityG47BGastroscopy, Intermediate ComplexityG47CGastroscopy, Minor ComplexityG48AColonoscopy, Major ComplexityG48BColonoscopy, Minor ComplexityG60ADigestive Malignancy, Major ComplexityG60BDigestive Malignancy, Minor ComplexityG61AGastrointestinal Haemorrhage, Major ComplexityG61BGastrointestinal Haemorrhage, Minor ComplexityG64AInflammatory Bowel Disease, Major ComplexityG64BInflammatory Bowel Disease, Minor ComplexityG65AGastrointestinal Obstruction, Major ComplexityG65BGastrointestinal Obstruction, Minor ComplexityG66AAbdominal Pain and Mesenteric Adenitis, Major ComplexityG66BAbdominal Pain and Mesenteric Adenitis, Minor ComplexityG67AOesophagitis and Gastroenteritis, Major ComplexityG67BOesophagitis and Gastroenteritis, Minor ComplexityG70AOther Digestive System Disorders, Major ComplexityG70BOther Digestive System Disorders, Intermediate ComplexityG70COther Digestive System Disorders, Minor ComplexityH01APancreas, Liver and Shunt Procedures, Major ComplexityH01BPancreas, Liver and Shunt Procedures, Intermediate ComplexityH01CPancreas, Liver and Shunt Procedures, Minor ComplexityH02AMajor Biliary Tract Procedures, Major ComplexityH02BMajor Biliary Tract Procedures, Intermediate ComplexityH02CMajor Biliary Tract Procedures, Minor ComplexityH05AHepatobiliary Diagnostic Procedures, Major ComplexityH05BHepatobiliary Diagnostic Procedures, Intermediate ComplexityH05CHepatobiliary Diagnostic Procedures, Minor ComplexityH06AOther Hepatobiliary and Pancreas GIs, Major ComplexityH06BOther Hepatobiliary and Pancreas GIs, Intermediate ComplexityH06COther Hepatobiliary and Pancreas GIs, Minor ComplexityH07AOpen Cholecystectomy, Major ComplexityH07BOpen Cholecystectomy, Intermediate ComplexityH07COpen Cholecystectomy, Minor ComplexityH08ALaparoscopic Cholecystectomy, Major ComplexityH08BLaparoscopic Cholecystectomy, Minor ComplexityH09ZLiver TransplantH60ACirrhosis and Alcoholic Hepatitis, Major ComplexityH60BCirrhosis and Alcoholic Hepatitis, Intermediate ComplexityH60CCirrhosis and Alcoholic Hepatitis, Minor ComplexityH61AMalignancy of Hepatobiliary System and Pancreas, Major ComplexityH61BMalignancy of Hepatobiliary System and Pancreas, Minor ComplexityH62ADisorders of Pancreas, Except Malignancy, Major ComplexityH62BDisorders of Pancreas, Except Malignancy, Minor ComplexityH63AOther Disorders of Liver, Major ComplexityH63BOther Disorders of Liver, Intermediate ComplexityH63COther Disorders of Liver, Minor ComplexityH64ADisorders of the Biliary Tract, Major ComplexityH64BDisorders of the Biliary Tract, Intermediate ComplexityH64CDisorders of the Biliary Tract, Minor ComplexityH65ABleeding Oesophageal Varices, Major ComplexityH65BBleeding Oesophageal Varices, Intermediate ComplexityH65CBleeding Oesophageal Varices, Minor ComplexityI01ABilateral and Multiple Major Joint Procedures of Lower Limb, Major ComplexityI01BBilateral and Multiple Major Joint Procedures of Lower Limb, Minor ComplexityI02AMicrovascular Tissue Transfers or Skin Grafts, Excluding Hand, Major ComplexityI02BMicrovascular Tissue Transfers or Skin Grafts, Excluding Hand, Intermediate CompI02CMicrovascular Tissue Transfers or Skin Grafts, Excluding Hand, Minor ComplexityI03AHip Replacement for Trauma, Major ComplexityI03BHip Replacement for Trauma, Minor ComplexityI04AKnee Replacement, Major ComplexityI04BKnee Replacement, Minor ComplexityI05AOther Joint Replacement, Major ComplexityI05BOther Joint Replacement, Minor ComplexityI06ZSpinal Fusion for DeformityI07ZAmputationI08AOther Hip and Femur Procedures, Major ComplexityI08BOther Hip and Femur Procedures, Intermediate ComplexityI08COther Hip and Femur Procedures, Minor ComplexityI09ASpinal Fusion, Major ComplexityI09BSpinal Fusion, Intermediate ComplexityI09CSpinal Fusion, Minor ComplexityI10AOther Back and Neck Procedures, Major ComplexityI10BOther Back and Neck Procedures, Minor ComplexityI11ZLimb Lengthening ProceduresI12AMisc Musculoskeletal Procs for Infect/Inflam of Bone/Joint, Major ComplexityI12BMisc Musculoskeletal Procs for Infect/Inflam of Bone/Joint, Intermediate CompI12CMisc Musculoskeletal Procs for Infect/Inflam of Bone/Joint, Minor ComplexityI13AHumerus, Tibia, Fibula and Ankle Procedures, Major ComplexityI13BHumerus, Tibia, Fibula and Ankle Procedures, Intermediate ComplexityI13CHumerus, Tibia, Fibula and Ankle Procedures, Minor ComplexityI15ZCranio-Facial SurgeryI16ZOther Shoulder ProceduresI17AMaxillo-Facial Surgery, Major ComplexityI17BMaxillo-Facial Surgery, Minor ComplexityI18AOther Knee Procedures, Major ComplexityI18BOther Knee Procedures, Minor ComplexityI19AOther Elbow and Forearm Procedures, Major ComplexityI19BOther Elbow and Forearm Procedures, Minor ComplexityI20AOther Foot Procedures, Major ComplexityI20BOther Foot Procedures, Minor ComplexityI21ALocal Excision and Removal of Internal Fixation Devices of Hip & Femur, Maj CompI21BLocal Excision and Removal of Internal Fixation Devices of Hip & Femur, Min CompI23ALocal Excision & Removal of Internal Fixation Device, Except Hip & Fmr, Maj CompI23BLocal Excision & Removal of Internal Fixation Device, Except Hip & Fmr, Min CompI24AArthroscopy, Major ComplexityI24BArthroscopy, Minor ComplexityI25ABone and Joint Diagnostic Procedures Including Biopsy, Major ComplexityI25BBone and Joint Diagnostic Procedures Including Biopsy, Minor ComplexityI27ASoft Tissue Procedures, Major ComplexityI27BSoft Tissue Procedures, Minor ComplexityI28AOther Musculoskeletal Procedures, Major ComplexityI28BOther Musculoskeletal Procedures, Intermediate ComplexityI28COther Musculoskeletal Procedures, Minor ComplexityI29ZKnee Reconstructions, and Revisions of ReconstructionsI30ZHand ProceduresI31ARevision of Hip Replacement, Major ComplexityI31BRevision of Hip Replacement, Intermediate ComplexityI31CRevision of Hip Replacement, Minor ComplexityI32ARevision of Knee Replacement, Major ComplexityI32BRevision of Knee Replacement, Minor ComplexityI33AHip Replacement for Non-Trauma, Major ComplexityI33BHip Replacement for Non-Trauma, Minor ComplexityI60ZFemoral Shaft FracturesI61ADistal Femoral Fractures, Major ComplexityI61BDistal Femoral Fractures, Minor ComplexityI63ASprains, Strains and Dislocations of Hip, Pelvis and Thigh, Major ComplexityI63BSprains, Strains and Dislocations of Hip, Pelvis and Thigh, Minor ComplexityI64AOsteomyelitis, Major ComplexityI64BOsteomyelitis, Minor ComplexityI65AMusculoskeletal Malignant Neoplasms, Major ComplexityI65BMusculoskeletal Malignant Neoplasms, Minor ComplexityI66AInflammatory Musculoskeletal Disorders, Major ComplexityI66BInflammatory Musculoskeletal Disorders, Minor ComplexityI67ASeptic Arthritis, Major ComplexityI67BSeptic Arthritis, Minor ComplexityI68ANon-surgical Spinal Disorders, Major ComplexityI68BNon-surgical Spinal Disorders, Minor ComplexityI69ABone Diseases and Arthropathies, Major ComplexityI69BBone Diseases and Arthropathies, Minor ComplexityI71AOther Musculotendinous Disorders, Major ComplexityI71BOther Musculotendinous Disorders, Minor ComplexityI72ASpecific Musculotendinous Disorders, Major ComplexityI72BSpecific Musculotendinous Disorders, Minor ComplexityI73AAftercare of Musculoskeletal Implants or Prostheses, Major ComplexityI73BAftercare of Musculoskeletal Implants or Prostheses, Intermediate ComplexityI73CAftercare of Musculoskeletal Implants or Prostheses, Minor ComplexityI74AInjuries to Forearm, Wrist, Hand and Foot, Major ComplexityI74BInjuries to Forearm, Wrist, Hand and Foot, Minor ComplexityI75AInjuries to Shoulder, Arm, Elbow, Knee, Leg and Ankle, Major ComplexityI75BInjuries to Shoulder, Arm, Elbow, Knee, Leg and Ankle, Intermediate ComplexityI75CInjuries to Shoulder, Arm, Elbow, Knee, Leg and Ankle, Minor ComplexityI76AOther Musculoskeletal Disorders, Major ComplexityI76BOther Musculoskeletal Disorders, Minor ComplexityI77AFractures of Pelvis, Major ComplexityI77BFractures of Pelvis, Minor ComplexityI78AFractures of Neck of Femur, Major ComplexityI78BFractures of Neck of Femur, Minor ComplexityI79APathological Fractures, Major ComplexityI79BPathological Fractures, Intermediate ComplexityI79CPathological Fractures, Minor ComplexityI80ZFemoral Fractures, Transferred to Acute Facility <2 DaysJ01AMicrovas Tiss Transf for Skin, Subcut Tiss & Breast Dsrds, Major ComplexityJ01BMicrovas Tiss Transf for Skin, Subcut Tiss & Breast Dsrds, Minor ComplexityJ06AMajor Procedures for Breast Disorders, Major ComplexityJ06BMajor Procedures for Breast Disorders, Minor ComplexityJ07ZMinor Procedures for Breast DisordersJ08AOther Skin Grafts and Debridement Procedures, Major ComplexityJ08BOther Skin Grafts and Debridement Procedures, Intermediate ComplexityJ08COther Skin Grafts and Debridement Procedures, Minor ComplexityJ09ZPerianal and Pilonidal ProceduresJ10APlastic GIs for Skin, Subcutaneous Tissue and Breast Disorders, Major CompJ10BPlastic GIs for Skin, Subcutaneous Tissue and Breast Disorders, Minor CompJ11AOther Skin, Subcutaneous Tissue and Breast Procedures, Major ComplexityJ11BOther Skin, Subcutaneous Tissue and Breast Procedures, Minor ComplexityJ12ALower Limb Procedures W Ulcer or Cellulitis, Major ComplexityJ12BLower Limb Procedures W Ulcer or Cellulitis, Minor ComplexityJ13ALower Limb Procedures W/O Ulcer or Cellulitis, Major ComplexityJ13BLower Limb Procedures W/O Ulcer or Cellulitis, Minor ComplexityJ14ZMajor Breast ReconstructionsJ60ASkin Ulcers, Major ComplexityJ60BSkin Ulcers, Intermediate ComplexityJ60CSkin Ulcers, Minor ComplexityJ62AMalignant Breast Disorders, Major ComplexityJ62BMalignant Breast Disorders, Minor ComplexityJ63ANon-Malignant Breast Disorders, Major ComplexityJ63BNon-Malignant Breast Disorders, Minor ComplexityJ64ACellulitis, Major ComplexityJ64BCellulitis, Minor ComplexityJ65ATrauma to Skin, Subcutaneous Tissue and Breast, Major ComplexityJ65BTrauma to Skin, Subcutaneous Tissue and Breast, Minor ComplexityJ67AMinor Skin Disorders, Major ComplexityJ67BMinor Skin Disorders, Minor ComplexityJ68AMajor Skin Disorders, Major ComplexityJ68BMajor Skin Disorders, Minor ComplexityJ69ASkin Malignancy, Major ComplexityJ69BSkin Malignancy, Minor ComplexityK01AGIs for Diabetic Complications, Major ComplexityK01BGIs for Diabetic Complications, Intermediate ComplexityK01CGIs for Diabetic Complications, Minor ComplexityK02ZPituitary ProceduresK03ZAdrenal ProceduresK05AParathyroid Procedures, Major ComplexityK05BParathyroid Procedures, Minor ComplexityK06AThyroid Procedures, Major ComplexityK06BThyroid Procedures, Minor ComplexityK08ZThyroglossal ProceduresK09AOther Endocrine, Nutritional and Metabolic GIs, Major ComplexityK09BOther Endocrine, Nutritional and Metabolic GIs, Minor ComplexityK10ZRevisional and Open Bariatric ProceduresK11ZMajor Laparoscopic Bariatric ProceduresK12ZOther Bariatric ProceduresK13ZPlastic GIs for Endocrine, Nutritional and Metabolic DisordersK40AEndoscopic and Investigative Procedures for Metabolic Disorders, Major CompK40BEndoscopic and Investigative Procedures for Metabolic Disorders, Minor CompK60ADiabetes, Major ComplexityK60BDiabetes, Minor ComplexityK61ASevere Nutritional Disturbance, Major ComplexityK61BSevere Nutritional Disturbance, Minor ComplexityK62AMiscellaneous Metabolic Disorders, Major ComplexityK62BMiscellaneous Metabolic Disorders, Intermediate ComplexityK62CMiscellaneous Metabolic Disorders, Minor ComplexityK63AInborn Errors of Metabolism, Major ComplexityK63BInborn Errors of Metabolism, Minor ComplexityK64AEndocrine Disorders, Major ComplexityK64BEndocrine Disorders, Minor ComplexityL02AOperative Insertion of Peritoneal Catheter for Dialysis, Major ComplexityL02BOperative Insertion of Peritoneal Catheter for Dialysis, Minor ComplexityL03AKidney, Ureter and Major Bladder Procedures for Neoplasm, Major ComplexityL03BKidney, Ureter and Major Bladder Procedures for Neoplasm, Intermediate CompL03CKidney, Ureter and Major Bladder Procedures for Neoplasm, Minor ComplexityL04AKidney, Ureter and Major Bladder Procedures for Non-Neoplasm, Major ComplexityL04BKidney, Ureter and Major Bladder Procedures for Non-Neoplasm, Intermediate CompL04CKidney, Ureter and Major Bladder Procedures for Non-Neoplasm, Minor ComplexityL05ATransurethral Prostatectomy for Urinary Disorder, Major ComplexityL05BTransurethral Prostatectomy for Urinary Disorder, Minor ComplexityL06AMinor Bladder Procedures, Major ComplexityL06BMinor Bladder Procedures, Intermediate ComplexityL06CMinor Bladder Procedures, Minor ComplexityL07AOther Transurethral Procedures, Major ComplexityL07BOther Transurethral Procedures, Minor ComplexityL08AUrethral Procedures, Major ComplexityL08BUrethral Procedures, Minor ComplexityL09AOther Procedures for Kidney and Urinary Tract Disorders, Major ComplexityL09BOther Procedures for Kidney and Urinary Tract Disorders, Intermediate ComplexityL09COther Procedures for Kidney and Urinary Tract Disorders, Minor ComplexityL10AKidney Transplant, Age <=16 Years or Major ComplexityL10BKidney Transplant, Age >=17 Years and Minor ComplexityL40ZUreteroscopyL41ZCystourethroscopy for Urinary Disorder, SamedayL42ZESW LithotripsyL60AKidney Failure, Major ComplexityL60BKidney Failure, Intermediate ComplexityL60CKidney Failure, Minor ComplexityL61ZHaemodialysisL62AKidney and Urinary Tract Neoplasms, Major ComplexityL62BKidney and Urinary Tract Neoplasms, Intermediate ComplexityL62CKidney and Urinary Tract Neoplasms, Minor ComplexityL63AKidney and Urinary Tract Infections, Major ComplexityL63BKidney and Urinary Tract Infections, Minor ComplexityL64AUrinary Stones and Obstruction, Major ComplexityL64BUrinary Stones and Obstruction, Minor ComplexityL65AKidney and Urinary Tract Signs and Symptoms, Major ComplexityL65BKidney and Urinary Tract Signs and Symptoms, Minor ComplexityL66ZUrethral StrictureL67AOther Kidney and Urinary Tract Disorders, Major ComplexityL67BOther Kidney and Urinary Tract Disorders, Intermediate ComplexityL67COther Kidney and Urinary Tract Disorders, Minor ComplexityL68ZPeritoneal DialysisM01AMajor Male Pelvic Procedures, Major ComplexityM01BMajor Male Pelvic Procedures, Minor ComplexityM02ATransurethral Prostatectomy for Reproductive System Disorder, Major ComplexityM02BTransurethral Prostatectomy for Reproductive System Disorder, Minor ComplexityM03APenis Procedures, Major ComplexityM03BPenis Procedures, Minor ComplexityM04ZTestes ProceduresM05ZCircumcisionM06AOther Male Reproductive System GIs, Major ComplexityM06BOther Male Reproductive System GIs, Minor ComplexityM40ZCystourethroscopy for Male Reproductive System Disorder, SamedayM60AMale Reproductive System Malignancy, Major ComplexityM60BMale Reproductive System Malignancy, Minor ComplexityM61ABenign Prostatic Hypertrophy, Major ComplexityM61BBenign Prostatic Hypertrophy, Minor ComplexityM62AMale Reproductive System Inflammation, Major ComplexityM62BMale Reproductive System Inflammation, Minor ComplexityM63ZMale Sterilisation ProceduresM64AOther Male Reproductive System Disorders, Major ComplexityM64BOther Male Reproductive System Disorders, Minor ComplexityN01ZPelvic Evisceration and Radical VulvectomyN04AHysterectomy for Non-Malignancy, Major ComplexityN04BHysterectomy for Non-Malignancy, Minor ComplexityN05AOophorectomy and Complex Fallopian Tube Procedures for Non-Malignancy, Maj CompN05BOophorectomy and Complex Fallopian Tube Procedures for Non-Malignancy, Min CompN06AFemale Reproductive System Reconstructive Procedures, Major ComplexityN06BFemale Reproductive System Reconstructive Procedures, Minor ComplexityN07AOther Uterus and Adnexa Procedures for Non-Malignancy, Major ComplexityN07BOther Uterus and Adnexa Procedures for Non-Malignancy, Minor ComplexityN08ZEndoscopic and Laparoscopic Procedures, Female Reproductive SystemN09AOther Vagina, Cervix and Vulva Procedures, Major ComplexityN09BOther Vagina, Cervix and Vulva Procedures, Minor ComplexityN10ZDiagnostic Curettage and Diagnostic HysteroscopyN11AOther Female Reproductive System GIs, Major ComplexityN11BOther Female Reproductive System GIs, Minor ComplexityN12AUterus and Adnexa Procedures for Malignancy, Major ComplexityN12BUterus and Adnexa Procedures for Malignancy, Intermediate ComplexityN12CUterus and Adnexa Procedures for Malignancy, Minor ComplexityN60AFemale Reproductive System Malignancy, Major ComplexityN60BFemale Reproductive System Malignancy, Minor ComplexityN61AFemale Reproductive System Infections, Major ComplexityN61BFemale Reproductive System Infections, Minor ComplexityN62AMenstrual and Other Female Reproductive System Disorders, Major ComplexityN62BMenstrual and Other Female Reproductive System Disorders, Minor ComplexityO01ACaesarean Delivery, Major ComplexityO01BCaesarean Delivery, Intermediate ComplexityO01CCaesarean Delivery, Minor ComplexityO02AVaginal Delivery W GIs, Major ComplexityO02BVaginal Delivery W GIs, Minor ComplexityO03ZEctopic PregnancyO04APostpartum and Post Abortion W GIs, Major ComplexityO04BPostpartum and Post Abortion W GIs, Minor ComplexityO05ZAbortion W GIsO60AVaginal Delivery, Major ComplexityO60BVaginal Delivery, Intermediate ComplexityO60CVaginal Delivery, Minor ComplexityO61APostpartum and Post Abortion W/O GIs, Major ComplexityO61BPostpartum and Post Abortion W/O GIs, Minor ComplexityO63AAbortion W/O GIs, Major ComplexityO63BAbortion W/O GIs, Minor ComplexityO66AAntenatal and Other Obstetric Admissions, Major ComplexityO66BAntenatal and Other Obstetric Admissions, Intermediate ComplexityO66CAntenatal and Other Obstetric Admissions, Minor ComplexityP01ZNeonate W Sig GI/Vent>=96hrs, Died or Transfer to Acute Facility <5DaysP02ZCardiothoracic and Vascular Procedures for NeonatesP03ANeonate, AdmWt 1000-1499g W Significant GI/Vent>=96hrs, Major ComplexityP03BNeonate, AdmWt 1000-1499g W Significant GI/Vent>=96hrs, Minor ComplexityP04ANeonate, AdmWt 1500-1999g W Significant GI/Vent>=96hrs, Major ComplexityP04BNeonate, AdmWt 1500-1999g W Significant GI/Vent>=96hrs, Minor ComplexityP05ANeonate, AdmWt 2000-2499g W Significant GI/Vent>=96hrs, Major ComplexityP05BNeonate, AdmWt 2000-2499g W Significant GI/Vent>=96hrs, Minor ComplexityP06ANeonate, AdmWt >=2500g W Significant GI/Vent>=96hrs, Major ComplexityP06BNeonate, AdmWt >=2500g W Significant GI/Vent>=96hrs, Minor ComplexityP07ZNeonate, AdmWt <750g W Significant GIsP08ZNeonate, AdmWt 750-999g W Significant GIsP60ANeonate W/O Sig GI/Vent>=96hrs, Died/Transfer Acute Facility <5 Days, MajCP60BNeonate W/O Sig GI/Vent>=96hrs, Died/Transfer Acute Facility <5 Days, MinCP61ZNeonate, AdmWt <750g W/O Significant GI procedureP62ANeonate, AdmWt 750-999g W/O Significant GIs, Major ComplexityP62BNeonate, AdmWt 750-999g W/O Significant GIs, Minor ComplexityP63ANeonate, AdmWt 1000-1249g W/O Significant GI/Vent>=96hrs, Major ComplexityP63BNeonate, AdmWt 1000-1249g W/O Significant GI/Vent>=96hrs, Minor ComplexityP64ANeonate, AdmWt 1250-1499g W/O Significant GI/Vent>=96hrs, Major ComplexityP64BNeonate, AdmWt 1250-1499g W/O Significant GI/Vent>=96hrs, Minor ComplexityP65ANeonate, AdmWt 1500-1999g W/O Significant GI/Vent>=96hrs, Extreme CompP65BNeonate, AdmWt 1500-1999g W/O Significant GI/Vent>=96hrs, Major ComplexityP65CNeonate, AdmWt 1500-1999g W/O Significant GI/Vent>=96hrs, Intermediate CompP65DNeonate, AdmWt 1500-1999g W/O Significant GI/Vent>=96hrs, Minor ComplexityP66ANeonate, AdmWt 2000-2499g W/O Significant GI/Vent>=96hrs, Extreme CompP66BNeonate, AdmWt 2000-2499g W/O Significant GI/Vent>=96hrs, Major ComplexityP66CNeonate, AdmWt 2000-2499g W/O Significant GI/Vent>=96hrs, Intermediate CompP66DNeonate, AdmWt 2000-2499g W/O Significant GI/Vent>=96hrs, Minor ComplexityP67ANeonate, AdmWt >=2500g W/O Sig GI/Vent>=96hrs, <37 Comp Wks Gest, Extr CompP67BNeonate, AdmWt >=2500g W/O Sig GI/Vent>=96hrs, <37 Comp Wks Gest, Maj CompP67CNeonate, AdmWt >=2500g W/O Sig GI/Vent>=96hrs, <37 Comp Wks Gest, Int CompP67DNeonate, AdmWt >=2500g W/O Sig GI/Vent>=96hrs, <37 Comp Wks Gest, Min CompP68ANeonate, AdmWt >=2500g W/O Sig GI/Vent>=96hrs, >=37 Comp Wks Gest, Ext CompP68BNeonate, AdmWt >=2500g W/O Sig GI/Vent>=96hrs, >=37 Comp Wks Gest, Maj CompP68CNeonate, AdmWt >=2500g W/O Sig GI/Vent>=96hrs, >=37 Comp Wks Gest, Int CompP68DNeonate, AdmWt >=2500g W/O Sig GI/Vent>=96hrs, >=37 Comp Wks Gest, Min CompQ01ZSplenectomyQ02ABlood and Immune System Disorders W Other GIs, Major ComplexityQ02BBlood and Immune System Disorders W Other GIs, Minor ComplexityQ60AReticuloendothelial and Immunity Disorders, Major ComplexityQ60BReticuloendothelial and Immunity Disorders, Minor ComplexityQ61ARed Blood Cell Disorders, Major ComplexityQ61BRed Blood Cell Disorders, Intermediate ComplexityQ61CRed Blood Cell Disorders, Minor ComplexityQ62ACoagulation Disorders, Major ComplexityQ62BCoagulation Disorders, Minor ComplexityR01ALymphoma and Leukaemia W Major GIs, Major ComplexityR01BLymphoma and Leukaemia W Major GIs, Minor ComplexityR02AOther Neoplastic Disorders W Major GIs, Major ComplexityR02BOther Neoplastic Disorders W Major GIs, Intermediate ComplexityR02COther Neoplastic Disorders W Major GIs, Minor ComplexityR03ALymphoma and Leukaemia W Other GIs, Major ComplexityR03BLymphoma and Leukaemia W Other GIs, Intermediate ComplexityR03CLymphoma and Leukaemia W Other GIs, Minor ComplexityR04AOther Neoplastic Disorders W Other GIs, Major ComplexityR04BOther Neoplastic Disorders W Other GIs, Minor ComplexityR05AAllogeneic Bone Marrow Transplant, Age <=16 Years or Major ComplexityR05BAllogeneic Bone Marrow Transplant, Age >=17 Years and Minor ComplexityR06AAutologous Bone Marrow Transplant, Major ComplexityR06BAutologous Bone Marrow Transplant, Minor ComplexityR60AAcute Leukaemia, Major ComplexityR60BAcute Leukaemia, Intermediate ComplexityR60CAcute Leukaemia, Minor ComplexityR61ALymphoma and Non-Acute Leukaemia, Major ComplexityR61BLymphoma and Non-Acute Leukaemia, Intermediate ComplexityR61CLymphoma and Non-Acute Leukaemia, Minor ComplexityR62AOther Neoplastic Disorders, Major ComplexityR62BOther Neoplastic Disorders, Intermediate ComplexityR62COther Neoplastic Disorders, Minor ComplexityR63ZChemotherapyT01AInfectious and Parasitic Diseases W GIs, Major ComplexityT01BInfectious and Parasitic Diseases W GIs, Intermediate ComplexityT01CInfectious and Parasitic Diseases W GIs, Minor ComplexityT40ZInfectious and Parasitic Diseases W Ventilator SupportT60ASepticaemia, Major ComplexityT60BSepticaemia, Intermediate ComplexityT60CSepticaemia, Minor ComplexityT61APostoperative Infections, Major ComplexityT61BPostoperative Infections, Minor ComplexityT62AFever of Unknown Origin, Major ComplexityT62BFever of Unknown Origin, Minor ComplexityT63AViral Illnesses, Major ComplexityT63BViral Illnesses, Minor ComplexityT64AOther Infectious and Parasitic Diseases, Major ComplexityT64BOther Infectious and Parasitic Diseases, Intermediate ComplexityT64COther Infectious and Parasitic Diseases, Minor ComplexityU40AMental Health Treatment W ECT, Sameday, Major ComplexityU40BMental Health Treatment W ECT, Sameday, Minor ComplexityU60ZMental Health Treatment W/O ECT, SamedayU61ASchizophrenia Disorders, Major ComplexityU61BSchizophrenia Disorders, Minor ComplexityU62AParanoia and Acute Psychotic Disorders, Major ComplexityU62BParanoia and Acute Psychotic Disorders, Minor ComplexityU63AMajor Affective Disorders, Major ComplexityU63BMajor Affective Disorders, Minor ComplexityU64AOther Affective and Somatoform Disorders, Major ComplexityU64BOther Affective and Somatoform Disorders, Minor ComplexityU65AAnxiety Disorders, Major ComplexityU65BAnxiety Disorders, Minor ComplexityU66AEating and Obsessive-Compulsive Disorders, Major ComplexityU66BEating and Obsessive-Compulsive Disorders, Minor ComplexityU67APersonality Disorders and Acute Reactions, Major ComplexityU67BPersonality Disorders and Acute Reactions, Minor ComplexityU68AChildhood Mental Disorders, Major ComplexityU68BChildhood Mental Disorders, Minor ComplexityV60AAlcohol Intoxication and Withdrawal, Major ComplexityV60BAlcohol Intoxication and Withdrawal, Minor ComplexityV61ADrug Intoxication and Withdrawal, Major ComplexityV61BDrug Intoxication and Withdrawal, Minor ComplexityV62AAlcohol Use and Dependence, Major ComplexityV62BAlcohol Use and Dependence, Minor ComplexityV63ZOpioid Use and DependenceV64AOther Drug Use and Dependence, Major ComplexityV64BOther Drug Use and Dependence, Minor ComplexityW01AVent, Trac & Cran Procs for Mult Sig Trauma, Major ComplexityW01BVent, Trac & Cran Procs for Mult Sig Trauma, Intermediate ComplexityW01CVent, Trac & Cran Procs for Mult Sig Trauma, Minor ComplexityW02AHip, Femur and Lower Limb Procedures for Multiple Sig Trauma, Major ComplexityW02BHip, Femur and Lower Limb Procedures for Multiple Sig Trauma, Minor ComplexityW03ZAbdominal Procedures for Multiple Significant TraumaW04AMultiple Significant Trauma W Other GIs, Major ComplexityW04BMultiple Significant Trauma W Other GIs, Minor ComplexityW60ZMultiple Sig Trauma, Transferred to Acute Facility <5 DaysW61AMultiple Significant Trauma W/O GIs, Major ComplexityW61BMultiple Significant Trauma W/O GIs, Minor ComplexityX02AMicrovascular Tissue Transfer and Skin Grafts for Injuries to Hand, Major CompX02BMicrovascular Tissue Transfer and Skin Grafts for Injuries to Hand, Minor CompX04AOther Procedures for Injuries to Lower Limb, Major ComplexityX04BOther Procedures for Injuries to Lower Limb, Minor ComplexityX05AOther Procedures for Injuries to Hand, Major ComplexityX05BOther Procedures for Injuries to Hand, Minor ComplexityX06AOther Procedures for Other Injuries, Major ComplexityX06BOther Procedures for Other Injuries, Intermediate ComplexityX06COther Procedures for Other Injuries, Minor ComplexityX07ASkin Grafts for Injuries Excluding Hand, Major ComplexityX07BSkin Grafts for Injuries Excluding Hand, Intermediate ComplexityX07CSkin Grafts for Injuries Excluding Hand, Minor ComplexityX40AInjuries, Poisoning and Toxic Effects of Drugs W Ventilator Support, Major CompX40BInjuries, Poisoning and Toxic Effects of Drugs W Ventilator Support, Minor CompX60AInjuries, Major ComplexityX60BInjuries, Minor ComplexityX61AAllergic Reactions, Major ComplexityX61BAllergic Reactions, Minor ComplexityX62APoisoning/Toxic Effects of Drugs and Other Substances, Major ComplexityX62BPoisoning/Toxic Effects of Drugs and Other Substances, Minor ComplexityX63ASequelae of Treatment, Major ComplexityX63BSequelae of Treatment, Minor ComplexityX64AOther Injuries, Poisonings and Toxic Effects, Major ComplexityX64BOther Injuries, Poisonings and Toxic Effects, Intermediate ComplexityX64COther Injuries, Poisonings and Toxic Effects, Minor ComplexityY01ZVent >=96hrs or Trach for Burns or GIs for Severe Full Thickness BurnsY02ASkin Grafts for Other Burns, Major ComplexityY02BSkin Grafts for Other Burns, Intermediate ComplexityY02CSkin Grafts for Other Burns, Minor ComplexityY03AOther GIs for Other Burns, Major ComplexityY03BOther GIs for Other Burns, Minor ComplexityY60ZBurns, Transferred to Acute Facility <5 DaysY61ZSevere BurnsY62AOther Burns, Major ComplexityY62BOther Burns, Minor ComplexityZ01AOther Contacts W Health Services W GIs, Major ComplexityZ01BOther Contacts W Health Services W GIs, Minor ComplexityZ40ZOther Contacts W Health Services W EndoscopyZ60ARehabilitation, Major ComplexityZ60BRehabilitation, Minor ComplexityZ61ASigns and Symptoms, Major ComplexityZ61BSigns and Symptoms, Minor ComplexityZ63AOther Follow Up After Surgery or Medical Care, Major ComplexityZ63BOther Follow Up After Surgery or Medical Care, Minor ComplexityZ64AOther Factors Influencing Health Status, Major ComplexityZ64BOther Factors Influencing Health Status, Minor ComplexityZ65ZCongenital Anomalies and Problems Arising from Neonatal PeriodZ66ZSleep Disorders ................
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