Table of Contents - Home | IHPA



-6985000Independent Hospital Pricing AuthorityAustralian Refined Diagnosis Related Groups Version 10.0 Final ReportFebruary 2019Australian Refined Diagnosis Related Groups Version 10.0 Final Report – February 2019? Independent Hospital Pricing Authority 2019This publication is available for your use under a Creative Commons BY Attribution 3.0 Australia licence, with the exception of the Independent Hospital Pricing Authority logo, photographs, images, signatures and where otherwise stated. The full licence terms are available from the Creative Commons website.Use of Independent Hospital Pricing Authority material under a Creative Commons BY Attribution 3.0 Australia licence requires you to attribute the work (but not in any way that suggests that the Independent Hospital Pricing Authority endorses you or your use of the work).Independent Hospital Pricing Authority material used 'as supplied'.Provided you have not modified or transformed Independent Hospital Pricing Authority material in any way including, for example, by changing Independent Hospital Pricing Authority text – then the Independent Hospital Pricing Authority prefers the following attribution:Source: The Independent Hospital Pricing AuthorityTable of Contents TOC \o "1-2" \h \z \u Acronyms and Abbreviations PAGEREF _Toc536011601 \h 3Executive Summary PAGEREF _Toc536011602 \h 41Introduction PAGEREF _Toc536011603 \h 51.1Australian Refined Diagnosis Related Groups PAGEREF _Toc536011604 \h 51.2Classification process PAGEREF _Toc536011605 \h 51.3Episode clinical complexity PAGEREF _Toc536011606 \h 71.4Governance and consultation process PAGEREF _Toc536011607 \h 71.5Other documents PAGEREF _Toc536011608 \h 82Development of Work Program PAGEREF _Toc536011609 \h 93Refinement of AR-DRG Version 10.0 PAGEREF _Toc536011610 \h 103.1Refinements to diagnosis exclusions PAGEREF _Toc536011611 \h 103.2Stability of the AR-DRG complexity model PAGEREF _Toc536011612 \h 113.3Nephrolithiasis interventions PAGEREF _Toc536011613 \h 123.4Removal of the rehabilitation ADRG PAGEREF _Toc536011614 \h 133.5Liver procurement from a living donor PAGEREF _Toc536011615 \h 133.6Osseointegration interventions PAGEREF _Toc536011616 \h 133.7Intervention hierarchy review PAGEREF _Toc536011617 \h 133.8ADRG splitting criteria review PAGEREF _Toc536011618 \h 144AR-DRG V10.0 Overview PAGEREF _Toc536011619 \h 164.1ADRG Structure PAGEREF _Toc536011620 \h 164.2Statistical Performance PAGEREF _Toc536011621 \h 16Appendix A: AR-DRG V10.0 Descriptions PAGEREF _Toc536011622 \h 17Acronyms and AbbreviationsABFActivity Based FundingACCD Australian Consortium for Classification DevelopmentACHIAustralian Classification of Health InterventionsACSAustralian Coding StandardsADRGAdjacent Diagnosis Related GroupAR-DRGAustralian Refined Diagnosis Related GroupCACClinical Advisory CommitteeCCAGClassifications Clinical Advisory GroupDCLDiagnosis Complexity LevelDRGDiagnosis Related GroupDTG DRG Technical GroupECCEpisode Clinical ComplexityECCSEpisode Clinical Complexity ScoreGIsGeneral InterventionsICD-10-AMInternational Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian ModificationIHPAIndependent Hospital Pricing AuthorityMDCMajor Diagnostic CategoryPDXPrincipal diagnosisRIDReduction in devianceVVersionExecutive SummaryThe Independent Hospital Pricing Authority (IHPA) is responsible for the development of the Australian Refined Diagnosis Related Groups (AR-DRGs) classification. AR-DRGs group together treatments and services provided for admitted acute care to enable hospitals to be funded for these services using Activity Based Funding (ABF) arrangements. This is the first time since IHPA was established and assumed responsibility for the AR-DRG classification that development of a new version has been undertaken within the agency. AR-DRG Version (V) 10.0 has been finalised following clinical and statistical analysis and in consultation with clinicians, jurisdictions and other health sector stakeholders. This report outlines the changes made for AR-DRG V10.0 and details the refinement process undertaken and the rationale for changes.Refinement and review of the stability of the AR-DRG complexity model was identified by stakeholders as the highest priority for AR-DRG V10.0 to ensure that it is robust and fit for purpose. As a result the major focus for V10.0 has been to review the diagnosis exclusions within the complexity model and its overall stability. Alongside this other changes have been informed by public submissions and development work held over from AR-DRG V9.0. IHPA has also undertaken a comprehensive review of the splitting of end classes and implemented changes resulting from a review of the intervention hierarchy.AR-DRG V10.0 is anticipated to be released in mid-2019 and used to price admitted acute episodes of care from 1 July 2020.IntroductionAustralian Refined Diagnosis Related GroupsIHPA has responsibility for the development of the AR-DRG classification, which groups together treatments and services provided for admitted acute care to enable hospitals to be funded for these services using ABF arrangements. The AR-DRG classification is underpinned by the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM), the Australian Classification of Health Interventions (ACHI) and the Australian Coding Standards (ACS); collectively known as ICD-10-AM/ACHI/ACS. All public and private hospitals in Australia use ICD-10-AM/ACHI/ACS and AR-DRGs to classify admitted acute care and the classifications are updated every two years to ensure they are fit for purpose and remain clinically current.The AR-DRG classification consists of approximately 800 end classes, with each admitted acute episode of care being classified based on diagnoses, interventions and other routinely collected data, such as age, sex, mode of separation, length of stay, newborn admission weight and hours of mechanical ventilation. While the AR-DRG classification is instrumental to ABF, it is also used for many other purposes including performance management, benchmarking, epidemiology and research.Development of AR-DRG V10.0 has been undertaken by IHPA in-house while the development of ICD-10-AM/ACHI/ACS has continued to be contracted to the Australian Consortium for Classification Development (ACCD) for Eleventh Edition. The classifications have been developed in consultation with clinicians, jurisdictions and other health sector stakeholders.It is anticipated that AR-DRG V10.0 will be released in mid-2019 and used to price admitted acute episodes of care from 1 July 2020. ICD-10-AM/ACHI/ACS Eleventh Edition will be implemented on 1 July 2019.Classification processThe process of classifying or ‘coding’ involves the translation of information (diagnoses and interventions) from the clinical record of a patient into alphanumeric codes within ICD-10-AM and ACHI.At the conclusion of a patient’s episode of care a clinical coder reviews the patient’s clinical record (the primary source for the coding of acute admitted episodes of care) and abstracts information recorded by clinicians to assign codes for the principal diagnosis, additional diagnoses and interventions performed in accordance with guidelines provided in the ACS.Following assignment of ICD-10-AM and ACHI codes episodes of care are assigned to a DRG in the AR-DRG classification. AR-DRGs group episodes of care with similar diagnoses and intervention codes. This process of assigning episodes of care to a DRG is a complex process and is carried out using software that contains the AR-DRG algorithms (often referred to as the ‘Grouper’). A schematic of the AR-DRG assignment process is at Figure 1.Figure 1: Schematic diagram for AR-DRG V10.0 assignmentDemographic and clinical edits: These edits check the validity of the data to be used for grouping; and include age, sex, neonatal admission weight, sameday status, hours of mechanical ventilation and mode of separation. They also validate all diagnosis (ICD-10-AM) and intervention (ACHI) codes, combined with a patient’s age and sex. Principal diagnosis is also checked to validate that it is an acceptable principal diagnosis code. Potential issues in relation to the validity of the data may result in assignment to one of the three error ADRGs:960Z Ungroupable;961Z Unacceptable Principal Diagnosis; 963Z Neonatal Diagnosis Not Consistent W Age/Weight. MDC assignment: After edit processing episodes are assigned to a Major Diagnostic Category (MDC) according to principal diagnosis, and are generally mutually exclusive. Pre MDC processing: Episodes are then assessed as to whether they meet Pre MDC criteria that identifies very high cost episodes (e.g. A13 Ventilation ≥ 336 hours) and is driven by a specific intervention code that overrides the outcome of the principal diagnosis based MDC assignment. ADRG assignment: Episodes are assigned to an Adjacent DRG (ADRG) mostly according to diagnosis and intervention codes. All MDCs have a hierarchical structure that separates the ADRGs into either the intervention or medical partition. DRG assignment: Within each ADRG episodes are then assigned to DRGs according to a complexity measure that quantifies relative levels of resource utilisation within each ADRG and is used to split ADRGs into different DRG levels on the basis of resource homogeneity.Episode clinical complexityThe AR-DRG classification has a measure in place to account for the complexity of patient episodes. A patient episode of care is initially assigned to an ADRG. An ADRG is a group of DRGs which have the same first three characters (for example B70 Stroke and Other Cerebrovascular Disorders). They broadly group episodes with the same diagnosis and intervention codes together. ADRGs are then subdivided into individual DRGs based on a complexity measure and occasionally other factors such as length of stay. DRGs ending in ‘A’ will be the most costly whereas DRGs ending in ‘D’ will be the least costly. For example:B70A Stroke and Other Cerebrovascular Disorders, Major Complexity;B70B Stroke and Other Cerebrovascular Disorders, Intermediate Complexity;B70C Stroke and Other Cerebrovascular Disorders, Minor Complexity;B70D Stroke and Other Cerebrovascular Disorders, Transferred < 5 days.AR-DRG V8.0 introduced a new methodology for determining clinical complexity, known as the Episode Clinical Complexity (ECC) Model. The Episode Clinical Complexity Score (ECCS) quantifies relative levels of resource utilisation within each ADRG and is used to split ADRGs into different DRG levels on the basis of resource homogeneity. The process of deriving an ECCS for each episode begins by assigning a Diagnosis Complexity Level (DCL) value to each diagnosis reported for the episode. DCLs are integers that quantify levels of resource utilisation associated with each diagnosis, relative to levels within the ADRG to which the episode belongs. DCL values are assigned to principal diagnosis and additional diagnosis codes and range between zero and five. A DCL value of zero indicates the diagnosis has no effect on complexity within that specific ADRG. Approximately 11,000 diagnosis codes have a DCL with a non-zero value in ARDRG V10.0, i.e. they contribute to the complexity of an episode of care.The ECCS determines the final DRG an episode of care is assigned to within an ADRG. For example, to be assigned to DRG B70A Stroke and Other Cerebrovascular Disorders, Major Complexity, an episode must have an ECCS greater than or equal to 4.0 (in AR-DRG V10.0).The AR-DRG V10.0 Technical Specifications provide further information with regards to the ECC model and ECCS derivations. Governance and consultation processIHPA has a number of technical groups to ensure consultation with a wide range of stakeholders as well as a clear governance process for endorsing changes to both ICD-10-AM/ACHI/ACS and AR-DRGs. IHPA has two groups which provide clinical and technical advice in regard to the refinement and development of AR-DRGs: Classifications Clinical Advisory Group (CCAG) – provide clinical advice and facilitate broad canvassing of clinicians to ensure that there is likely to be general acceptance of the developed proposals. Membership includes representation from medical, nursing and allied health professions. The group has two representatives from IHPA’s Clinical Advisory Committee (CAC).Diagnosis Related Groups Technical Group (DTG) – provide advice in regard to the refinement and development of AR-DRGs. DTG includes representatives from state and territory health departments, the Commonwealth, private hospitals, private health insurers and the New Zealand Ministry of AG and DTG advice was sought on all AR-DRG V10.0 refinements. A sub-group of CCAG clinicians also provided extensive advice in relation to the proposed diagnosis exclusions within the AR-DRG complexity model. See 3.1 Refinements to diagnosis exclusions.Consultation on refinements to the AR-DRG classification also occurs through IHPA’s CAC, Technical Advisory Committee, Jurisdictional Advisory Committee and Stakeholder Advisory Committee with final approval sought from the Pricing Authority.In addition to consultation through the advisory groups, IHPA undertook a public consultation in May/June 2018 on major refinements to be introduced in AR-DRG V10.0 to ensure the broadest possible consultation across the public and private health sector. Fifteen submissions were received and all submissions are published on IHPA’s website (except if specified as commercial in confidence). IHPA has responded to each submission individually.Other documents In addition to the AR-DRG V10.0 Final Report other reference documents have been developed to support AR-DRG V10.0: AR-DRG V10.0 Technical Specifications; AR-DRG V10.0 Definitions Manuals. AR-DRG V10.0 Technical Specifications: This document accompanies the AR-DRG V10.0 Final Report. It provides the methodology and technical specifications used in developing AR-DRG V10.0 including: Data preparation and modification; Derivation of the ECCS; ADRG splitting review; ADRG hierarchy review.AR-DRG V10.0 Definitions ManualsThe AR-DRG Definitions Manuals are reference documents that detail the definition logic for the DRG process performed by the grouper. The manuals provide documentation of how particular episodes of care group to particular DRGs. While the manuals assist with the identification of likely DRG assignments for individual episodes, they are not a substitute for the grouping software that is provided by various vendors under licence from IHPA.Development of Work ProgramIHPA drafted a work program in late 2017 outlining areas for consideration in the development of AR-DRG V10.0 and to identify other areas stakeholders considered to be a priority. This work program was approved through IHPA’s technical and advisory committees in early 2018 with tasks sourced from a number of areas, including:Issues held over from AR-DRG V9.0 development;Areas identified through IHPA’s pricing work;Submissions from stakeholders to consultations on the annual Pricing Framework for Australian Public Hospital Services;AR-DRG public submissions.Refinement and review of the stability of the AR-DRG complexity model was identified as the highest priority for AR-DRG V10.0 to ensure that it is robust and fit for purpose.The work program was reviewed by IHPA’s advisory committees and a list of priorities for AR-DRG V10.0 was finalised.Refinement of AR-DRG Version 10.0Refinements to diagnosis exclusionsA number of diagnosis codes are excluded from consideration in the AR-DRG ECC Model based on guiding principles formalised during its initial development (V8.0). These guiding principles aimed to characterise the scope of the model in terms of diagnoses considered relevant for DRG classification purposes. Clinical determination of exclusions for all (approximately) 16,000 diagnosis codes was not possible during the development of the complexity model for V8.0, however, it was acknowledged that further refinement of diagnosis codes considered as in-scope and out of scope for the model would be required.IHPA undertook this refinement for AR-DRG V10.0 and in so doing expanded the guiding principles for exclusion as outlined in REF _Ref344450 \h Table 1:Table 1: Guiding principles for exclusion in the AR-DRG complexity modelOriginal (AR-DRG V8.0)Additional (AR-DRG V10.0)Codes for undefined or ill-specified conditions Codes for asymptomatic or sub-clinical conditions e.g. latent conditions Codes for symptoms and findings or transient conditionsCodes that represent markers of other diseases e.g. hypercholesterolaemiaCodes that provide additional or contextual informationCodes that represent minor conditions that do not generally result in an admitted acute episode of careMost unacceptable principal diagnosis codesCodes that represent an underlying cause of disease e.g. tobacco dependence/useA comprehensive review of the current in-scope code set (12,559 codes) informed by the guiding principles was undertaken in consultation with a sub-group of clinicians from CCAG, the wider CCAG group and DTG to refine the code set. The results of this review also went out to public consultation during May/June 2018. Particular attention was also given to a review of those codes with a large increase in assignment between 2015-16 and 2016-17, coinciding with the introduction of AR-DRG V8.0 on 1 July 2016.Impact analysis was then undertaken on the proposed diagnosis exclusions to determine which codes should potentially be reincorporated into the ECC Model. An iterative consultation process was conducted that included further analysis and consultation with CCAG, DTG and CAC, and the CCAG sub-group, which also took into consideration feedback from the public consultation.A list of codes for exclusion was then finalised based on a combination of the impact analysis and clinical advice.Of the 12,559 codes initially in-scope within the complexity model 1,576 were proposed for exclusion, decreasing the in-scope codes by approximately 12.5%. Following feedback from stakeholders, the impact analysis and further clinical advice from the CCAG sub-group the final list excludes 1,511 codes (with 65 having been reincorporated), reducing the in-scope codes by approximately 12.0%.Stability of the AR-DRG complexity modelThe ECC Model provides a systematic method for refining complexity weights with each new version of AR-DRGs. Prior to this a systematic review of diagnosis complexity weights had not occurred since AR-DRG V4.0 was introduced in 2000. A primary benefit of the ECC Model is that it facilitates continual refinement of the model by utilising the most recent cost and activity data. This means that to some extent the model is ‘self-correcting’ and reflects changes in the underlying data. For example, a significant increase in the reporting of a specific diagnosis code may result in a reduction in the complexity weight with all else being equal. The ‘self-correcting’ nature of the model, however, needs to be balanced against stability. Stakeholders have an expectation that while AR-DRG versions should reflect changes in resource use they should at the same time remain reasonably stable.In order to assess the overall AR-DRG classification stability, a number of levers in the ECC Model were considered:DCLs: The DCLs represent the relative costs associated with each diagnosis within the context of specific ADRGs. DCL weights are calculated for every combination of diagnosis and ADRG, resulting in approximately 6.7 million different combinations and range between zero and five.Refinement in the number of complexity splits: Introduction or removal of complexity splits within an ADRG, for example, an ADRG changing from having an ‘A’ and a ‘B’ DRG to having an ‘A’, ‘B’ and ‘C’ DRG.Refinement of complexity thresholds: Changes to the thresholds within an ADRG that determine which episodes are assigned to an ‘A’, ‘B’ or ‘C’ DRG.Changes to any of these levers can result in movement of episodes between complexity levels within an ADRG. As part of the AR-DRG V10.0 development IHPA developed and adopted a number of stability measures to ensure the robustness and stability of the complexity model both for V10.0 and future versions of the AR-DRG classification. REF _Ref344635 \h Table 2 outlines the stability measures that have been adopted for AR-DRG V10.0. Table 2: AR-DRG complexity split stability measuresAreaMeasure Stability of DCL weightsFor AR-DRG V10.0 a stability criterion has been adopted when deriving the DCL weights. DCL weights are rounded integers between zero and five, therefore unrounded DCLs of 0.498 and 0.505 results in DCL weights of zero and one respectively. To avoid large shifts in rounded DCL weights, unrounded DCLs need to shift by more than ±0.2 relative to the AR-DRG V9.0 DCL to warrant a change.Stability of complexity splits within ADRGsChanging the number of splits within an ADRG needs to be considered carefully, especially taking into account the interval since the last modification. IHPA has further refined the splitting criteria to ensure there is a strong evidence base in the data before a split is introduced or removed.Both AR-DRG V8.0 and V9.0 were taken into consideration when assessing the number of splits. That is, if the number of splits has not changed between V8.0 and V9.0, there needed to be greater evidence (statistical or clinical) to warrant a change in V10.0. ADRGs with large movements of episodes between complexity groups were assessed on a case by case basis, to ensure all movements are understood and justified relative to AR-DRG V9.0.Overall stability performance measureThe overall stability has been evaluated by reviewing the proportion of episodes shifting complexity within and outside ADRGs. This measure facilitates identification of large movements in episodes within the AR-DRG classification, following which a review can occur to ensure any such large movements are justified.Nephrolithiasis interventionsDuring AR-DRG V9.0 development a number of options were considered for combining or redefining the ADRGs for nephrolithiasis interventions with the aim of creating more clinically coherent groups for these interventions and removing the reliance on the sameday criterion. ADRGs under review were:L40 Ureteroscopy;L41 Cystourethroscopy for Urinary Disorder, Sameday;L42 Extracorporeal Shock Wave (ESW) Lithotripsy.This work was not progressed in V9.0 mostly due to the movement of some high cost episodes into proposed new ADRGs that could not be resolved.In reconsidering this issue for AR-DRG V10.0 an initial proposal was to create a new ADRG for nephrolithiasis interventions that combined the content of L40 and L41 and removed the sameday variable. While data analysis supported the resource homogeneity of these new groupings it did result in some high cost episodes moving into the new ADRGs, the same issue that was encountered during V9.0 development. To mitigate this issue the intervention hierarchy was adjusted and certain principal diagnoses codes were excluded from informing the new ADRG L44 where they were clinically better represented by their original ADRGs. This provided more clinically coherent groupings for nephrolithiasis interventions and removed the sameday variable that informed the former L41. The final outcome was to replace ADRGs L40, L41 and L42 with two new ADRGs:L43 Nephrolithiasis Interventions;L44 Cystourethroscopy for Urinary Disorder. IHPA has not proposed changes to ADRGs L07 Other Transurethral Procedures or L08 Urethral Procedures, as they group interventions for nephrolithiasis of a more significant ‘surgical’ nature and a different cost profile to those in ADRGs L40, L41 and L42.Removal of the rehabilitation ADRGADRG Z60 Rehabilitation became obsolete as a consequence of an update to an ACS implemented in Ninth Edition (1 July 2015). Rehabilitation episodes now group to various ADRGs according to a principal diagnosis that reflect the underlying condition requiring rehabilitation and so this ADRG has been removed in AR-DRG V10.0.Liver procurement from a living donorA public submission highlighted an inconsistency in the grouping of liver procurement from living donors. Episodes of care for living donor kidney procurement group to a body system MDC (MDC 11 Diseases and Disorders of the Kidney and Urinary Tract). In contrast, episodes of care for living donor liver procurement group to MDC 23 Factors Influencing Health Status and Other Contacts with Health Services, resulting in assignment to ADRG Z01 Other Contacts with Health Services with General Interventions.In AR-DRG V10.0 episodes of liver procurement from living donors will group to ADRG H01 Pancreas, Liver and Shunt Procedures in MDC 07 Diseases and Disorders of the Hepatobiliary System. This grouping is more clinically coherent and consistent with the grouping of other living organ procurement episodes.Osseointegration interventionsA public submission highlighted a discrepancy in the grouping of osseointegration procedures of the digits and limbs, whereby some episodes inappropriately group to ADRG I15 Cranio-Facial Surgery.This has been amended in V10.0 and these episodes will now group more appropriately to ADRG I28 Other Musculoskeletal Procedures.Intervention hierarchy reviewWithin each MDC in the AR-DRG classification episodes are allocated to an ADRG in a specific hierarchical order. The hierarchy of the intervention partition is important as episodes have the potential to meet multiple surgical and/or other ADRG criteria.The intervention hierarchy is generally based on cost, with high cost ADRGs higher in the hierarchy. However, cost is not the only determinant. Other factors are also considered such as specific ADRGs being positioned higher than non-specific ADRGs and treatment intervention ADRGs being positioned higher than diagnostic intervention ADRGs.Changes to the partitioning of the AR-DRG classification in AR-DRG V9.0 resulted in a single ‘intervention’ partition by combining the former ‘other’ and ‘surgical’ partitions. Additionally V9.0 saw a number of changes with respect to revision of Pre-MDC ADRGs and those using Pre-MDC reassignment logic.A hierarchy review to assess the impact of the partition modification and the Pre-MDC revision was not performed during V9.0 development; however, has been undertaken for AR-DRG V10.0.Building on principles used in previous AR-DRG versions IHPA developed criteria that were used to assess and inform changes to the hierarchy for AR-DRG V10.0. These criteria are outlined in REF _Ref344690 \h Table 3.Table 3: Intervention hierarchy criteriaCriteriaDescriptionCost Sorting of intervention ADRGs from high to low cost with decisions based on both mean and median cost.Specificity Sorting of intervention ADRGs from specific to non-specific ADRGs (the most common of these are the other/catch-all ADRGs at the bottom of the intervention hierarchy, just before ADRG 801 General Interventions (GIs) Unrelated to Principal Diagnosis). This criterion may override the cost criterion.Procedure typeSorting of intervention ADRGs from the initial definitive intervention, to follow-up and supportive interventions and from major to minor/other interventions.Treatment typeSorting of intervention ADRGs from treatment to diagnostic interventions.With the introduction of new ADRGs and/or modification to ADRG logic it is necessary to re-assess the ADRG intervention hierarchy to ensure that changes are appropriately accounted for within the intervention hierarchy.The intervention hierarchy review for V10.0 resulted in hierarchy position changes to eleven of the 25 MDCs. The AR-DRG V10.0 Technical Specifications provide further details as to the methodology and outcomes of the intervention hierarchy review for AR-DRG V10.0.ADRG splitting criteria reviewAn episode of care is initially assigned to an ADRG which broadly group episodes with the same diagnosis and intervention profiles. The final stage is to subdivide (or ‘split’) each ADRG into individual DRGs based on the ECCS and occasionally other factors such as length of stay and transfer status. Splitting criteria are used to determine when a complexity split is warranted within an ADRG. In AR-DRG V10.0 the ADRG splitting criteria remains largely unchanged relative to V9.0, apart from the introduction of a new criterion that assesses the appropriateness of the episode complexity profiles within an ADRG.This new criterion requires an inverse trend between sample size and complexity level to incorporate a clinical coherence principle within the splitting methodology; with the expectation the more complex DRG would have a smaller proportion of episodes. These criteria are expected to be met for the majority of the ADRGs. While it is optimal that all splitting criteria are met there are some exceptions where ADRGs have been split without satisfying all criteria. REF _Ref344751 \h Table 4 outlines the criteria used for splitting ADRGs in V10.0.Table 4: AR-DRG V10.0 splitting criteriaCriteriaOptimum threshold1Minimum episodes per category 200 per year2Minimum cost per category $1m per year3Minimum percentage per category 10 percent per year4Minimum absolute change in mean cost between consecutive categories $3,700Either criterion 4 or criterion 55Minimum relative change in mean cost between consecutive categories 2*6Inverse trend between sample size and complexity level*The increase in the cost of a category needs to be, as a minimum, twice as much e.g. if the cost of a category is $3,000 the increase in cost needs to be at least $6,000.IHPA reviewed all the ADRG complexity splits for AR-DRG V10.0 following the principles outlined above, the outcome of which is detailed in REF _Ref344839 \h Table 5.Table 5: ADRG splitting profile for V9.0 and V10.0Number of splitsAR-DRG V9.0AR-DRG V10.00 (Z)87871 (A,B)2252272 (A, B, C)82783 (A, B, C, D)55Total399397Of the 397 ADRGs in V10.0 the majority (57%) have one split (A, B). Of these, 395 are directly comparable to V9.0. REF _Ref344928 \h Table 6 provides a summary of these comparable ADRGs.Table 6: Comparable ADRGs by number of splits in V9.0 and V10.0Number of splitsAR-DRG V9.00123TotalAR-DRG V10.008160087132157022520375078300055Total84224825395Of the 395 comparable ADRGs, 376 have the same number of splits as in V9.0. Of the 19 that have changed six have an increased number of splits and 13 have seen a decrease in the number of splits. AR-DRG V10.0 OverviewADRG StructureIn AR-DRG V10.0 there are a total of 397 ADRGs, with two new ADRGs and four ADRGs having been removed as outlined in REF _Ref344974 \h Table 7.Table 7: New and removed ADRGsNew/RemovedADRGDescriptionNew ADRGsL43Nephrolithiasis InterventionsL44Cystourethroscopy for Urinary DisorderRemoved ADRGsL40UreteroscopyL41Cystourethroscopy for Urinary Disorder, SamedayL42ESW LithotripsyZ60RehabilitationOverall there is a decrease in the total number of ADRGs from 399 in V9.0 to 397 in V10.0.Statistical PerformanceThe performance of the AR-DRG classification has historically been measured using the Reduction in Deviance (RID) statistic. RID measures how much of the variability in cost is explained by the AR-DRG classification and is expressed as a percentage. The higher the percentage value, the higher percentage of cost variation is explained by the system.The overall statistical performance of AR-DRG V10.0 as measured by the RID statistic is 64.6% which is comparable with an RID of 65.2% in AR-DRG V9.0. The change in the overall statistical performance is within expectations given the AR-DRG V10.0 refinement was primarily driven by clinical coherence principles, in particular the diagnosis exclusion review. Appendix A: AR-DRG V10.0 DescriptionsADRGPartitionDRGDescriptionA13IA13AVentilation >=336hours, Major ComplexityA13IA13BVentilation >=336hours, Minor ComplexityA14IA14AVentilation >=96hours & <336hours, Major ComplexityA14IA14BVentilation >=96hours & <336hours, Intermediate ComplexityA14IA14CVentilation >=96hours & <336hours, Minor ComplexityA15IA15ATracheostomy, Major ComplexityA15IA15BTracheostomy, Intermediate ComplexityA15IA15CTracheostomy, Minor ComplexityA40IA40ZECMOB01IB01ZVentricular Shunt RevisionB02IB02ACranial Interventions, Major ComplexityB02IB02BCranial Interventions, Intermediate ComplexityB02IB02CCranial Interventions, Minor ComplexityB03IB03ASpinal Interventions, Major ComplexityB03IB03BSpinal Interventions, Intermediate ComplexityB03IB03CSpinal Interventions, Minor ComplexityB04IB04AExtracranial Vascular Interventions, Major ComplexityB04IB04BExtracranial Vascular Interventions, Intermediate ComplexityB04IB04CExtracranial Vascular Interventions, Minor ComplexityB05IB05ZCarpal Tunnel ReleaseB06IB06AInterventions for Cerebral Palsy, Muscular Dystrophy and Neuropathy, Major CompB06IB06BInterventions for Cerebral Palsy, Muscular Dystrophy and Neuropathy, Interm CompB06IB06CInterventions for Cerebral Palsy, Muscular Dystrophy and Neuropathy, Minor CompB07IB07ACranial or Peripheral Nerve and Other Nervous System Interventions, Major CompB07IB07BCranial or Peripheral Nerve and Other Nervous System Interventions, Minor CompB40IB40ZPlasmapheresis W Neurological Disease, SamedayB41IB41ATelemetric EEG Monitoring, Major ComplexityB41IB41BTelemetric EEG Monitoring, Minor ComplexityB42IB42ANervous System Disorders W Ventilator Support, Major ComplexityB42IB42BNervous System Disorders W Ventilator Support, Intermediate ComplexityB42IB42CNervous System Disorders W Ventilator Support, Minor ComplexityB62MB62ZApheresisB63MB63ADementia and Other Chronic Disturbances of Cerebral Function, Major ComplexityB63MB63BDementia and Other Chronic Disturbances of Cerebral Function, Minor ComplexityB64MB64ADelirium, Major ComplexityB64MB64BDelirium, Minor ComplexityB65MB65ZCerebral PalsyB66MB66ANervous System Neoplasms, Major ComplexityB66MB66BNervous System Neoplasms, Minor ComplexityB67MB67ADegenerative Nervous System Disorders, Major ComplexityB67MB67BDegenerative Nervous System Disorders, Intermediate ComplexityB67MB67CDegenerative Nervous System Disorders, Minor ComplexityB68MB68AMultiple Sclerosis and Cerebellar Ataxia, Major ComplexityB68MB68BMultiple Sclerosis and Cerebellar Ataxia, Minor ComplexityB69MB69ATIA and Precerebral Occlusion, Major ComplexityB69MB69BTIA and Precerebral Occlusion, Minor ComplexityB70MB70AStroke and Other Cerebrovascular Disorders, Major ComplexityB70MB70BStroke and Other Cerebrovascular Disorders, Intermediate ComplexityB70MB70CStroke and Other Cerebrovascular Disorders, Minor ComplexityB70MB70DStroke and Other Cerebrovascular Disorders, Transferred <5 DaysB71MB71ACranial and Peripheral Nerve Disorders, Major ComplexityB71MB71BCranial and Peripheral Nerve Disorders, Minor ComplexityB72MB72ANervous System Infection Except Viral Meningitis, Major ComplexityB72MB72BNervous System Infection Except Viral Meningitis, Minor ComplexityB73MB73AViral Meningitis, Major ComplexityB73MB73BViral Meningitis, Minor ComplexityB74MB74ANontraumatic Stupor and Coma, Major ComplexityB74MB74BNontraumatic Stupor and Coma, Minor ComplexityB75MB75ZFebrile ConvulsionsB76MB76ASeizures, Major ComplexityB76MB76BSeizures, Minor ComplexityB77MB77AHeadaches, Major ComplexityB77MB77BHeadaches, Minor ComplexityB78MB78AIntracranial Injuries, Major ComplexityB78MB78BIntracranial Injuries, Minor ComplexityB78MB78CIntracranial Injuries, Transferred <5 DaysB79MB79ASkull Fractures, Major ComplexityB79MB79BSkull Fractures, Minor ComplexityB80MB80AOther Head Injuries, Major ComplexityB80MB80BOther Head Injuries, Minor ComplexityB81MB81AOther Disorders of the Nervous System, Major ComplexityB81MB81BOther Disorders of the Nervous System, Minor ComplexityB82MB82AChronic & Unspec Para/Quadriplegia, Major ComplexityB82MB82BChronic & Unspec Para/Quadriplegia, Intermediate ComplexityB82MB82CChronic & Unspec Para/Quadriplegia, Minor ComplexityB83MB83AAcute Paraplegia and Quadriplegia and Spinal Cord Conditions, Major ComplexityB83MB83BAcute Paraplegia and Quadriplegia and Spinal Cord Conditions, Interm CompB83MB83CAcute Paraplegia and Quadriplegia and Spinal Cord Conditions, Minor ComplexityC01IC01ZInterventions for Penetrating Eye InjuryC02IC02AEnucleations and Orbital Interventions, Major ComplexityC02IC02BEnucleations and Orbital Interventions, Minor ComplexityC03IC03ARetinal Interventions, Major ComplexityC03IC03BRetinal Interventions, Minor ComplexityC04IC04AMajor Corneal, Scleral and Conjunctival Interventions, Major ComplexityC04IC04BMajor Corneal, Scleral and Conjunctival Interventions, Minor ComplexityC05IC05ZDacryocystorhinostomyC10IC10ZStrabismus InterventionsC11IC11ZEyelid InterventionsC12IC12AOther Corneal, Scleral and Conjunctival Interventions, Major ComplexityC12IC12BOther Corneal, Scleral and Conjunctival Interventions, Minor ComplexityC13IC13ZLacrimal InterventionsC14IC14AOther Eye Interventions, Major ComplexityC14IC14BOther Eye Interventions, Minor ComplexityC15IC15AGlaucoma and Complex Cataract Interventions, Major ComplexityC15IC15BGlaucoma and Complex Cataract Interventions, Minor ComplexityC16IC16ZLens InterventionsC60MC60AAcute and Major Eye Infections, Major ComplexityC60MC60BAcute and Major Eye Infections, Minor ComplexityC61MC61ANeurological and Vascular Disorders of the Eye, Major ComplexityC61MC61BNeurological and Vascular Disorders of the Eye, Minor ComplexityC62MC62AHyphaema and Medically Managed Trauma to the Eye, Major ComplexityC62MC62BHyphaema and Medically Managed Trauma to the Eye, Minor ComplexityC63MC63AOther Disorders of the Eye, Major ComplexityC63MC63BOther Disorders of the Eye, Minor ComplexityD01ID01ZCochlear ImplantD02ID02AHead and Neck Interventions, Major ComplexityD02ID02BHead and Neck Interventions, Intermediate ComplexityD02ID02CHead and Neck Interventions, Minor ComplexityD03ID03ASurgical Repair for Cleft Lip and Palate Disorders, Major ComplexityD03ID03BSurgical Repair for Cleft Lip and Palate Disorders, Minor ComplexityD04ID04AMaxillo Surgery, Major ComplexityD04ID04BMaxillo Surgery, Minor ComplexityD05ID05ZParotid Gland InterventionsD06ID06ZSinus and Complex Middle Ear InterventionsD10ID10ZNasal InterventionsD11ID11ZTonsillectomy and AdenoidectomyD12ID12AOther Ear, Nose, Mouth and Throat Interventions, Major ComplexityD12ID12BOther Ear, Nose, Mouth and Throat Interventions, Minor ComplexityD13ID13ZMyringotomy W Tube InsertionD14ID14AMouth and Salivary Gland Interventions, Major ComplexityD14ID14BMouth and Salivary Gland Interventions, Minor ComplexityD15ID15ZMastoid InterventionsD40ID40ZDental Extractions and RestorationsD60MD60AEar, Nose, Mouth and Throat Malignancy, Major ComplexityD60MD60BEar, Nose, Mouth and Throat Malignancy, Minor ComplexityD61MD61ADysequilibrium, Major ComplexityD61MD61BDysequilibrium, Minor ComplexityD62MD62AEpistaxis, Major ComplexityD62MD62BEpistaxis, Minor ComplexityD63MD63AOtitis Media and Upper Respiratory Infections, Major ComplexityD63MD63BOtitis Media and Upper Respiratory Infections, Minor ComplexityD64MD64ALaryngotracheitis and Epiglottitis, Major ComplexityD64MD64BLaryngotracheitis and Epiglottitis, Minor ComplexityD65MD65ANasal Trauma and Deformity, Major ComplexityD65MD65BNasal Trauma and Deformity, Minor ComplexityD66MD66AOther Ear, Nose, Mouth and Throat Disorders, Major ComplexityD66MD66BOther Ear, Nose, Mouth and Throat Disorders, Minor ComplexityD67MD67AOral and Dental Disorders, Major ComplexityD67MD67BOral and Dental Disorders, Minor ComplexityE01IE01AMajor Chest Interventions, Major ComplexityE01IE01BMajor Chest Interventions, Intermediate ComplexityE01IE01CMajor Chest Interventions, Minor ComplexityE02IE02AOther Respiratory System GIs, Major ComplexityE02IE02BOther Respiratory System GIs, Intermediate ComplexityE02IE02COther Respiratory System GIs, Minor ComplexityE03IE03ZLung or Heart-Lung TransplantE40IE40ARespiratory System Disorders W Ventilator Support, Major ComplexityE40IE40BRespiratory System Disorders W Ventilator Support, Minor ComplexityE41IE41ARespiratory System Disorders W Non-Invasive Ventilation, Major ComplexityE41IE41BRespiratory System Disorders W Non-Invasive Ventilation, Minor ComplexityE42IE42ABronchoscopy, Major ComplexityE42IE42BBronchoscopy, Intermediate ComplexityE42IE42CBronchoscopy, Minor ComplexityE60ME60ACystic Fibrosis, Major ComplexityE60ME60BCystic Fibrosis, Minor ComplexityE61ME61APulmonary Embolism, Major ComplexityE61ME61BPulmonary Embolism, Minor ComplexityE62ME62ARespiratory Infections and Inflammations, Major ComplexityE62ME62BRespiratory Infections and Inflammations, Minor ComplexityE63ME63ASleep Apnoea, Major ComplexityE63ME63BSleep Apnoea, Minor ComplexityE64ME64APulmonary Oedema and Respiratory Failure, Major ComplexityE64ME64BPulmonary Oedema and Respiratory Failure, Minor ComplexityE65ME65AChronic Obstructive Airways Disease, Major ComplexityE65ME65BChronic Obstructive Airways Disease, Minor ComplexityE66ME66AMajor Chest Trauma, Major ComplexityE66ME66BMajor Chest Trauma, Minor ComplexityE67ME67ARespiratory Signs and Symptoms, Major ComplexityE67ME67BRespiratory Signs and Symptoms, Minor ComplexityE68ME68APneumothorax, Major ComplexityE68ME68BPneumothorax, Minor ComplexityE69ME69ABronchitis and Asthma, Major ComplexityE69ME69BBronchitis and Asthma, Minor ComplexityE70ME70AWhooping Cough and Acute Bronchiolitis, Major ComplexityE70ME70BWhooping Cough and Acute Bronchiolitis, Minor ComplexityE71ME71ARespiratory Neoplasms, Major ComplexityE71ME71BRespiratory Neoplasms, Minor ComplexityE72ME72ZRespiratory Problems Arising from Neonatal PeriodE73ME73APleural Effusion, Major ComplexityE73ME73BPleural Effusion, Intermediate ComplexityE73ME73CPleural Effusion, Minor ComplexityE74ME74AInterstitial Lung Disease, Major ComplexityE74ME74BInterstitial Lung Disease, Minor ComplexityE75ME75AOther Respiratory System Disorders, Major ComplexityE75ME75BOther Respiratory System Disorders, Minor ComplexityE76ME76ARespiratory Tuberculosis, Major ComplexityE76ME76BRespiratory Tuberculosis, Minor ComplexityE77ME77ABronchiectasis, Major ComplexityE77ME77BBronchiectasis, Minor ComplexityF01IF01AImplantation and Replacement of AICD, Total System, Major ComplexityF01IF01BImplantation and Replacement of AICD, Total System, Minor ComplexityF02IF02ZOther AICD InterventionsF03IF03ACardiac Valve Int W CPB Pump W Invasive Cardiac Investigation, Major ComplexityF03IF03BCardiac Valve Int W CPB Pump W Invasive Cardiac Investigation, Minor ComplexityF04IF04ACardiac Valve Interventions W CPB Pump W/O Invasive Cardiac Invest, Major CompF04IF04BCardiac Valve Interventions W CPB Pump W/O Invasive Cardiac Invest, Interm CompF04IF04CCardiac Valve Interventions W CPB Pump W/O Invasive Cardiac Invest, Minor CompF05IF05ACoronary Bypass W Invasive Cardiac Investigation, Major ComplexityF05IF05BCoronary Bypass W Invasive Cardiac Investigation, Minor ComplexityF06IF06ACoronary Bypass W/O Invasive Cardiac Investigation, Major ComplexityF06IF06BCoronary Bypass W/O Invasive Cardiac Investigation, Intermediate ComplexityF06IF06CCoronary Bypass W/O Invasive Cardiac Investigation, Minor ComplexityF07IF07AOther Cardiothoracic/Vascular Interventions W CPB Pump, Major ComplexityF07IF07BOther Cardiothoracic/Vascular Interventions W CPB Pump, Intermediate ComplexityF07IF07COther Cardiothoracic/Vascular Interventions W CPB Pump, Minor ComplexityF08IF08AMajor Reconstructive Vascular Interventions W/O CPB Pump, Major ComplexityF08IF08BMajor Reconstructive Vascular Interventions W/O CPB Pump, Interm ComplexityF08IF08CMajor Reconstructive Vascular Interventions W/O CPB Pump, Minor ComplexityF09IF09AOther Cardiothoracic Interventions W/O CPB Pump, Major ComplexityF09IF09BOther Cardiothoracic Interventions W/O CPB Pump, Minor ComplexityF10IF10AInterventional Coronary Procedures, Admitted for AMI, Major ComplexityF10IF10BInterventional Coronary Procedures, Admitted for AMI, Minor ComplexityF11IF11AAmputation, Except Upper Limb and Toe, for Circulatory Disorders, Major CompF11IF11BAmputation, Except Upper Limb and Toe, for Circulatory Disorders, Minor CompF12IF12AImplantation and Replacement of Pacemaker, Total System, Major ComplexityF12IF12BImplantation and Replacement of Pacemaker, Total System, Minor ComplexityF13IF13AAmputation, Upper Limb and Toe, for Circulatory Disorders, Major ComplexityF13IF13BAmputation, Upper Limb and Toe, for Circulatory Disorders, Minor ComplexityF14IF14AVascular Interventions, Except Major Reconstruction, W/O CPB Pump, Major CompF14IF14BVascular Interventions, Except Major Reconstruction, W/O CPB Pump, Interm CompF14IF14CVascular Interventions, Except Major Reconstruction, W/O CPB Pump, Minor CompF17IF17AInsertion and Replacement of Pacemaker Generator, Major ComplexityF17IF17BInsertion and Replacement of Pacemaker Generator, Minor ComplexityF18IF18ZOther Pacemaker InterventionsF19IF19ATrans-Vascular Percutaneous Cardiac Intervention, Major ComplexityF19IF19BTrans-Vascular Percutaneous Cardiac Intervention, Minor ComplexityF20IF20ZVein Ligation and StrippingF21IF21AOther Circulatory System GIs, Major ComplexityF21IF21BOther Circulatory System GIs, Intermediate ComplexityF21IF21COther Circulatory System GIs, Minor ComplexityF22IF22ZInsertion of Artificial Heart DeviceF23IF23ZHeart TransplantF24IF24AInterventional Coronary Procs, Not Adm for AMI, Major CompF24IF24BInterventional Coronary Procs, Not Adm for AMI, Minor CompF40IF40ACirculatory Disorders W Ventilator Support, Major ComplexityF40IF40BCirculatory Disorders W Ventilator Support, Minor ComplexityF41IF41ACirculatory Disorders, Adm for AMI W Invasive Cardiac Inves Int, Major CompF41IF41BCirculatory Disorders, Adm for AMI W Invasive Cardiac Inves Int, Minor CompF42IF42ACirculatory Dsrds, Not Adm for AMI W Invasive Cardiac Inves Int, Major CompF42IF42BCirculatory Dsrds, Not Adm for AMI W Invasive Cardiac Inves Int, Minor CompF43IF43ACirculatory Disorders W Non-Invasive Ventilation, Major ComplexityF43IF43BCirculatory Disorders W Non-Invasive Ventilation, Minor ComplexityF60MF60ACirculatory Dsrd, Adm for AMI W/O Invas Card Inves InterventionF60MF60BCirculatory Dsrd, Adm for AMI W/O Invas Card Inves Intervention, Transf <5 DaysF61MF61AInfective Endocarditis, Major ComplexityF61MF61BInfective Endocarditis, Minor ComplexityF62MF62AHeart Failure and Shock, Major ComplexityF62MF62BHeart Failure and Shock, Minor ComplexityF62MF62CHeart Failure and Shock, Transferred <5 DaysF63MF63AVenous Thrombosis, Major ComplexityF63MF63BVenous Thrombosis, Minor ComplexityF64MF64ASkin Ulcers in Circulatory Disorders, Major ComplexityF64MF64BSkin Ulcers in Circulatory Disorders, Intermediate ComplexityF64MF64CSkin Ulcers in Circulatory Disorders, Minor ComplexityF65MF65APeripheral Vascular Disorders, Major ComplexityF65MF65BPeripheral Vascular Disorders, Minor ComplexityF66MF66ACoronary Atherosclerosis, Major ComplexityF66MF66BCoronary Atherosclerosis, Minor ComplexityF67MF67AHypertension, Major ComplexityF67MF67BHypertension, Minor ComplexityF68MF68ZCongenital Heart DiseaseF69MF69AValvular Disorders, Major ComplexityF69MF69BValvular Disorders, Minor ComplexityF72MF72AUnstable Angina, Major ComplexityF72MF72BUnstable Angina, Minor ComplexityF73MF73ASyncope and Collapse, Major ComplexityF73MF73BSyncope and Collapse, Minor ComplexityF74MF74AChest Pain, Major ComplexityF74MF74BChest Pain, Minor ComplexityF75MF75AOther Circulatory Disorders, Major ComplexityF75MF75BOther Circulatory Disorders, Minor ComplexityF76MF76AArrhythmia, Cardiac Arrest and Conduction Disorders, Major ComplexityF76MF76BArrhythmia, Cardiac Arrest and Conduction Disorders, Minor ComplexityG01IG01ARectal Resection, Major ComplexityG01IG01BRectal Resection, Intermediate ComplexityG01IG01CRectal Resection, Minor ComplexityG02IG02AMajor Small and Large Bowel Interventions, Major ComplexityG02IG02BMajor Small and Large Bowel Interventions, Intermediate ComplexityG02IG02CMajor Small and Large Bowel Interventions, Minor ComplexityG03IG03AStomach, Oesophageal and Duodenal Interventions, Major ComplexityG03IG03BStomach, Oesophageal and Duodenal Interventions, Intermediate ComplexityG03IG03CStomach, Oesophageal and Duodenal Interventions, Minor ComplexityG04IG04APeritoneal Adhesiolysis, Major ComplexityG04IG04BPeritoneal Adhesiolysis, Intermediate ComplexityG04IG04CPeritoneal Adhesiolysis, Minor ComplexityG05IG05AMinor Small and Large Bowel Interventions, Major ComplexityG05IG05BMinor Small and Large Bowel Interventions, Minor ComplexityG06IG06ZPyloromyotomyG07IG07AAppendicectomy, Major ComplexityG07IG07BAppendicectomy, Minor ComplexityG10IG10AHernia Interventions, Major ComplexityG10IG10BHernia Interventions, Minor ComplexityG11IG11AAnal and Stomal Interventions, Major ComplexityG11IG11BAnal and Stomal Interventions, Minor ComplexityG12IG12AOther Digestive System GIs, Major ComplexityG12IG12BOther Digestive System GIs, Intermediate ComplexityG12IG12COther Digestive System GIs, Minor ComplexityG46IG46AComplex Endoscopy, Major ComplexityG46IG46BComplex Endoscopy, Minor ComplexityG47IG47AGastroscopy, Major ComplexityG47IG47BGastroscopy, Intermediate ComplexityG47IG47CGastroscopy, Minor ComplexityG48IG48AColonoscopy, Major ComplexityG48IG48BColonoscopy, Minor ComplexityG60MG60ADigestive Malignancy, Major ComplexityG60MG60BDigestive Malignancy, Minor ComplexityG61MG61AGastrointestinal Haemorrhage, Major ComplexityG61MG61BGastrointestinal Haemorrhage, Minor ComplexityG64MG64ZInflammatory Bowel DiseaseG65MG65AGastrointestinal Obstruction, Major ComplexityG65MG65BGastrointestinal Obstruction, Minor ComplexityG66MG66AAbdominal Pain and Mesenteric Adenitis, Major ComplexityG66MG66BAbdominal Pain and Mesenteric Adenitis, Minor ComplexityG67MG67AOesophagitis and Gastroenteritis, Major ComplexityG67MG67BOesophagitis and Gastroenteritis, Minor ComplexityG70MG70AOther Digestive System Disorders, Major ComplexityG70MG70BOther Digestive System Disorders, Intermediate ComplexityG70MG70COther Digestive System Disorders, Minor ComplexityH01IH01APancreas, Liver and Shunt Interventions, Major ComplexityH01IH01BPancreas, Liver and Shunt Interventions, Intermediate ComplexityH01IH01CPancreas, Liver and Shunt Interventions, Minor ComplexityH02IH02AMajor Biliary Tract Interventions, Major ComplexityH02IH02BMajor Biliary Tract Interventions, Intermediate ComplexityH02IH02CMajor Biliary Tract Interventions, Minor ComplexityH05IH05AHepatobiliary Diagnostic Interventions, Major ComplexityH05IH05BHepatobiliary Diagnostic Interventions, Intermediate ComplexityH05IH05CHepatobiliary Diagnostic Interventions, Minor ComplexityH06IH06AOther Hepatobiliary and Pancreas GIs, Major ComplexityH06IH06BOther Hepatobiliary and Pancreas GIs, Intermediate ComplexityH06IH06COther Hepatobiliary and Pancreas GIs, Minor ComplexityH07IH07AOpen Cholecystectomy, Major ComplexityH07IH07BOpen Cholecystectomy, Intermediate ComplexityH07IH07COpen Cholecystectomy, Minor ComplexityH08IH08ALaparoscopic Cholecystectomy, Major ComplexityH08IH08BLaparoscopic Cholecystectomy, Minor ComplexityH09IH09ZLiver TransplantH60MH60ACirrhosis and Alcoholic Hepatitis, Major ComplexityH60MH60BCirrhosis and Alcoholic Hepatitis, Intermediate ComplexityH60MH60CCirrhosis and Alcoholic Hepatitis, Minor ComplexityH61MH61AMalignancy of Hepatobiliary System and Pancreas, Major ComplexityH61MH61BMalignancy of Hepatobiliary System and Pancreas, Minor ComplexityH62MH62ADisorders of Pancreas, Except Malignancy, Major ComplexityH62MH62BDisorders of Pancreas, Except Malignancy, Minor ComplexityH63MH63AOther Disorders of Liver, Major ComplexityH63MH63BOther Disorders of Liver, Intermediate ComplexityH63MH63COther Disorders of Liver, Minor ComplexityH64MH64ADisorders of the Biliary Tract, Major ComplexityH64MH64BDisorders of the Biliary Tract, Minor ComplexityH65MH65ABleeding Oesophageal Varices, Major ComplexityH65MH65BBleeding Oesophageal Varices, Intermediate ComplexityH65MH65CBleeding Oesophageal Varices, Minor ComplexityI01II01ABilateral and Multiple Major Joint Interventions of Lower Limb, Major ComplexityI01II01BBilateral and Multiple Major Joint Interventions of Lower Limb, Minor ComplexityI02II02AMicrovascular Tissue Transfers or Skin Grafts, Excluding Hand, Major ComplexityI02II02BMicrovascular Tissue Transfers or Skin Grafts, Excluding Hand, Intermediate CompI02II02CMicrovascular Tissue Transfers or Skin Grafts, Excluding Hand, Minor ComplexityI03II03AHip Replacement for Trauma, Major ComplexityI03II03BHip Replacement for Trauma, Minor ComplexityI04II04AKnee Replacement, Major ComplexityI04II04BKnee Replacement, Minor ComplexityI05II05AOther Joint Replacement, Major ComplexityI05II05BOther Joint Replacement, Minor ComplexityI06II06ZSpinal Fusion for DeformityI07II07ZAmputationI08II08AOther Hip and Femur Interventions, Major ComplexityI08II08BOther Hip and Femur Interventions, Intermediate ComplexityI08II08COther Hip and Femur Interventions, Minor ComplexityI09II09ASpinal Fusion, Major ComplexityI09II09BSpinal Fusion, Intermediate ComplexityI09II09CSpinal Fusion, Minor ComplexityI10II10AOther Back and Neck Interventions, Major ComplexityI10II10BOther Back and Neck Interventions, Minor ComplexityI11II11ZLimb Lengthening InterventionsI12II12AMisc Musculoskeletal Interventions for Infect/Inflam of Bone/Joint, Major CompI12II12BMisc Musculoskeletal Interventions for Infect/Inflam of Bone/Joint, Interm CompI12II12CMisc Musculoskeletal Interventions for Infect/Inflam of Bone/Joint, Minor CompI13II13AHumerus, Tibia, Fibula and Ankle Interventions, Major ComplexityI13II13BHumerus, Tibia, Fibula and Ankle Interventions, Intermediate ComplexityI13II13CHumerus, Tibia, Fibula and Ankle Interventions, Minor ComplexityI15II15ZCranio-Facial SurgeryI16II16ZOther Shoulder InterventionsI17II17AMaxillo-Facial Surgery, Major ComplexityI17II17BMaxillo-Facial Surgery, Minor ComplexityI18II18AOther Knee Interventions, Major ComplexityI18II18BOther Knee Interventions, Minor ComplexityI19II19AOther Elbow and Forearm Interventions, Major ComplexityI19II19BOther Elbow and Forearm Interventions, Minor ComplexityI20II20AOther Foot Interventions, Major ComplexityI20II20BOther Foot Interventions, Minor ComplexityI21II21ALocal Excision and Removal of Internal Fixation Devices of Hip & Femur, Maj CompI21II21BLocal Excision and Removal of Internal Fixation Devices of Hip & Femur, Min CompI23II23ALocal Excision & Removal of Internal Fixation Device, Except Hip & Fmr, Maj CompI23II23BLocal Excision & Removal of Internal Fixation Device, Except Hip & Fmr, Min CompI24II24AArthroscopy, Major ComplexityI24II24BArthroscopy, Minor ComplexityI25II25ABone and Joint Diagnostic Interventions Including Biopsy, Major ComplexityI25II25BBone and Joint Diagnostic Interventions Including Biopsy, Minor ComplexityI27II27ASoft Tissue Interventions, Major ComplexityI27II27BSoft Tissue Interventions, Minor ComplexityI28II28AOther Musculoskeletal Interventions, Major ComplexityI28II28BOther Musculoskeletal Interventions, Intermediate ComplexityI28II28COther Musculoskeletal Interventions, Minor ComplexityI29II29ZKnee Reconstructions, and Revisions of ReconstructionsI30II30ZHand InterventionsI31II31ARevision of Hip Replacement, Major ComplexityI31II31BRevision of Hip Replacement, Intermediate ComplexityI31II31CRevision of Hip Replacement, Minor ComplexityI32II32ARevision of Knee Replacement, Major ComplexityI32II32BRevision of Knee Replacement, Minor ComplexityI33II33AHip Replacement for Non-Trauma, Major ComplexityI33II33BHip Replacement for Non-Trauma, Minor ComplexityI60MI60ZFemoral Shaft FracturesI61MI61ZDistal Femoral FracturesI63MI63ASprains, Strains and Dislocations of Hip, Pelvis and Thigh, Major ComplexityI63MI63BSprains, Strains and Dislocations of Hip, Pelvis and Thigh, Minor ComplexityI64MI64AOsteomyelitis, Major ComplexityI64MI64BOsteomyelitis, Minor ComplexityI65MI65AMusculoskeletal Malignant Neoplasms, Major ComplexityI65MI65BMusculoskeletal Malignant Neoplasms, Minor ComplexityI66MI66AInflammatory Musculoskeletal Disorders, Major ComplexityI66MI66BInflammatory Musculoskeletal Disorders, Minor ComplexityI67MI67ASeptic Arthritis, Major ComplexityI67MI67BSeptic Arthritis, Minor ComplexityI68MI68ANon-surgical Spinal Disorders, Major ComplexityI68MI68BNon-surgical Spinal Disorders, Minor ComplexityI69MI69ABone Diseases and Arthropathies, Major ComplexityI69MI69BBone Diseases and Arthropathies, Minor ComplexityI71MI71AOther Musculotendinous Disorders, Major ComplexityI71MI71BOther Musculotendinous Disorders, Minor ComplexityI72MI72ASpecific Musculotendinous Disorders, Major ComplexityI72MI72BSpecific Musculotendinous Disorders, Minor ComplexityI73MI73AAftercare of Musculoskeletal Implants or Prostheses, Major ComplexityI73MI73BAftercare of Musculoskeletal Implants or Prostheses, Minor ComplexityI74MI74AInjuries to Forearm, Wrist, Hand and Foot, Major ComplexityI74MI74BInjuries to Forearm, Wrist, Hand and Foot, Minor ComplexityI75MI75AInjuries to Shoulder, Arm, Elbow, Knee, Leg and Ankle, Major ComplexityI75MI75BInjuries to Shoulder, Arm, Elbow, Knee, Leg and Ankle, Intermediate ComplexityI75MI75CInjuries to Shoulder, Arm, Elbow, Knee, Leg and Ankle, Minor ComplexityI76MI76AOther Musculoskeletal Disorders, Major ComplexityI76MI76BOther Musculoskeletal Disorders, Minor ComplexityI77MI77AFractures of Pelvis, Major ComplexityI77MI77BFractures of Pelvis, Minor ComplexityI78MI78AFractures of Neck of Femur, Major ComplexityI78MI78BFractures of Neck of Femur, Minor ComplexityI79MI79APathological Fractures, Major ComplexityI79MI79BPathological Fractures, Minor ComplexityI80MI80ZFemoral Fractures, Transferred to Acute Facility <2 DaysJ01IJ01AMicrovas Tiss Transf for Skin, Subcut Tiss & Breast Dsrds, Major ComplexityJ01IJ01BMicrovas Tiss Transf for Skin, Subcut Tiss & Breast Dsrds, Minor ComplexityJ06IJ06AMajor Interventions for Breast Disorders, Major ComplexityJ06IJ06BMajor Interventions for Breast Disorders, Minor ComplexityJ07IJ07ZMinor Interventions for Breast DisordersJ08IJ08AOther Skin Grafts and Debridement Interventions, Major ComplexityJ08IJ08BOther Skin Grafts and Debridement Interventions, Intermediate ComplexityJ08IJ08COther Skin Grafts and Debridement Interventions, Minor ComplexityJ09IJ09ZPerianal and Pilonidal InterventionsJ10IJ10APlastic GIs for Skin, Subcutaneous Tissue and Breast Disorders, Major CompJ10IJ10BPlastic GIs for Skin, Subcutaneous Tissue and Breast Disorders, Minor CompJ11IJ11AOther Skin, Subcutaneous Tissue and Breast Interventions, Major ComplexityJ11IJ11BOther Skin, Subcutaneous Tissue and Breast Interventions, Minor ComplexityJ12IJ12ALower Limb Interventions W Ulcer or Cellulitis, Major ComplexityJ12IJ12BLower Limb Interventions W Ulcer or Cellulitis, Minor ComplexityJ13IJ13ALower Limb Interventions W/O Ulcer or Cellulitis, Major ComplexityJ13IJ13BLower Limb Interventions W/O Ulcer or Cellulitis, Minor ComplexityJ14IJ14ZMajor Breast ReconstructionsJ60MJ60ASkin Ulcers, Major ComplexityJ60MJ60BSkin Ulcers, Intermediate ComplexityJ60MJ60CSkin Ulcers, Minor ComplexityJ62MJ62AMalignant Breast Disorders, Major ComplexityJ62MJ62BMalignant Breast Disorders, Minor ComplexityJ63MJ63ZNon-Malignant Breast DisordersJ64MJ64ACellulitis, Major ComplexityJ64MJ64BCellulitis, Minor ComplexityJ65MJ65ATrauma to Skin, Subcutaneous Tissue and Breast, Major ComplexityJ65MJ65BTrauma to Skin, Subcutaneous Tissue and Breast, Minor ComplexityJ67MJ67AMinor Skin Disorders, Major ComplexityJ67MJ67BMinor Skin Disorders, Minor ComplexityJ68MJ68AMajor Skin Disorders, Major ComplexityJ68MJ68BMajor Skin Disorders, Minor ComplexityJ69MJ69ASkin Malignancy, Major ComplexityJ69MJ69BSkin Malignancy, Minor ComplexityK01IK01AGIs for Diabetic Complications, Major ComplexityK01IK01BGIs for Diabetic Complications, Intermediate ComplexityK01IK01CGIs for Diabetic Complications, Minor ComplexityK02IK02ZPituitary InterventionsK03IK03ZAdrenal InterventionsK05IK05AParathyroid Interventions, Major ComplexityK05IK05BParathyroid Interventions, Minor ComplexityK06IK06AThyroid Interventions, Major ComplexityK06IK06BThyroid Interventions, Minor ComplexityK08IK08ZThyroglossal InterventionsK09IK09AOther Endocrine, Nutritional and Metabolic GIs, Major ComplexityK09IK09BOther Endocrine, Nutritional and Metabolic GIs, Minor ComplexityK10IK10ZRevisional and Open Bariatric InterventionsK11IK11AMajor Laparoscopic Bariatric Interventions, Major ComplexityK11IK11BMajor Laparoscopic Bariatric Interventions, Minor ComplexityK12IK12ZOther Bariatric InterventionsK13IK13ZPlastic GIs for Endocrine, Nutritional and Metabolic DisordersK40IK40AEndoscopic and Investigative Interventions for Metabolic Disorders, Major CompK40IK40BEndoscopic and Investigative Interventions for Metabolic Disorders, Minor CompK60MK60ADiabetes, Major ComplexityK60MK60BDiabetes, Minor ComplexityK61MK61ASevere Nutritional Disturbance, Major ComplexityK61MK61BSevere Nutritional Disturbance, Minor ComplexityK62MK62AMiscellaneous Metabolic Disorders, Major ComplexityK62MK62BMiscellaneous Metabolic Disorders, Intermediate ComplexityK62MK62CMiscellaneous Metabolic Disorders, Minor ComplexityK63MK63AInborn Errors of Metabolism, Major ComplexityK63MK63BInborn Errors of Metabolism, Minor ComplexityK64MK64AEndocrine Disorders, Major ComplexityK64MK64BEndocrine Disorders, Minor ComplexityL02IL02AOperative Insertion of Peritoneal Catheter for Dialysis, Major ComplexityL02IL02BOperative Insertion of Peritoneal Catheter for Dialysis, Minor ComplexityL03IL03AKidney, Ureter and Major Bladder Interventions for Neoplasm, Major ComplexityL03IL03BKidney, Ureter and Major Bladder Interventions for Neoplasm, Intermediate CompL03IL03CKidney, Ureter and Major Bladder Interventions for Neoplasm, Minor ComplexityL04IL04AKidney, Ureter and Major Bladder Interventions for Non-Neoplasm, Major CompL04IL04BKidney, Ureter and Major Bladder Interventions for Non-Neoplasm, Interm CompL04IL04CKidney, Ureter and Major Bladder Interventions for Non-Neoplasm, Minor CompL05IL05ATransurethral Prostatectomy for Urinary Disorder, Major ComplexityL05IL05BTransurethral Prostatectomy for Urinary Disorder, Minor ComplexityL06IL06AMinor Bladder Interventions, Major ComplexityL06IL06BMinor Bladder Interventions, Intermediate ComplexityL06IL06CMinor Bladder Interventions, Minor ComplexityL07IL07AOther Transurethral Interventions, Major ComplexityL07IL07BOther Transurethral Interventions, Minor ComplexityL08IL08ZUrethral InterventionsL09IL09AOther Interventions for Kidney and Urinary Tract Disorders, Major ComplexityL09IL09BOther Interventions for Kidney and Urinary Tract Disorders, Interm ComplexityL09IL09COther Interventions for Kidney and Urinary Tract Disorders, Minor ComplexityL10IL10AKidney Transplant, Age <=16 Years or Major ComplexityL10IL10BKidney Transplant, Age >=17 Years and Minor ComplexityL43IL43ANephrolithiasis Interventions, Major ComplexityL43IL43BNephrolithiasis Interventions, Minor ComplexityL44IL44ACystourethroscopy for Urinary Disorder, Major ComplexityL44IL44BCystourethroscopy for Urinary Disorder, Minor ComplexityL60ML60AKidney Failure, Major ComplexityL60ML60BKidney Failure, Intermediate ComplexityL60ML60CKidney Failure, Minor ComplexityL61ML61ZHaemodialysisL62ML62AKidney and Urinary Tract Neoplasms, Major ComplexityL62ML62BKidney and Urinary Tract Neoplasms, Intermediate ComplexityL62ML62CKidney and Urinary Tract Neoplasms, Minor ComplexityL63ML63AKidney and Urinary Tract Infections, Major ComplexityL63ML63BKidney and Urinary Tract Infections, Minor ComplexityL64ML64AUrinary Stones and Obstruction, Major ComplexityL64ML64BUrinary Stones and Obstruction, Minor ComplexityL65ML65AKidney and Urinary Tract Signs and Symptoms, Major ComplexityL65ML65BKidney and Urinary Tract Signs and Symptoms, Minor ComplexityL66ML66ZUrethral StrictureL67ML67AOther Kidney and Urinary Tract Disorders, Major ComplexityL67ML67BOther Kidney and Urinary Tract Disorders, Intermediate ComplexityL67ML67COther Kidney and Urinary Tract Disorders, Minor ComplexityL68ML68ZPeritoneal DialysisM01IM01AMajor Male Pelvic Interventions, Major ComplexityM01IM01BMajor Male Pelvic Interventions, Minor ComplexityM02IM02ATransurethral Prostatectomy for Reproductive System Disorder, Major ComplexityM02IM02BTransurethral Prostatectomy for Reproductive System Disorder, Minor ComplexityM03IM03APenis Interventions, Major ComplexityM03IM03BPenis Interventions, Minor ComplexityM04IM04ZTestes InterventionsM05IM05ZCircumcisionM06IM06AOther Male Reproductive System GIs, Major ComplexityM06IM06BOther Male Reproductive System GIs, Minor ComplexityM40IM40ZCystourethroscopy for Male Reproductive System Disorder, SamedayM60MM60AMale Reproductive System Malignancy, Major ComplexityM60MM60BMale Reproductive System Malignancy, Minor ComplexityM61MM61ABenign Prostatic Hypertrophy, Major ComplexityM61MM61BBenign Prostatic Hypertrophy, Minor ComplexityM62MM62AMale Reproductive System Inflammation, Major ComplexityM62MM62BMale Reproductive System Inflammation, Minor ComplexityM63MM63ZMale Sterilisation InterventionsM64MM64AOther Male Reproductive System Disorders, Major ComplexityM64MM64BOther Male Reproductive System Disorders, Minor ComplexityN01IN01ZPelvic Evisceration and Radical VulvectomyN04IN04AHysterectomy for Non-Malignancy, Major ComplexityN04IN04BHysterectomy for Non-Malignancy, Minor ComplexityN05IN05AOophorectomy and Complex Fallopian Tube Int for Non-Malignancy, Maj CompN05IN05BOophorectomy and Complex Fallopian Tube Int for Non-Malignancy, Min CompN06IN06AFemale Reproductive System Reconstructive Interventions, Major ComplexityN06IN06BFemale Reproductive System Reconstructive Interventions, Minor ComplexityN07IN07AOther Uterus and Adnexa Interventions for Non-Malignancy, Major ComplexityN07IN07BOther Uterus and Adnexa Interventions for Non-Malignancy, Minor ComplexityN08IN08ZEndoscopic and Laparoscopic Interventions, Female Reproductive SystemN09IN09AOther Vagina, Cervix and Vulva Interventions, Major ComplexityN09IN09BOther Vagina, Cervix and Vulva Interventions, Minor ComplexityN10IN10ZDiagnostic Curettage and Diagnostic HysteroscopyN11IN11AOther Female Reproductive System GIs, Major ComplexityN11IN11BOther Female Reproductive System GIs, Minor ComplexityN12IN12AUterus and Adnexa Interventions for Malignancy, Major ComplexityN12IN12BUterus and Adnexa Interventions for Malignancy, Intermediate ComplexityN12IN12CUterus and Adnexa Interventions for Malignancy, Minor ComplexityN60MN60AFemale Reproductive System Malignancy, Major ComplexityN60MN60BFemale Reproductive System Malignancy, Minor ComplexityN61MN61AFemale Reproductive System Infections, Major ComplexityN61MN61BFemale Reproductive System Infections, Minor ComplexityN62MN62AMenstrual and Other Female Reproductive System Disorders, Major ComplexityN62MN62BMenstrual and Other Female Reproductive System Disorders, Minor ComplexityO01IO01ACaesarean Delivery, Major ComplexityO01IO01BCaesarean Delivery, Intermediate ComplexityO01IO01CCaesarean Delivery, Minor ComplexityO02IO02AVaginal Delivery W GIs, Major ComplexityO02IO02BVaginal Delivery W GIs, Minor ComplexityO03IO03ZEctopic PregnancyO04IO04APostpartum and Post Abortion W GIs, Major ComplexityO04IO04BPostpartum and Post Abortion W GIs, Minor ComplexityO05IO05ZAbortion W GIsO60MO60AVaginal Delivery, Major ComplexityO60MO60BVaginal Delivery, Intermediate ComplexityO60MO60CVaginal Delivery, Minor ComplexityO61MO61APostpartum and Post Abortion W/O GIs, Major ComplexityO61MO61BPostpartum and Post Abortion W/O GIs, Minor ComplexityO63MO63AAbortion W/O GIs, Major ComplexityO63MO63BAbortion W/O GIs, Minor ComplexityO66MO66AAntenatal and Other Obstetric Admissions, Major ComplexityO66MO66BAntenatal and Other Obstetric Admissions, Intermediate ComplexityO66MO66CAntenatal and Other Obstetric Admissions, Minor ComplexityP01IP01ZNeonate W Sig GI/Vent>=96hrs, Died or Transfer to Acute Facility <5DaysP02IP02ZCardiothoracic and Vascular Interventions for NeonatesP03IP03ANeonate, AdmWt 1000-1499g W Significant GI/Vent>=96hrs, Major ComplexityP03IP03BNeonate, AdmWt 1000-1499g W Significant GI/Vent>=96hrs, Minor ComplexityP04IP04ANeonate, AdmWt 1500-1999g W Significant GI/Vent>=96hrs, Major ComplexityP04IP04BNeonate, AdmWt 1500-1999g W Significant GI/Vent>=96hrs, Minor ComplexityP05IP05ANeonate, AdmWt 2000-2499g W Significant GI/Vent>=96hrs, Major ComplexityP05IP05BNeonate, AdmWt 2000-2499g W Significant GI/Vent>=96hrs, Minor ComplexityP06IP06ANeonate, AdmWt >=2500g W Significant GI/Vent>=96hrs, Major ComplexityP06IP06BNeonate, AdmWt >=2500g W Significant GI/Vent>=96hrs, Minor ComplexityP07IP07ZNeonate, AdmWt <750g W Significant GIsP08IP08ZNeonate, AdmWt 750-999g W Significant GIsP60MP60ANeonate W/O Sig GI/Vent>=96hrs, Died/Transfer Acute Facility <5 Days, Maj CompP60MP60BNeonate W/O Sig GI/Vent>=96hrs, Died/Transfer Acute Facility <5 Days, Min CompP61MP61ZNeonate, AdmWt <750g W/O Significant GI procedureP62MP62ANeonate, AdmWt 750-999g W/O Significant GIs, Major ComplexityP62MP62BNeonate, AdmWt 750-999g W/O Significant GIs, Minor ComplexityP63MP63ANeonate, AdmWt 1000-1249g W/O Significant GI/Vent>=96hrs, Major ComplexityP63MP63BNeonate, AdmWt 1000-1249g W/O Significant GI/Vent>=96hrs, Minor ComplexityP64MP64ANeonate, AdmWt 1250-1499g W/O Significant GI/Vent>=96hrs, Major ComplexityP64MP64BNeonate, AdmWt 1250-1499g W/O Significant GI/Vent>=96hrs, Minor ComplexityP65MP65ANeonate, AdmWt 1500-1999g W/O Significant GI/Vent>=96hrs, Extreme CompP65MP65BNeonate, AdmWt 1500-1999g W/O Significant GI/Vent>=96hrs, Major ComplexityP65MP65CNeonate, AdmWt 1500-1999g W/O Significant GI/Vent>=96hrs, Intermediate CompP65MP65DNeonate, AdmWt 1500-1999g W/O Significant GI/Vent>=96hrs, Minor ComplexityP66MP66ANeonate, AdmWt 2000-2499g W/O Significant GI/Vent>=96hrs, Extreme CompP66MP66BNeonate, AdmWt 2000-2499g W/O Significant GI/Vent>=96hrs, Major ComplexityP66MP66CNeonate, AdmWt 2000-2499g W/O Significant GI/Vent>=96hrs, Intermediate CompP66MP66DNeonate, AdmWt 2000-2499g W/O Significant GI/Vent>=96hrs, Minor ComplexityP67MP67ANeonate, AdmWt >=2500g W/O Sig GI/Vent>=96hrs, <37 Comp Wks Gest, Extr CompP67MP67BNeonate, AdmWt >=2500g W/O Sig GI/Vent>=96hrs, <37 Comp Wks Gest, Maj CompP67MP67CNeonate, AdmWt >=2500g W/O Sig GI/Vent>=96hrs, <37 Comp Wks Gest, Int CompP67MP67DNeonate, AdmWt >=2500g W/O Sig GI/Vent>=96hrs, <37 Comp Wks Gest, Min CompP68MP68ANeonate, AdmWt >=2500g W/O Sig GI/Vent>=96hrs, >=37 Comp Wks Gest, Ext CompP68MP68BNeonate, AdmWt >=2500g W/O Sig GI/Vent>=96hrs, >=37 Comp Wks Gest, Maj CompP68MP68CNeonate, AdmWt >=2500g W/O Sig GI/Vent>=96hrs, >=37 Comp Wks Gest, Int CompP68MP68DNeonate, AdmWt >=2500g W/O Sig GI/Vent>=96hrs, >=37 Comp Wks Gest, Min CompQ01IQ01ZSplenectomyQ02IQ02ABlood and Immune System Disorders W Other GIs, Major ComplexityQ02IQ02BBlood and Immune System Disorders W Other GIs, Minor ComplexityQ60MQ60AReticuloendothelial and Immunity Disorders, Major ComplexityQ60MQ60BReticuloendothelial and Immunity Disorders, Minor ComplexityQ61MQ61ARed Blood Cell Disorders, Major ComplexityQ61MQ61BRed Blood Cell Disorders, Intermediate ComplexityQ61MQ61CRed Blood Cell Disorders, Minor ComplexityQ62MQ62ACoagulation Disorders, Major ComplexityQ62MQ62BCoagulation Disorders, Minor ComplexityR01IR01ALymphoma and Leukaemia W Major GIs, Major ComplexityR01IR01BLymphoma and Leukaemia W Major GIs, Minor ComplexityR02IR02AOther Neoplastic Disorders W Major GIs, Major ComplexityR02IR02BOther Neoplastic Disorders W Major GIs, Intermediate ComplexityR02IR02COther Neoplastic Disorders W Major GIs, Minor ComplexityR03IR03ALymphoma and Leukaemia W Other GIs, Major ComplexityR03IR03BLymphoma and Leukaemia W Other GIs, Intermediate ComplexityR03IR03CLymphoma and Leukaemia W Other GIs, Minor ComplexityR04IR04AOther Neoplastic Disorders W Other GIs, Major ComplexityR04IR04BOther Neoplastic Disorders W Other GIs, Minor ComplexityR05IR05AAllogeneic Bone Marrow Transplant, Age <=16 Years or Major ComplexityR05IR05BAllogeneic Bone Marrow Transplant, Age >=17 Years and Minor ComplexityR06IR06AAutologous Bone Marrow Transplant, Major ComplexityR06IR06BAutologous Bone Marrow Transplant, Intermediate ComplexityR06IR06CAutologous Bone Marrow Transplant, Minor ComplexityR60MR60AAcute Leukaemia, Major ComplexityR60MR60BAcute Leukaemia, Intermediate ComplexityR60MR60CAcute Leukaemia, Minor ComplexityR61MR61ALymphoma and Non-Acute Leukaemia, Major ComplexityR61MR61BLymphoma and Non-Acute Leukaemia, Intermediate ComplexityR61MR61CLymphoma and Non-Acute Leukaemia, Minor ComplexityR62MR62AOther Neoplastic Disorders, Major ComplexityR62MR62BOther Neoplastic Disorders, Intermediate ComplexityR62MR62COther Neoplastic Disorders, Minor ComplexityR63MR63ZChemotherapyT01IT01AInfectious and Parasitic Diseases W GIs, Major ComplexityT01IT01BInfectious and Parasitic Diseases W GIs, Intermediate ComplexityT01IT01CInfectious and Parasitic Diseases W GIs, Minor ComplexityT40IT40ZInfectious and Parasitic Diseases W Ventilator SupportT60MT60ASepticaemia, Major ComplexityT60MT60BSepticaemia, Intermediate ComplexityT60MT60CSepticaemia, Minor ComplexityT61MT61APostoperative Infections, Major ComplexityT61MT61BPostoperative Infections, Minor ComplexityT62MT62AFever of Unknown Origin, Major ComplexityT62MT62BFever of Unknown Origin, Minor ComplexityT63MT63AViral Illnesses, Major ComplexityT63MT63BViral Illnesses, Minor ComplexityT64MT64AOther Infectious and Parasitic Diseases, Major ComplexityT64MT64BOther Infectious and Parasitic Diseases, Intermediate ComplexityT64MT64COther Infectious and Parasitic Diseases, Minor ComplexityU40IU40ZMental Health Treatment W ECT, SamedayU60MU60ZMental Health Treatment W/O ECT, SamedayU61MU61ASchizophrenia Disorders, Major ComplexityU61MU61BSchizophrenia Disorders, Minor ComplexityU62MU62AParanoia and Acute Psychotic Disorders, Major ComplexityU62MU62BParanoia and Acute Psychotic Disorders, Minor ComplexityU63MU63AMajor Affective Disorders, Major ComplexityU63MU63BMajor Affective Disorders, Minor ComplexityU64MU64AOther Affective and Somatoform Disorders, Major ComplexityU64MU64BOther Affective and Somatoform Disorders, Minor ComplexityU65MU65AAnxiety Disorders, Major ComplexityU65MU65BAnxiety Disorders, Minor ComplexityU66MU66AEating and Obsessive-Compulsive Disorders, Major ComplexityU66MU66BEating and Obsessive-Compulsive Disorders, Minor ComplexityU67MU67APersonality Disorders and Acute Reactions, Major ComplexityU67MU67BPersonality Disorders and Acute Reactions, Minor ComplexityU68MU68AChildhood Mental Disorders, Major ComplexityU68MU68BChildhood Mental Disorders, Minor ComplexityV60MV60AAlcohol Intoxication and Withdrawal, Major ComplexityV60MV60BAlcohol Intoxication and Withdrawal, Minor ComplexityV61MV61ADrug Intoxication and Withdrawal, Major ComplexityV61MV61BDrug Intoxication and Withdrawal, Minor ComplexityV62MV62AAlcohol Use and Dependence, Major ComplexityV62MV62BAlcohol Use and Dependence, Minor ComplexityV63MV63ZOpioid Use and DependenceV64MV64AOther Drug Use and Dependence, Major ComplexityV64MV64BOther Drug Use and Dependence, Minor ComplexityW01IW01AVent, Trac & Cran Interventions for Mult Sig Trauma, Major ComplexityW01IW01BVent, Trac & Cran Interventions for Mult Sig Trauma, Intermediate ComplexityW01IW01CVent, Trac & Cran Interventions for Mult Sig Trauma, Minor ComplexityW02IW02AHip, Femur and Lower Limb Interventions for Multiple Sig Trauma, Major CompW02IW02BHip, Femur and Lower Limb Interventions for Multiple Sig Trauma, Minor CompW03IW03ZAbdominal Interventions for Multiple Significant TraumaW04IW04AMultiple Significant Trauma W Other GIs, Major ComplexityW04IW04BMultiple Significant Trauma W Other GIs, Minor ComplexityW60MW60ZMultiple Sig Trauma, Transferred to Acute Facility <5 DaysW61MW61AMultiple Significant Trauma W/O GIs, Major ComplexityW61MW61BMultiple Significant Trauma W/O GIs, Minor ComplexityX02IX02AMicrovascular Tissue Transfer and Skin Grafts for Injuries to Hand, Major CompX02IX02BMicrovascular Tissue Transfer and Skin Grafts for Injuries to Hand, Minor CompX04IX04AOther Interventions for Injuries to Lower Limb, Major ComplexityX04IX04BOther Interventions for Injuries to Lower Limb, Minor ComplexityX05IX05AOther Interventions for Injuries to Hand, Major ComplexityX05IX05BOther Interventions for Injuries to Hand, Minor ComplexityX06IX06AOther Interventions for Other Injuries, Major ComplexityX06IX06BOther Interventions for Other Injuries, Intermediate ComplexityX06IX06COther Interventions for Other Injuries, Minor ComplexityX07IX07ASkin Grafts for Injuries Excluding Hand, Major ComplexityX07IX07BSkin Grafts for Injuries Excluding Hand, Intermediate ComplexityX07IX07CSkin Grafts for Injuries Excluding Hand, Minor ComplexityX40IX40AInjuries, Poisoning and Toxic Effects of Drugs W Ventilator Support, Major CompX40IX40BInjuries, Poisoning and Toxic Effects of Drugs W Ventilator Support, Minor CompX60MX60AInjuries, Major ComplexityX60MX60BInjuries, Minor ComplexityX61MX61AAllergic Reactions, Major ComplexityX61MX61BAllergic Reactions, Minor ComplexityX62MX62APoisoning/Toxic Effects of Drugs and Other Substances, Major ComplexityX62MX62BPoisoning/Toxic Effects of Drugs and Other Substances, Minor ComplexityX63MX63ASequelae of Treatment, Major ComplexityX63MX63BSequelae of Treatment, Minor ComplexityX64MX64AOther Injuries, Poisonings and Toxic Effects, Major ComplexityX64MX64BOther Injuries, Poisonings and Toxic Effects, Intermediate ComplexityX64MX64COther Injuries, Poisonings and Toxic Effects, Minor ComplexityY01IY01ZVent >=96hrs or Trach for Burns or GIs for Severe Full Thickness BurnsY02IY02ASkin Grafts for Other Burns, Major ComplexityY02IY02BSkin Grafts for Other Burns, Intermediate ComplexityY02IY02CSkin Grafts for Other Burns, Minor ComplexityY03IY03AOther GIs for Other Burns, Major ComplexityY03IY03BOther GIs for Other Burns, Minor ComplexityY60MY60ZBurns, Transferred to Acute Facility <5 DaysY61MY61ZSevere BurnsY62MY62AOther Burns, Major ComplexityY62MY62BOther Burns, Minor ComplexityZ01IZ01AOther Contacts W Health Services W GIs, Major ComplexityZ01IZ01BOther Contacts W Health Services W GIs, Minor ComplexityZ40IZ40ZOther Contacts W Health Services W EndoscopyZ61MZ61ASigns and Symptoms, Major ComplexityZ61MZ61BSigns and Symptoms, Minor ComplexityZ63MZ63AOther Follow Up After Surgery or Medical Care, Major ComplexityZ63MZ63BOther Follow Up After Surgery or Medical Care, Minor ComplexityZ64MZ64AOther Factors Influencing Health Status, Major ComplexityZ64MZ64BOther Factors Influencing Health Status, Minor ComplexityZ65MZ65ZCongenital Anomalies and Problems Arising from Neonatal PeriodZ66MZ66ZSleep Disorders801I801AGIs Unrelated to Principal Diagnosis, Major Complexity801I801BGIs Unrelated to Principal Diagnosis, Intermediate Complexity801I801CGIs Unrelated to Principal Diagnosis, Minor Complexity960M960ZUngroupable961M961ZUnacceptable Principal Diagnosis963M963ZNeonatal Diagnosis Not Consistent W Age/Weight00003048007782560Independent Hospital Pricing Authority?Level 6, 1 Oxford StreetSydney NSW 2000Phone 02 8215 1100Email enquiries.ihpa@.auTwitter @IHPAnews.au00Independent Hospital Pricing Authority?Level 6, 1 Oxford StreetSydney NSW 2000Phone 02 8215 1100Email enquiries.ihpa@.auTwitter @IHPAnews.au1524007630160?evel 6, 1 Oxford StreetSydney NSW 2000Phone 02 8215 1100Email enquiries.ihpa@.auTwitter @IHPAnews.au00?evel 6, 1 Oxford StreetSydney NSW 2000Phone 02 8215 1100Email enquiries.ihpa@.auTwitter @IHPAnews.au ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download