Diagnosis Related Groups Assigned to Hospital Acquired Conditions

$79 / year

The following dataset consists of Hospital-Acquired Conditions (HACs) which are conditions that occur after the physician writes the inpatient admission order and that could have been reasonably prevented through the application of evidence-based guidelines and best practices.

Complexity

A Diagnosis-Related Group (DRG) is a statistical system of classifying any inpatient stay into groups for the purposes of payment. The DRG classification system divides possible diagnoses into 25 major body systems and subdivides them into one of 747 groups for the purpose of Medicare reimbursement. DRG grouper system has been used by Medicare since 1983 to reimburse hospitals for inpatient admissions. Factors used to determine the DRG payment amount include the diagnosis involved as well as the hospital resources necessary to treat the condition. Also used by a few states for all payors and by many private health plans (usually non-HMO) for contracting purpose. Hospitals are paid a fixed rate for inpatient services corresponding to the DRG group assigned to a given patient.

In 2007, CMS began monitoring claims for hospital-acquired conditions (HAC). Today, Medicare denies approximately $20 million per year under the HAC policy.

Additionally, four HACs comprise 12.2% of total medical professional liability costs:
– Hospital-acquired infections
– Hospital-acquired injuries
– Objects left in surgery
– Pressure ulcers

CMS focuses on these HACs due to the abundance of data that supports the assertion that these are preventable conditions. Reporting and capturing HACs allow hospital administrators and CMS to measure the facility’s performance, distinguish between pre-existing conditions and those acquired in the hospital, and to increase the validity of hospital report cards related to quality.

Date Created

2016-10-01

Last Modified

2018-05-13

Version

35.0A

Update Frequency

Annual

Temporal Coverage

N/A

Spatial Coverage

United States

Source

John Snow Labs => Centers for Medicare & Medicaid Services

Source License URL

John Snow Labs Standard License

Source License Requirements

N/A

Source Citation

N/A

Keywords

DRG, DRG Codes, Diagnosis Related Groups, CMS DRG, Diagnosis Group, HAC, Hospital Acquired Conditions

Other Titles

DRG Codes Assigned to Hospital Acquired Conditions, Diagnosis Group Assigned to Hospital Acquired Conditions

NameDescriptionTypeConstraints
Hospital_Acquired_Condition_CodeCodes assigned to hospital-acquired conditions ( HAC 01 - HAC 14)string-
Description_of_Hospital_Acquired_Condition_CodeDescription of HAC Codestring-
Procedure_CodeProcedure code from ICD-10-PCS code list, that accurately represents the procedure performed.string-
Procedure_DescriptionDescription of the procedure codestring-
Primary_Diagnosis_CodeICD-10 Diagnosis Code pertaining to Primary Diagnosisstring-
Primary_Diagnosis_DescriptionDescription of ICD-10 Diagnosis Code for Primary Diagnosisstring-
Secondary_DiagnosisICD-10 Diagnosis Code pertaining to Secondary Diagnosisstring-
Secondary_Diagnosis_LevelRefers to either a complication or comorbidity (CC) or a major complication or comorbidity (MCC) when used as a secondary diagnosis.string-
Secondary_Diagnosis_DescriptionDescription of ICD-10 Diagnosis Code for Secondary Diagnosisstring-
Hospital_Acquired_Condition_CodeDescription_of_Hospital_Acquired_Condition_CodeProcedure_CodeProcedure_DescriptionPrimary_Diagnosis_CodePrimary_Diagnosis_DescriptionSecondary_DiagnosisSecondary_Diagnosis_LevelSecondary_Diagnosis_Description
HAC 05FALLS AND TRAUMAT281XXACCBurn of esophagus, initial encounter
HAC 05FALLS AND TRAUMAM9918CCSubluxation complex (vertebral) of rib cage
HAC 05FALLS AND TRAUMAT286XXACCCorrosion of esophagus, initial encounter
HAC 05FALLS AND TRAUMAS070XXACCCrushing injury of face, initial encounter
HAC 05FALLS AND TRAUMAS343XXAMCCInjury of cauda equina, initial encounter
HAC 06CATHETER-ASSOCIATED URINARY TRACT INFECTION (UTI)N136CCPyonephrosis
HAC 05FALLS AND TRAUMAS071XXACCCrushing injury of skull, initial encounter
HAC 05FALLS AND TRAUMAT670XXACCHeatstroke and sunstroke, initial encounter
HAC 05FALLS AND TRAUMAM9910CCSubluxation complex (vertebral) of head region
HAC 05FALLS AND TRAUMAT69022ACCImmersion foot, left foot, initial encounter