Diagnosis Related Groups Assigned to Hospital Acquired Conditions

$179 / 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

2020-01-30

Version

2020-01-30

Update Frequency

Annual

Temporal Coverage

N/A

Spatial Coverage

United States

Source

John Snow Labs; Centers for Medicare & Medicaid Services;

Source License URL

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 01FOREIGN OBJECT RETAINED AFTER SURGERYT81500ACCUnspecified complication of foreign body accidentally left in body following surgical operation, initial encounter
HAC 01FOREIGN OBJECT RETAINED AFTER SURGERYT81501ACCUnspecified complication of foreign body accidentally left in body following infusion or transfusion, initial encounter
HAC 01FOREIGN OBJECT RETAINED AFTER SURGERYT81502ACCUnspecified complication of foreign body accidentally left in body following kidney dialysis, initial encounter
HAC 01FOREIGN OBJECT RETAINED AFTER SURGERYT81503ACCUnspecified complication of foreign body accidentally left in body following injection or immunization, initial encounter
HAC 01FOREIGN OBJECT RETAINED AFTER SURGERYT81504ACCUnspecified complication of foreign body accidentally left in body following endoscopic examination, initial encounter
HAC 01FOREIGN OBJECT RETAINED AFTER SURGERYT81505ACCUnspecified complication of foreign body accidentally left in body following heart catheterization, initial encounter
HAC 01FOREIGN OBJECT RETAINED AFTER SURGERYT81506ACCUnspecified complication of foreign body accidentally left in body following aspiration, puncture or other catheterization, initial encounter
HAC 01FOREIGN OBJECT RETAINED AFTER SURGERYT81507ACCUnspecified complication of foreign body accidentally left in body following removal of catheter or packing, initial encounter
HAC 01FOREIGN OBJECT RETAINED AFTER SURGERYT81508ACCUnspecified complication of foreign body accidentally left in body following other procedure, initial encounter
HAC 01FOREIGN OBJECT RETAINED AFTER SURGERYT81509ACCUnspecified complication of foreign body accidentally left in body following unspecified procedure, initial encounter