Principal Diagnosis PDX Exclusion List

$447.50 / year

This dataset shows the presence of various diagnoses that is used as a secondary diagnosis that leads to substantially increased hospital resource use and are categorized as either complication or comorbidity (CC) or major complication or comorbidity (MCC). Some MCCs and CCs are excluded because they are too closely related to the principal diagnoses. This is called the PDX Exclusion List that identifies conditions that will not be considered a CC or MCC for a given principal diagnosis.

Complexity

The MS-DRG System: The MS-DRGs (Medicare Severity Diagnosis Related Groups) range from 001-999, with many unused numbers to accommodate future MS-DRG expansion.
One MS-DRG is assigned to each inpatient stay. The MS-DRGs are assigned using the principal diagnosis and additional diagnoses, the principal procedure and additional procedures, sex and discharge status. Diagnoses and procedures assigned by using ICD-10-CM codes determine the MS-DRG assignment. Accurate and complete ICD-10-CM coding by HIM (Health Information Management) professionals is essential for correct MS-DRG assignment and subsequent reimbursement.

In the MS-DRG system, many DRGs are split into one, two or three MS-DRGs based on whether any one of the secondary diagnoses has been categorized as an MCC, a CC or no CC.

Example of MS-DRGs with a three way split include:
MS-DRG 539, Osteomyelitis with MCC
MS-DRG 540, Osteomyelitis with CC
MS-DRG 541, Osteomyelitis without CC/MCC

MCC/CC List: Under MS-DRGs, CMS identified those diagnoses whose presence as a secondary diagnosis leads to substantially increased hospital resource use. They then categorized this list into two different levels of severity as follows:
Major complications or comorbidities (MCCs) reflect the highest level of severity
CCs represent the next level of severity.

Some MCCs and CCs are excluded because they are too closely related to the principal diagnoses. This is called the CC Exclusion List and identifies conditions that will not be considered a CC or MCC for a given principal diagnosis. For example, primary cardiomyopathy (425.4) is not a CC for congestive heart failure (428.0).

Date Created

2007

Last Modified

2015-08-20

Version

33

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

Clinical Software, CCS, Clinical Classifications Software, Clinical Classifications Software for Services and Procedures, Code Book, ICD-10-CM Definition, ICD-10-CM Book, ICD-10-CM Manual, ICD-10-CM and ICD-10-PCS Coding Handbook

Other Titles

PDX Exclusion List Clinical Software, PDX Exclusion List CCS, PDX Exclusion List Clinical Classifications Software, PDX Exclusion List Code Book

NameDescriptionTypeConstraints
ICD_10_CM_Diagnosis_CodesICD-10-CM Codesstring-
Severity_Level_of_DiagnosisSeverity Level of Diagnosis MCC Stands for Major complications or comorbidities, whereas CC stands for complications or comorbiditiesstringrequired : 1
PDX_ExclusionsCCs and MCCs that have been excluded because they are too closely related to the principal diagnoses.stringrequired : 1
ICD_10_CM_Codes_DescriptionDescription of ICD Codesstringrequired : 1
ICD 10 CM Diagnosis CodesSeverity Level of DiagnosisPDX ExclusionsICD 10 CM Codes Description
A000CC0002:3 codesCholera due to Vibrio cholerae 01, biovar cholerae
A001CC0002:3 codesCholera due to Vibrio cholerae 01, biovar eltor
A009CC0002:3 codesCholera, unspecified
A0100CC0003:11 codesTyphoid fever, unspecified
A0101CC0003:11 codesTyphoid meningitis
A0102CC0003:11 codesTyphoid fever with heart involvement
A0103CC0003:11 codesTyphoid pneumonia
A0104CC0003:11 codesTyphoid arthritis
A0105CC0003:11 codesTyphoid osteomyelitis
A0109CC0003:11 codesTyphoid fever with other complications