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Home Health & Hospice Week

Post-Acute Care:

More Hospital DRGs Subject To Post-Acute Transfer Proration

Published on Sun Aug 17, 2003

 

Hospitals now will have 29 rather than 10 diagnosis related groups that Medicare will pay them less for if they discharge to home care.

In its Aug. 1 final 2004 inpatient payment rule, the Centers for Medicare & Medicaid Services deletes two DRGs from the old list of 10 affected codes and adds 21 new ones.

Under the post-acute transfer policies, certain discharges to post-acute settings, including home care, qualify as a "transfer" for payment purposes rather than a discharge. The net result is that hospitals get a per diem rate for the care rather than the full DRG payment.

That means hospitals may be more reluctant to discharge patients with the affected diagnoses to home care. Post-acute transfer rules will apply to the following DRGs starting Oct. 1, 2003:

  • 12    Degenerative Nervous System Disorders

  • 14    Intracranial Hemorrhage and Stroke With Infarction

  • 24    Seizure and Headache Age >17 With CC

  • 25    Seizure and Headache Age >17 Without CC

  • 88    Chronic Obstructive Pulmonary Disease

  • 89    Simple Pneumonia and Pleurisy Age > 17 With CC

  • 90    Simple Pneumonia and Pleurisy Age > 17 Without CC

  • 113   Amputation for Circulatory System Disorders Except Upper Limb and Toe

  • 121   Circulatory Disorders With AMI and Major Complication, Discharged Alive

  • 122   Circulatory Disorders With AMI and Without Major Complication, Discharged Alive

  • 127   Heart Failure and Shock

  • 130   Peripheral Vascular Disorders With CC

  • 131   Peripheral Vascular Disorders Without CC

  • 209   Major Joint and Limb Reattachment Procedures of Lower Extremity

  • 210   Hip and Femur Procedures Except Major Joint Age >17 With CC

  • 211   Hip and Femur Procedures Except Major Joint Age >17 Without CC

  • 236   Fractures of Hip and Pelvis

  • 239   Pathological Fractures and Musculoskeletal and Connective Tissue Malignancy

  • 277   Cellulitis Age >17 With CC

  • 278   Cellulitis Age >17 Without CC

  • 294   Diabetes Age >35

  • 296   Nutritional and Miscellaneous Metabolic Disorders Age >17 With CC

  • 297   Nutritional and Miscellaneous Metabolic Disorders Age >17 Without CC

  • 320   Kidney and Urinary Tract Infectious Age >17 With CC

  • 321   Kidney and Urinary Tract Infectious Age >17 Without CC

  • 395   Red Blood Cell Disorders Age >17

  • 429   Organic Disturbances and Mental Retardation

  • 468   Extensive O.R. Procedure Unrelated to Principal Diagnosis

  • 483   Tracheotomy With Mechanical Ventilation 96+ Hours or Principal Diagnosis Except Face, Mouth and Neck Diagnoses

    Editor's Note: The rule is at www.access.gpo.gov/su_docs/fedreg/a030801c.html.

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