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.