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Methodology 2018 19
Casemix Funding for
South Australian
Public Hospitals
For Official Use Only-I2-A2
Published October 2018 by the South Australian Department for Health and Wellbeing
Funding Models, Finance and Corporate Services, PO Box 287 Rundle Mall 5000
South Australia, Australia
The National Library of Australia Cataloguing-in-Publication entry:
Casemix funding for hospitals: Methodology 2018 19
ISBN 978-1-76083-043-4
1. Hospitals - South Australia - Business management. 2.
Hospitals - South Australia - Finance. 3. Diagnosis
Related Groups - South Australia. 4. Public health - South
Australia. I. South Australia. Department for Health and Wellbeing. Funding Models.
362.11099423
Copyright Funding Models, Department for Health and Wellbeing, 2018
The Department for Health and Wellbeing owns the copyright of the contents within this folder
(including algorithm diagrams). The information may be reproduced in whole or in part for study and
training purposes subject to the inclusion of an acknowledgment of the source and no commercial
usage or resale. Under copyright law, reproduction for purposes other than those stated above
requires the written permission of Funding Models, Finance and Corporate Services, Department for
Health and Wellbeing, PO Box 287, Rundle Mall, SA, 5000.
.
For Official Use Only-I2-A2
METHODOLOGY 2018 19
TABLE OF CONTENTS
1 INTRODUCTION ............................................................................................................................. 1
1.1 Purpose of the document ........................................................................................................ 1
1.2 Funding principles ................................................................................................................... 1
1.3 The National ABF System ....................................................................................................... 3
1.4 Priorities for SA Health Funding Reform ................................................................................. 4
1.5 Changes to the South Australian Casemix Funding Model for 2018 19 ................................ 5
1.6 Future developments .............................................................................................................. 5
1.7 Contacts .................................................................................................................................. 6
2 SA s PRICING AND FUNDING FRAMEWORK .............................................................................. 7
2.1 SA Health Casemix funding governance ................................................................................ 7
2.2 LHN responsibilities ................................................................................................................ 7
3 ACTIVITY BASED MANAGEMENT PRINCIPLES .......................................................................... 9
3.1 What is Activity Based Management? .................................................................................... 9
3.2 ABF management practices .................................................................................................... 9
3.3 Implications for LHN analysis and reporting ......................................................................... 11
4 SPECIFIC FUNDING DETAILS ..................................................................................................... 12
4.1 Activity Payment .................................................................................................................... 12
4.1.1 Acute Admitted .............................................................................................................. 12
4.1.2 Sub-Acute and Non Acute ............................................................................................. 14
4.1.3 Non Admitted Activity - Outpatients .................................................................................. 15
4.1.4 Emergency Department / Services ................................................................................... 16
4.2 Teaching Grant...................................................................................................................... 17
4.2.1 Nursing .............................................................................................................................. 17
4.2.2 Medical Officers................................................................................................................. 17
4.2.3 Other Health Professionals ............................................................................................... 18
4.3 Special Grants ....................................................................................................................... 18
4.4 Rural Access Grant ............................................................................................................... 18
5 Section ........................................................................................................................................... 19
5.1 Section 1: 2018 19 AR-DRG version 9.0 price weights and adjustments ........................... 19
5.2 Section 2: ICD-10-AM 10th edition Procedure Codes Eligible for Radiotherapy Adjustments
57
5.3 Section 3: ICD-10-AM 10th edition Procedure Codes Eligible for Dialysis Adjustment ........ 59
5.4 Section 4: 2018 19 AN-SNAP v4.0 price weights ................................................................ 60
For Official Use Only-I2-A2
5.5 Section 5: Special Grants ...................................................................................................... 65
5.6 Section 6: Low Volume / Minimum Budget / Grant Funded Hospitals .................................. 67
5.7 Section 7: Non-Admitted Patients - Tier 2 Clinic v5.0 ........................................................... 68
5.8 Section 8: List of hospitals by Emergency Classification type .............................................. 72
5.9 Section 9: Emergency Department Urgency Related Groups (URG) v1.4 ........................ 75
5.10 Section 10: Emergency Department UDG v1.3 ................................................................. 78
5.11 Section 11: List of hospitals by Peer Group .......................................................................... 79
For Official Use Only-I2-A2 1
1 INTRODUCTION
This chapter provides an overview of the funding principles and approaches to funding the public
health system in South Australia, as well as identifying the priorities and developments at a State
level, taking into account the work that is happening under the national Activity Based Funding (ABF)
program.
The terms Activity Based Funding (ABF) and Casemix Funding, in a health context, are
interchangeable. They refer to a method of funding hospital services that is primarily based on the
level of activity undertaken, at an agreed price . The services are broken down into work streams
(e.g. inpatient, emergency department, outpatient, teaching and training), with each having a specific
taxonomy (classification) that enables activities to be grouped according to clinical need and relative
costs. In this document, the term Casemix Funding will primarily be used. The term Activity Based
Funding (or ABF) is only used in the context of the national ABF program.
1.1 Purpose of the document
Casemix Funding is the resource allocation tool used within SA Health to fund public hospitals. As a
consequence, its application, the funding levels it determines and the management data it produces
are of key concern and use to Local Hospital Networks and the Department.
This document provides guidance regarding the health funding allocations made to public hospitals in
South Australia. It incorporates information on the policy setting in which Casemix Funding is applied,
the technical allocation methodologies used in the Casemix Funding Model and also describes
Activity Based Management (ABM) approaches that can assist the health system efficiently manage
services within an ABF environment.
1.2 Funding principles
Casemix Funding was first introduced into the South Australian public health system in July 1994.
The Casemix Funding Model has been progressively adapted and updated over the years to reflect
the changing service profile and models of care delivered by our metropolitan and country public
hospitals.
As the primary resource allocation tool for public hospital services, Casemix Funding represents a
significant portion of the total funding provided to LHNs, as reported in the Table 1.1 below (by work
stream):
Table 1.1: Proportion of casemix funded budget by work stream
Work stream % of budget funded by Casemix
Acute admitted 57.8%
ED 10.3%
Outpatient 14.5%
Sub-acute, non-acute (include GEM and Palliative Care) 4.2%
Teaching, training and research 2.6%
Site Specifics 9.3%
For Official Use Only-I2-A2 2
The health care system is a dynamic and complex array of services. With increasing patient demand
and advancements in technology, increased emphasis has been placed on output-based tools (such
as Casemix) that improve operational efficiency. In this context, the utilisation of Casemix aims to:
? Provide equity in the funding of health units.
? Enable sound business decisions about resource allocation.
? Analyse the link between the costs of services and patient care.
? Provide a basis of comparison for activity between health units.
? Maintain a high level of care while striving for the most efficient and effective use of resources.
The key components of a Casemix system are summarised in Figure 1.1 below.
Figure 1.1: Components of a Casemix System
Product identification
and classification
A system of taxonomies that adequately classifies
care across different care types and settings and to a
level that allows for variation in complexity and care
needs.
Product counting
A system that supports accurate, electronic counting
of all patient related services, linking clinical and
accounting feeder systems.
Product costing
Product level costing with as close to full cost
absorption as possible yielding a recognised unit cost
per product type.
Data management,
analysis and
reporting
Data management, analysis and reporting is a
supporting element for counting, costing,
benchmarking whilst supporting flexible local reporting
requirements
Funding
A system of activity based funding based on accepted
activity based costs and classification of products.
Governance and
management
A model of clinical and corporate governance at a
jurisdictional and regional / local level. It includes
activity based management systems and processes.
The primary benefit of Casemix is that it provides incentives to shift the focus of health service funding
and management towards the delivery of patient services and health outcomes by better aligning SA
Health resources to LHNs and to patients.
Casemix is an important tool for health service management. Sometimes termed Activity Based
Management (ABM), the utilisation of data produced from Casemix activities for a range of
undertakings beyond hospital funding (e.g. service planning and performance monitoring) and is
essential in the current economic environment. This data allows for a richer and more detailed
analysis of health service throughput and workload, providing a basis for more meaningful
comparisons of health service activity levels and efficiency through the classification and weighting of
different patient groups. As the activities and costs of the health sector grows, the need for and
reliance on Casemix data also grows.
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1.3 The National ABF System
On 2 August 2011, the Commonwealth government, together with all state and territory governments,
signed the National Health Reform Agreement (NHRA). Under the NHRA, the Australian Government
and states and territories have joint responsibility for the funding of public hospital services so that the
increase in health service demand and costs can be met.
The reforms focus on increased accountability and transparency. The funding arrangements and
performance and accountability requirements are the domain of three independent national bodies:
? Independent Hospital Pricing Authority (IHPA)
? National Health Funding Body (NHFB)
? Australian Commission for Safety and Quality in Health Care (ACSQHC).
Of these, the IHPA s main function is to determine the National Efficient Price (NEP) for public
hospital services and the National Efficient Cost (NEC) block-funded services. The IHPA also
determines the public hospital services that are eligible for an Australian Government funding
contribution and formulates the standards and requirements for public hospital activity and cost data
that is provided by Commonwealth and state and territory governments.
IHPA deploys a range of classifications for pricing components of its funding model as shown in Table
1.2 below.
Table 1.2: Current national ABF work streams
Work stream Current classification system
Acute inpatients AR-DRG V9.0
Mental Health inpatients AR-DRG V9.0
Sub-Acute (Rehabilitation, Palliative Care, GEM) AN-SNAP V4.0
Non Acute (Maintenance Care) AN-SNAP V4.0
Emergency Department/ Services URG V1.4 and UDG V1.3
Outpatients Tier 2 Clinics V5.0
Teaching, training and research Block funded (NEC)
Community Non-Admitted Services Tier 2 Clinics V5.0
Community service obligations (low volume hospitals) National Efficient Cost (NEC)
Under the terms of the NHRA:
? The Commonwealth will contribute 45 per cent of efficient growth in eligible public hospital
activity and funding in 2018 19, with a national funding cap of 6.5 per cent.
? Each state, as the system manager of their respective public hospital system, is responsible for
determining the total level of funding to LHNs. States are free to decide which, if any, elements
of the national ABF model they wish to adopt to determine their own funding of LHNs.
? The Commonwealth s funding of LHNs is based on the concept of a NEP.
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? The NEP is a single figure, set by IHPA in March each year based on the average cost per
weighted acute separation in Australian public hospitals. The NEP has two primary functions:
o It is multiplied by a number of National Weighted Activity Units (NWAUs), which are derived
from activity volumes and price relativities, to determine Commonwealth funding allocations.
A NWAU is a weighted measure of health service activity expressed as a common unit,
against which the NEP is paid. It provides a way of comparing and valuing each public
hospital service (whether it is an admission, emergency department presentation or
outpatient episode), by weighting it for its clinical complexity and relative resource use.
o The NEP provides a price signal, or benchmark, for the efficient cost of providing public
hospital services and is intended to drive improvements in service delivery costs.
There are a range of benefits for states and territories from the National ABF program, beyond the
funding elements. These include:
? Based on national activity and cost data, and with a continuous development program led by
IHPA, ABF can provide greater precision in overall hospital funding if jurisdictions adopt
components of the national model in their own local funding model, particularly as these ABF
components become more robust and improve over time.
? Access to de-identified patient level costing data from hospitals across Australia provides
opportunities for national benchmarking that were previously unachievable.
? The NEP is a benchmark based on robust national data and is now recognised as a key measure
of hospital efficiency in Australia against which individual hospitals and LHNs can be compared.
The National ABF continues to be developed by IHPA, with the key development activities scheduled
for 2018 19 being:
? Ongoing development of the Australian Mental Health Care classification.
? The finalisation of a new patient based emergency care classification system.
? Continued development of a new patient based classification for non admitted services.
? Refinement of a classification for Teaching Training and Research activities.
? Continued development of funding / pricing approach for safety and quality, now focusing on
avoidable hospital readmissions.
1.4 Priorities for SA Health Funding Reform
The key over-arching objectives of SA Health s funding approach, which includes a state-based
Casemix funding methodology and a national ABF system for Commonwealth funding, are:
? Improved efficiency of health service delivery.
? Better use of resources, ensuring greater value for money and improved financial sustainability
within quality and safety standards.
? Increased utilisation of available data on the cost and performance of LHNs to assist with
management decision-making processes. This will be achieved by the further adoption of ABM
principles and processes.
One of SA Health s key objectives is to appraise the elements of the National ABF System with a view
to local implementation, where appropriate. In addition, the Funding Models Unit is actively working
to provide LHNs with improved patient level costing data, which is stored in a centrally maintained
patient costing system, with detailed and customised outputs made available to LHNs.
For Official Use Only-I2-A2 5
Casemix funding in itself will not improve patient care, but patient-level costing data, when coupled
with outcome data (e.g. readmissions, mortality) can provide a basis for monitoring the effectiveness
and efficiency of care. Casemix data can facilitate an understanding of variations in work practices
and the impact on costs and outcomes for patients with similar morbidity profiles.
1.5 Changes to the South Australian Casemix Funding Model for 2018 19
The Casemix model in 2018-19 has undergone further refinements in line with the National ABF
System. Following the appraisal of the National ABF System, SA Health decided to implement the
remaining components, except for National Efficient Cost model for low volume hospitals.
The extensive and ongoing development work that is being undertaken by the IHPA under the
national ABF program provided the opportunity to refresh and improve SA s Casemix funding model.
As components of the national ABF model benefit from extensive national activity and cost data and
significant investment in classification development, they have become superior to their equivalent
components in the state-based Casemix model. It is sensible for SA to replace components of its
own model with the equivalent components from the national ABF model. This process commenced,
with the adoption of the acute admitted component of the national model in 2014 15.
Key changes to the model in 2018 19 are summarised below:
? The funding rate has been reviewed and based on the 2018 19 NEP.
? All activity is now measured in NWAUs and applying the national weights published by IHPA.
? Australian Refined Diagnosis Related Groups (AR-DRG) version 9 has been adopted for the
acute admitted activity. ICD-10-AM / ACHI / ACS 10th edition, the system used for recording
diagnoses and procedures will continue to be used.
? Site-specific grants have been reviewed to determine if they are still necessary to supplement the
funding allocation derived from actual activity (based on the national price weights). Grants that
are considered unnecessary have been discontinued and where possible funded based on
activity.
? Hospital Acquired Complication adjustment (note for 2018-19 this has been set to zero).
In determining whether the price should be set to be equivalent to the 2018 19 NEP ($5,012), the
following factors were considered:
? The total funding for health services needed to fit within SA Health s overall 2018 19 budget
allocation.
? The resultant savings requirements for each LHN.
The LHN NEP has been set below the NEP to take account of cost in the NEP that relate to services
managed centrally (e.g. some ICT, workforce, procurement).
1.6 Future developments
In future financial years, more changes to the SA Casemix funding model may be made as the
national ABF model is developed further.
A national ABF model component will only be adopted if it can be clearly demonstrated that it is a
significant improvement on the local component. The evaluation of these components will be
For Official Use Only-I2-A2 6
underpinned by modelling and sensitivity analyses to determine the impact of adopting the
components on LHN funding.
1.7 Contacts
This manual has been compiled by the Funding Models Unit. Any requests, comments or
suggestions are welcome and can be addressed to:
Funding Models
Finance and Corporate Services
Email: Health.ABF@sa.gov.au
November 2018
Krystyna Parrott
For Official Use Only-I2-A2 7
2 SA s PRICING AND FUNDING FRAMEWORK
This chapter provides an overview of the existing governance and policy framework with respect to
Casemix funding.
2.1 SA Health Casemix funding governance
The Department for Health and Wellbeing has established Service Level Agreements (SLAs) with
each LHN which set out the parties mutual understanding of their respective statutory and other legal
functions and obligations. The SLAs stipulate that the Department for Health and Wellbeing Chief
Executive is responsible for being the system manager and single purchaser of public health services
and functions.
As identified earlier, Casemix is the primary resource allocation tool within the South Australian public
health system. The Casemix funding calculations are undertaken by the Finance and Corporate
Services Division, as part of the annual budget setting process, taking into account:
? Agreed activity allocations for each LHN (including counting changes) as set out in the 2018-19
Purchasing Principles and Priorities.
? Agreed activity movements and / or service profile changes in accordance with Purchasing
priorities. The Purchasing Principles and Priorities will be updated annually to reflect agreed
state-wide priorities. Annual purchasing plans developed for each LHN will reflect local projects
and priorities.
? Implementation and monitoring of specified savings measures announced in State Budgets.
? Other funding streams. Not all the funding allocation is determined through commissioning.
There are grants for a range of services, like teaching, training and research and site specifics
that need to be considered within the total funding allocation.
Casemix funding principles are endorsed by the Department s Purchasing and Performance
Committee and discussed with LHN Chief Executives and Chief Finance Officers.
2.2 LHN responsibilities
LHNs have critical responsibilities in respect to Casemix funding that extend to the need to accurately
classify, count and cost activities.
In this respect, LHN must place an emphasis on:
? Counting and reporting the services provided (timely and accurate coding and classification).
? The accuracy and timeliness of costing services in accordance with Australian Hospital Patient
Costing Standards.
? Understanding the relationship between price and cost, in order to make more informed
decisions on services within the available funding parameters.
? Managing within their funding allocations and understanding their required level of savings and
the role of transition grants as LHNs work to reduce costs down to the level that will enable them
to operate within the NEP.
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Projections of expected activity levels and service profiles are a key input into the commissioning and
funding process. Typically, these projections are based on an analysis of historical activity levels.
Robust processes and systems to accurately count, code and report activity are required by LHN s to
ensure system-wide activity and resources are appropriately managed.
Service agreements require LHNs to ensure appropriate systems and processes are in place to
enable accurate recording of activity, and provision of data requirements to enable monitoring of
outcome measures and KPIs and to support the implementation of Activity Based Funding (ABF).
In practice, this requires LHNs to count activity accurately and promptly, which includes the consistent
application of data collection definitions and standards. If activity is not coded accurately and in a
timely manner, inappropriate decisions may be made about the complexity and service profile, and by
extension, the appropriate cost and funding profile expected of the site.
Delays in coding of inpatient encounters and errors in allocating patients to the right classification
group are largely related to incomplete medical record documentation. An appropriate level of coding
resources to optimise coding accuracy and timeliness is an important enabler to good quality Casemix
data and to ensure funding is commensurate with the level of patient activity.
Cost data for a patient encounter is made up of a number of components, such as nursing, medical,
drugs, theatres and allied health costs. The data is dependent on a number of factors, such as
coding and financial information as well as being able to link a service to a patient. The costing
process needs to be validated and monitored for accuracy and timeliness to ensure the information
used in the funding process is reliable and consistent with the Australian Hospital Patient Costing
Standards.
Good costing provides information for benchmarking against other facilities. It helps managers
(clinical and administrative) understand the difference in cost for each service provided, highlighting
not only potential inefficiencies but also areas of costing inaccuracies or changes in service profile.
Variations in clinical models of care and treatment protocols can then be assessed in the context of
cost variations for patients with similar morbidity profiles.
For Official Use Only-I2-A2 9
3 ACTIVITY BASED MANAGEMENT PRINCIPLES
This document describes the methodology underpinning SA Health s 2018 19 public hospital funding
model, which is based on Casemix funding principles. However, it is important to note that Casemix
is actually a specialised application of Activity Based Management (ABM), tailored to the specific
needs of hospital funding. ABM is a broad management and funding methodology which has
applications across many industries. This chapter provides an overview of ABM principles, noting its
particular applications to public hospital funding.
3.1 What is Activity Based Management?
ABM involves using available information generated as part of the funding process to understand the
costs and costs drivers in service delivery and to make management decisions to change and
improve these factors. ABM is just one hospital management tool that can be integrated into an
organisation at both a strategic and operational level.
3.2 ABF management practices
The process of managing under a Casemix funding model requires a high level of understanding of
activity and costs. The adoption of ABM principles and processes are becoming more widespread in
Australia due to the national ABF program and the greater focus it brings on Casemix activities.
Adopting ABM approaches requires regional executives, managers, directors and executive directors,
both clinical and corporate, to work collaboratively to understand the LHN s operations.
The key outputs of an ABM system can be categorised into four key components namely:
? The activities and associated costs for the range of patient services that are delivered.
? The cost of non-patient related activities.
? Activity-based performance measures.
? The key cost drivers associated with service delivery and models of care.
An ABM model is depicted in Figure 3.1 below that illustrates the interrelationship between costing
and the performance management that supports continuous quality improvement
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Figure 3.1: The ABM model
LHNs already have systems in place to support planning, organising, resourcing, leading, monitoring
and improving health services and making best use of limited funds. However, a fully implemented
ABM program can provide new opportunities in the management of health services. These data can
be used to support a number of management processes:
? Facilitating a better understanding of costs and cost drivers.
? Benchmarking.
? Managing budgets and activity.
? Comparing costs of services to activity.
? Developing budgets.
? Negotiating for funds.
In this environment, standard practice at LHNs is expected to include:
? Capturing consistent and detailed information on inpatients, sub-acute, ED, outpatients, mental
health and community services accurately (at the patient level).
? Accurately measuring the costs of delivery at the patient level for hospitals to support service
improvement.
? Understanding the relationship between funds allocated and services provided.
? Strengthening health management s focus on outputs, outcomes and quality.
? Encouraging clinicians and managers to identify drivers for the variations in costs and practices
so these can be managed at a local level in the context of improving efficiency and effectiveness.
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3.3 Implications for LHN analysis and reporting
It is expected that LHNs will embark on a suite of analysis and reporting to better understand cost and
activity. This reporting should be cascaded through the LHN to ensure all managers develop an
improved understanding of LHN activity and cost performance.
The patient costing system will provide patient level costing data for all metropolitan public hospitals
and the larger country public hospitals. While processing is being undertaken centrally, LHNs are
responsible for ensuring the resource data required for the system (feeder systems) are as extensive
as possible and the costing allocation processes are optimised in consultation with the central patient
costing team.
Detailed cost analyses can be conducted by specifically trained LHN staff through direct access to SA
Health s patient costing system, SA Health s LHN Analytics and Reporting System (LARS) or IHPA s
National Benchmarking Portal (based on the National Health Costing Data Collection). The analysis
can be conducted at the patient level and can include the number, type and cost of diagnostic service
provided, of theatre procedures performed and of drugs supplied and the level of clinical staff costs
attributed, as well as other goods and services and overhead costs.
Benchmarking and similar comparative performance analysis, produced from these data will have
significant relevance for clinicians in terms of:
? Developing and evaluating models of care and clinical pathways.
? Monitoring performance indicators.
? Understanding the drivers of cost associated with multiple modes of service delivery including
inpatient, sub-acute, emergency, mental health and community health services.
? Understanding the costs of daily service delivery.
A wide range of leadership and performance committees established by LHNs would also benefit from
activity and cost data being presented at monthly forums. Indicative types of analysis that would
provide the biggest impact on decision making could include:
? Cost profile analysis and benchmarking of DRG cost outcomes to peer hospitals and services.
? Trend analysis of costs overtime.
? Comparative analysis at a summary and DRG level of costs and funding to identify activities
where there are discrepancies between funding levels and cost of service delivery.
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4 SPECIFIC FUNDING DETAILS
4.1 Activity Payment
For 2018 19, activity payments will be funded based on the SA LHN NEP is $4,503 per NWAU. This
price is based on the 2018 19 NEP of $5,012 and is adjusted to account for the impact of some
centrally managed services (e.g. some ICT, WorkCover levy, Procurement Services, etc).
The classification systems, price weights and adjustments used are specified below. These are
published by IHPA as part of the 2018 19 National Efficient Price (NEP) Determination.
4.1.1 Acute Admitted
For 2018 19, SA Health will use Australian Refined Diagnosis Related Groups Version 9.0 (AR-DRG
v9.0)
This applies to inpatient admitted acute and mental health activity performed in all hospitals.
The 2018 19 NEP Determination also includes a number of price weight adjustments that have been
incorporated into the 2018 19 funding model, as summarised in the following table.
Name of Adjustment Description Amount Applied
ICU Adjustment Applies to patients that spend time in
ICU (WCH, RAH, TQEH, FMC and
LMH only) and are assigned to a
DRG where ICU costs are not
bundled (see Section 5.1).
0.0439 NWAU per ICU
Hour
Indigenous Adjustment Applies to Aboriginal and / or Torres
Strait Islander patients.
4 per cent
Outer Regional
Adjustment
Applies to patients with a residential
address classified as Outer
Regional
8 per cent
Remote Area Adjustment Applies to patients with a residential
address classified as Remote
25 per cent
Very Remote Area
Adjustment
Applies to patients with a residential
address classified as Very Remote
29 per cent
Private Patient
Accommodation
Adjustment
Applies to all private patients to
account for accommodation costs
borne by the patient.
0.0516 NWAU (same-day)
0.0711 NWAU per day
(overnight)
Private Patient Service
Adjustment
Applies to all private patients to
account for medical service costs
borne by the patient.
Varies by DRG. See
Appendix 5.1.
Paediatric Adjustment Applies to patients aged 17 or less
and treated at a specialised
paediatric hospital (i.e. WCH only).
Varies by DRG. See
Appendix 5.1.
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Name of Adjustment Description Amount Applied
Specialist Psychiatric Age
Adjustment (<= 17 years
AND in MDC 19 or 20)
Applies to patients aged 17 years or
less that have one or more
Psychiatric Days recorded and are
assigned to an AR-DRG in MCD 19
or 20.
41 per cent
(or 15 per cent at WCH)
Specialist Psychiatric Age
Adjustment (<= 17 years
AND NOT in MDC 19 or 20)
Applies to patients aged 17 years or
less that have one or more
Psychiatric Days recorded and are
not assigned to an AR-DRG in MCD
19 or 20.
71 per cent
(or 58 per cent at WCH)
Specialist Psychiatric Age
Adjustment (>17 years and
NOT in MDC 19 or 20)
Applies to patients aged 17 years or
over that have one or more
Psychiatric Days recorded and are
not assigned to an AR-DRG in MCD
19 or 20.
30 per cent
Radiotherapy Adjustment Applies to patients with a specified
ICD-10-AM 10th Edition radiotherapy
procedure code recorded (see
Section 5.2).
32 per cent
Dialysis Adjustment Applies to patients with a specified
ICD-10-AM 10th Edition renal dialysis
procedure code recorded (see
Section 5.3) where the patient is
NOT coded to an AR-DRG of L61Z
or L68Z.
27 per cent
Section 5.1 also contains a table that outlines the price weights and associated parameters that apply
to each DRG, including:
? The price weights that apply to each DRG, including inlier, short-stay outlier and long-stay outlier
weights.
? The short-stay and long-stay outlier trim points.
? Private patient service adjustment
? Paediatric adjustment
Note that admitted mental health patients will be funded as acute patients according to the price
weights and loadings associated with the DRG to which the patient is assigned. Further work will be
undertaken over the medium to longer term to develop appropriate methodologies for the funding of
mental health services.
For Official Use Only-I2-A2 14
4.1.2 Sub-Acute and Non Acute
For 2018 19, the SA Health will use Australian National Subacute and Non-Acute Patient (AN-SNAP)
classification version 4.0. See Section 5.4
Sub-Acute and Non Acute includes the following episodes of care:
? Palliative Care
? Rehabilitation
? Psychogeriatric Care
? Geriatric Evaluation and Management (GEM)
? Maintenance Care
For Rehabilitation [Refer Technical Bulletin 16 for further information] the Australian Institute of Health
and Welfare (AIHW) defines it as follows:
? Rehabilitation care is care in which the primary clinical purpose or treatment goal is improvement
in the functioning of a patient with an impairment, activity limitation or participation restriction due
to a health condition. The patient will be capable of actively participating.
Rehabilitation care is always:
o delivered under the management of or informed by a clinician with specialised expertise in
rehabilitation, and
o evidenced by an individualised multidisciplinary management plan, which is documented in
the patient s medical record, that includes negotiated goals within specified time frames and
formal assessment of functional ability.
For sub-acute and non- acute activity that cannot be classified using AN-SNAP or for rehabilitation
performed in another hospital (not listed above) will be funded as acute patients according to the price
weights and loadings associated with the DRG to which the patient is assigned
The 2018 19 NEP Determination also includes a number of price weight adjustments for sub-acute
and non-acute activity that have been incorporated into the 2018 19 funding model, as summarised
in the following table.
Name of Adjustment Description Amount Applied
Indigenous Adjustment Applies to Aboriginal and / or
Torres Strait Islander patients.
4 per cent
Outer Regional
Adjustment
Applies to patients with a residential
address classified as Outer
Regional
8 per cent
Remote Area Adjustment Applies to patients with a residential
address classified as Remote
25 per cent
Very Remote Area
Adjustment
Applies to patients with a residential
address classified as Very Remote
29 per cent
Private Patient
Accommodation
Adjustment
Applies to all private patients to
account for accommodation costs
borne by the patient.
0.0516 NWAU (same-day)
0.0711 NWAU per day
(overnight)
For Official Use Only-I2-A2 15
Name of Adjustment Description Amount Applied
Private Patient Service
Adjustment
Applies to all private patients to
account for medical service costs
borne by the patient.
Palliative Care 3.9%
Rehabilitation 4.0%
Psychogeriatric Care 3.7%
GEM 3.3%
Maintenance Care 1.5%
Section 5.4 contains a table that outlines the price weights and associated parameters that apply to
each AN-SNAP, including:
? The price weights that apply to each AN-SNAP including inlier, short-stay outlier and long-stay
outlier weights.
? The short-stay and long-stay outlier trim points.
For WCH paediatric palliative care patients the following per diem rate is applied that is applied to the
length of stay to determine the number of NWAUs.
Care Type Same Day Overnight
Palliative Care 0.6014 0.6014
Maintenance care will also apply to those patients who cannot be formally classified as maintenance
care patients due to the Commonwealth 35 day rule but have been assessed by ACAT teams as
requiring such services and are admitted to a public acute hospital.
Where an acute episode occurs during a maintenance care episode the classification can be changed
to an acute episode and the relevant AR-DRG payment will apply.
4.1.3 Non Admitted Activity - Outpatients
[Refer Technical Bulletin 23 for further information]
For 2018 19, the SA Health will use Tier 2 Non-Admitted Service Classification v5.0 to fund all non-
admitted activity performed in by all hospitals. See Section 5.7
The 2018 19 NEP Determination also includes the following price weight adjustment that has been
incorporated into the 2018 19 funding model, as summarised below.
Name of Adjustment Description Amount Applied
Multidisciplinary Clinic Applies to service events
where three or more health
providers ( each of a different
speciality) are present
55 per cent
Section 5.7 contains a table that outlines the price weights that apply to each Tier 2 Clinic,
As per IHPA s definitions non admitted services provided in the home (Tier 2 clinics, 10.15, 10.16,
10.17 and 10.18) are counted and funded on a per calendar month basis.
Tier 2 Clinic 10.19 Ventilation home delivered is now being block funded.
For Official Use Only-I2-A2 16
SA has expanded the endoscopy clinic and created a 10.80 series for reporting purposes which will
map to Tier 2 clinics 10.06 or 10.09 for funding purposes.
In addition SA has added the 10.90 series clinics for Home Oxygen, which is not in scope in the
national model and the weights used, are based on the 2015 16 funding rates.
Based on SA hospitals cost data it was determined that there is sufficient cost differential between
peer groups that warranted a peer group adjustment to be applied. SA has included the following
peer group adjustment that is to be applied to non-admitted service events.
Peer Group Amount Applied
Metro - WCH 0.7756
Metro - Large 1.1903
Metro - Other 0.8235
Country - Large 0.4147
Country - Other 0.3312
Refer Section 5.11 for list of hospitals by Peer Group
4.1.4 Emergency Department / Services
For 2018 19, the SA Health will use Urgency Related Groups (URG) classification version 1.4 and
Urgency Diagnostic Groups (UDG) classification version 1.3 to fund all emergency activity performed
in hospitals classified as having an Emergency Department or Emergency Services respectively.
Section 5.8 provides the list of hospitals by emergency classification type.
The 2018 19 NEP Determination also includes a number of price weight adjustments that have been
incorporated into the 2018 19 funding model, as summarised in the following table.
Name of Adjustment Description Amount Applied
Indigenous Adjustment Applies to Aboriginal and / or Torres
Strait Islander patients.
4 per cent
Remoteness Adjustment Applies to Acute Outer Regional 8 per cent
Remoteness Adjustment
Applies to Acute Remote
Applies to ED Remote
25 per cent
22 per cent
Remoteness Adjustment
Applies to Acute Very Remote
Applies to ED Very Remote
29 per cent
22 per cent
Emergency Age Adjustment
age 65 to 79 years
Applies to patients aged between
65 and 79 years inclusive
13 per cent
Emergency Age Adjustment
age 80+ years
Applies to patients aged 80 years or
older
20 per cent
For Official Use Only-I2-A2 17
Sections 5.9 and 5.10 also contains tables that outline the price weights that apply to each URG and
UDG respectively.
If an ED presentation cannot be classified to the URG classification it will default to a UDG where
possible.
Based on SA hospitals cost data and National peer group cost data it was determined that there is
sufficient cost differential between peer groups that warranted a peer group adjustment to be applied.
SA has included the following peer group adjustment that is to be applied to emergency activity.
Peer Group Amount Applied
Metro - WCH 1.0000
Metro - Large 1.0350
Metro - Other 0.9650
Country - Large 0.7562
Country - Other 0.3203
Refer Section 5.11 for list of hospitals by Peer Group
4.2 Teaching Grant
The following outlines the basic framework for funding teaching in recognised teaching hospitals.
4.2.1 Nursing
[Refer Technical Bulletin 4 for further information]
The grant aims to cover the costs of graduate nurse training and on-going education and
development of nursing staff.
In 2018 19 for public acute hospitals:
? $11 000 will be paid for each graduate nurse in an approved program with a maximum level of
nurses undergoing such programs being set at 12% of the total nursing headcount (excluding
external participants).
? $4000 will be paid per nurse in an approved hospital course with the additional funding of $1000
per external participant where the cost is incurred by the employing unit.
? $6000 will be paid per participant for critical care, neonatal intensive care, cardiothoracic,
emergency, aged care, child and adolescent mental health, and midwifery refresher courses for
participants from rural health units.
4.2.2 Medical Officers
The grant is calculated on the basis of:
? A training component for training medical officer (TMO) paid at the rate of 50% of their base
salary to compensate for their reduced clinical productivity.
? A supervisory component for visiting medical officer / salaried medical officer time paid at 25% of
a senior director s salary, applied to the number of TMO full time equivalents supervised.
For Official Use Only-I2-A2 18
? A supervision allowance for medical undergraduates paid at 10% of the total hospital medical
salaries and wages payments.
4.2.3 Other Health Professionals
The actual cost to hospitals for the education and supervision of allied health, dental, scientific and
technical staff has not been measured. The pre-casemix Output Performance Model used 5% of the
total salaries and wages for these health workers and this formula will be applied until such time as
the true cost is calculated for allied health, dental, technical and scientific staff. The grant is to
compensate hospitals for all professional training costs incurred through the employment of these
employees.
The grant will be calculated on the basis of 5% of the salaries and wages costs for allied health,
dental, scientific and technical staff.
4.3 Special Grants
The following criteria determine the services that may be considered to receive a special grant:
? where patient related costs are efficiently incurred but the related activity is not recorded in the
hospital s patient activity data; or
? where the classification systems and associated reimbursement mechanisms are not appropriate
and DHW has endorsed the model of care/service provision difference; or
? where the DHW endorsed service is not related to routine operations of the hospital; or
? where it is not possible to recharge for the services; or
? where provision for a special grant is made under arrangements with the Commonwealth
Government.
A list of the special grants for 2018 19 is contained in Section 5.5
4.4 Rural Access Grant
It is inevitable under Casemix that some small country hospitals with low activity levels and relatively
high fixed costs will, sometimes inappropriately, appear to be 'inefficient' in comparison with other
regional and metropolitan hospitals.
Where Casemix-based payments to these small and grant funded hospitals (refer to Technical
Bulletin 2 for further information) will not be sufficient to cover their expenditure:
? A minimum budget will be set for hospitals with low activity volumes.
? Country hospitals with a gap between the Casemix budget and their minimum budget will be
given a rural access grant to make up the difference.
? Those hospitals declared as minimum budget hospitals for 2018 19 will retain this status for the
full financial year.
A list of hospitals that receive the rural access grant for 2018 19 is contained in Section 5.6
For Official Use Only-I2-A2 19
5 Section
5.1 Section 1: 2018 19 AR-DRG version 9.0 price weights and adjustments
The following table is from the 2018 19 National Efficient Price Determination and, for each DRG, outlines the NWAU and associated adjustments that apply to it.
AR-DRG
V9.0 Description
Same-
Day
Pay-
ment
Bundled
ICU ALOS
1
Inlier Bounds Adjustments Price Weights
Lower
Bound
Upper
Bound
Private
Patient
Service Adj.
Paediatric
Adj. Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
801A GIs Unrelated to Principal Diagnosis, Major Complexity NO NO 24.9 8 75 18% 129% 0.0000 0.9030 1.0293 9.1372 0.2715
801B GIs Unrelated to Principal Diagnosis, Intermediate Complexity NO NO 10.3 3 31 15% 100% 0.0000 0.6569 1.2627 4.4451 0.2739
801C GIs Unrelated to Principal Diagnosis, Minor Complexity NO NO 2.8 1 9 22% 100% 0.0000 0.0000 0.0000 1.2842 0.3010
A13A Ventilation >=336hours, Major Complexity NO NO 32.6 10 98 11% 148% 0.0000 1.8251 2.7359 29.1839 0.3421
A13B Ventilation >=336hours, Minor Complexity NO NO 13.2 4 40 13% 100% 0.0000 1.0193 4.0089 17.0548 0.3477
A14A Ventilation >=96hours & <336hours, Major Complexity NO NO 33.1 11 99 15% 120% 0.0000 2.5004 1.7130 21.3431 0.3515
A14B Ventilation >=96hours & <336hours, Intermediate Complexity NO NO 15.4 5 46 13% 113% 0.0000 0.9737 2.2123 12.0350 0.3647
A14C Ventilation >=96hours & <336hours, Minor Complexity NO NO 7.7 2 23 12% 100% 0.0000 0.3427 3.2481 6.8389 0.3633
A15A Tracheostomy, Major Complexity NO NO 35.6 11 107 17% 100% 0.0000 3.4064 1.4188 19.0135 0.3239
A15B Tracheostomy, Intermediate Complexity NO NO 18.4 6 55 20% 100% 0.0000 2.0044 1.6328 11.8012 0.2921
A15C Tracheostomy, Minor Complexity NO NO 12.5 4 37 13% 100% 0.0000 0.8500 1.6709 7.5335 0.3812
1 excluding designated SD and unbundled ICU
For Official Use Only-I2-A2 20
AR-DRG
V9.0 Description
Same-
Day
Pay-
ment
Bundled
ICU ALOS
1
Inlier Bounds Adjustments Price Weights
Lower
Bound
Upper
Bound
Private
Patient
Service Adj.
Paediatric
Adj. Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
A40Z ECMO NO NO 13.0 4 39 13% 200% 0.0000 2.2828 4.1820 19.0109 0.4834
B01Z Ventricular Shunt Revision NO NO 6.9 2 21 22% 84% 0.0000 0.7626 1.3358 3.4341 0.3242
B02A Cranial Procedures, Major Complexity NO NO 19.4 6 58 18% 133% 0.0000 1.6436 1.5933 11.2035 0.2974
B02B Cranial Procedures, Intermediate Complexity NO NO 9.5 3 29 24% 110% 0.0000 1.5362 1.4453 5.8722 0.2651
B02C Cranial Procedures, Minor Complexity NO NO 6.2 2 19 26% 94% 0.0000 1.2376 1.3823 4.0022 0.2568
B03A Spinal Procedures, Major Complexity NO NO 20.4 6 61 21% 108% 0.0000 1.9498 1.1603 8.9116 0.2890
B03B Spinal Procedures, Intermediate Complexity NO NO 6.4 2 19 29% 100% 0.0000 1.7206 1.2646 4.2498 0.3451
B03C Spinal Procedures, Minor Complexity NO NO 3.4 1 10 30% 100% 0.0000 0.0000 0.0000 2.6537 0.2972
B04A Extracranial Vascular Procedures, Major Complexity NO NO 14.2 4 43 19% 100% 0.0000 1.2765 1.3961 6.8608 0.2677
B04B Extracranial Vascular Procedures, Intermediate Complexity NO NO 6.9 2 21 16% 100% 0.0000 1.2534 1.5049 4.2631 0.2522
B04C Extracranial Vascular Procedures, Minor Complexity NO NO 3.3 1 10 22% 100% 0.0000 0.0000 0.0000 2.3549 0.2506
B05Z Carpal Tunnel Release NO NO 1.0 1 3 30% 100% 0.0000 0.0000 0.0000 0.4093 0.1102
B06A Procedures for Cerebral Palsy, Muscular Dystrophy and Neuropathy, Major Comp NO NO 16.3 5 49 12% 80% 0.0000 1.0882 1.2543 7.3596 0.2509
B06B Procedures for Cerebral Palsy, Muscular Dystrophy and Neuropathy, Interm Comp NO NO 6.8 2 21 15% 88% 0.0000 0.6382 1.4040 3.4463 0.2207
B06C Procedures for Cerebral Palsy, Muscular Dystrophy and Neuropathy, Minor Comp YES NO 2.3 1 8 23% 166% 0.6508 0.0000 0.0000 1.5351 0.2895
B07A Cranial or Peripheral Nerve and Other Nervous System Procs, Major Comp NO NO 11.7 3 35 17% 100% 0.0000 0.9748 1.1384 4.3900 0.2273
B07B Cranial or Peripheral Nerve and Other Nervous System Procs, Minor Comp YES NO 2.0 1 6 19% 113% 0.6289 0.0000 0.0000 1.3919 0.3540
B40Z Plasmapheresis W Neurological Disease, Sameday NO NO 1.0 1 1 12% 100% 0.0000 0.0000 0.0000 0.2486 0.0000
B41A Telemetric EEG Monitoring, Major Complexity NO NO 7.2 2 22 17% 148% 0.0000 0.0000 0.9700 1.9400 0.3053
B41B Telemetric EEG Monitoring, Minor Complexity NO NO 3.8 1 11 15% 92% 0.0000 0.0000 0.0000 1.4004 0.2322
B42A Nervous System Disorders W Ventilator Support, Major Complexity NO NO 16.0 5 48 7% 100% 0.0000 0.1054 1.4326 7.2683 0.2876
B42B Nervous System Disorders W Ventilator Support, Intermediate Complexity NO NO 6.0 2 18 11% 140% 0.0000 0.0000 1.6374 3.2748 0.3066
For Official Use Only-I2-A2 21
AR-DRG
V9.0 Description
Same-
Day
Pay-
ment
Bundled
ICU ALOS
1
Inlier Bounds Adjustments Price Weights
Lower
Bound
Upper
Bound
Private
Patient
Service Adj.
Paediatric
Adj. Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
B42C Nervous System Disorders W Ventilator Support, Minor Complexity NO NO 2.2 1 7 10% 100% 0.0000 0.0000 0.0000 1.5190 0.3046
B62Z Apheresis NO NO 1.0 1 3 7% 119% 0.0000 0.0000 0.0000 0.2409 0.1918
B63A Dementia & Other Chronic Disturbances of Cerebral Function, Major Complexity NO NO 18.5 6 55 4% 100% 0.0000 0.0000 0.7229 4.3371 0.1925
B63B Dementia & Other Chronic Disturbances of Cerebral Function, Minor Complexity NO NO 7.7 2 23 5% 100% 0.0000 0.0000 0.8936 1.7871 0.1897
B64A Delirium, Major Complexity NO NO 8.4 2 25 8% 100% 0.0000 0.0000 1.0476 2.0951 0.2250
B64B Delirium, Minor Complexity YES NO 3.1 1 9 13% 100% 0.0980 0.0000 0.0000 0.7363 0.2372
B65Z Cerebral Palsy NO NO 1.4 1 4 6% 106% 0.0000 0.0000 0.0000 0.4937 0.3371
B66A Nervous System Neoplasms, Major Complexity NO NO 11.2 3 34 8% 100% 0.0000 0.0000 1.0070 3.0211 0.2357
B66B Nervous System Neoplasms, Minor Complexity YES NO 4.8 1 15 13% 124% 0.3351 0.0000 0.0000 1.2921 0.2253
B67A Degenerative Nervous System Disorders, Major Complexity NO NO 13.2 4 40 5% 138% 0.0000 0.0000 0.8877 3.5509 0.2263
B67B Degenerative Nervous System Disorders, Intermediate Complexity YES NO 6.4 2 19 8% 136% 0.1604 0.0000 0.7873 1.5746 0.2074
B67C Degenerative Nervous System Disorders, Minor Complexity NO NO 1.2 1 4 13% 193% 0.0000 0.0000 0.0000 0.1965 0.1412
B68A Multiple Sclerosis and Cerebellar Ataxia, Major Complexity YES NO 7.5 2 22 9% 159% 0.2980 0.0000 0.9868 1.9737 0.2552
B68B Multiple Sclerosis and Cerebellar Ataxia, Minor Complexity NO NO 1.1 1 3 7% 189% 0.0000 0.0000 0.0000 0.2598 0.1975
B69A TIA and Precerebral Occlusion, Major Complexity NO NO 5.6 1 17 15% 100% 0.0000 0.0000 0.0000 1.4256 0.2340
B69B TIA and Precerebral Occlusion, Minor Complexity NO NO 2.0 1 6 21% 100% 0.0000 0.0000 0.0000 0.4816 0.2401
B70A Stroke and Other Cerebrovascular Disorders, Major Complexity NO NO 20.1 6 60 8% 100% 0.0000 0.0000 0.9157 5.4942 0.2512
B70B Stroke and Other Cerebrovascular Disorders, Intermediate Complexity NO NO 8.3 2 25 11% 100% 0.0000 0.0000 1.0974 2.1948 0.2384
B70C Stroke and Other Cerebrovascular Disorders, Minor Complexity YES NO 4.4 1 13 14% 200% 0.1988 0.0000 0.0000 1.1343 0.2415
B70D Stroke and Other Cerebrovascular Disorders, Transferred <5 Days YES NO 2.4 1 4 17% 100% 0.1921 0.0000 0.0000 0.7817 0.0000
B71A Cranial and Peripheral Nerve Disorders, Major Complexity YES NO 5.9 1 18 9% 149% 0.2116 0.0000 0.0000 1.4564 0.2650
For Official Use Only-I2-A2 22
AR-DRG
V9.0 Description
Same-
Day
Pay-
ment
Bundled
ICU ALOS
1
Inlier Bounds Adjustments Price Weights
Lower
Bound
Upper
Bound
Private
Patient
Service Adj.
Paediatric
Adj. Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
B71B Cranial and Peripheral Nerve Disorders, Minor Complexity NO NO 1.1 1 3 11% 200% 0.0000 0.0000 0.0000 0.1930 0.1378
B72A Nervous System Infection Except Viral Meningitis, Major Complexity NO NO 11.4 3 34 8% 124% 0.0000 0.0000 1.2520 3.7561 0.2824
B72B Nervous System Infection Except Viral Meningitis, Minor Complexity NO NO 3.5 1 10 11% 176% 0.0000 0.0000 0.0000 0.5985 0.1912
B73A Viral Meningitis, Major Complexity NO NO 4.9 1 15 9% 88% 0.0000 0.0000 0.0000 1.3508 0.2435
B73B Viral Meningitis, Minor Complexity NO NO 2.5 1 7 11% 124% 0.0000 0.0000 0.0000 0.6871 0.2724
B74A Nontraumatic Stupor and Coma, Major Complexity NO NO 5.8 1 17 11% 100% 0.0000 0.0000 0.0000 1.4345 0.2602
B74B Nontraumatic Stupor and Coma, Minor Complexity NO NO 1.6 1 5 13% 128% 0.0000 0.0000 0.0000 0.3184 0.2223
B75Z Febrile Convulsions NO NO 1.2 1 4 9% 100% 0.0000 0.0000 0.0000 0.3060 0.2346
B76A Seizures, Major Complexity YES NO 5.0 1 15 10% 132% 0.1969 0.0000 0.0000 1.2988 0.2524
B76B Seizures, Minor Complexity YES NO 1.9 1 6 14% 175% 0.1199 0.0000 0.0000 0.4810 0.2588
B77A Headaches, Major Complexity YES NO 3.3 1 10 12% 135% 0.1284 0.0000 0.0000 0.8100 0.2400
B77B Headaches, Minor Complexity NO NO 1.2 1 4 19% 175% 0.0000 0.0000 0.0000 0.1910 0.1257
B78A Intracranial Injuries, Major Complexity NO NO 11.2 3 34 9% 100% 0.0000 0.0000 1.0565 3.1696 0.2605
B78B Intracranial Injuries, Minor Complexity NO NO 3.5 1 10 11% 110% 0.0000 0.0000 0.0000 0.8888 0.2565
B78C Intracranial Injuries, Transferred <5 Days NO NO 1.5 1 4 16% 100% 0.0000 0.0000 0.0000 0.4525 0.0000
B79A Skull Fractures, Major Complexity NO NO 5.3 1 16 17% 100% 0.0000 0.0000 0.0000 1.4777 0.2627
B79B Skull Fractures, Minor Complexity NO NO 1.7 1 5 10% 147% 0.0000 0.0000 0.0000 0.3986 0.2535
B80A Other Head Injuries, Major Complexity YES NO 4.0 1 12 15% 100% 0.1208 0.0000 0.0000 0.8462 0.2138
B80B Other Head Injuries, Minor Complexity NO NO 1.1 1 3 19% 87% 0.0000 0.0000 0.0000 0.1488 0.1123
B81A Other Disorders of the Nervous System, Major Complexity NO NO 8.9 2 27 9% 122% 0.0000 0.0000 1.1079 2.2157 0.2151
B81B Other Disorders of the Nervous System, Minor Complexity YES NO 3.6 1 11 15% 151% 0.2472 0.0000 0.0000 0.8082 0.2126
B82A Chronic & Unspec Para/Quadriplegia, Major Complexity NO NO 22.1 7 66 6% 100% 0.0000 0.0000 0.8077 5.6538 0.2543
B82B Chronic & Unspec Para/Quadriplegia, Intermediate Complexity NO NO 6.2 2 19 6% 100% 0.0000 0.0000 0.8953 1.7906 0.2486
For Official Use Only-I2-A2 23
AR-DRG
V9.0 Description
Same-
Day
Pay-
ment
Bundled
ICU ALOS
1
Inlier Bounds Adjustments Price Weights
Lower
Bound
Upper
Bound
Private
Patient
Service Adj.
Paediatric
Adj. Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
B82C Chronic & Unspec Para/Quadriplegia, Minor Complexity NO NO 2.6 1 8 10% 100% 0.0000 0.0000 0.0000 0.6664 0.2581
B83A Acute Paraplegia and Quadriplegia and Spinal Cord Conditions, Major Complexity NO NO 26.9 8 81 6% 100% 0.0000 0.0000 1.0136 8.1090 0.2603
B83B Acute Paraplegia and Quadriplegia and Spinal Cord Conditions, Interm Comp NO NO 8.0 2 24 11% 100% 0.0000 0.0000 0.9943 1.9885 0.2150
B83C Acute Paraplegia and Quadriplegia and Spinal Cord Conditions, Minor Complexity NO NO 3.4 1 10 8% 100% 0.0000 0.0000 0.0000 0.9717 0.2705
C01A Procedures for Penetrating Eye Injury, Major Complexity NO NO 4.3 1 13 12% 100% 0.0000 0.0000 0.0000 2.4489 0.3567
C01B Procedures for Penetrating Eye Injury, Minor Complexity NO NO 1.8 1 5 12% 100% 0.0000 0.0000 0.0000 1.2486 0.4474
C02A Enucleations and Orbital Procedures, Major Complexity YES NO 5.6 1 17 17% 143% 0.5781 0.0000 0.0000 2.6119 0.3445
C02B Enucleations and Orbital Procedures, Minor Complexity YES NO 1.9 1 6 23% 100% 0.6452 0.0000 0.0000 1.4715 0.2862
C03A Retinal Procedures, Major Complexity NO NO 1.4 1 4 89% 133% 0.0000 0.0000 0.0000 0.8468 0.2898
C03B Retinal Procedures, Minor Complexity NO NO 1.0 1 3 97% 200% 0.0000 0.0000 0.0000 0.3277 0.1724
C04A Major Corneal, Scleral and Conjunctival Procedures, Major Complexity NO NO 5.0 1 15 19% 100% 0.0000 0.0000 0.0000 2.2383 0.3031
C04B Major Corneal, Scleral and Conjunctival Procedures, Minor Complexity NO NO 1.3 1 4 34% 100% 0.0000 0.0000 0.0000 1.2556 0.3107
C05Z Dacryocystorhinostomy NO NO 1.2 1 3 38% 100% 0.0000 0.0000 0.0000 0.9176 0.3474
C10Z Strabismus Procedures NO NO 1.0 1 3 35% 109% 0.0000 0.0000 0.0000 0.7824 0.2734
C11Z Eyelid Procedures YES NO 1.9 1 6 35% 108% 0.5573 0.0000 0.0000 1.0523 0.3258
C12A Other Corneal, Scleral and Conjunctival Procedures, Major Complexity NO NO 4.4 1 13 25% 100% 0.0000 0.0000 0.0000 1.4995 0.2730
C12B Other Corneal, Scleral and Conjunctival Procedures, Minor Complexity NO NO 1.0 1 3 35% 143% 0.0000 0.0000 0.0000 0.6190 0.2406
C13Z Lacrimal Procedures NO NO 1.1 1 3 23% 92% 0.0000 0.0000 0.0000 0.4638 0.1612
C14A Other Eye Procedures, Major Complexity NO NO 4.5 1 13 9% 100% 0.0000 0.0000 0.0000 1.3432 0.3077
C14B Other Eye Procedures, Minor Complexity NO NO 1.0 1 3 32% 113% 0.0000 0.0000 0.0000 0.4326 0.1748
C15Z Glaucoma and Complex Cataract Procedures NO NO 1.3 1 4 53% 151% 0.0000 0.0000 0.0000 0.7573 0.2712
C16Z Lens Procedures NO NO 1.0 1 4 83% 182% 0.0000 0.0000 0.0000 0.5284 0.2119
For Official Use Only-I2-A2 24
AR-DRG
V9.0 Description
Same-
Day
Pay-
ment
Bundled
ICU ALOS
1
Inlier Bounds Adjustments Price Weights
Lower
Bound
Upper
Bound
Private
Patient
Service Adj.
Paediatric
Adj. Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
C60A Acute and Major Eye Infections, Major Complexity NO NO 7.3 2 22 3% 100% 0.0000 0.0000 1.0564 2.1128 0.2927
C60B Acute and Major Eye Infections, Minor Complexity NO NO 3.1 1 9 5% 149% 0.0000 0.0000 0.0000 0.8493 0.2869
C61A Neurological and Vascular Disorders of the Eye, Major Complexity YES NO 4.1 1 12 15% 130% 0.2749 0.0000 0.0000 1.1347 0.2563
C61B Neurological and Vascular Disorders of the Eye, Minor Complexity YES NO 2.5 1 8 16% 200% 0.1427 0.0000 0.0000 0.6858 0.2641
C62A Hyphaema and Medically Managed Trauma to the Eye, Major Complexity YES NO 4.7 1 14 11% 144% 0.1355 0.0000 0.0000 1.1370 0.2342
C62B Hyphaema and Medically Managed Trauma to the Eye, Minor Complexity NO NO 1.2 1 4 19% 185% 0.0000 0.0000 0.0000 0.1962 0.1278
C63A Other Disorders of the Eye, Major Complexity YES NO 4.2 1 13 7% 130% 0.3133 0.0000 0.0000 1.1852 0.2554
C63B Other Disorders of the Eye, Minor Complexity YES NO 2.1 1 6 13% 180% 0.1582 0.0000 0.0000 0.5633 0.2402
D01Z Cochlear Implant NO NO 1.2 1 3 81% 122% 0.0000 0.0000 0.0000 6.5079 0.7224
D02A Head and Neck Procedures, Major Complexity NO NO 8.8 2 27 15% 100% 0.0000 1.1336 2.3423 5.8182 0.4280
D02B Head and Neck Procedures, Minor Complexity NO NO 2.2 1 7 15% 100% 0.0000 0.0000 0.0000 1.8345 0.4516
D03A Surgical Repair for Cleft Lip and Palate Disorders, Major Complexity NO NO 2.2 1 7 13% 100% 0.0000 0.0000 0.0000 2.1731 0.4838
D03B Surgical Repair for Cleft Lip and Palate Disorders, Minor Complexity NO NO 1.6 1 5 14% 100% 0.0000 0.0000 0.0000 1.6218 0.4740
D04A Maxillo Surgery, Major Complexity NO NO 2.6 1 8 17% 94% 0.0000 0.0000 0.0000 2.3903 0.3929
D04B Maxillo Surgery, Minor Complexity NO NO 1.6 1 5 18% 113% 0.0000 0.0000 0.0000 1.4512 0.4294
D05Z Parotid Gland Procedures NO NO 2.4 1 7 18% 100% 0.0000 0.0000 0.0000 2.4027 0.4576
D06Z Sinus and Complex Middle Ear Procedures NO NO 1.2 1 4 30% 100% 0.0000 0.0000 0.0000 1.3189 0.4545
D10Z Nasal Procedures NO NO 1.1 1 3 23% 82% 0.0000 0.0000 0.0000 1.0055 0.3771
D11Z Tonsillectomy and Adenoidectomy NO NO 1.1 1 3 19% 100% 0.0000 0.0000 0.0000 0.7158 0.3521
D12A Other Ear, Nose, Mouth and Throat Procedures, Major Complexity YES NO 5.2 1 15 12% 105% 0.6770 0.0000 0.0000 2.2104 0.2959
D12B Other Ear, Nose, Mouth and Throat Procedures, Minor Complexity NO NO 1.3 1 4 23% 100% 0.0000 0.0000 0.0000 0.7600 0.2292
D13Z Myringotomy W Tube Insertion NO NO 1.1 1 3 32% 106% 0.0000 0.0000 0.0000 0.3957 0.1272
For Official Use Only-I2-A2 25
AR-DRG
V9.0 Description
Same-
Day
Pay-
ment
Bundled
ICU ALOS
1
Inlier Bounds Adjustments Price Weights
Lower
Bound
Upper
Bound
Private
Patient
Service Adj.
Paediatric
Adj. Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
D14A Mouth and Salivary Gland Procedures, Major Complexity NO NO 2.0 1 6 13% 113% 0.0000 0.0000 0.0000 1.0743 0.3183
D14B Mouth and Salivary Gland Procedures, Minor Complexity NO NO 1.1 1 3 15% 109% 0.0000 0.0000 0.0000 0.5510 0.1956
D15Z Mastoid Procedures NO NO 2.1 1 6 37% 95% 0.0000 0.0000 0.0000 2.0742 0.6256
D40Z Dental Extractions and Restorations NO NO 1.1 1 3 14% 100% 0.0000 0.0000 0.0000 0.6579 0.1794
D60A Ear, Nose, Mouth and Throat Malignancy, Major Complexity NO NO 8.9 2 27 8% 100% 0.0000 0.2085 1.4446 3.0976 0.2696
D60B Ear, Nose, Mouth and Throat Malignancy, Minor Complexity YES NO 2.7 1 8 11% 148% 0.3593 0.0000 0.0000 0.9077 0.2475
D61A Dysequilibrium, Major Complexity YES NO 4.0 1 12 15% 100% 0.1028 0.0000 0.0000 0.9277 0.2194
D61B Dysequilibrium, Minor Complexity NO NO 1.4 1 4 18% 154% 0.0000 0.0000 0.0000 0.2314 0.1674
D62A Epistaxis, Major Complexity NO NO 3.8 1 11 11% 100% 0.0000 0.0000 0.0000 0.9882 0.2443
D62B Epistaxis, Minor Complexity NO NO 1.4 1 4 11% 120% 0.0000 0.0000 0.0000 0.2404 0.1491
D63A Otitis Media and Upper Respiratory Infections, Major Complexity YES NO 3.1 1 9 9% 112% 0.1474 0.0000 0.0000 0.8243 0.2502
D63B Otitis Media and Upper Respiratory Infections, Minor Complexity NO NO 1.3 1 4 9% 120% 0.0000 0.0000 0.0000 0.2542 0.1975
D64A Laryngotracheitis and Epiglottitis, Major Complexity NO NO 1.7 1 5 9% 107% 0.0000 0.0000 0.0000 0.5428 0.2994
D64B Laryngotracheitis and Epiglottitis, Minor Complexity NO NO 1.1 1 3 9% 80% 0.0000 0.0000 0.0000 0.2066 0.1579
D65A Nasal Trauma and Deformity, Major Complexity NO NO 3.4 1 10 12% 100% 0.0000 0.0000 0.0000 0.6938 0.2281
D65B Nasal Trauma and Deformity, Minor Complexity NO NO 1.1 1 3 18% 113% 0.0000 0.0000 0.0000 0.2650 0.1256
D66A Other Ear, Nose, Mouth and Throat Disorders, Major Complexity YES NO 3.9 1 12 10% 100% 0.3092 0.0000 0.0000 1.0310 0.2468
D66B Other Ear, Nose, Mouth and Throat Disorders, Minor Complexity NO NO 1.2 1 4 14% 100% 0.0000 0.0000 0.0000 0.2901 0.1484
D67A Oral and Dental Disorders, Major Complexity YES NO 4.1 1 12 7% 129% 0.2369 0.0000 0.0000 1.0934 0.2555
D67B Oral and Dental Disorders, Minor Complexity NO NO 1.3 1 4 17% 127% 0.0000 0.0000 0.0000 0.2742 0.1383
E01A Major Chest Procedures, Major Complexity NO NO 19.5 6 59 16% 95% 0.0000 1.2431 1.1718 8.2741 0.2836
E01B Major Chest Procedures, Intermediate Complexity NO NO 9.9 3 30 18% 100% 0.0000 1.1076 1.2117 4.7426 0.2629
For Official Use Only-I2-A2 26
AR-DRG
V9.0 Description
Same-
Day
Pay-
ment
Bundled
ICU ALOS
1
Inlier Bounds Adjustments Price Weights
Lower
Bound
Upper
Bound
Private
Patient
Service Adj.
Paediatric
Adj. Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
E01C Major Chest Procedures, Minor Complexity NO NO 6.2 2 19 18% 119% 0.0000 0.5995 1.3594 3.3183 0.2825
E02A Other Respiratory System GIs, Major Complexity NO NO 12.5 4 37 13% 129% 0.0000 0.6196 1.0436 4.7940 0.2718
E02B Other Respiratory System GIs, Intermediate Complexity YES NO 3.5 1 11 18% 80% 0.6404 0.0000 0.0000 1.8134 0.2709
E02C Other Respiratory System GIs, Minor Complexity NO NO 1.1 1 3 17% 94% 0.0000 0.0000 0.0000 0.8190 0.3242
E03Z Lung or Heart-Lung Transplant NO NO 23.2 10 98 12% 100% 0.0000 4.5443 1.9412 23.9563 0.6039
E40A Respiratory System Disorders W Ventilator Support, Major Complexity NO NO 9.7 3 29 10% 100% 0.0000 0.0000 1.7351 5.2054 0.2954
E40B Respiratory System Disorders W Ventilator Support, Minor Complexity NO NO 5.0 1 15 11% 81% 0.0000 0.0000 0.0000 2.8042 0.2651
E41A Respiratory System Disorders W Non-Invasive Ventilation, Major Complexity NO NO 11.6 3 35 9% 85% 0.0000 0.0000 1.5143 4.5429 0.2954
E41B Respiratory System Disorders W Non-Invasive Ventilation, Minor Complexity NO NO 6.0 2 18 8% 80% 0.0000 0.0000 1.1219 2.2437 0.2830
E42A Bronchoscopy, Major Complexity NO NO 12.5 4 38 12% 142% 0.0000 0.2771 0.9302 3.9979 0.2681
E42B Bronchoscopy, Intermediate Complexity YES NO 6.2 2 19 14% 127% 0.5056 0.3541 1.0322 2.4185 0.2683
E42C Bronchoscopy, Minor Complexity YES NO 2.9 1 9 26% 113% 0.4405 0.0000 0.0000 1.2408 0.2359
E60A Cystic Fibrosis, Major Complexity NO NO 12.0 4 36 4% 143% 0.0000 0.0000 0.9624 3.8496 0.2505
E60B Cystic Fibrosis, Minor Complexity NO NO 7.4 2 22 3% 134% 0.0000 0.0000 1.2815 2.5631 0.1962
E61A Pulmonary Embolism, Major Complexity NO NO 6.7 2 20 13% 100% 0.0000 0.0000 0.9515 1.9030 0.2378
E61B Pulmonary Embolism, Minor Complexity YES NO 3.2 1 10 18% 100% 0.1610 0.0000 0.0000 0.7862 0.1772
E62A Respiratory Infections and Inflammations, Major Complexity NO NO 6.4 2 19 9% 100% 0.0000 0.0000 0.8656 1.7311 0.2397
E62B Respiratory Infections and Inflammations, Minor Complexity YES NO 3.0 1 9 10% 80% 0.1114 0.0000 0.0000 0.7599 0.2254
E63A Sleep Apnoea, Major Complexity NO NO 2.2 1 7 15% 124% 0.0000 0.0000 0.0000 0.5864 0.2709
E63B Sleep Apnoea, Minor Complexity NO NO 1.2 1 4 31% 100% 0.0000 0.0000 0.0000 0.2931 0.1668
E64A Pulmonary Oedema and Respiratory Failure, Major Complexity NO NO 6.8 2 20 10% 100% 0.0000 0.0000 0.9996 1.9991 0.2370
E64B Pulmonary Oedema and Respiratory Failure, Minor Complexity NO NO 2.6 1 8 10% 100% 0.0000 0.0000 0.0000 0.7041 0.2312
For Official Use Only-I2-A2 27
AR-DRG
V9.0 Description
Same-
Day
Pay-
ment
Bundled
ICU ALOS
1
Inlier Bounds Adjustments Price Weights
Lower
Bound
Upper
Bound
Private
Patient
Service Adj.
Paediatric
Adj. Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
E65A Chronic Obstructive Airways Disease, Major Complexity NO NO 6.1 2 18 8% 100% 0.0000 0.0000 0.7849 1.5697 0.2309
E65B Chronic Obstructive Airways Disease, Minor Complexity NO NO 2.9 1 9 10% 175% 0.0000 0.0000 0.0000 0.6696 0.2233
E66A Major Chest Trauma, Major Complexity NO NO 9.3 3 28 9% 100% 0.0000 0.0000 0.8568 2.5704 0.2298
E66B Major Chest Trauma, Intermediate Complexity NO NO 4.2 1 12 10% 100% 0.0000 0.0000 0.0000 1.0733 0.2500
E66C Major Chest Trauma, Minor Complexity NO NO 1.9 1 6 14% 100% 0.0000 0.0000 0.0000 0.4310 0.2421
E67A Respiratory Signs and Symptoms, Major Complexity YES NO 3.3 1 10 14% 86% 0.2411 0.0000 0.0000 0.8868 0.2450
E67B Respiratory Signs and Symptoms, Minor Complexity NO NO 1.2 1 4 15% 80% 0.0000 0.0000 0.0000 0.2422 0.1812
E68A Pneumothorax, Major Complexity NO NO 5.9 1 18 10% 100% 0.0000 0.0000 0.0000 1.6617 0.2674
E68B Pneumothorax, Minor Complexity NO NO 2.5 1 7 14% 117% 0.0000 0.0000 0.0000 0.6564 0.2694
E69A Bronchitis and Asthma, Major Complexity NO NO 3.2 1 10 9% 100% 0.0000 0.0000 0.0000 0.8415 0.2503
E69B Bronchitis and Asthma, Minor Complexity NO NO 1.4 1 4 8% 80% 0.0000 0.0000 0.0000 0.3262 0.2281
E70A Whooping Cough and Acute Bronchiolitis, Major Complexity NO NO 2.8 1 8 5% 100% 0.0000 0.0000 0.0000 0.9942 0.3761
E70B Whooping Cough and Acute Bronchiolitis, Minor Complexity NO NO 1.7 1 6 5% 83% 0.0000 0.0000 0.0000 0.5524 0.3266
E71A Respiratory Neoplasms, Major Complexity NO NO 9.0 2 27 9% 100% 0.0000 0.0000 1.2582 2.5164 0.2462
E71B Respiratory Neoplasms, Minor Complexity YES NO 4.2 1 13 12% 133% 0.2861 0.0000 0.0000 1.0661 0.2460
E72Z Respiratory Problems Arising from Neonatal Period NO NO 2.3 1 11 10% 80% 0.0000 0.0000 0.0000 0.6349 0.2960
E73A Pleural Effusion, Major Complexity NO NO 9.5 3 28 11% 100% 0.0000 0.0000 0.9233 2.7699 0.2503
E73B Pleural Effusion, Intermediate Complexity NO NO 4.6 1 14 14% 100% 0.0000 0.0000 0.0000 1.2430 0.2411
E73C Pleural Effusion, Minor Complexity YES NO 2.8 1 8 21% 100% 0.1745 0.0000 0.0000 0.7204 0.2120
E74A Interstitial Lung Disease, Major Complexity NO NO 6.8 2 20 8% 100% 0.0000 0.0000 0.9170 1.8341 0.2361
E74B Interstitial Lung Disease, Minor Complexity YES NO 4.0 1 12 12% 100% 0.2507 0.0000 0.0000 0.9722 0.2149
E75A Other Respiratory System Disorders, Major Complexity NO NO 4.1 1 12 9% 121% 0.0000 0.0000 0.0000 1.0200 0.2525
For Official Use Only-I2-A2 28
AR-DRG
V9.0 Description
Same-
Day
Pay-
ment
Bundled
ICU ALOS
1
Inlier Bounds Adjustments Price Weights
Lower
Bound
Upper
Bound
Private
Patient
Service Adj.
Paediatric
Adj. Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
E75B Other Respiratory System Disorders, Minor Complexity YES NO 2.0 1 6 11% 91% 0.1085 0.0000 0.0000 0.4917 0.2413
E76Z Respiratory Tuberculosis NO NO 14.4 4 43 10% 100% 0.0000 0.0000 0.9985 3.9942 0.2226
E77A Bronchiectasis, Major Complexity NO NO 8.1 2 24 8% 200% 0.0000 0.0000 1.0398 2.0796 0.2185
E77B Bronchiectasis, Minor Complexity NO NO 4.9 1 15 8% 200% 0.0000 0.0000 0.0000 1.1146 0.1992
F01A Implantation and Replacement of AICD, Total System, Major Complexity NO NO 10.8 3 32 69% 100% 0.0000 3.5927 1.7264 8.7719 0.3051
F01B Implantation and Replacement of AICD, Total System, Minor Complexity YES NO 2.5 1 8 100% 100% 2.6494 0.0000 0.0000 4.5928 0.2991
F02Z Other AICD Procedures NO NO 4.1 1 12 32% 100% 0.0000 0.0000 0.0000 2.2891 0.2943
F03A Cardiac Valve Procs W CPB Pump W Invasive Cardiac Investigation, Maj Comp NO NO 22.5 7 67 22% 100% 0.0000 4.2970 1.3768 13.9346 0.2889
F03B Cardiac Valve Procs W CPB Pump W Invasive Cardiac Investigation, Min Comp NO NO 12.9 4 39 22% 100% 0.0000 5.7893 1.0210 9.8734 0.2420
F04A Cardiac Valve Procedures W CPB Pump W/O Invasive Cardiac Invest, Major Comp NO NO 17.9 5 54 24% 105% 0.0000 3.6741 1.7774 12.5612 0.2995
F04B Cardiac Valve Procs W CPB Pump W/O Invasive Cardiac Invest, Interm Comp NO NO 9.2 3 28 23% 105% 0.0000 4.8346 1.1034 8.1448 0.2992
F04C Cardiac Valve Procedures W CPB Pump W/O Invasive Cardiac Invest, Minor Comp NO NO 6.4 2 19 20% 106% 0.0000 5.8293 0.3680 6.5653 0.1730
F05A Coronary Bypass W Invasive Cardiac Investigation, Major Complexity NO NO 18.3 6 55 17% 100% 0.0000 2.7209 1.3013 10.5288 0.3545
F05B Coronary Bypass W Invasive Cardiac Investigation, Minor Complexity NO NO 12.0 4 36 18% 100% 0.0000 2.4232 1.3247 7.7222 0.3313
F06A Coronary Bypass W/O Invasive Cardiac Investigation, Major Complexity NO NO 13.6 4 41 19% 100% 0.0000 2.5341 1.5386 8.6886 0.3032
F06B Coronary Bypass W/O Invasive Cardiac Investigation, Intermediate Complexity NO NO 8.4 2 25 20% 100% 0.0000 2.4128 1.8943 6.2014 0.2861
F06C Coronary Bypass W/O Invasive Cardiac Investigation, Minor Complexity NO NO 6.5 2 19 21% 100% 0.0000 2.0534 1.5519 5.1572 0.2924
F07A Other Cardiothoracic/Vascular Procs W CPB Pump, Major Complexity NO NO 11.7 3 35 21% 107% 0.0000 3.2785 2.1243 9.6514 0.4660
F07B Other Cardiothoracic/Vascular Procs W CPB Pump, Minor Complexity NO NO 6.2 2 19 24% 100% 0.0000 1.9860 1.8971 5.7802 0.3241
F08A Major Reconstructive Vascular Procs W/O CPB Pump, Major Complexity NO NO 19.3 6 58 19% 100% 0.0000 3.7347 1.2562 11.2716 0.3090
F08B Major Reconstructive Vascular Procs W/O CPB Pump, Intermediate Complexity NO NO 8.7 2 26 26% 100% 0.0000 3.3290 1.4495 6.2280 0.2525
For Official Use Only-I2-A2 29
AR-DRG
V9.0 Description
Same-
Day
Pay-
ment
Bundled
ICU ALOS
1
Inlier Bounds Adjustments Price Weights
Lower
Bound
Upper
Bound
Private
Patient
Service Adj.
Paediatric
Adj. Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
F08C Major Reconstructive Vascular Procs W/O CPB Pump, Minor Complexity NO NO 4.4 1 13 34% 100% 0.0000 0.0000 0.0000 3.9549 0.2567
F09A Other Cardiothoracic Procedures W/O CPB Pump, Major Complexity NO NO 10.0 3 30 16% 95% 0.0000 1.3799 1.5626 6.0675 0.2913
F09B Other Cardiothoracic Procedures W/O CPB Pump, Intermediate Complexity NO NO 5.7 1 17 17% 100% 0.0000 0.0000 0.0000 3.4077 0.3215
F09C Other Cardiothoracic Procedures W/O CPB Pump, Minor Complexity NO NO 2.3 1 7 19% 100% 0.0000 0.0000 0.0000 1.9768 0.3866
F10A Interventional Coronary Procedures, Admitted for AMI, Major Complexity NO NO 7.0 2 21 27% 100% 0.0000 0.9058 1.3312 3.5681 0.3289
F10B Interventional Coronary Procedures, Admitted for AMI, Minor Complexity NO NO 3.1 1 9 44% 100% 0.0000 0.0000 0.0000 2.0089 0.3143
F11A Amputation, Except Upper Limb and Toe, for Circulatory Disorders, Major Comp NO NO 38.1 12 114 12% 100% 0.0000 1.5050 1.0605 14.2311 0.2797
F11B Amputation, Except Upper Limb and Toe, for Circulatory Disorders, Minor Comp NO NO 16.7 5 50 12% 100% 0.0000 0.7694 1.2060 6.7997 0.3175
F12A Implant and Replacement of Pacemaker, Total System, Major Complexity NO NO 8.2 2 24 41% 100% 0.0000 1.2691 1.5105 4.2902 0.2822
F12B Implant and Replacement of Pacemaker, Total System, Minor Complexity YES NO 2.8 1 8 61% 100% 1.0132 0.0000 0.0000 2.2086 0.2560
F13A Amputation, Upper Limb and Toe, for Circulatory Disorders, Major Complexity NO NO 17.0 5 51 10% 100% 0.0000 0.4736 1.2609 6.7782 0.3220
F13B Amputation, Upper Limb and Toe, for Circulatory Disorders, Minor Complexity NO NO 7.3 2 22 15% 100% 0.0000 0.4834 1.1647 2.8128 0.2785
F14A Vascular Procs, Ex Major Reconstruction, W/O CPB Pump, Major Complexity NO NO 13.2 4 40 17% 127% 0.0000 1.1496 1.2474 6.1393 0.2860
F14B Vascular Procs, Ex Major Reconstruction, W/O CPB Pump, Interm Comp NO NO 4.4 1 13 26% 117% 0.0000 0.0000 0.0000 2.5665 0.2647
F14C Vascular Procs, Ex Major Reconstruction, W/O CPB Pump, Minor Complexity YES NO 1.9 1 6 33% 135% 0.8860 0.0000 0.0000 1.6242 0.2789
F17A Insertion and Replacement of Pacemaker Generator, Major Complexity NO NO 3.6 1 11 100% 100% 0.0000 0.0000 0.0000 2.2112 0.3376
F17B Insertion and Replacement of Pacemaker Generator, Minor Complexity NO NO 1.1 1 3 97% 100% 0.0000 0.0000 0.0000 1.1777 0.1389
F18Z Other Pacemaker Procedures NO NO 4.3 1 13 20% 100% 0.0000 0.0000 0.0000 2.2093 0.3220
F19A Trans-Vascular Percutaneous Cardiac Intervention, Major Complexity NO NO 6.2 2 19 21% 95% 0.0000 1.6936 1.6262 4.9460 0.2502
F19B Trans-Vascular Percutaneous Cardiac Intervention, Minor Complexity NO NO 1.6 1 5 30% 139% 0.0000 0.0000 0.0000 2.1784 0.1619
F20Z Vein Ligation and Stripping NO NO 1.2 1 4 20% 100% 0.0000 0.0000 0.0000 1.0033 0.3289
For Official Use Only-I2-A2 30
AR-DRG
V9.0 Description
Same-
Day
Pay-
ment
Bundled
ICU ALOS
1
Inlier Bounds Adjustments Price Weights
Lower
Bound
Upper
Bound
Private
Patient
Service Adj.
Paediatric
Adj. Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
F21A Other Circulatory System GIs, Major Complexity NO NO 25.4 8 76 12% 100% 0.0000 0.5444 1.0102 8.6259 0.2739
F21B Other Circulatory System GIs, Intermediate Complexity NO NO 9.9 3 30 11% 100% 0.0000 0.4831 0.9643 3.3761 0.2373
F21C Other Circulatory System GIs, Minor Complexity YES NO 3.4 1 10 14% 113% 0.7661 0.0000 0.0000 1.6553 0.2044
F22Z Insertion of Artificial Heart Device NO NO 43.9 14 132 32% 153% 0.0000 23.5919 2.4783 58.2877 0.6040
F23Z Heart Transplant NO NO 21.6 13 121 32% 100% 0.0000 3.6712 1.7823 26.8407 0.5327
F24A Interventional Coronary Procs, Not Adm for AMI, Major Comp NO NO 6.3 2 19 27% 100% 0.0000 1.0285 1.3029 3.6344 0.2898
F24B Interventional Coronary Procs, Not Adm for AMI, Minor Comp NO NO 1.6 1 5 45% 168% 0.0000 0.0000 0.0000 1.7130 0.2622
F40A Circulatory Disorders W Ventilator Support, Major Complexity NO NO 10.3 3 31 13% 100% 0.0000 0.2167 1.7852 5.5724 0.3128
F40B Circulatory Disorders W Ventilator Support, Minor Complexity NO NO 2.9 1 9 15% 100% 0.0000 0.0000 0.0000 1.9263 0.3373
F41A Circulatory Disorders, Adm for AMI W Invasive Cardiac Inves Proc, Major Comp NO NO 7.1 2 21 16% 100% 0.0000 0.3466 1.2631 2.8728 0.2754
F41B Circulatory Disorders, Adm for AMI W Invasive Cardiac Inves Proc, Minor Comp YES NO 3.6 1 11 22% 100% 0.5232 0.0000 0.0000 1.5860 0.2497
F42A Circulatory Dsrds, Not Adm for AMI W Invasive Cardiac Inves Proc, Major Comp NO NO 5.9 1 18 18% 124% 0.0000 0.0000 0.0000 2.2037 0.2732
F42B Circulatory Dsrds, Not Adm for AMI W Invasive Cardiac Inves Proc, Minor Comp YES NO 2.7 1 8 28% 196% 0.5403 0.0000 0.0000 1.1983 0.2274
F43A Circulatory Disorders W Non-Invasive Ventilation, Major Complexity NO NO 15.0 4 45 10% 100% 0.0000 0.0000 1.3982 5.5928 0.2659
F43B Circulatory Disorders W Non-Invasive Ventilation, Minor Complexity NO NO 7.6 2 23 12% 100% 0.0000 0.0000 1.4136 2.8272 0.2673
F60A Circulatory Dsrd, Adm for AMI W/O Invas Card Inves Proc NO NO 4.9 1 16 10% 100% 0.0000 0.0000 0.0000 1.3598 0.2561
F60B Circulatory Dsrd, Adm for AMI W/O Invas Card Inves Proc, Transf <5 Days NO NO 1.5 1 4 22% 100% 0.0000 0.0000 0.0000 0.5383 0.0000
F61A Infective Endocarditis, Major Complexity NO NO 23.2 7 70 11% 100% 0.0000 0.0000 1.0104 7.0725 0.2036
F61B Infective Endocarditis, Intermediate Complexity NO NO 13.3 4 40 11% 100% 0.0000 0.0000 1.0247 4.0987 0.1957
F61C Infective Endocarditis, Minor Complexity NO NO 7.4 2 22 11% 100% 0.0000 0.0000 1.0024 2.0049 0.1317
F62A Heart Failure and Shock, Major Complexity NO NO 8.3 2 25 9% 100% 0.0000 0.0000 1.0944 2.1887 0.2445
For Official Use Only-I2-A2 31
AR-DRG
V9.0 Description
Same-
Day
Pay-
ment
Bundled
ICU ALOS
1
Inlier Bounds Adjustments Price Weights
Lower
Bound
Upper
Bound
Private
Patient
Service Adj.
Paediatric
Adj. Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
F62B Heart Failure and Shock, Minor Complexity NO NO 3.6 1 11 11% 100% 0.0000 0.0000 0.0000 0.8636 0.2304
F62C Heart Failure and Shock, Transferred <5 Days NO NO 1.6 1 4 18% 100% 0.0000 0.0000 0.0000 0.4213 0.0000
F63A Venous Thrombosis, Major Complexity NO NO 5.7 1 17 13% 100% 0.0000 0.0000 0.0000 1.3157 0.2274
F63B Venous Thrombosis, Minor Complexity YES NO 3.6 1 11 18% 100% 0.0976 0.0000 0.0000 0.6297 0.1153
F64A Skin Ulcers in Circulatory Disorders, Major Complexity NO NO 13.3 4 40 7% 100% 0.0000 0.0000 0.8603 3.4414 0.2317
F64B Skin Ulcers in Circulatory Disorders, Intermediate Complexity NO NO 6.2 2 18 9% 100% 0.0000 0.0000 0.7823 1.5646 0.2011
F64C Skin Ulcers in Circulatory Disorders, Minor Complexity YES NO 3.9 1 12 10% 100% 0.1877 0.0000 0.0000 0.8831 0.1632
F65A Peripheral Vascular Disorders, Major Complexity NO NO 6.5 2 20 11% 100% 0.0000 0.0000 0.9524 1.9049 0.2220
F65B Peripheral Vascular Disorders, Minor Complexity YES NO 2.9 1 9 17% 135% 0.2617 0.0000 0.0000 0.8091 0.1950
F66A Coronary Atherosclerosis, Major Complexity NO NO 4.1 1 12 10% 100% 0.0000 0.0000 0.0000 1.0910 0.2552
F66B Coronary Atherosclerosis, Minor Complexity NO NO 1.4 1 4 21% 100% 0.0000 0.0000 0.0000 0.2898 0.2142
F67A Hypertension, Major Complexity YES NO 4.5 1 13 11% 183% 0.1533 0.0000 0.0000 1.1509 0.2424
F67B Hypertension, Minor Complexity NO NO 1.4 1 4 15% 128% 0.0000 0.0000 0.0000 0.2500 0.1787
F68Z Congenital Heart Disease NO NO 1.8 1 5 18% 186% 0.0000 0.0000 0.0000 0.4413 0.2169
F69A Valvular Disorders, Major Complexity YES NO 6.0 2 18 11% 100% 0.2258 0.0000 0.8880 1.7760 0.2435
F69B Valvular Disorders, Minor Complexity NO NO 1.2 1 4 25% 200% 0.0000 0.0000 0.0000 0.2075 0.1547
F72A Unstable Angina, Major Complexity YES NO 3.9 1 12 14% 100% 0.1403 0.0000 0.0000 1.0649 0.2413
F72B Unstable Angina, Minor Complexity YES NO 1.9 1 6 19% 100% 0.1031 0.0000 0.0000 0.5091 0.2361
F73A Syncope and Collapse, Major Complexity NO NO 4.9 1 15 11% 100% 0.0000 0.0000 0.0000 1.1655 0.2318
F73B Syncope and Collapse, Minor Complexity YES NO 1.8 1 6 20% 127% 0.1153 0.0000 0.0000 0.4355 0.2313
F74A Chest Pain, Major Complexity NO NO 2.0 1 6 17% 178% 0.0000 0.0000 0.0000 0.4360 0.2409
F74B Chest Pain, Minor Complexity NO NO 1.1 1 3 24% 169% 0.0000 0.0000 0.0000 0.1492 0.1057
F75A Other Circulatory Disorders, Major Complexity NO NO 9.9 3 30 11% 154% 0.0000 0.0000 1.0775 3.2325 0.2439
For Official Use Only-I2-A2 32
AR-DRG
V9.0 Description
Same-
Day
Pay-
ment
Bundled
ICU ALOS
1
Inlier Bounds Adjustments Price Weights
Lower
Bound
Upper
Bound
Private
Patient
Service Adj.
Paediatric
Adj. Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
F75B Other Circulatory Disorders, Intermediate Complexity YES NO 4.9 1 15 12% 175% 0.2771 0.0000 0.0000 1.4237 0.2530
F75C Other Circulatory Disorders, Minor Complexity YES NO 2.6 1 8 14% 200% 0.2109 0.0000 0.0000 0.7082 0.2366
F76A Arrhythmia, Cardiac Arrest and Conduction Disorders, Major Complexity NO NO 4.3 1 13 12% 154% 0.0000 0.0000 0.0000 1.1175 0.2419
F76B Arrhythmia, Cardiac Arrest and Conduction Disorders, Minor Complexity YES NO 1.9 1 6 20% 200% 0.1601 0.0000 0.0000 0.4775 0.2223
G01A Rectal Resection, Major Complexity NO NO 26.1 8 78 16% 100% 0.0000 2.6830 1.1026 11.5040 0.2950
G01B Rectal Resection, Intermediate Complexity NO NO 13.9 4 42 17% 100% 0.0000 2.0446 1.2292 6.9613 0.2891
G01C Rectal Resection, Minor Complexity NO NO 8.1 2 24 19% 100% 0.0000 1.6709 1.5133 4.6974 0.2831
G02A Major Small and Large Bowel Procedures, Major Complexity NO NO 24.2 8 73 13% 127% 0.0000 1.6547 1.1092 10.5282 0.2950
G02B Major Small and Large Bowel Procedures, Intermediate Complexity NO NO 10.5 3 31 16% 116% 0.0000 1.2912 1.1967 4.8813 0.2844
G02C Major Small and Large Bowel Procedures, Minor Complexity NO NO 5.6 1 17 17% 100% 0.0000 0.0000 0.0000 3.0403 0.3184
G03A Stomach, Oesophageal and Duodenal Procedures, Major Complexity NO NO 17.0 5 51 16% 100% 0.0000 1.9596 1.4353 9.1361 0.3079
G03B Stomach, Oesophageal and Duodenal Procedures, Intermediate Complexity NO NO 8.0 2 24 15% 117% 0.0000 1.1261 1.6593 4.4448 0.3323
G03C Stomach, Oesophageal and Duodenal Procedures, Minor Complexity NO NO 3.8 1 11 15% 119% 0.0000 0.0000 0.0000 2.3537 0.3299
G04A Peritoneal Adhesiolysis, Major Complexity NO NO 13.4 4 40 11% 121% 0.0000 1.2048 1.1079 5.6365 0.3119
G04B Peritoneal Adhesiolysis, Intermediate Complexity NO NO 6.0 2 18 15% 133% 0.0000 0.8497 1.0253 2.9003 0.2870
G04C Peritoneal Adhesiolysis, Minor Complexity NO NO 2.6 1 9 16% 125% 0.0000 0.0000 0.0000 1.6293 0.3255
G05A Minor Small and Large Bowel Procedures, Major Complexity NO NO 10.4 3 31 14% 100% 0.0000 1.1118 1.0329 4.2106 0.2732
G05B Minor Small and Large Bowel Procedures, Minor Complexity NO NO 3.7 1 11 15% 80% 0.0000 0.0000 0.0000 1.9595 0.3531
G06Z Pyloromyotomy NO NO 3.2 1 11 17% 100% 0.0000 0.0000 0.0000 1.8326 0.3896
G07A Appendicectomy, Major Complexity NO NO 4.4 1 13 12% 136% 0.0000 0.0000 0.0000 2.0347 0.3173
G07B Appendicectomy, Minor Complexity NO NO 2.1 1 7 14% 121% 0.0000 0.0000 0.0000 1.2585 0.3020
G10A Hernia Procedures, Major Complexity NO NO 3.7 1 11 15% 88% 0.0000 0.0000 0.0000 1.9713 0.2978
For Official Use Only-I2-A2 33
AR-DRG
V9.0 Description
Same-
Day
Pay-
ment
Bundled
ICU ALOS
1
Inlier Bounds Adjustments Price Weights
Lower
Bound
Upper
Bound
Private
Patient
Service Adj.
Paediatric
Adj. Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
G10B Hernia Procedures, Minor Complexity NO NO 1.3 1 4 23% 80% 0.0000 0.0000 0.0000 0.9914 0.2692
G11A Anal and Stomal Procedures, Major Complexity NO NO 4.5 1 14 13% 168% 0.0000 0.0000 0.0000 1.5287 0.2501
G11B Anal and Stomal Procedures, Minor Complexity NO NO 1.4 1 4 16% 107% 0.0000 0.0000 0.0000 0.6831 0.2538
G12A Other Digestive System GIs, Major Complexity NO NO 18.4 6 55 12% 100% 0.0000 0.6161 1.0277 6.7825 0.2745
G12B Other Digestive System GIs, Intermediate Complexity NO NO 7.2 2 22 14% 126% 0.0000 0.5084 1.1179 2.7442 0.2448
G12C Other Digestive System GIs, Minor Complexity YES NO 3.3 1 10 18% 132% 0.7348 0.0000 0.0000 1.5273 0.2397
G46A Complex Endoscopy, Major Complexity YES NO 6.9 2 21 14% 162% 0.4891 0.3275 1.0382 2.4038 0.2804
G46B Complex Endoscopy, Minor Complexity NO NO 1.1 1 3 34% 200% 0.0000 0.0000 0.0000 0.4326 0.3086
G47A Gastroscopy, Major Complexity NO NO 6.3 2 19 12% 163% 0.0000 0.2206 0.9379 2.0964 0.2642
G47B Gastroscopy, Intermediate Complexity YES NO 3.0 1 9 19% 138% 0.3616 0.0000 0.0000 0.9897 0.2306
G47C Gastroscopy, Minor Complexity YES NO 2.0 1 6 28% 153% 0.2849 0.0000 0.0000 0.7131 0.2059
G48A Colonoscopy, Major Complexity YES NO 6.2 2 18 14% 170% 0.3615 0.2205 0.8317 1.8840 0.2330
G48B Colonoscopy, Minor Complexity NO NO 1.1 1 3 39% 200% 0.0000 0.0000 0.0000 0.3458 0.1104
G60A Digestive Malignancy, Major Complexity NO NO 8.1 2 24 8% 100% 0.0000 0.0000 1.0275 2.0550 0.2277
G60B Digestive Malignancy, Minor Complexity YES NO 3.5 1 10 13% 100% 0.2705 0.0000 0.0000 0.7384 0.2027
G61A Gastrointestinal Haemorrhage, Major Complexity NO NO 4.2 1 13 13% 111% 0.0000 0.0000 0.0000 0.9522 0.2317
G61B Gastrointestinal Haemorrhage, Minor Complexity YES NO 2.1 1 6 14% 137% 0.1106 0.0000 0.0000 0.4892 0.2078
G64A Inflammatory Bowel Disease, Major Complexity YES NO 5.1 1 15 11% 173% 0.2308 0.0000 0.0000 1.1971 0.2350
G64B Inflammatory Bowel Disease, Minor Complexity NO NO 1.1 1 3 8% 100% 0.0000 0.0000 0.0000 0.2975 0.2277
G65A Gastrointestinal Obstruction, Major Complexity NO NO 5.8 1 17 10% 112% 0.0000 0.0000 0.0000 1.4783 0.2558
G65B Gastrointestinal Obstruction, Minor Complexity NO NO 2.6 1 8 15% 89% 0.0000 0.0000 0.0000 0.6221 0.2279
G66A Abdominal Pain and Mesenteric Adenitis, Major Complexity YES NO 2.5 1 8 15% 123% 0.1101 0.0000 0.0000 0.6059 0.2357
For Official Use Only-I2-A2 34
AR-DRG
V9.0 Description
Same-
Day
Pay-
ment
Bundled
ICU ALOS
1
Inlier Bounds Adjustments Price Weights
Lower
Bound
Upper
Bound
Private
Patient
Service Adj.
Paediatric
Adj. Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
G66B Abdominal Pain and Mesenteric Adenitis, Minor Complexity NO NO 1.2 1 4 19% 138% 0.0000 0.0000 0.0000 0.1999 0.1534
G67A Oesophagitis and Gastroenteritis, Major Complexity NO NO 3.8 1 11 10% 106% 0.0000 0.0000 0.0000 0.8995 0.2466
G67B Oesophagitis and Gastroenteritis, Minor Complexity NO NO 1.3 1 4 13% 110% 0.0000 0.0000 0.0000 0.2337 0.1757
G70A Other Digestive System Disorders, Major Complexity NO NO 5.4 1 16 10% 161% 0.0000 0.0000 0.0000 1.3019 0.2538
G70B Other Digestive System Disorders, Intermediate Complexity YES NO 2.8 1 9 13% 159% 0.1468 0.0000 0.0000 0.6512 0.2109
G70C Other Digestive System Disorders, Minor Complexity NO NO 1.3 1 4 17% 153% 0.0000 0.0000 0.0000 0.2333 0.1740
H01A Pancreas, Liver and Shunt Procedures, Major Complexity NO NO 20.5 6 61 16% 100% 0.0000 2.9734 1.1580 9.9212 0.2975
H01B Pancreas, Liver and Shunt Procedures, Intermediate Complexity NO NO 8.5 2 26 18% 100% 0.0000 0.6096 2.2949 5.1993 0.3062
H01C Pancreas, Liver and Shunt Procedures, Minor Complexity NO NO 2.9 1 9 23% 100% 0.0000 0.0000 0.0000 1.8536 0.4599
H02A Major Biliary Tract Procedures, Major Complexity NO NO 20.1 6 60 15% 93% 0.0000 1.4689 1.1491 8.3635 0.2944
H02B Major Biliary Tract Procedures, Intermediate Complexity NO NO 9.0 3 27 20% 100% 0.0000 0.6914 1.0926 3.9692 0.2541
H02C Major Biliary Tract Procedures, Minor Complexity NO NO 3.9 1 12 23% 100% 0.0000 0.0000 0.0000 1.7735 0.3106
H05A Hepatobiliary Diagnostic Procedures, Major Complexity NO NO 10.5 3 31 20% 100% 0.0000 0.7100 1.4108 4.9426 0.2718
H05B Hepatobiliary Diagnostic Procedures, Intermediate Complexity NO NO 4.2 1 13 16% 100% 0.0000 0.0000 0.0000 1.9498 0.3040
H05C Hepatobiliary Diagnostic Procedures, Minor Complexity NO NO 1.4 1 4 35% 100% 0.0000 0.0000 0.0000 0.6789 0.3392
H06A Other Hepatobiliary and Pancreas GIs, Major Complexity NO NO 19.6 13 29 10% 100% 0.0000 0.4592 0.5286 7.3311 0.3000
H06B Other Hepatobiliary and Pancreas GIs, Intermediate Complexity NO NO 8.5 2 25 18% 100% 0.0000 0.3772 1.3771 3.1314 0.2298
H06C Other Hepatobiliary and Pancreas GIs, Minor Complexity NO NO 1.6 1 5 63% 100% 0.0000 0.0000 0.0000 0.8093 0.2979
H07A Open Cholecystectomy, Major Complexity NO NO 15.2 5 46 14% 100% 0.0000 1.3734 1.0173 6.4600 0.3079
H07B Open Cholecystectomy, Intermediate Complexity NO NO 7.8 2 23 14% 100% 0.0000 1.3553 1.2838 3.9229 0.2721
H07C Open Cholecystectomy, Minor Complexity NO NO 4.7 1 14 14% 100% 0.0000 0.0000 0.0000 2.6669 0.3136
For Official Use Only-I2-A2 35
AR-DRG
V9.0 Description
Same-
Day
Pay-
ment
Bundled
ICU ALOS
1
Inlier Bounds Adjustments Price Weights
Lower
Bound
Upper
Bound
Private
Patient
Service Adj.
Paediatric
Adj. Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
H08A Laparoscopic Cholecystectomy, Major Complexity NO NO 6.0 2 18 17% 100% 0.0000 0.8523 1.0627 2.9777 0.2738
H08B Laparoscopic Cholecystectomy, Minor Complexity NO NO 2.0 1 6 19% 125% 0.0000 0.0000 0.0000 1.5255 0.2771
H09Z Liver Transplant NO NO 20.9 6 63 6% 156% 0.0000 4.3635 2.8453 21.4352 0.5264
H60A Cirrhosis and Alcoholic Hepatitis, Major Complexity NO NO 12.0 3 36 10% 100% 0.0000 0.0000 1.2287 3.6860 0.2639
H60B Cirrhosis and Alcoholic Hepatitis, Intermediate Complexity NO NO 5.0 1 15 11% 100% 0.0000 0.0000 0.0000 1.3837 0.2515
H60C Cirrhosis and Alcoholic Hepatitis, Minor Complexity YES NO 3.2 1 10 15% 100% 0.2615 0.0000 0.0000 0.8202 0.2195
H61A Malignancy of Hepatobiliary System and Pancreas, Major Complexity NO NO 8.6 2 26 13% 100% 0.0000 0.1448 1.2095 2.5637 0.2591
H61B Malignancy of Hepatobiliary System and Pancreas, Minor Complexity YES NO 4.2 1 13 19% 137% 0.3302 0.0000 0.0000 1.0811 0.2465
H62A Disorders of Pancreas, Except Malignancy, Major Complexity NO NO 6.8 2 20 12% 151% 0.0000 0.0000 1.0003 2.0005 0.2881
H62B Disorders of Pancreas, Except Malignancy, Minor Complexity YES NO 3.0 1 9 16% 168% 0.2492 0.0000 0.0000 0.7519 0.2381
H63A Other Disorders of Liver, Major Complexity NO NO 7.4 2 22 13% 142% 0.0000 0.0000 0.9643 1.9286 0.2277
H63B Other Disorders of Liver, Intermediate Complexity YES NO 3.7 1 11 19% 152% 0.2034 0.0000 0.0000 0.7712 0.1701
H63C Other Disorders of Liver, Minor Complexity YES NO 2.2 1 6 28% 146% 0.2550 0.0000 0.0000 0.6092 0.2000
H64A Disorders of the Biliary Tract, Major Complexity NO NO 7.2 2 22 15% 157% 0.0000 0.1494 1.0617 2.2728 0.2581
H64B Disorders of the Biliary Tract, Intermediate Complexity YES NO 3.7 1 11 18% 173% 0.3375 0.0000 0.0000 1.0595 0.2478
H64C Disorders of the Biliary Tract, Minor Complexity YES NO 2.4 1 7 23% 142% 0.2637 0.0000 0.0000 0.6750 0.2344
H65A Bleeding Oesophageal Varices, Major Complexity NO NO 9.3 3 28 13% 100% 0.0000 0.4694 1.0538 3.6308 0.2610
H65B Bleeding Oesophageal Varices, Intermediate Complexity NO NO 4.7 1 14 13% 100% 0.0000 0.0000 0.0000 1.8922 0.3223
H65C Bleeding Oesophageal Varices, Minor Complexity NO NO 2.6 1 8 14% 100% 0.0000 0.0000 0.0000 1.0018 0.3557
I01A Bilateral and Multiple Major Joint Procs of Lower Limb, Major Complexity NO NO 24.8 8 75 27% 100% 0.0000 3.7508 1.1144 12.6658 0.2457
I01B Bilateral and Multiple Major Joint Procs of Lower Limb, Minor Complexity NO NO 6.3 2 19 27% 100% 0.0000 4.1599 1.1132 6.3863 0.2313
For Official Use Only-I2-A2 36
AR-DRG
V9.0 Description
Same-
Day
Pay-
ment
Bundled
ICU ALOS
1
Inlier Bounds Adjustments Price Weights
Lower
Bound
Upper
Bound
Private
Patient
Service Adj.
Paediatric
Adj. Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
I02A Microvascular Tissue Transfers or Skin Grafts, Excluding Hand, Major Complexity NO NO 38.2 12 115 15% 100% 0.0000 4.1908 1.1364 17.8271 0.3000
I02B Microvascular Tissue Transfers or Skin Grafts, Ex Hand, Intermediate Comp NO NO 17.7 5 53 15% 100% 0.0000 0.9755 1.4995 8.4731 0.3111
I02C Microvascular Tissue Transfers or Skin Grafts, Excluding Hand, Minor Complexity NO NO 6.8 2 20 14% 83% 0.0000 0.5166 1.7578 4.0321 0.3321
I03A Hip Replacement for Trauma, Major Complexity NO NO 17.2 5 52 23% 100% 0.0000 2.0719 0.9287 6.7153 0.2466
I03B Hip Replacement for Trauma, Minor Complexity NO NO 8.2 2 25 29% 100% 0.0000 2.1216 0.9647 4.0509 0.2362
I04A Knee Replacement, Major Complexity NO NO 9.8 3 30 28% 100% 0.0000 2.0638 1.0709 5.2766 0.2468
I04B Knee Replacement, Minor Complexity NO NO 4.7 1 14 42% 100% 0.0000 0.0000 0.0000 3.7899 0.2328
I05A Other Joint Replacement, Major Complexity NO NO 8.9 2 27 37% 100% 0.0000 2.9523 1.4525 5.8572 0.2475
I05B Other Joint Replacement, Minor Complexity NO NO 3.0 1 9 34% 100% 0.0000 0.0000 0.0000 3.9061 0.2805
I06Z Spinal Fusion for Deformity NO NO 8.5 2 26 41% 110% 0.0000 3.8509 3.5721 10.9950 0.4865
I07Z Amputation NO NO 23.3 8 73 24% 100% 0.0000 1.0376 0.9631 8.7420 0.2663
I08A Other Hip and Femur Procedures, Major Complexity NO NO 19.7 6 59 15% 91% 0.0000 1.4853 0.9728 7.3219 0.2387
I08B Other Hip and Femur Procedures, Intermediate Complexity NO NO 10.7 3 32 20% 90% 0.0000 1.2630 1.0132 4.3026 0.2292
I08C Other Hip and Femur Procedures, Minor Complexity NO NO 6.3 2 19 23% 100% 0.0000 0.9759 0.9609 2.8977 0.2369
I09A Spinal Fusion, Major Complexity NO NO 19.2 6 58 25% 100% 0.0000 4.5532 1.1667 11.5537 0.2731
I09B Spinal Fusion, Intermediate Complexity NO NO 7.6 2 23 40% 100% 0.0000 3.1065 1.7599 6.6262 0.3226
I09C Spinal Fusion, Minor Complexity NO NO 4.3 1 13 33% 100% 0.0000 0.0000 0.0000 4.7882 0.3525
I10A Other Back and Neck Procedures, Major Complexity NO NO 9.3 3 28 16% 100% 0.0000 1.3214 1.1198 4.6809 0.2748
I10B Other Back and Neck Procedures, Minor Complexity NO NO 2.9 1 9 35% 100% 0.0000 0.0000 0.0000 2.0608 0.2820
I11Z Limb Lengthening Procedures NO NO 6.0 1 14 24% 142% 0.0000 0.0000 0.0000 3.5895 0.2941
I12A Misc Musculoskeletal Procs for Infect/ Inflam of Bone/Joint, Major Complexity NO NO 23.0 15 35 9% 108% 0.0000 0.7500 0.4697 7.7949 0.2418
I12B Misc Musculoskeletal Procs for Infect/ Inflam of Bone/Joint, Intermediate Comp NO NO 11.1 3 33 9% 91% 0.0000 0.6066 1.0073 3.6285 0.1907
For Official Use Only-I2-A2 37
AR-DRG
V9.0 Description
Same-
Day
Pay-
ment
Bundled
ICU ALOS
1
Inlier Bounds Adjustments Price Weights
Lower
Bound
Upper
Bound
Private
Patient
Service Adj.
Paediatric
Adj. Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
I12C Misc Musculoskeletal Procs for Infect/ Inflam of Bone/Joint, Minor Complexity NO NO 4.4 1 13 11% 119% 0.0000 0.0000 0.0000 1.5219 0.2160
I13A Humerus, Tibia, Fibula and Ankle Procedures, Major Complexity NO NO 12.2 4 36 18% 100% 0.0000 1.1720 1.0258 5.2754 0.2629
I13B Humerus, Tibia, Fibula and Ankle Procedures, Intermediate Complexity NO NO 5.0 1 15 23% 86% 0.0000 0.0000 0.0000 2.6966 0.2798
I13C Humerus, Tibia, Fibula and Ankle Procedures, Minor Complexity NO NO 2.4 1 7 25% 80% 0.0000 0.0000 0.0000 1.7200 0.3408
I15Z Cranio-Facial Surgery NO NO 4.8 1 14 24% 164% 0.0000 0.0000 0.0000 3.0569 0.2778
I16Z Other Shoulder Procedures NO NO 1.3 1 4 25% 100% 0.0000 0.0000 0.0000 1.5580 0.4578
I17A Maxillo-Facial Surgery, Major Complexity NO NO 3.6 1 11 18% 100% 0.0000 0.0000 0.0000 3.0119 0.4087
I17B Maxillo-Facial Surgery, Minor Complexity NO NO 1.5 1 4 14% 100% 0.0000 0.0000 0.0000 1.5486 0.4824
I18A Other Knee Procedures, Major Complexity YES NO 3.9 1 12 17% 106% 0.6699 0.0000 0.0000 1.7190 0.2113
I18B Other Knee Procedures, Minor Complexity NO NO 1.0 1 3 36% 154% 0.0000 0.0000 0.0000 0.6876 0.2082
I19A Other Elbow and Forearm Procedures, Major Complexity NO NO 6.3 2 19 20% 100% 0.0000 1.1124 1.1122 3.3369 0.2538
I19B Other Elbow and Forearm Procedures, Minor Complexity NO NO 1.7 1 5 30% 87% 0.0000 0.0000 0.0000 1.5551 0.2992
I20A Other Foot Procedures, Major Complexity NO NO 5.5 1 16 19% 108% 0.0000 0.0000 0.0000 2.5013 0.2467
I20B Other Foot Procedures, Minor Complexity NO NO 1.5 1 5 21% 100% 0.0000 0.0000 0.0000 1.2616 0.3031
I21A
Local Excision and Removal of Internal
Fixation Devices of Hip & Femur, Maj
Comp
NO NO 4.5 1 13 12% 80% 0.0000 0.0000 0.0000 1.8489 0.2942
I21B Local Excision and Removal of Internal Fixation Devs of Hip & Femur, Min Comp NO NO 1.1 1 3 9% 93% 0.0000 0.0000 0.0000 0.9753 0.2986
I23A Local Excision & Removal of Internal Fixation Device, Ex Hip & Fmr, Maj Comp YES NO 2.9 1 9 14% 112% 0.6626 0.0000 0.0000 1.6305 0.2338
I23B Local Excision & Removal of Internal Fixation Device, Ex Hip & Fmr, Min Comp NO NO 1.0 1 3 15% 100% 0.0000 0.0000 0.0000 0.5649 0.1641
I24A Arthroscopy, Major Complexity NO NO 3.4 1 10 16% 100% 0.0000 0.0000 0.0000 1.4651 0.2182
I24B Arthroscopy, Minor Complexity NO NO 1.1 1 3 16% 100% 0.0000 0.0000 0.0000 0.7044 0.2548
I25A Bone and Joint Diagnostic Procedures Including Biopsy, Major Complexity NO NO 11.8 3 35 12% 93% 0.0000 0.3171 1.3068 4.2374 0.2401
I25B Bone and Joint Diagnostic Procedures Including Biopsy, Minor Complexity YES NO 4.4 1 13 17% 108% 0.4808 0.0000 0.0000 1.6569 0.2238
For Official Use Only-I2-A2 38
AR-DRG
V9.0 Description
Same-
Day
Pay-
ment
Bundled
ICU ALOS
1
Inlier Bounds Adjustments Price Weights
Lower
Bound
Upper
Bound
Private
Patient
Service Adj.
Paediatric
Adj. Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
I27A Soft Tissue Procedures, Major Complexity NO NO 11.4 3 34 10% 81% 0.0000 0.6912 1.2816 4.5362 0.2557
I27B Soft Tissue Procedures, Minor Complexity YES NO 2.2 1 7 16% 115% 0.5684 0.0000 0.0000 1.2574 0.2719
I28A Other Musculoskeletal Procedures, Major Complexity NO NO 12.6 4 38 13% 100% 0.0000 0.9017 0.9301 4.6219 0.2516
I28B Other Musculoskeletal Procedures, Intermediate Complexity YES NO 2.7 1 8 26% 112% 1.0472 0.0000 0.0000 1.8410 0.2352
I28C Other Musculoskeletal Procedures, Minor Complexity YES NO 2.0 1 6 18% 111% 0.5723 0.0000 0.0000 1.0868 0.2581
I29Z Knee Reconstructions, and Revisions of Reconstructions NO NO 1.3 1 4 32% 112% 0.0000 0.0000 0.0000 1.7094 0.4721
I30Z Hand Procedures NO NO 1.2 1 4 21% 93% 0.0000 0.0000 0.0000 0.8282 0.2198
I31A Revision of Hip Replacement, Major Complexity NO NO 26.1 8 78 22% 100% 0.0000 3.0916 1.0144 11.2068 0.2255
I31B Revision of Hip Replacement, Intermediate Complexity NO NO 12.1 4 36 25% 100% 0.0000 2.8282 0.9657 6.6911 0.2200
I31C Revision of Hip Replacement, Minor Complexity NO NO 6.9 2 21 37% 100% 0.0000 2.6445 1.0574 4.7593 0.2020
I32A Revision of Knee Replacement, Major Complexity NO NO 20.2 13 30 25% 100% 0.0000 3.9533 0.4573 9.8988 0.1585
I32B Revision of Knee Replacement, Minor Complexity NO NO 7.5 2 23 25% 100% 0.0000 1.8855 1.7029 5.2912 0.1587
I33A Hip Replacement for Non-Trauma, Major Complexity NO NO 9.4 3 28 41% 100% 0.0000 2.5064 0.9644 5.3996 0.2613
I33B Hip Replacement for Non-Trauma, Minor Complexity NO NO 4.4 1 13 53% 100% 0.0000 0.0000 0.0000 3.9319 0.2180
I60Z Femoral Shaft Fractures NO NO 9.4 3 28 5% 100% 0.0000 0.2099 0.9866 3.1697 0.2501
I61A Distal Femoral Fractures, Major Complexity NO NO 14.1 4 42 9% 100% 0.0000 0.0000 0.7963 3.1853 0.2124
I61B Distal Femoral Fractures, Minor Complexity NO NO 4.9 1 15 7% 113% 0.0000 0.0000 0.0000 0.8147 0.2268
I63A Sprains, Strains and Dislocations of Hip, Pelvis and Thigh, Major Complexity NO NO 5.2 1 16 9% 100% 0.0000 0.0000 0.0000 1.1783 0.2400
I63B Sprains, Strains and Dislocations of Hip, Pelvis and Thigh, Minor Complexity NO NO 1.5 1 4 14% 127% 0.0000 0.0000 0.0000 0.2903 0.2084
I64A Osteomyelitis, Major Complexity NO NO 14.6 4 44 8% 110% 0.0000 0.0000 0.9390 3.7559 0.1752
I64B Osteomyelitis, Minor Complexity NO NO 6.6 2 20 8% 100% 0.0000 0.0000 0.7416 1.4832 0.1203
For Official Use Only-I2-A2 39
AR-DRG
V9.0 Description
Same-
Day
Pay-
ment
Bundled
ICU ALOS
1
Inlier Bounds Adjustments Price Weights
Lower
Bound
Upper
Bound
Private
Patient
Service Adj.
Paediatric
Adj. Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
I65A Musculoskeletal Malignant Neoplasms, Major Complexity NO NO 10.3 3 31 9% 100% 0.0000 0.0000 1.0918 3.2753 0.2563
I65B Musculoskeletal Malignant Neoplasms, Minor Complexity NO NO 4.1 1 12 10% 115% 0.0000 0.0000 0.0000 1.1996 0.2500
I66A Inflammatory Musculoskeletal Disorders, Major Complexity NO NO 7.1 2 21 11% 114% 0.0000 0.0000 1.0897 2.1794 0.2678
I66B Inflammatory Musculoskeletal Disorders, Minor Complexity NO NO 1.3 1 4 10% 100% 0.0000 0.0000 0.0000 0.3148 0.2321
I67A Septic Arthritis, Major Complexity NO NO 12.5 4 38 9% 100% 0.0000 0.0000 0.9281 3.7122 0.1989
I67B Septic Arthritis, Minor Complexity NO NO 4.7 1 14 8% 117% 0.0000 0.0000 0.0000 0.7895 0.1581
I68A Non-surgical Spinal Disorders, Major Complexity NO NO 6.3 2 19 10% 113% 0.0000 0.0000 0.8549 1.7099 0.2049
I68B Non-surgical Spinal Disorders, Minor Complexity NO NO 1.6 1 5 12% 150% 0.0000 0.0000 0.0000 0.3034 0.2127
I69A Bone Diseases and Arthropathies, Major Complexity NO NO 5.6 1 17 10% 80% 0.0000 0.0000 0.0000 1.2571 0.2311
I69B Bone Diseases and Arthropathies, Minor Complexity NO NO 1.8 1 5 12% 138% 0.0000 0.0000 0.0000 0.2682 0.1885
I71A Other Musculotendinous Disorders, Major Complexity NO NO 4.3 1 13 10% 91% 0.0000 0.0000 0.0000 0.9823 0.2438
I71B Other Musculotendinous Disorders, Minor Complexity NO NO 1.4 1 4 15% 157% 0.0000 0.0000 0.0000 0.2285 0.1632
I72A Specific Musculotendinous Disorders, Major Complexity NO NO 5.8 1 17 7% 100% 0.0000 0.0000 0.0000 1.2833 0.2412
I72B Specific Musculotendinous Disorders, Minor Complexity NO NO 1.9 1 6 12% 100% 0.0000 0.0000 0.0000 0.3037 0.1863
I73A Aftercare of Musculoskeletal Implants or Prostheses, Major Complexity NO NO 11.8 3 35 6% 87% 0.0000 0.0000 0.9171 2.7514 0.1843
I73B Aftercare of Musculoskeletal Implants or Prostheses, Intermediate Complexity NO NO 4.4 1 13 12% 100% 0.0000 0.0000 0.0000 0.6705 0.1337
I73C Aftercare of Musculoskeletal Implants or Prostheses, Minor Complexity NO NO 1.3 1 4 14% 159% 0.0000 0.0000 0.0000 0.3105 0.1587
I74A Injuries to Forearm, Wrist, Hand and Foot, Major Complexity NO NO 4.0 1 12 13% 88% 0.0000 0.0000 0.0000 0.7929 0.2118
I74B Injuries to Forearm, Wrist, Hand and Foot, Minor Complexity NO NO 1.2 1 3 27% 133% 0.0000 0.0000 0.0000 0.3083 0.1731
I75A Injuries to Shoulder, Arm, Elbow, Knee, Leg and Ankle, Major Complexity NO NO 9.6 3 29 8% 84% 0.0000 0.0000 0.7845 2.3534 0.1984
I75B Injuries to Shoulder, Arm, Elbow, Knee, Leg and Ankle, Intermediate Complexity NO NO 2.1 1 6 14% 130% 0.0000 0.0000 0.0000 0.4204 0.2240
For Official Use Only-I2-A2 40
AR-DRG
V9.0 Description
Same-
Day
Pay-
ment
Bundled
ICU ALOS
1
Inlier Bounds Adjustments Price Weights
Lower
Bound
Upper
Bound
Private
Patient
Service Adj.
Paediatric
Adj. Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
I75C Injuries to Shoulder, Arm, Elbow, Knee, Leg and Ankle, Minor Complexity NO NO 1.2 1 4 16% 166% 0.0000 0.0000 0.0000 0.1802 0.1329
I76A Other Musculoskeletal Disorders, Major Complexity NO NO 6.5 2 20 10% 100% 0.0000 0.1091 0.8344 1.7780 0.1936
I76B Other Musculoskeletal Disorders, Minor Complexity NO NO 1.4 1 4 18% 129% 0.0000 0.0000 0.0000 0.2385 0.1762
I77A Fractures of Pelvis, Major Complexity NO NO 10.9 3 33 8% 100% 0.0000 0.0000 0.8945 2.6835 0.2136
I77B Fractures of Pelvis, Minor Complexity NO NO 3.7 1 11 11% 100% 0.0000 0.0000 0.0000 0.7678 0.2207
I78A Fractures of Neck of Femur, Major Complexity NO NO 13.3 4 40 9% 100% 0.0000 0.0000 0.7293 2.9174 0.1955
I78B Fractures of Neck of Femur, Minor Complexity NO NO 5.0 1 15 14% 100% 0.0000 0.0000 0.0000 0.9726 0.2108
I79A Pathological Fractures, Major Complexity NO NO 14.9 4 45 9% 100% 0.0000 0.0000 1.0256 4.1023 0.2533
I79B Pathological Fractures, Intermediate Complexity NO NO 7.0 2 21 10% 100% 0.0000 0.0000 0.9605 1.9211 0.2344
I79C Pathological Fractures, Minor Complexity NO NO 3.4 1 10 10% 100% 0.0000 0.0000 0.0000 0.8419 0.2531
I80Z Femoral Fractures, Transferred to Acute Facility <2 Days NO NO 1.0 1 1 53% 100% 0.0000 0.0000 0.0000 0.2192 0.0000
J01A Microvas Tiss Transf for Skin, Subcut Tiss & Breast Dsrds, Major Complexity NO NO 21.4 7 64 25% 100% 0.0000 4.3945 1.1587 12.5051 0.2729
J01B Microvas Tiss Transf for Skin, Subcut Tiss & Breast Dsrds, Minor Complexity NO NO 8.7 2 26 28% 100% 0.0000 2.9167 1.4815 5.8798 0.2335
J06A Major Procedures for Breast Disorders, Major Complexity NO NO 6.2 2 19 18% 100% 0.0000 1.0489 0.9704 2.9897 0.1859
J06B Major Procedures for Breast Disorders, Minor Complexity NO NO 3.0 1 9 29% 93% 0.0000 0.0000 0.0000 1.7945 0.1744
J07Z Minor Procedures for Breast Disorders NO NO 1.1 1 3 32% 100% 0.0000 0.0000 0.0000 0.8676 0.3049
J08A Other Skin Grafts and Debridement Procedures, Major Complexity NO NO 19.1 6 57 7% 100% 0.0000 0.4922 0.9717 6.3223 0.2549
J08B Other Skin Grafts and Debridement Procedures, Intermediate Complexity YES NO 4.6 1 14 11% 115% 0.6367 0.0000 0.0000 1.6446 0.2372
J08C Other Skin Grafts and Debridement Procedures, Minor Complexity YES NO 2.5 1 8 24% 121% 0.5735 0.0000 0.0000 1.2985 0.2273
J09Z Perianal and Pilonidal Procedures NO NO 2.1 1 7 13% 105% 0.0000 0.0000 0.0000 0.7532 0.2719
J10A Plastic GIs for Skin, Subcutaneous Tissue and Breast Disorders, Major Comp YES NO 3.7 1 11 21% 100% 0.6796 0.0000 0.0000 1.9876 0.2463
J10B Plastic GIs for Skin, Subcutaneous Tissue and Breast Disorders, Minor Comp NO NO 1.1 1 3 30% 105% 0.0000 0.0000 0.0000 0.6189 0.1805
For Official Use Only-I2-A2 41
AR-DRG
V9.0 Description
Same-
Day
Pay-
ment
Bundled
ICU ALOS
1
Inlier Bounds Adjustments Price Weights
Lower
Bound
Upper
Bound
Private
Patient
Service Adj.
Paediatric
Adj. Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
J11A Other Skin, Subcutaneous Tissue and Breast Procedures, Major Complexity YES NO 4.4 1 13 16% 100% 0.5447 0.0000 0.0000 1.3813 0.2281
J11B Other Skin, Subcutaneous Tissue and Breast Procedures, Minor Complexity NO NO 1.0 1 3 25% 109% 0.0000 0.0000 0.0000 0.4304 0.1353
J12A Lower Limb Procedures W Ulcer or Cellulitis, Major Complexity NO NO 17.8 5 53 9% 100% 0.0000 0.2633 1.0617 5.5720 0.2784
J12B Lower Limb Procedures W Ulcer or Cellulitis, Minor Complexity NO NO 6.5 2 20 8% 100% 0.0000 0.2581 0.9658 2.1896 0.2352
J13A Lower Limb Procedures W/O Ulcer or Cellulitis, Major Complexity NO NO 7.7 2 23 10% 100% 0.0000 0.5079 1.1816 2.8711 0.2459
J13B Lower Limb Procedures W/O Ulcer or Cellulitis, Minor Complexity YES NO 3.9 1 12 15% 100% 0.5520 0.0000 0.0000 1.5928 0.2365
J14Z Major Breast Reconstructions NO NO 6.6 2 23 19% 100% 0.0000 0.9645 2.0644 5.0932 0.3943
J60A Skin Ulcers, Major Complexity NO NO 10.6 3 32 7% 100% 0.0000 0.0000 0.9033 2.7100 0.2232
J60B Skin Ulcers, Intermediate Complexity YES NO 5.4 1 16 9% 100% 0.1677 0.0000 0.0000 1.0738 0.1875
J60C Skin Ulcers, Minor Complexity YES NO 4.4 1 13 10% 100% 0.1713 0.0000 0.0000 0.7318 0.1584
J62A Malignant Breast Disorders, Major Complexity NO NO 8.6 2 26 7% 100% 0.0000 0.0000 1.1334 2.2668 0.2355
J62B Malignant Breast Disorders, Minor Complexity YES NO 4.4 1 13 13% 100% 0.2250 0.0000 0.0000 0.8582 0.1754
J63A Non-Malignant Breast Disorders, Major Complexity YES NO 2.9 1 9 9% 100% 0.2364 0.0000 0.0000 0.7675 0.2021
J63B Non-Malignant Breast Disorders, Minor Complexity YES NO 2.5 1 8 10% 100% 0.2741 0.0000 0.0000 0.5964 0.1892
J64A Cellulitis, Major Complexity NO NO 5.9 1 18 9% 95% 0.0000 0.0000 0.0000 1.4059 0.2247
J64B Cellulitis, Minor Complexity YES NO 2.9 1 9 8% 125% 0.1533 0.0000 0.0000 0.6730 0.1502
J65A Trauma to Skin, Subcutaneous Tissue and Breast, Major Complexity YES NO 5.0 1 15 11% 85% 0.1216 0.0000 0.0000 1.1538 0.2226
J65B Trauma to Skin, Subcutaneous Tissue and Breast, Minor Complexity NO NO 1.2 1 4 17% 128% 0.0000 0.0000 0.0000 0.2069 0.1545
J67A Minor Skin Disorders, Major Complexity YES NO 4.0 1 12 8% 115% 0.2470 0.0000 0.0000 1.0108 0.2368
J67B Minor Skin Disorders, Minor Complexity YES NO 2.0 1 6 18% 128% 0.1895 0.0000 0.0000 0.4220 0.1970
J68A Major Skin Disorders, Major Complexity YES NO 5.1 1 15 7% 100% 0.2322 0.0000 0.0000 1.4230 0.2607
J68B Major Skin Disorders, Minor Complexity YES NO 2.9 1 9 8% 115% 0.1747 0.0000 0.0000 0.7781 0.2474
J69A Skin Malignancy, Major Complexity NO NO 10.7 3 32 7% 100% 0.0000 0.0000 1.0608 3.1823 0.2392
For Official Use Only-I2-A2 42
AR-DRG
V9.0 Description
Same-
Day
Pay-
ment
Bundled
ICU ALOS
1
Inlier Bounds Adjustments Price Weights
Lower
Bound
Upper
Bound
Private
Patient
Service Adj.
Paediatric
Adj. Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
J69B Skin Malignancy, Minor Complexity YES NO 5.1 1 15 7% 100% 0.1596 0.0000 0.0000 1.2128 0.2209
K01A GIs for Diabetic Complications, Major Complexity NO NO 30.7 10 92 8% 100% 0.0000 0.7289 1.0042 10.7704 0.2834
K01B GIs for Diabetic Complications, Intermediate Complexity NO NO 17.9 5 54 7% 100% 0.0000 0.4016 1.0585 5.6941 0.2392
K01C GIs for Diabetic Complications, Minor Complexity NO NO 7.8 2 24 8% 100% 0.0000 0.3301 1.2002 2.7305 0.2554
K02Z Pituitary Procedures NO NO 7.0 2 21 26% 100% 0.0000 1.3643 1.4187 4.2017 0.3539
K03Z Adrenal Procedures NO NO 4.5 2 20 15% 100% 0.0000 1.0573 1.0602 3.1777 0.4003
K05A Parathyroid Procedures, Major Complexity NO NO 5.1 1 15 20% 100% 0.0000 0.0000 0.0000 2.5018 0.2683
K05B Parathyroid Procedures, Minor Complexity NO NO 1.3 1 4 28% 100% 0.0000 0.0000 0.0000 1.3386 0.3235
K06A Thyroid Procedures, Major Complexity NO NO 4.0 1 12 19% 100% 0.0000 0.0000 0.0000 2.9914 0.3838
K06B Thyroid Procedures, Minor Complexity NO NO 1.6 1 5 19% 111% 0.0000 0.0000 0.0000 1.7170 0.4469
K08Z Thyroglossal Procedures NO NO 1.4 1 4 15% 90% 0.0000 0.0000 0.0000 1.3441 0.4283
K09A Other Endocrine, Nutritional and Metabolic GIs, Major Complexity NO NO 16.8 5 50 12% 100% 0.0000 0.7965 1.3107 7.3502 0.3027
K09B Other Endocrine, Nutritional and Metabolic GIs, Minor Complexity NO NO 4.5 1 14 12% 100% 0.0000 0.0000 0.0000 2.5273 0.2811
K10Z Revisional and Open Bariatric Procedures NO NO 10.2 3 30 15% 100% 0.0000 1.5016 0.8463 4.0407 0.2967
K11Z Major Laparoscopic Bariatric Procedures NO NO 2.8 1 8 45% 100% 0.0000 0.0000 0.0000 2.2050 0.4656
K12Z Other Bariatric Procedures NO NO 2.4 1 7 15% 100% 0.0000 0.0000 0.0000 1.5437 0.4362
K13Z Plastic GIs for Endocrine, Nutritional and Metabolic Disorders NO NO 4.3 1 12 15% 100% 0.0000 0.0000 0.0000 2.1046 0.3222
K40A Endoscopic and Investigative Procedures for Metabolic Disorders, Major Comp NO NO 9.6 3 29 10% 106% 0.0000 0.2967 1.1485 3.7423 0.2729
K40B Endoscopic and Investigative Procedures for Metabolic Disorders, Minor Comp NO NO 1.1 1 3 28% 198% 0.0000 0.0000 0.0000 0.3809 0.3003
K60A Diabetes, Major Complexity NO NO 5.6 1 17 9% 139% 0.0000 0.0000 0.0000 1.5964 0.2574
K60B Diabetes, Minor Complexity YES NO 3.1 1 9 22% 192% 0.1804 0.0000 0.0000 0.7957 0.2165
K61A Severe Nutritional Disturbance, Major Complexity NO NO 12.4 4 37 8% 109% 0.0000 0.0000 0.9266 3.7062 0.2769
K61B Severe Nutritional Disturbance, Minor Complexity NO NO 6.2 2 19 4% 100% 0.0000 0.0000 0.9269 1.8538 0.2378
For Official Use Only-I2-A2 43
AR-DRG
V9.0 Description
Same-
Day
Pay-
ment
Bundled
ICU ALOS
1
Inlier Bounds Adjustments Price Weights
Lower
Bound
Upper
Bound
Private
Patient
Service Adj.
Paediatric
Adj. Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
K62A Miscellaneous Metabolic Disorders, Major Complexity NO NO 6.0 2 18 9% 143% 0.0000 0.0000 0.8771 1.7543 0.2445
K62B Miscellaneous Metabolic Disorders, Intermediate Complexity YES NO 2.9 1 9 11% 141% 0.1468 0.0000 0.0000 0.7684 0.2418
K62C Miscellaneous Metabolic Disorders, Minor Complexity YES NO 1.9 1 6 12% 162% 0.0943 0.0000 0.0000 0.4429 0.2452
K63A Inborn Errors of Metabolism, Major Complexity NO NO 4.6 1 14 7% 124% 0.0000 0.0000 0.0000 1.3701 0.3436
K63B Inborn Errors of Metabolism, Minor Complexity NO NO 1.1 1 3 9% 138% 0.0000 0.0000 0.0000 0.2276 0.1741
K64A Endocrine Disorders, Major Complexity YES NO 4.6 1 14 10% 162% 0.2559 0.0000 0.0000 1.3388 0.2381
K64B Endocrine Disorders, Minor Complexity YES NO 2.4 1 7 12% 181% 0.1626 0.0000 0.0000 0.6618 0.2366
L02A Operative Insertion of Peritoneal Catheter for Dialysis, Major Complexity NO NO 9.4 3 28 9% 100% 0.0000 0.5732 1.1931 4.1524 0.3131
L02B Operative Insertion of Peritoneal Catheter for Dialysis, Minor Complexity NO NO 1.5 1 5 9% 100% 0.0000 0.0000 0.0000 0.9402 0.3432
L03A Kidney, Ureter and Major Bladder Procs for Neoplasm, Major Complexity NO NO 14.6 4 44 17% 100% 0.0000 2.0540 1.6301 8.5745 0.3636
L03B Kidney, Ureter and Major Bladder Procs for Neoplasm, Intermediate Comp NO NO 6.1 2 18 19% 100% 0.0000 0.8063 1.8572 4.5207 0.3959
L03C Kidney, Ureter and Major Bladder Procs for Neoplasm, Minor Complexity NO NO 3.4 1 10 21% 100% 0.0000 0.0000 0.0000 2.7561 0.5459
L04A Kidney, Ureter and Major Bladder Procs for Non-Neoplasm, Major Complexity NO NO 12.0 4 36 13% 100% 0.0000 1.0007 1.1306 5.5231 0.2995
L04B Kidney, Ureter and Major Bladder Procs for Non-Neoplasm, Intermediate Comp YES NO 4.3 1 13 19% 100% 0.7790 0.0000 0.0000 2.3729 0.2652
L04C Kidney, Ureter and Major Bladder Procs for Non-Neoplasm, Minor Complexity YES NO 1.8 1 6 25% 136% 0.7362 0.0000 0.0000 1.4738 0.3767
L05A Transurethral Prostatectomy for Urinary Disorder, Major Complexity NO NO 8.6 2 26 18% 100% 0.0000 0.6700 1.2471 3.1643 0.2676
L05B Transurethral Prostatectomy for Urinary Disorder, Minor Complexity NO NO 2.4 1 7 22% 100% 0.0000 0.0000 0.0000 1.3024 0.2538
L06A Minor Bladder Procedures, Major Complexity NO NO 12.5 4 37 14% 100% 0.0000 0.8286 1.0176 4.8990 0.2788
L06B Minor Bladder Procedures, Intermediate Complexity NO NO 4.3 1 13 15% 92% 0.0000 0.0000 0.0000 1.9914 0.2879
L06C Minor Bladder Procedures, Minor Complexity YES NO 2.0 1 6 15% 121% 0.4929 0.0000 0.0000 1.1091 0.2828
L07A Other Transurethral Procedures, Major Complexity NO NO 5.3 1 16 15% 100% 0.0000 0.0000 0.0000 1.9701 0.2522
For Official Use Only-I2-A2 44
AR-DRG
V9.0 Description
Same-
Day
Pay-
ment
Bundled
ICU ALOS
1
Inlier Bounds Adjustments Price Weights
Lower
Bound
Upper
Bound
Private
Patient
Service Adj.
Paediatric
Adj. Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
L07B Other Transurethral Procedures, Minor Complexity NO NO 1.3 1 4 27% 121% 0.0000 0.0000 0.0000 0.7720 0.2971
L08A Urethral Procedures, Major Complexity YES NO 4.8 1 14 15% 100% 0.5796 0.0000 0.0000 1.9254 0.3634
L08B Urethral Procedures, Minor Complexity NO NO 1.3 1 4 15% 80% 0.0000 0.0000 0.0000 0.8898 0.2994
L09A Other Procedures for Kidney and Urinary Tract Disorders, Major Complexity NO NO 17.7 5 53 12% 100% 0.0000 0.7115 1.2396 6.9096 0.3302
L09B Other Procedures for Kidney and Urinary Tract Disorders, Intermediate Complexity NO NO 4.5 1 13 22% 112% 0.0000 0.0000 0.0000 1.7259 0.1986
L09C Other Procedures for Kidney and Urinary Tract Disorders, Minor Complexity NO NO 1.2 1 4 20% 80% 0.0000 0.0000 0.0000 0.9861 0.3404
L10A Kidney Transplant, Age <=16 Years or Major Complexity NO NO 12.6 4 38 9% 100% 0.0000 1.9909 2.2081 10.8233 0.4666
L10B Kidney Transplant, Age >=17 Years and Minor Complexity NO NO 8.1 2 24 9% 100% 0.0000 1.8592 2.9938 7.8468 0.4741
L40Z Ureteroscopy NO NO 1.4 1 6 16% 100% 0.0000 0.0000 0.0000 0.8157 0.2819
L41Z Cystourethroscopy for Urinary Disorder, Sameday NO NO 1.0 1 1 27% 200% 0.0000 0.0000 0.0000 0.2327 0.0000
L42Z ESW Lithotripsy NO NO 1.1 1 3 31% 100% 0.0000 0.0000 0.0000 0.7104 0.3005
L60A Kidney Failure, Major Complexity NO NO 11.4 3 34 10% 100% 0.0000 0.0000 1.2178 3.6535 0.2820
L60B Kidney Failure, Intermediate Complexity YES NO 4.8 1 14 11% 156% 0.3142 0.0000 0.0000 1.2920 0.2488
L60C Kidney Failure, Minor Complexity YES NO 2.4 1 7 9% 145% 0.4792 0.0000 0.0000 0.5770 0.2191
L61Z Haemodialysis NO NO 1.0 1 3 13% 200% 0.0000 0.0000 0.0000 0.1007 0.0806
L62A Kidney and Urinary Tract Neoplasms, Major Complexity NO NO 10.6 3 32 10% 100% 0.0000 0.0000 1.0382 3.1147 0.2600
L62B Kidney and Urinary Tract Neoplasms, Intermediate Complexity NO NO 5.0 1 15 10% 140% 0.0000 0.0000 0.0000 1.3242 0.2305
L62C Kidney and Urinary Tract Neoplasms, Minor Complexity NO NO 1.8 1 5 15% 157% 0.0000 0.0000 0.0000 0.4858 0.2651
L63A Kidney and Urinary Tract Infections, Major Complexity NO NO 5.3 1 16 10% 100% 0.0000 0.0000 0.0000 1.2851 0.2346
L63B Kidney and Urinary Tract Infections, Minor Complexity YES NO 2.4 1 8 11% 125% 0.0939 0.0000 0.0000 0.5707 0.2130
L64A Urinary Stones and Obstruction, Major Complexity YES NO 2.8 1 8 21% 175% 0.1252 0.0000 0.0000 0.9150 0.2631
L64B Urinary Stones and Obstruction, Minor Complexity NO NO 1.2 1 4 29% 200% 0.0000 0.0000 0.0000 0.2503 0.1595
For Official Use Only-I2-A2 45
AR-DRG
V9.0 Description
Same-
Day
Pay-
ment
Bundled
ICU ALOS
1
Inlier Bounds Adjustments Price Weights
Lower
Bound
Upper
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Private
Patient
Service Adj.
Paediatric
Adj. Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
L65A Kidney and Urinary Tract Signs and Symptoms, Major Complexity NO NO 5.4 1 16 9% 117% 0.0000 0.0000 0.0000 1.3511 0.2523
L65B Kidney and Urinary Tract Signs and Symptoms, Minor Complexity YES NO 2.1 1 6 12% 164% 0.1171 0.0000 0.0000 0.5420 0.2286
L66Z Urethral Stricture NO NO 1.7 1 5 14% 80% 0.0000 0.0000 0.0000 0.6109 0.2548
L67A Other Kidney and Urinary Tract Disorders, Major Complexity YES NO 5.3 1 16 10% 135% 0.2616 0.0000 0.0000 1.4054 0.2429
L67B Other Kidney and Urinary Tract Disorders, Intermediate Complexity YES NO 2.3 1 7 16% 196% 0.1773 0.0000 0.0000 0.5874 0.2093
L67C Other Kidney and Urinary Tract Disorders, Minor Complexity NO NO 1.1 1 3 15% 200% 0.0000 0.0000 0.0000 0.1945 0.1501
L68Z Peritoneal Dialysis NO NO 1.0 1 3 9% 200% 0.0000 0.0000 0.0000 0.1211 0.0919
M01A Major Male Pelvic Procedures, Major Complexity NO NO 6.3 2 19 18% 100% 0.0000 2.7099 0.9694 4.6487 0.3259
M01B Major Male Pelvic Procedures, Minor Complexity NO NO 3.3 1 10 17% 100% 0.0000 0.0000 0.0000 3.3416 0.1367
M02A TURP for Reproductive System Disorder, Major Complexity NO NO 6.2 2 19 16% 100% 0.0000 0.6571 0.9092 2.4754 0.2703
M02B TURP for Reproductive System Disorder, Minor Complexity NO NO 2.3 1 7 24% 100% 0.0000 0.0000 0.0000 1.3143 0.2738
M03A Penis Procedures, Major Complexity NO NO 2.0 1 6 20% 82% 0.0000 0.0000 0.0000 1.5906 0.3833
M03B Penis Procedures, Minor Complexity NO NO 1.2 1 4 18% 100% 0.0000 0.0000 0.0000 0.9186 0.2950
M04Z Testes Procedures NO NO 1.3 1 4 19% 86% 0.0000 0.0000 0.0000 0.8057 0.2637
M05Z Circumcision NO NO 1.1 1 3 16% 87% 0.0000 0.0000 0.0000 0.6308 0.2041
M06A Other Male Reproductive System GIs, Major Complexity YES NO 8.2 2 25 20% 100% 0.7870 0.7280 1.4656 3.6593 0.3032
M06B Other Male Reproductive System GIs, Minor Complexity NO NO 1.5 1 5 26% 81% 0.0000 0.0000 0.0000 1.5047 0.3182
M40Z Cystourethroscopy for Male Reproductive System Disorder, Sameday NO NO 1.0 1 1 46% 100% 0.0000 0.0000 0.0000 0.2265 0.0000
M60A Male Reproductive System Malignancy, Major Complexity NO NO 7.9 2 24 7% 100% 0.0000 0.0981 0.9931 2.0843 0.2250
M60B Male Reproductive System Malignancy, Minor Complexity NO NO 1.1 1 4 30% 100% 0.0000 0.0000 0.0000 0.3626 0.2524
M61A Benign Prostatic Hypertrophy, Major Complexity NO NO 4.5 1 14 11% 100% 0.0000 0.0000 0.0000 1.1534 0.2338
M61B Benign Prostatic Hypertrophy, Minor Complexity NO NO 1.3 1 4 16% 100% 0.0000 0.0000 0.0000 0.4029 0.2416
For Official Use Only-I2-A2 46
AR-DRG
V9.0 Description
Same-
Day
Pay-
ment
Bundled
ICU ALOS
1
Inlier Bounds Adjustments Price Weights
Lower
Bound
Upper
Bound
Private
Patient
Service Adj.
Paediatric
Adj. Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
M62A Male Reproductive System Inflammation, Major Complexity YES NO 4.9 1 15 12% 100% 0.2294 0.0000 0.0000 1.2005 0.2156
M62B Male Reproductive System Inflammation, Minor Complexity YES NO 2.4 1 7 11% 126% 0.1176 0.0000 0.0000 0.5655 0.1942
M63Z Male Sterilisation Procedures NO NO 1.0 1 3 23% 100% 0.0000 0.0000 0.0000 0.4410 0.1455
M64A Other Male Reproductive System Disorders, Major Complexity NO NO 2.7 1 8 11% 100% 0.0000 0.0000 0.0000 0.6508 0.2196
M64B Other Male Reproductive System Disorders, Minor Complexity NO NO 1.2 1 3 18% 130% 0.0000 0.0000 0.0000 0.2537 0.1470
N01Z Pelvic Evisceration and Radical Vulvectomy NO NO 7.7 2 23 17% 100% 0.0000 1.3217 1.3257 3.9731 0.3888
N04A Hysterectomy for Non-Malignancy, Major Complexity NO NO 4.4 1 13 13% 100% 0.0000 0.0000 0.0000 2.9393 0.3616
N04B Hysterectomy for Non-Malignancy, Minor Complexity NO NO 2.6 1 8 15% 100% 0.0000 0.0000 0.0000 2.0498 0.3506
N05A Oophorectomy & Complex Fallopian Tube Procs for Non-Malignancy, Maj Comp NO NO 4.2 1 13 12% 100% 0.0000 0.0000 0.0000 2.5775 0.3496
N05B Oophorectomy & Complex Fallopian Tube Procs for Non-Malignancy, Min Comp NO NO 1.6 1 5 15% 100% 0.0000 0.0000 0.0000 1.4815 0.3709
N06A Female Reproductive System Reconstructive Procs, Major Complexity NO NO 3.7 1 11 15% 100% 0.0000 0.0000 0.0000 2.3079 0.3455
N06B Female Reproductive System Reconstructive Procs, Minor Complexity NO NO 1.9 1 6 21% 100% 0.0000 0.0000 0.0000 1.3849 0.3801
N07A Other Uterus and Adnexa Procedures for Non-Malignancy, Major Complexity YES NO 1.9 1 6 17% 100% 0.8365 0.0000 0.0000 1.5299 0.3017
N07B Other Uterus and Adnexa Procedures for Non-Malignancy, Minor Complexity NO NO 1.0 1 3 33% 100% 0.0000 0.0000 0.0000 0.5519 0.1736
N08Z Endoscopic and Laparoscopic Procs, Female Reproductive System YES NO 1.9 1 6 17% 110% 0.7328 0.0000 0.0000 1.2966 0.3264
N09A Other Vagina, Cervix and Vulva Procedures, Major Complexity NO NO 2.2 1 7 13% 100% 0.0000 0.0000 0.0000 1.0805 0.3190
N09B Other Vagina, Cervix and Vulva Procedures, Minor Complexity NO NO 1.0 1 3 18% 125% 0.0000 0.0000 0.0000 0.4953 0.1762
N10Z Diagnostic Curettage and Diagnostic Hysteroscopy NO NO 1.1 1 3 19% 100% 0.0000 0.0000 0.0000 0.4811 0.1424
N11A Other Female Reproductive System GIs, Major Complexity NO NO 5.8 1 17 13% 100% 0.0000 0.0000 0.0000 2.3636 0.3137
N11B Other Female Reproductive System GIs, Minor Complexity NO NO 1.0 1 3 15% 100% 0.0000 0.0000 0.0000 0.3721 0.2977
N12A Uterus and Adnexa Procedures for Malignancy, Major Complexity NO NO 10.3 3 31 15% 100% 0.0000 1.4670 1.4353 5.7728 0.4052
For Official Use Only-I2-A2 47
AR-DRG
V9.0 Description
Same-
Day
Pay-
ment
Bundled
ICU ALOS
1
Inlier Bounds Adjustments Price Weights
Lower
Bound
Upper
Bound
Private
Patient
Service Adj.
Paediatric
Adj. Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
N12B Uterus and Adnexa Procedures for Malignancy, Intermediate Complexity NO NO 4.6 1 14 16% 100% 0.0000 0.0000 0.0000 3.0125 0.3220
N12C Uterus and Adnexa Procedures for Malignancy, Minor Complexity NO NO 2.5 1 8 17% 100% 0.0000 0.0000 0.0000 2.0892 0.3707
N60A Female Reproductive System Malignancy, Major Complexity NO NO 9.6 3 29 7% 100% 0.0000 0.0000 0.9717 2.9152 0.2403
N60B Female Reproductive System Malignancy, Minor Complexity NO NO 2.8 1 8 7% 139% 0.0000 0.0000 0.0000 0.7290 0.2429
N61A Female Reproductive System Infections, Major Complexity NO NO 3.4 1 10 12% 100% 0.0000 0.0000 0.0000 0.8961 0.2596
N61B Female Reproductive System Infections, Minor Complexity NO NO 1.6 1 5 8% 170% 0.0000 0.0000 0.0000 0.3717 0.2636
N62A Menstrual & Other Female Reproductive System Disorders, Major Complexity NO NO 2.2 1 7 10% 109% 0.0000 0.0000 0.0000 0.5764 0.2574
N62B Menstrual & Other Female Reproductive System Disorders, Minor Complexity NO NO 1.2 1 4 14% 158% 0.0000 0.0000 0.0000 0.2217 0.1445
O01A Caesarean Delivery, Major Complexity NO NO 7.0 2 21 10% 100% 0.0000 0.8439 1.1705 3.1850 0.2684
O01B Caesarean Delivery, Intermediate Complexity NO NO 4.2 1 13 14% 100% 0.0000 0.0000 0.0000 2.2002 0.2369
O01C Caesarean Delivery, Minor Complexity NO NO 3.1 1 9 16% 100% 0.0000 0.0000 0.0000 1.8164 0.2761
O02A Vaginal Delivery W GIs, Major Complexity NO NO 4.2 1 12 10% 100% 0.0000 0.0000 0.0000 2.3360 0.3369
O02B Vaginal Delivery W GIs, Minor Complexity NO NO 2.9 1 9 9% 100% 0.0000 0.0000 0.0000 1.6428 0.3431
O03Z Ectopic Pregnancy NO NO 1.7 1 5 13% 100% 0.0000 0.0000 0.0000 1.0774 0.3032
O04A Postpartum and Post Abortion W GIs, Major Complexity NO NO 4.4 1 13 15% 100% 0.0000 0.0000 0.0000 1.7998 0.2783
O04B Postpartum and Post Abortion W GIs, Minor Complexity YES NO 2.1 1 7 19% 100% 0.4821 0.0000 0.0000 0.9893 0.2886
O05Z Abortion W GIs NO NO 1.1 1 3 20% 100% 0.0000 0.0000 0.0000 0.4814 0.1905
O60A Vaginal Delivery, Major Complexity NO NO 3.8 1 12 12% 100% 0.0000 0.0000 0.0000 1.6418 0.2747
O60B Vaginal Delivery, Intermediate Complexity NO NO 2.5 1 7 14% 118% 0.0000 0.0000 0.0000 1.1219 0.3015
O60C Vaginal Delivery, Minor Complexity NO NO 1.8 1 5 15% 114% 0.0000 0.0000 0.0000 0.8145 0.3196
O61A Postpartum and Post Abortion W/O GIs, Major Complexity NO NO 4.4 1 13 8% 100% 0.0000 0.0000 0.0000 1.1887 0.2724
O61B Postpartum and Post Abortion W/O GIs, Minor Complexity YES NO 2.2 1 7 7% 100% 0.1330 0.0000 0.0000 0.5917 0.2134
For Official Use Only-I2-A2 48
AR-DRG
V9.0 Description
Same-
Day
Pay-
ment
Bundled
ICU ALOS
1
Inlier Bounds Adjustments Price Weights
Lower
Bound
Upper
Bound
Private
Patient
Service Adj.
Paediatric
Adj. Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
O63A Abortion W/O GIs, Major Complexity NO NO 1.5 1 5 16% 100% 0.0000 0.0000 0.0000 0.6434 0.4301
O63B Abortion W/O GIs, Minor Complexity NO NO 1.1 1 3 16% 100% 0.0000 0.0000 0.0000 0.2098 0.1495
O66A Antenatal and Other Obstetric Admissions, Major Complexity YES NO 3.3 1 10 6% 100% 0.1812 0.0000 0.0000 0.8662 0.2157
O66B Antenatal and Other Obstetric Admissions, Intermediate Complexity NO NO 1.3 1 4 9% 169% 0.0000 0.0000 0.0000 0.2401 0.1754
O66C Antenatal and Other Obstetric Admissions, Minor Complexity NO NO 1.0 1 3 15% 100% 0.0000 0.0000 0.0000 0.1140 0.0899
P01Z Neonate W Sig GI/Vent>=96hrs, Died or Transfer to Acute Facility <5Days NO YES 1.7 1 4 10% 100% 0.0000 0.0000 0.0000 1.7376 0.5823
P02Z Cardiothoracic and Vascular Procedures for Neonates NO YES 33.8 21 48 10% 100% 0.0000 3.1742 1.2485 29.3935 0.7168
P03A Neonate, AdmWt 1000-1499g W Signif GI/Vent>=96hrs, Major Complexity NO YES 62.9 41 94 10% 100% 0.0000 0.0000 0.6959 28.5324 0.4087
P03B Neonate, AdmWt 1000-1499g W Signif GI/Vent>=96hrs, Minor Complexity NO YES 38.7 12 116 9% 100% 0.0000 0.1490 1.3451 16.2907 0.3681
P04A Neonate, AdmWt 1500-1999g W Signif GI/Vent>=96hrs, Major Complexity NO YES 57.1 19 171 12% 100% 0.0000 0.2599 1.3909 26.6876 0.4434
P04B Neonate, AdmWt 1500-1999g W Signif GI/Vent>=96hrs, Minor Complexity NO YES 28.2 9 84 10% 100% 0.0000 0.0000 1.2506 11.2556 0.3227
P05A Neonate, AdmWt 2000-2499g W Signif GI/Vent>=96hrs, Major Complexity NO YES 47.4 31 71 12% 100% 0.0000 0.6265 0.8364 26.5548 0.4623
P05B Neonate, AdmWt 2000-2499g W Signif GI/Vent>=96hrs, Minor Complexity NO YES 19.1 6 57 12% 100% 0.0000 0.3342 1.3838 8.6369 0.3447
P06A Neonate, AdmWt >=2500g W Significant GI/Vent>=96hrs, Major Complexity NO YES 39.6 13 119 9% 100% 0.0000 0.5173 1.5822 21.0858 0.5109
P06B Neonate, AdmWt >=2500g W Significant GI/Vent>=96hrs, Minor Complexity NO YES 11.8 3 35 10% 100% 0.0000 0.5067 1.8972 6.1984 0.4288
P07Z Neonate, AdmWt <750g W Significant GIs NO YES 120.9 39 358 10% 100% 0.0000 0.2263 1.6270 63.6787 0.4926
P08Z Neonate, AdmWt 750-999g W Significant GIs NO YES 87.7 32 297 10% 100% 0.0000 0.7902 1.4696 47.8172 0.4158
P60A Neonate W/O Sig GI/Vent>=96hrs, Died/ Transfer Acute Facility <5 Days, MajC NO YES 2.4 1 4 13% 100% 0.0000 0.0000 0.0000 1.1804 0.0000
P60B Neonate W/O Sig GI/Vent>=96hrs, Died/ Transfer Acute Facility <5 Days, MinC YES YES 2.0 1 4 11% 100% 0.2247 0.0000 0.0000 0.9040 0.0000
P61Z Neonate, AdmWt <750g W/O Significant GI procedure NO YES 83.0 27 249 9% 100% 0.0000 0.0000 1.6254 43.8870 0.4283
P62A Neonate, AdmWt 750-999g W/O Significant GIs, Major Complexity NO YES 72.3 24 217 9% 100% 0.0000 0.0000 1.4020 33.6474 0.3964
For Official Use Only-I2-A2 49
AR-DRG
V9.0 Description
Same-
Day
Pay-
ment
Bundled
ICU ALOS
1
Inlier Bounds Adjustments Price Weights
Lower
Bound
Upper
Bound
Private
Patient
Service Adj.
Paediatric
Adj. Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
P62B Neonate, AdmWt 750-999g W/O Significant GIs, Minor Complexity NO YES 30.1 10 90 8% 100% 0.0000 0.0000 1.3927 13.9274 0.3146
P63A Neonate, AdmWt 1000-1249g W/O Signif GI/Vent>=96hrs, Major Complexity NO YES 33.6 11 101 9% 100% 0.0000 0.0000 1.0622 11.6841 0.3334
P63B Neonate, AdmWt 1000-1249g W/O Signif GI/Vent>=96hrs, Minor Complexity NO YES 12.9 4 39 9% 100% 0.0000 0.0000 1.5569 6.2276 0.2858
P64A Neonate, AdmWt 1250-1499g W/O Signif GI/Vent>=96hrs, Major Complexity NO YES 33.5 11 101 9% 100% 0.0000 0.0000 1.0041 11.0455 0.2812
P64B Neonate, AdmWt 1250-1499g W/O Signif GI/Vent>=96hrs, Minor Complexity NO YES 21.8 7 65 9% 100% 0.0000 0.0000 1.0070 7.0487 0.2544
P65A Neonate, AdmWt 1500-1999g W/O Signif GI/Vent>=96hrs, Extreme Comp NO YES 28.6 9 86 5% 100% 0.0000 0.0000 0.9843 8.8589 0.2949
P65B Neonate, AdmWt 1500-1999g W/O Signif GI/Vent>=96hrs, Major Complexity NO YES 20.5 6 62 9% 100% 0.0000 0.0000 1.0643 6.3858 0.2880
P65C Neonate, AdmWt 1500-1999g W/O Signif GI/Vent>=96hrs, Intermediate Comp NO YES 16.8 5 50 9% 100% 0.0000 0.0000 0.9974 4.9871 0.2773
P65D Neonate, AdmWt 1500-1999g W/O Signif GI/Vent>=96hrs, Minor Complexity NO YES 12.3 4 37 8% 100% 0.0000 0.0000 0.9922 3.9689 0.2876
P66A Neonate, AdmWt 2000-2499g W/O Signif GI/Vent>=96hrs, Extreme Comp NO YES 17.9 11 27 6% 100% 0.0000 0.0000 0.5139 5.6528 0.2804
P66B Neonate, AdmWt 2000-2499g W/O Signif GI/Vent>=96hrs, Major Complexity NO YES 12.6 4 38 8% 100% 0.0000 0.0000 0.9763 3.9052 0.2709
P66C Neonate, AdmWt 2000-2499g W/O Signif GI/Vent>=96hrs, Intermediate Comp NO YES 8.4 2 25 8% 100% 0.0000 0.0000 1.3201 2.6401 0.2724
P66D Neonate, AdmWt 2000-2499g W/O Signif GI/Vent>=96hrs, Minor Complexity NO YES 4.0 1 13 5% 100% 0.0000 0.0000 0.0000 1.2610 0.2767
P67A Neonate,AdmWt>=2500g w/o Sig GI/Vent >=96hrs,<37 Comp Wks Gest, Extr Comp NO YES 13.9 4 42 9% 100% 0.0000 0.0000 1.1175 4.4700 0.2839
P67B Neonate,AdmWt>=2500g w/o Sig GI/Vent >=96hrs, <37 Comp Wks Gest, Maj Comp NO YES 9.2 3 28 6% 100% 0.0000 0.0000 0.9947 2.9842 0.2790
P67C Neonate,AdmWt>=2500g w/o Sig GI/Vent >=96hrs, <37 Comp Wks Gest, Int Comp NO YES 7.3 2 22 9% 100% 0.0000 0.0000 1.1872 2.3744 0.2751
P67D Neonate,AdmWt>=2500g w/o Sig GI/Vent >=96hrs, <37 Comp Wks Gest, Min Comp NO YES 5.0 1 15 5% 100% 0.0000 0.0000 0.0000 1.5980 0.2792
P68A Neonate,AdmWt>=2500g w/o Sig GI/Vent >=96hrs,>=37Comp Wks Gest, Ext Comp NO YES 8.3 2 25 12% 100% 0.0000 0.0000 1.4629 2.9258 0.3063
P68B Neonate,AdmWt>=2500g w/o Sig GI/Vent >=96hrs,>=37Comp Wks Gest, Maj Comp NO YES 4.3 1 13 11% 100% 0.0000 0.0000 0.0000 1.4431 0.3086
P68C Neonate,AdmWt>=2500g w/o Sig GI/Vent >=96hrs,>=37 Comp Wks Gest, Int Comp NO YES 3.0 1 9 12% 100% 0.0000 0.0000 0.0000 1.0360 0.2864
P68D Neonate,AdmWt>=2500g w/o Sig GI/Vent >=96hrs,>=37Comp Wks Gest, Min Comp NO YES 2.1 1 6 11% 100% 0.0000 0.0000 0.0000 0.7316 0.2657
For Official Use Only-I2-A2 50
AR-DRG
V9.0 Description
Same-
Day
Pay-
ment
Bundled
ICU ALOS
1
Inlier Bounds Adjustments Price Weights
Lower
Bound
Upper
Bound
Private
Patient
Service Adj.
Paediatric
Adj. Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
Q01Z Splenectomy NO NO 6.4 2 19 15% 100% 0.0000 1.1051 1.2592 3.6234 0.3117
Q02A Blood and Immune System Disorders W Other GIs, Major Complexity NO NO 9.9 3 30 13% 134% 0.0000 0.4935 1.2273 4.1753 0.3012
Q02B Blood and Immune System Disorders W Other GIs, Minor Complexity YES NO 2.9 1 9 19% 113% 0.5876 0.0000 0.0000 1.4094 0.2340
Q60A Reticuloendothelial and Immunity Disorders, Major Complexity YES NO 5.6 1 17 9% 140% 0.2521 0.0000 0.0000 1.6539 0.3212
Q60B Reticuloendothelial and Immunity Disorders, Minor Complexity NO NO 1.1 1 3 12% 153% 0.0000 0.0000 0.0000 0.1953 0.1456
Q61A Red Blood Cell Disorders, Major Complexity YES NO 4.3 1 13 14% 135% 0.3128 0.0000 0.0000 1.1332 0.2441
Q61B Red Blood Cell Disorders, Intermediate Complexity NO NO 1.1 1 3 18% 166% 0.0000 0.0000 0.0000 0.1954 0.1491
Q61C Red Blood Cell Disorders, Minor Complexity NO NO 1.0 1 3 27% 100% 0.0000 0.0000 0.0000 0.0644 0.0515
Q62A Coagulation Disorders, Major Complexity YES NO 6.0 1 18 14% 87% 0.2253 0.0000 0.0000 1.5922 0.2654
Q62B Coagulation Disorders, Minor Complexity YES NO 2.5 1 7 13% 118% 0.1646 0.0000 0.0000 0.5398 0.1973
R01A Lymphoma and Leukaemia W Major GIs, Major Complexity NO NO 19.7 6 59 15% 100% 0.0000 0.8969 1.4052 9.3281 0.3540
R01B Lymphoma and Leukaemia W Major GIs, Minor Complexity NO NO 4.2 1 12 23% 100% 0.0000 0.0000 0.0000 2.1230 0.4142
R02A Other Neoplastic Disorders W Major GIs, Major Complexity NO NO 13.5 4 41 18% 100% 0.0000 2.1719 1.1809 6.8956 0.2636
R02B Other Neoplastic Disorders W Major GIs, Intermediate Complexity NO NO 7.5 2 23 18% 100% 0.0000 0.8166 1.6151 4.0467 0.1925
R02C Other Neoplastic Disorders W Major GIs, Minor Complexity NO NO 3.9 1 12 20% 100% 0.0000 0.0000 0.0000 1.8632 0.1975
R03A Lymphoma and Leukaemia W Other GIs, Major Complexity NO NO 30.1 10 90 16% 100% 0.0000 0.5963 1.1550 12.1460 0.3430
R03B Lymphoma and Leukaemia W Other GIs, Intermediate Complexity NO NO 11.4 3 34 14% 108% 0.0000 0.4540 1.4965 4.9436 0.2980
R03C Lymphoma and Leukaemia W Other GIs, Minor Complexity YES NO 4.9 1 15 26% 158% 0.5459 0.0000 0.0000 1.9352 0.2450
R04A Other Neoplastic Disorders W Other GIs, Major Complexity NO NO 8.0 2 24 16% 100% 0.0000 0.6911 1.5956 3.8822 0.2475
R04B Other Neoplastic Disorders W Other GIs, Minor Complexity YES NO 3.1 1 9 17% 100% 0.8653 0.0000 0.0000 1.6217 0.2865
R05A Allogeneic Bone Marrow Transplant, Age <=16 Years or Major Complexity NO NO 50.2 16 150 8% 170% 0.0000 0.0000 1.6692 26.7076 0.4709
For Official Use Only-I2-A2 51
AR-DRG
V9.0 Description
Same-
Day
Pay-
ment
Bundled
ICU ALOS
1
Inlier Bounds Adjustments Price Weights
Lower
Bound
Upper
Bound
Private
Patient
Service Adj.
Paediatric
Adj. Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
R05B Allogeneic Bone Marrow Transplant, Age >=17 Years and Minor Complexity NO NO 24.4 8 73 6% 100% 0.0000 0.1063 1.5878 12.8085 0.4271
R06A Autologous Bone Marrow Transplant, Major Complexity NO NO 22.5 15 34 8% 200% 0.0000 0.0000 0.6071 9.1058 0.3850
R06B Autologous Bone Marrow Transplant, Minor Complexity NO NO 12.6 4 38 9% 100% 0.0000 0.0000 1.2846 5.1382 0.2915
R60A Acute Leukaemia, Major Complexity NO NO 17.1 11 26 9% 117% 0.0000 0.0903 0.7108 7.9090 0.3272
R60B Acute Leukaemia, Intermediate Complexity YES NO 6.3 2 19 11% 100% 0.3294 0.1192 1.1039 2.3271 0.2974
R60C Acute Leukaemia, Minor Complexity YES NO 4.9 1 15 14% 160% 0.2365 0.0000 0.0000 1.3165 0.1345
R61A Lymphoma and Non-Acute Leukaemia, Major Complexity NO NO 10.0 3 30 10% 149% 0.0000 0.0000 1.1724 3.5173 0.2948
R61B Lymphoma and Non-Acute Leukaemia, Intermediate Complexity YES NO 4.1 1 12 11% 160% 0.2698 0.0000 0.0000 1.3922 0.2623
R61C Lymphoma and Non-Acute Leukaemia, Minor Complexity NO NO 1.1 1 3 16% 200% 0.0000 0.0000 0.0000 0.2375 0.1734
R62A Other Neoplastic Disorders, Major Complexity NO NO 9.3 3 28 9% 88% 0.0000 0.0000 1.0058 3.0173 0.2541
R62B Other Neoplastic Disorders, Intermediate Complexity YES NO 4.6 1 14 6% 95% 0.9552 0.0000 0.0000 1.2689 0.2158
R62C Other Neoplastic Disorders, Minor Complexity YES NO 2.7 1 8 11% 142% 0.4914 0.0000 0.0000 0.6664 0.1709
R63Z Chemotherapy NO NO 1.0 1 3 9% 100% 0.0000 0.0000 0.0000 0.2635 0.1736
T01A Infectious and Parasitic Diseases W GIs, Major Complexity NO NO 26.1 8 78 11% 127% 0.0000 0.7342 1.1818 10.1890 0.2969
T01B Infectious and Parasitic Diseases W GIs, Intermediate Complexity NO NO 11.8 3 36 12% 107% 0.0000 0.4195 1.2449 4.1542 0.2457
T01C Infectious and Parasitic Diseases W GIs, Minor Complexity NO NO 7.0 2 21 13% 100% 0.0000 0.3359 1.0378 2.4115 0.2350
T40Z Infectious and Parasitic Diseases W Ventilator Support NO NO 8.6 2 24 11% 100% 0.0000 0.0000 2.2731 4.5462 0.3190
T60A Septicaemia, Major Complexity NO NO 13.3 4 40 11% 115% 0.0000 0.0000 1.0489 4.1956 0.2369
T60B Septicaemia, Intermediate Complexity NO NO 7.0 2 21 11% 110% 0.0000 0.0000 0.9958 1.9916 0.2378
T60C Septicaemia, Minor Complexity NO NO 4.1 1 12 12% 115% 0.0000 0.0000 0.0000 1.0392 0.2362
T61A Postoperative Infections, Major Complexity NO NO 6.5 2 19 8% 121% 0.0000 0.0000 0.8124 1.6248 0.2003
T61B Postoperative Infections, Minor Complexity NO NO 3.3 1 10 8% 146% 0.0000 0.0000 0.0000 0.6458 0.1593
For Official Use Only-I2-A2 52
AR-DRG
V9.0 Description
Same-
Day
Pay-
ment
Bundled
ICU ALOS
1
Inlier Bounds Adjustments Price Weights
Lower
Bound
Upper
Bound
Private
Patient
Service Adj.
Paediatric
Adj. Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
T62A Fever of Unknown Origin, Major Complexity NO NO 5.5 1 17 12% 115% 0.0000 0.0000 0.0000 1.4497 0.2576
T62B Fever of Unknown Origin, Minor Complexity NO NO 2.1 1 6 12% 92% 0.0000 0.0000 0.0000 0.4932 0.2622
T63A Viral Illnesses, Major Complexity YES NO 4.3 1 13 9% 122% 0.1673 0.0000 0.0000 1.0967 0.2527
T63B Viral Illnesses, Minor Complexity NO NO 1.4 1 5 10% 117% 0.0000 0.0000 0.0000 0.3086 0.2148
T64A Other Infectious and Parasitic Diseases, Major Complexity NO NO 17.5 11 26 7% 100% 0.0000 0.0000 0.5699 6.2687 0.2699
T64B Other Infectious and Parasitic Diseases, Intermediate Complexity NO NO 9.2 3 28 8% 105% 0.0000 0.0000 0.8438 2.5313 0.1983
T64C Other Infectious and Parasitic Diseases, Minor Complexity YES NO 4.9 1 15 10% 100% 0.2484 0.0000 0.0000 1.1371 0.1884
U40A Mental Health Treatment W ECT, Sameday, Major Complexity NO NO 1.0 1 1 18% 100% 0.0000 0.0000 0.0000 0.1913 0.0000
U40B Mental Health Treatment W ECT, Sameday, Minor Complexity NO NO 1.0 1 1 12% 100% 0.0000 0.0000 0.0000 0.1587 0.0000
U60Z Mental Health Treatment W/O ECT, Sameday NO NO 1.0 1 1 14% 200% 0.0000 0.0000 0.0000 0.1008 0.0000
U61A Schizophrenia Disorders, Major Complexity NO NO 44.7 29 67 2% 100% 0.0000 0.0000 0.3390 9.8306 0.1841
U61B Schizophrenia Disorders, Minor Complexity NO NO 19.7 13 30 1% 100% 0.0000 0.0000 0.3496 4.5444 0.1849
U62A Paranoia and Acute Psychotic Disorders, Major Complexity NO NO 22.4 14 34 2% 100% 0.0000 0.0000 0.4368 6.1148 0.2051
U62B Paranoia and Acute Psychotic Disorders, Minor Complexity NO NO 11.1 7 17 2% 191% 0.0000 0.0000 0.4135 2.8943 0.1968
U63A Major Affective Disorders, Major Complexity NO NO 27.7 18 42 2% 184% 0.0000 0.0000 0.3946 7.1023 0.2083
U63B Major Affective Disorders, Minor Complexity NO NO 12.4 8 19 2% 154% 0.0000 0.0000 0.4219 3.3753 0.2007
U64A Other Affective and Somatoform Disorders, Major Complexity NO NO 12.9 8 19 3% 170% 0.0000 0.0000 0.4270 3.4157 0.1924
U64B Other Affective and Somatoform Disorders, Minor Complexity NO NO 5.9 3 9 2% 179% 0.0000 0.0000 0.5108 1.5323 0.2028
U65A Anxiety Disorders, Major Complexity NO NO 8.5 5 13 5% 159% 0.0000 0.0000 0.5037 2.5186 0.2180
U65B Anxiety Disorders, Minor Complexity NO NO 3.2 2 5 6% 182% 0.0000 0.0000 0.4449 0.8898 0.2290
U66A Eating and Obsessive-Compulsive Disorders, Major Complexity NO NO 23.9 15 36 3% 110% 0.0000 0.0000 0.5078 7.6167 0.2479
For Official Use Only-I2-A2 53
AR-DRG
V9.0 Description
Same-
Day
Pay-
ment
Bundled
ICU ALOS
1
Inlier Bounds Adjustments Price Weights
Lower
Bound
Upper
Bound
Private
Patient
Service Adj.
Paediatric
Adj. Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
U66B Eating and Obsessive-Compulsive Disorders, Minor Complexity NO NO 12.9 8 19 3% 118% 0.0000 0.0000 0.5650 4.5200 0.2793
U67A Personality Disorders and Acute Reactions, Major Complexity NO NO 11.2 7 17 3% 176% 0.0000 0.0000 0.4361 3.0528 0.2006
U67B Personality Disorders and Acute Reactions, Minor Complexity NO NO 4.8 3 7 2% 181% 0.0000 0.0000 0.4452 1.3357 0.2165
U68A Childhood Mental Disorders, Major Complexity NO NO 9.8 6 15 2% 134% 0.0000 0.0000 0.5883 3.5299 0.2740
U68B Childhood Mental Disorders, Minor Complexity NO NO 5.4 3 8 2% 139% 0.0000 0.0000 0.6479 1.9438 0.2625
V60A Alcohol Intoxication and Withdrawal, Major Complexity NO NO 3.5 2 5 6% 100% 0.0000 0.0000 0.4459 0.8919 0.2105
V60B Alcohol Intoxication and Withdrawal, Minor Complexity NO NO 1.3 1 2 12% 85% 0.0000 0.0000 0.0000 0.1867 0.1345
V61A Drug Intoxication and Withdrawal, Major Complexity NO NO 7.3 4 11 3% 160% 0.0000 0.0000 0.4692 1.8769 0.2146
V61B Drug Intoxication and Withdrawal, Minor Complexity NO NO 3.3 2 5 4% 100% 0.0000 0.0000 0.3999 0.7998 0.1871
V62A Alcohol Use and Dependence, Major Complexity NO NO 8.7 5 13 4% 100% 0.0000 0.0000 0.4144 2.0721 0.2331
V62B Alcohol Use and Dependence, Minor Complexity NO NO 4.3 2 6 3% 100% 0.0000 0.0000 0.4317 0.8634 0.1574
V63Z Opioid Use and Dependence NO NO 5.0 3 7 4% 100% 0.0000 0.0000 0.4131 1.2394 0.1858
V64A Other Drug Use and Dependence, Major Complexity NO NO 8.9 5 13 3% 100% 0.0000 0.0000 0.3744 1.8720 0.1808
V64B Other Drug Use and Dependence, Minor Complexity NO NO 3.9 2 6 3% 100% 0.0000 0.0000 0.4528 0.9056 0.1849
W01A Vent, Trac & Cran Procs for Mult Sig Trauma, Major Complexity NO NO 30.4 10 91 12% 100% 0.0000 3.3569 2.0923 24.2803 0.3818
W01B Vent, Trac & Cran Procs for Mult Sig Trauma, Intermediate Complexity NO NO 18.5 6 55 12% 100% 0.0000 1.7842 2.2344 15.1907 0.3576
W01C Vent, Trac & Cran Procs for Mult Sig Trauma, Minor Complexity NO NO 9.9 3 30 12% 100% 0.0000 1.2213 2.3423 8.2483 0.4157
W02A Hip, Femur and Lower Limb Procedures for Multiple Sig Trauma, Major Complexity NO NO 21.9 7 66 18% 100% 0.0000 2.0828 1.3196 11.3199 0.3157
W02B Hip, Femur and Lower Limb Procedures for Multiple Sig Trauma, Minor Complexity NO NO 12.2 4 36 20% 100% 0.0000 1.3152 0.9970 5.3031 0.2727
W03Z Abdominal Procedures for Multiple Significant Trauma NO NO 10.0 3 30 14% 100% 0.0000 0.9635 1.3674 5.0656 0.3690
W04A Multiple Significant Trauma W Other GIs, Major Complexity NO NO 18.1 6 54 15% 100% 0.0000 1.5320 1.2862 9.2495 0.3433
For Official Use Only-I2-A2 54
AR-DRG
V9.0 Description
Same-
Day
Pay-
ment
Bundled
ICU ALOS
1
Inlier Bounds Adjustments Price Weights
Lower
Bound
Upper
Bound
Private
Patient
Service Adj.
Paediatric
Adj. Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
W04B Multiple Significant Trauma W Other GIs, Minor Complexity NO NO 8.2 2 24 15% 100% 0.0000 1.1902 1.6640 4.5182 0.3321
W60Z Multiple Sig Trauma, Transferred to Acute Facility <5 Days NO NO 1.6 1 4 24% 100% 0.0000 0.0000 0.0000 1.2700 0.0000
W61A Multiple Significant Trauma W/O GIs, Major Complexity NO NO 13.6 4 41 9% 100% 0.0000 0.0000 0.9663 3.8654 0.2566
W61B Multiple Significant Trauma W/O GIs, Minor Complexity NO NO 5.4 1 16 10% 116% 0.0000 0.0000 0.0000 1.5151 0.2660
X02A Microvascular Tissue Transfer and Skin Grafts for Injuries to Hand, Major Comp NO NO 7.8 2 23 30% 100% 0.0000 0.6738 1.9798 4.6335 0.3594
X02B Microvascular Tissue Transfer and Skin Grafts for Injuries to Hand, Minor Comp NO NO 1.7 1 5 31% 120% 0.0000 0.0000 0.0000 0.9898 0.4795
X04A Other Procedures for Injuries to Lower Limb, Major Complexity NO NO 10.7 3 32 12% 100% 0.0000 0.6868 1.0974 3.9789 0.2421
X04B Other Procedures for Injuries to Lower Limb, Minor Complexity YES NO 2.3 1 7 16% 105% 0.4724 0.0000 0.0000 1.0546 0.2686
X05A Other Procedures for Injuries to Hand, Major Complexity NO NO 3.2 1 10 13% 110% 0.0000 0.0000 0.0000 1.6189 0.2874
X05B Other Procedures for Injuries to Hand, Minor Complexity NO NO 1.3 1 4 21% 92% 0.0000 0.0000 0.0000 0.6025 0.2086
X06A Other Procedures for Other Injuries, Major Complexity NO NO 12.3 4 37 10% 144% 0.0000 0.7558 1.0038 4.7711 0.2500
X06B Other Procedures for Other Injuries, Intermediate Complexity NO NO 4.2 1 13 15% 100% 0.0000 0.0000 0.0000 1.6410 0.2501
X06C Other Procedures for Other Injuries, Minor Complexity NO NO 1.8 1 5 13% 92% 0.0000 0.0000 0.0000 0.8266 0.2964
X07A Skin Grafts for Injuries Excluding Hand, Major Complexity NO NO 23.5 7 70 12% 100% 0.0000 0.8070 1.0971 8.4865 0.3148
X07B Skin Grafts for Injuries Excluding Hand, Intermediate Complexity NO NO 9.3 3 28 9% 100% 0.0000 0.5292 0.9965 3.5186 0.2653
X07C Skin Grafts for Injuries Excluding Hand, Minor Complexity NO NO 4.5 1 13 10% 100% 0.0000 0.0000 0.0000 1.8226 0.2987
X40A Injuries, Poisoning and Toxic Effects of Drugs W Ventilator Support, Major Comp NO NO 6.2 2 19 7% 100% 0.0000 0.0000 1.6447 3.2893 0.2651
X40B Injuries, Poisoning and Toxic Effects of Drugs W Ventilator Support, Minor Comp NO NO 3.2 1 9 9% 100% 0.0000 0.0000 0.0000 1.5341 0.2557
X60A Injuries, Major Complexity YES NO 4.8 1 14 11% 100% 0.1730 0.0000 0.0000 1.0556 0.2134
X60B Injuries, Minor Complexity NO NO 1.2 1 4 18% 158% 0.0000 0.0000 0.0000 0.2105 0.1570
X61A Allergic Reactions, Major Complexity NO NO 1.8 1 5 16% 115% 0.0000 0.0000 0.0000 0.4226 0.2805
For Official Use Only-I2-A2 55
AR-DRG
V9.0 Description
Same-
Day
Pay-
ment
Bundled
ICU ALOS
1
Inlier Bounds Adjustments Price Weights
Lower
Bound
Upper
Bound
Private
Patient
Service Adj.
Paediatric
Adj. Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
X61B Allergic Reactions, Minor Complexity NO NO 1.0 1 3 12% 100% 0.0000 0.0000 0.0000 0.1187 0.0823
X62A Poisoning/Toxic Effects of Drugs and Other Substances, Major Complexity YES NO 4.4 1 13 7% 150% 0.1461 0.0000 0.0000 1.1001 0.2388
X62B Poisoning/Toxic Effects of Drugs and Other Substances, Minor Complexity NO NO 1.3 1 4 9% 108% 0.0000 0.0000 0.0000 0.2546 0.1788
X63A Sequelae of Treatment, Major Complexity YES NO 5.7 1 17 10% 137% 0.2030 0.0000 0.0000 1.3861 0.2261
X63B Sequelae of Treatment, Minor Complexity YES NO 2.3 1 7 13% 100% 0.1401 0.0000 0.0000 0.5001 0.1535
X64A Other Injuries, Poisonings and Toxic Effects, Major Complexity NO NO 5.9 1 18 11% 100% 0.0000 0.0000 0.0000 1.4019 0.2278
X64B Other Injuries, Poisonings and Toxic Effects, Intermediate Complexity NO NO 1.7 1 5 12% 144% 0.0000 0.0000 0.0000 0.3569 0.2442
X64C Other Injuries, Poisonings and Toxic Effects, Minor Complexity NO NO 1.1 1 3 16% 118% 0.0000 0.0000 0.0000 0.1774 0.1329
Y01Z Vent >=96hrs or Trach for Burns or GIs for Severe Full Thickness Burns NO NO 25.5 18 164 7% 100% 0.0000 4.7871 2.1714 43.8732 0.9659
Y02A Skin Grafts for Other Burns, Major Complexity NO NO 16.8 11 25 6% 100% 0.0000 0.6290 0.7834 9.2468 0.4655
Y02B Skin Grafts for Other Burns, Intermediate Complexity NO NO 6.4 2 19 4% 100% 0.0000 0.3397 1.7253 3.7903 0.3787
Y02C Skin Grafts for Other Burns, Minor Complexity NO NO 2.2 1 7 9% 100% 0.0000 0.0000 0.0000 1.0523 0.5357
Y03A Other GIs for Other Burns, Major Complexity NO NO 7.8 2 23 7% 100% 0.0000 0.3999 1.4028 3.2055 0.2847
Y03B Other GIs for Other Burns, Minor Complexity NO NO 1.7 1 5 10% 100% 0.0000 0.0000 0.0000 0.7770 0.3662
Y60Z Burns, Transferred to Acute Facility <5 Days NO NO 1.3 1 4 4% 100% 0.0000 0.0000 0.0000 0.4412 0.0000
Y61Z Severe Burns NO NO 4.3 1 10 4% 143% 0.0000 0.0000 0.0000 0.9844 0.3236
Y62A Other Burns, Major Complexity YES NO 5.8 1 17 4% 123% 0.2349 0.0000 0.0000 1.6723 0.3184
Y62B Other Burns, Minor Complexity YES NO 2.2 1 7 5% 149% 0.1186 0.0000 0.0000 0.5540 0.2667
Z01A Other Contacts W Health Services W GIs, Major Complexity NO NO 9.4 3 28 15% 100% 0.0000 0.6618 1.1462 4.1005 0.2082
Z01B Other Contacts W Health Services W GIs, Minor Complexity NO NO 1.2 1 4 38% 100% 0.0000 0.0000 0.0000 0.6664 0.2674
Z40Z Other Contacts W Health Services W Endoscopy NO NO 1.1 1 3 39% 175% 0.0000 0.0000 0.0000 0.2783 0.0944
Z61A Signs and Symptoms, Major Complexity YES NO 5.7 1 17 9% 124% 0.2077 0.0000 0.0000 1.3014 0.2151
For Official Use Only-I2-A2 56
AR-DRG
V9.0 Description
Same-
Day
Pay-
ment
Bundled
ICU ALOS
1
Inlier Bounds Adjustments Price Weights
Lower
Bound
Upper
Bound
Private
Patient
Service Adj.
Paediatric
Adj. Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
Z61B Signs and Symptoms, Minor Complexity YES NO 2.4 1 7 15% 114% 0.2176 0.0000 0.0000 0.5188 0.2109
Z63A Other Follow Up After Surgery or Medical Care, Major Complexity NO NO 9.3 3 28 8% 167% 0.0000 0.0000 0.7754 2.3262 0.2050
Z60A Rehabilitation, Major Complexity NO NO 0.0 0 0 0% 0% 0.0000 0.0000 0.0000 0.0000 0.0000
Z60B Rehabilitation, Minor Complexity NO NO 0.0 0 0 0% 0% 0.0000 0.0000 0.0000 0.0000 0.0000
Z63B Other Follow Up After Surgery or Medical Care, Minor Complexity NO NO 3.4 1 10 16% 80% 0.0000 0.0000 0.0000 0.6261 0.1672
Z64A Other Factors Influencing Health Status, Major Complexity NO NO 6.2 2 19 9% 100% 0.0000 0.0000 0.9028 1.8057 0.1871
Z64B Other Factors Influencing Health Status, Minor Complexity YES NO 4.2 1 13 49% 125% 0.1991 0.0000 0.0000 0.5996 0.1876
Z65Z Congenital Anomalies and Problems Arising from Neonatal Period NO NO 2.5 1 12 14% 116% 0.0000 0.0000 0.0000 0.6250 0.3216
Z66Z Sleep Disorders NO NO 2.3 1 8 11% 94% 0.0000 0.0000 0.0000 0.4101 0.1843
For Official Use Only-I2-A2 57
5.2 Section 2: ICD-10-AM 10th edition Procedure Codes Eligible for
Radiotherapy Adjustments
The following table lists the ICD-10-AM 10th edition procedure codes that are eligible for a
radiotherapy adjustment. This is from the 2018 19 National Efficient Price Determination, published
by IHPA.
Procedure
Codes Description
15000-00 Radiation treatment, superficial, 1 field
15003-00 Radiation treatment, superficial, >= 2 fields
15100-00 Radiation treatment, orthovoltage, 1 field
15103-00 Radiation treatment, orthovoltage, >= 2 fields
15224-00 Radiation treatment, megavoltage, 1 field, single modality linear accelerator
15239-00 Radiation treatment, megavoltage, >= 2 fields, single modality linear accelerator
15254-00 Radiation treatment, megavoltage, 1 field, dual modality linear accelerator
15269-00 Radiation treatment, megavoltage, >= 2 fields, dual modality linear accelerator
15600-00 Stereotactic radiation treatment, single dose
15600-01 Stereotactic radiation treatment, fractionated
15600-02 Hemi body irradiation
15600-03 Total body irradiation
15600-04 Total skin irradiation
15303-00 Brachytherapy, intrauterine, low dose rate
15304-00 Brachytherapy, intrauterine, high dose rate
15311-00 Brachytherapy, intravaginal, low dose rate
15312-00 Brachytherapy, intravaginal, high dose rate
15319-00 Brachytherapy, combined intrauterine and intravaginal, low dose rate
15320-00 Brachytherapy, combined intrauterine and intravaginal, high dose rate
90764-00 Brachytherapy, intracavitary, low dose rate
90764-01 Brachytherapy, intracavitary, high dose rate
15327-00 Brachytherapy with implantation of removable single plane, low dose rate
15327-01 Brachytherapy with implantation of removable single plane, pulsed dose rate
15327-02 Brachytherapy with implantation of removable multiple planes or volume implant, low dose rate
15327-03 Brachytherapy with implantation of removable multiple planes or volume implant, pulsed dose rate
15327-04 Brachytherapy with implantation of permanent implant, < 10 sources
15327-05 Brachytherapy with implantation of permanent implant, >= 10 sources
15327-06 Brachytherapy with implantation of removable single plane, high dose rate
15327-07 Brachytherapy with implantation of removable multiple planes or volume implant, high dose rate
15338-00 Brachytherapy, prostate
15360-00 Brachytherapy, intravascular
15339-00 Removal of sealed radioactive source
15012-00 Brachytherapy, eye
90766-00 Brachytherapy using surface applicators, other sites
16003-00 Administration of a therapeutic dose of Yttrium 90
16009-00 Administration of a therapeutic dose of Iodine 131
For Official Use Only-I2-A2 58
Procedure
Codes Description
16012-00 Administration of a therapeutic dose of Phosphorous 32
16015-00 Administration of a therapeutic dose of Strontium 89
16018-00 Administration of a therapeutic dose of 153 SM-Lexidronan
90960-00 Administration of a therapeutic dose of other unsealed radioisotope
15342-00 Construction and application of radioactive surface mould
15351-00 Construction and application of eye applicator
90765-00 Construction and fitting of immobilisation device, simple
90765-01 Construction and fitting of immobilisation device, intermediate
90765-02 Construction and fitting of immobilisation device, complex
90765-03 Construction and fitting of customised blocks
90765-04 Construction and fitting of treatment accessories
15500-00 Radiation field setting using simulator, simple
15503-00 Radiation field setting using simulator, intermediate
15506-00 Radiation field setting using simulator, complex
15506-01 Radiation field setting using dedicated CT scanner
15506-02 Radiation field setting for intensity modulated radiation therapy [IMRT]
15509-00 Radiation field setting using diagnostic x-ray unit
15550-00 Radiation field setting for three dimensional conformal radiation therapy [3DCRT]
15518-00 Dosimetry by CT interfacing computer, simple
15521-00 Dosimetry by CT interfacing computer, intermediate
15524-00 Dosimetry by CT interfacing computer, complex
15524-01 Dosimetry by CT interfacing computer for intensity modulated radiation therapy [IMRT]
15527-00 Dosimetry by non-CT interfacing computer, simple
15530-00 Dosimetry by non-CT interfacing computer, intermediate
15533-00 Dosimetry by non-CT interfacing computer, complex
15536-00 Brachytherapy planning, simple
15536-01 Brachytherapy planning, intermediate
15536-02 Brachytherapy planning, complex
15539-00 Brachytherapy planning, prostate
15541-00 Brachytherapy planning, intravascular
15556-00 Dosimetry by CT interfacing computer for three dimensional conformal radiation therapy [3DCRT]
15556-01 Dosimetry by non-CT interfacing computer for three dimensional conformal radiation therapy [3DCRT]
37217-01 Implantation of fiducial markers
For Official Use Only-I2-A2 59
5.3 Section 3: ICD-10-AM 10th edition Procedure Codes Eligible for Dialysis
Adjustment
The following table lists the ICD-10-AM 10th edition procedure codes that are eligible for a dialysis
adjustment. Note that a patient is only eligible for a dialysis adjustment if he or she is assigned to a
procedure code listed in the following table and is not assigned to AR-DRG L61Z (Haemodialysis) or
L68Z (Peritoneal Dialysis).
This table is from the 2018 19 National Efficient Price Determination published by IHPA.
Procedure
Codes Description
13100-00 Haemodialysis
13100-01 Intermittent haemofiltration
13100-02 Continuous haemofiltration
13100-03 Intermittent haemodiafiltration
13100-04 Continuous haemodiafiltration
13100-05 Haemoperfusion
13100-06 Peritoneal dialysis, short term
13100-07 Intermittent peritoneal dialysis, long term
13100-08 Continuous peritoneal dialysis, long term
For Official Use Only-I2-A2 60
5.4 Section 4: 2018 19 AN-SNAP v4.0 price weights
The following table lists the price weights for admitted subacute and non-acute patients using AN-SNAP V4.0
This table is from the 2018 19 National Efficient Price Determination published by IHPA
AN-
SNAP
V4.0
Care Type Episode Type Description Same Day ALOS
Inlier Bounds Price Weights
Lower
Bound
Upper
Bound
Same
Day
Short-Stay
Outlier Per
Diem
Inlier
Long-
Stay
Outlier
Per Diem
4AZ1 Rehabilitation Admitted Adult Rehabilitation
Weighted FIM motor score 13-18, Brain,
Spine, MMT, Age >= 49 NO 56.9 42 84 0.0000 0.3756 15.7757 0.2635
4AZ2 Rehabilitation Admitted Adult Rehabilitation
Weighted FIM motor score 13-18, Brain,
Spine, MMT, Age <= 48 NO 83.9 58 108 0.0000 0.3997 23.1826 0.2830
4AZ3 Rehabilitation Admitted Adult Rehabilitation
Weighted FIM motor score 13-18, All other
impairments, Age >= 65 NO 27.9 19 42 0.0000 0.3435 6.5265 0.2038
4AZ4 Rehabilitation Admitted Adult Rehabilitation
Weighted FIM motor score 13-18, All other
impairments, Age <= 64 NO 42.0 30 66 0.0000 0.3618 10.8537 0.2037
4AA1 Rehabilitation Admitted Adult Rehabilitation
Stroke, weighted FIM motor 51-91, FIM
cognition 29-35 NO 14.2 10 23 0.0000 0.3037 3.0371 0.1619
4AA2 Rehabilitation Admitted Adult Rehabilitation
Stroke, weighted FIM motor 51-91, FIM
cognition 19-28 NO 18.2 12 28 0.0000 0.3204 3.8454 0.1828
4AA3 Rehabilitation Admitted Adult Rehabilitation
Stroke, weighted FIM motor 51-91, FIM
cognition 5-18 NO 28.2 18 43 0.0000 0.3335 6.0033 0.2030
4AA4 Rehabilitation Admitted Adult Rehabilitation
Stroke, weighted FIM motor 36-50, Age >=
68 NO 28.2 17 41 0.0000 0.3437 5.8428 0.1967
4AA5 Rehabilitation Admitted Adult Rehabilitation
Stroke, weighted FIM motor 36-50, Age <=
67 NO 36.8 23 56 0.0000 0.3674 8.4512 0.2085
4AA6 Rehabilitation Admitted Adult Rehabilitation
Stroke, weighted FIM motor 19-35, Age >=
68 NO 33.8 22 51 0.0000 0.3457 7.6059 0.2173
4AA7 Rehabilitation Admitted Adult Rehabilitation
Stroke, weighted FIM motor 19-35, Age <=
67 NO 49.7 31 68 0.0000 0.3740 11.5945 0.2446
4AB1 Rehabilitation Admitted Adult Rehabilitation
Brain dysfunction, weighted FIM motor 71-
91, FIM cognition 26-35 NO 13.9 8 20 0.0000 0.3799 3.0396 0.2211
4AB2 Rehabilitation Admitted Adult Rehabilitation
Brain dysfunction, weighted FIM motor 71-
91, FIM cognition 5-25 NO 23.8 13 31 0.0000 0.4082 5.3061 0.2529
For Official Use Only-I2-A2 61
AN-
SNAP
V4.0
Care Type Episode Type Description Same Day ALOS
Inlier Bounds Price Weights
Lower
Bound
Upper
Bound
Same
Day
Short-Stay
Outlier Per
Diem
Inlier
Long-
Stay
Outlier
Per Diem
4AB3 Rehabilitation Admitted Adult Rehabilitation
Brain dysfunction, weighted FIM motor 41-
70, FIM cognition 26-35 NO 20.2 13 30 0.0000 0.3298 4.2875 0.2379
4AB4 Rehabilitation Admitted Adult Rehabilitation
Brain dysfunction, weighted FIM motor 41-
70, FIM cognition 17-25 NO 22.9 16 38 0.0000 0.3226 5.1612 0.1969
4AB5 Rehabilitation Admitted Adult Rehabilitation
Brain dysfunction, weighted FIM motor 41-
70, FIM cognition 5-16 NO 33.8 21 50 0.0000 0.3634 7.6312 0.2223
4AB6 Rehabilitation Admitted Adult Rehabilitation
Brain dysfunction, weighted FIM motor 29-
40 NO 35.0 21 48 0.0000 0.3451 7.2475 0.2340
4AB7 Rehabilitation Admitted Adult Rehabilitation
Brain dysfunction, weighted FIM motor 19-
28 NO 42.3 26 60 0.0000 0.3652 9.4951 0.2242
4AC1 Rehabilitation Admitted Adult Rehabilitation
Neurological conditions, weighted FIM
motor 62-91 NO 15.6 10 24 0.0000 0.3136 3.1365 0.1679
4AC2 Rehabilitation Admitted Adult Rehabilitation
Neurological conditions, weighted FIM
motor 43-61 NO 22.8 15 35 0.0000 0.2974 4.4616 0.1847
4AC3 Rehabilitation Admitted Adult Rehabilitation
Neurological conditions, weighted FIM
motor 19-42 NO 28.8 21 45 0.0000 0.2961 6.2181 0.1923
4AD1 Rehabilitation Admitted Adult Rehabilitation
Spinal cord dysfunction, Age >= 50,
weighted FIM motor 42-91 NO 33.3 22 51 0.0000 0.3735 8.2170 0.2354
4AD2 Rehabilitation Admitted Adult Rehabilitation
Spinal cord dysfunction, Age >= 50,
weighted FIM motor 19-41 NO 51.4 32 69 0.0000 0.3761 12.0348 0.2467
4AD3 Rehabilitation Admitted Adult Rehabilitation
Spinal cord dysfunction, Age <= 49,
weighted FIM motor 34-91 NO 36.8 21 56 0.0000 0.4638 9.7397 0.2870
4AD4 Rehabilitation Admitted Adult Rehabilitation
Spinal cord dysfunction, Age <= 49,
weighted FIM motor 19-33 NO 61.1 50 97 0.0000 0.3458 17.2906 0.1912
4AE1 Rehabilitation Admitted Adult Rehabilitation
Amputation of limb, Age >= 54, weighted
FIM motor 68-91 NO 23.0 15 35 0.0000 0.3272 4.9076 0.1812
4AE2 Rehabilitation Admitted Adult Rehabilitation
Amputation of limb, Age >= 54, weighted
FIM motor 31-67 NO 27.1 18 41 0.0000 0.3269 5.8850 0.2006
4AE3 Rehabilitation Admitted Adult Rehabilitation
Amputation of limb, Age >= 54, weighted
FIM motor 19-30 NO 26.0 17 39 0.0000 0.3706 6.2995 0.1894
4AE4 Rehabilitation Admitted Adult Rehabilitation
Amputation of limb, Age <= 53, weighted
FIM motor 19-91 NO 26.1 19 40 0.0000 0.3366 6.3961 0.1932
4AH1 Rehabilitation Admitted Adult Rehabilitation
Orthopaedic conditions, fractures, weighted
FIM motor 49-91, FIM cognition 33-35 NO 14.1 9 22 0.0000 0.3087 2.7779 0.1640
4AH2 Rehabilitation Admitted Adult Rehabilitation
Orthopaedic conditions, fractures, weighted
FIM motor 49-91, FIM cognition 5-32 NO 18.9 12 29 0.0000 0.2975 3.5698 0.1716
4AH3 Rehabilitation Admitted Adult Rehabilitation
Orthopaedic conditions, fractures, weighted
FIM motor 38-48 NO 22.4 15 35 0.0000 0.2924 4.3859 0.1703
4AH4 Rehabilitation Admitted Adult Rehabilitation
Orthopaedic conditions, fractures, weighted
FIM motor 19-37 NO 24.0 16 37 0.0000 0.3067 4.9078 0.1748
4A21 Rehabilitation Admitted Adult Rehabilitation
Orthopaedic conditions, all other (including
replacements), weighted FIM motor 68-91 NO 11.0 7 17 0.0000 0.2906 2.0339 0.1669
For Official Use Only-I2-A2 62
AN-
SNAP
V4.0
Care Type Episode Type Description Same Day ALOS
Inlier Bounds Price Weights
Lower
Bound
Upper
Bound
Same
Day
Short-Stay
Outlier Per
Diem
Inlier
Long-
Stay
Outlier
Per Diem
4A22 Rehabilitation Admitted Adult Rehabilitation
Orthopaedic conditions, all other (including
replacements), weighted FIM motor 50-67 NO 13.4 9 21 0.0000 0.2919 2.6270 0.1722
4A23 Rehabilitation Admitted Adult Rehabilitation
Orthopaedic conditions, all other (including
replacements), weighted FIM motor 19-49 NO 19.5 13 30 0.0000 0.2910 3.7828 0.1813
4A31 Rehabilitation Admitted Adult Rehabilitation
Cardiac, Pain syndromes, Pulmonary,
weighted FIM motor 72-91 NO 10.9 7 16 0.0000 0.3027 2.1187 0.1747
4A32 Rehabilitation Admitted Adult Rehabilitation
Cardiac, Pain syndromes, Pulmonary,
weighted FIM motor 55-71 NO 14.7 9 22 0.0000 0.3099 2.7892 0.1723
4A33 Rehabilitation Admitted Adult Rehabilitation
Cardiac, Pain syndromes, Pulmonary,
weighted FIM motor 34-54 NO 18.1 12 29 0.0000 0.3077 3.6929 0.1694
4A34 Rehabilitation Admitted Adult Rehabilitation
Cardiac, Pain syndromes, Pulmonary,
weighted FIM motor 19-33 NO 20.5 14 34 0.0000 0.3088 4.3232 0.1579
4AP1 Rehabilitation Admitted Adult Rehabilitation
Major Multiple Trauma, weighted FIM motor
19-91 NO 29.2 19 44 0.0000 0.3691 7.0131 0.2604
4AR1 Rehabilitation Admitted Adult Rehabilitation Reconditioning, weighted FIM motor 67-91 NO 13.3 8 20 0.0000 0.3181 2.5444 0.1741
4AR2 Rehabilitation Admitted Adult Rehabilitation
Reconditioning, weighted FIM motor 50-66,
FIM cognition 26-35 NO 15.8 11 25 0.0000 0.3022 3.3237 0.1748
4AR3 Rehabilitation Admitted Adult Rehabilitation
Reconditioning, weighted FIM motor 50-66,
FIM cognition 5-25 NO 17.4 11 27 0.0000 0.3264 3.5908 0.1889
4AR4 Rehabilitation Admitted Adult Rehabilitation
Reconditioning, weighted FIM motor 34-49,
FIM cognition 31-35 NO 18.7 12 29 0.0000 0.3596 4.3151 0.2281
4AR5 Rehabilitation Admitted Adult Rehabilitation
Reconditioning, weighted FIM motor 34-49,
FIM cognition 5-30 NO 20.1 13 31 0.0000 0.3256 4.2325 0.1880
4AR6 Rehabilitation Admitted Adult Rehabilitation Reconditioning, weighted FIM motor 19-33 NO 21.7 14 33 0.0000 0.3488 4.8832 0.2078
4A91 Rehabilitation Admitted Adult Rehabilitation
All other impairments, weighted FIM motor
55-91 NO 14.9 10 24 0.0000 0.3217 3.2170 0.1864
4A92 Rehabilitation Admitted Adult Rehabilitation
All other impairments, weighted FIM motor
33-54 NO 22.1 13 32 0.0000 0.3408 4.4300 0.2058
4A93 Rehabilitation Admitted Adult Rehabilitation
All other impairments, weighted FIM motor
19-32 NO 26.2 16 38 0.0000 0.3335 5.3361 0.2029
4J01 Rehabilitation Admitted Adult Rehabilitation Adult Same-Day Rehabilitation YES 1.0 0 0 0.0978 0.0000 0.0000 0.0000
4F01 Rehabilitation Admitted Paed Rehabilitation Rehabilitation, Age <= 3 NO 17.3 14 0 0.0000 0.7350 0.0000 0.0000
4F02 Rehabilitation Admitted Paed Rehabilitation
Rehabilitation, Age >= 4, Spinal cord
dysfunction NO 32.6 29 0 0.0000 0.4715 0.0000 0.0000
4F03 Rehabilitation Admitted Paed Rehabilitation Rehabilitation, Age >= 4, Brain dysfunction NO 24.7 19 0 0.0000 0.5787 0.0000 0.0000
4F04 Rehabilitation Admitted Paed Rehabilitation
Rehabilitation, Age >= 4, Neurological
conditions NO 11.5 10 0 0.0000 0.4759 0.0000 0.0000
For Official Use Only-I2-A2 63
AN-
SNAP
V4.0
Care Type Episode Type Description Same Day ALOS
Inlier Bounds Price Weights
Lower
Bound
Upper
Bound
Same
Day
Short-Stay
Outlier Per
Diem
Inlier
Long-
Stay
Outlier
Per Diem
4F05 Rehabilitation Admitted Paed Rehabilitation
Rehabilitation, Age >= 4, All other
impairments NO 17.4 11 27 0.0000 0.5908 6.4993 0.4409
4O01 Rehabilitation Admitted Paed Rehabilitation Paediatric Same-Day Rehabilitation YES 1.0 0 0 0.3414 0.0000 0.0000 0.0000
4BS1 Palliative Care Admitted Adult Palliative Care Stable phase, RUG-ADL 4-5 NO 7.1 5 12 0.0000 0.3395 1.6977 0.1981
4BS2 Palliative Care Admitted Adult Palliative Care Stable phase, RUG-ADL 6-16 NO 8.1 5 13 0.0000 0.3827 1.9135 0.2148
4BS3 Palliative Care Admitted Adult Palliative Care Stable phase, RUG-ADL 17-18 NO 7.3 5 12 0.0000 0.3529 1.7644 0.2225
4BU1 Palliative Care Admitted Adult Palliative Care
Unstable phase, First Phase in Episode,
RUG-ADL 4-13 NO 3.2 1 5 0.0000 0.0000 0.4865 0.2855
4BU2 Palliative Care Admitted Adult Palliative Care
Unstable phase, First Phase in Episode,
RUG-ADL 14-18 NO 2.8 1 5 0.0000 0.0000 0.4130 0.2563
4BU3 Palliative Care Admitted Adult Palliative Care
Unstable phase, Not first Phase in Episode,
RUG-ADL 4-5 NO 2.5 1 4 0.0000 0.0000 0.4816 0.3016
4BU4 Palliative Care Admitted Adult Palliative Care
Unstable phase, Not first Phase in Episode,
RUG-ADL 6-18 NO 2.0 1 4 0.0000 0.0000 0.4383 0.2431
4BD1 Palliative Care Admitted Adult Palliative Care Deteriorating phase, RUG-ADL 4-14 NO 5.3 3 9 0.0000 0.0000 1.2082 0.2030
4BD2 Palliative Care Admitted Adult Palliative Care
Deteriorating phase, RUG-ADL 15-18, Age
>= 75 NO 4.3 2 7 0.0000 0.4407 0.8814 0.2186
4BD3 Palliative Care Admitted Adult Palliative Care
Deteriorating phase, RUG-ADL 15-18, Age
55-74 NO 4.8 2 7 0.0000 0.4543 0.9085 0.2362
4BD4 Palliative Care Admitted Adult Palliative Care
Deteriorating phase, RUG-ADL 15-18, Age
<= 54 NO 5.1 3 9 0.0000 0.3930 1.1791 0.2292
4BT1 Palliative Care Admitted Adult Palliative Care Terminal phase NO 2.4 1 4 0.0000 0.0000 0.5015 0.2599
4K01 Palliative Care Admitted Adult Palliative Care Adult Same-Day Palliative Care YES 1.0 0 0 0.1483 0.0000 0.0000 0.0000
4CH1 GEM Admitted GEM FIM motor 57-91 with Delirium or Dementia NO 21.0 14 33 0.0000 0.2680 3.7519 0.1624
4CH2 GEM Admitted GEM FIM motor 57-91 without Delirium or Dementia NO 14.1 9 22 0.0000 0.2806 2.5255 0.1363
4CM1 GEM Admitted GEM FIM motor 18-56 with Delirium or Dementia NO 22.4 14 34 0.0000 0.2936 4.1110 0.1652
4CM2 GEM Admitted GEM FIM motor 18-56 without Delirium or Dementia NO 19.7 13 30 0.0000 0.2819 3.6649 0.1622
4CL1 GEM Admitted GEM FIM motor 13-17 with Delirium or Dementia NO 24.4 18 39 0.0000 0.2662 4.7922 0.1679
4CL2 GEM Admitted GEM FIM motor 13-17 without Delirium or Dementia NO 22.2 14 34 0.0000 0.2758 3.8611 0.1628
For Official Use Only-I2-A2 64
AN-
SNAP
V4.0
Care Type Episode Type Description Same Day ALOS
Inlier Bounds Price Weights
Lower
Bound
Upper
Bound
Same
Day
Short-Stay
Outlier Per
Diem
Inlier
Long-
Stay
Outlier
Per Diem
4L01 GEM Admitted GEM Same-Day GEM YES 1.0 0 0 0.1123 0.0000 0.0000 0.0000
4DS1 Psychogeriatric Care
Admitted
Psychogeriatric
HoNOS 65+ Overactive behaviour 3-4, LOS
<= 91 NO 22.2 15 36 0.0000 0.4645 6.9679 0.2922
4DS2 Psychogeriatric Care
Admitted
Psychogeriatric
HoNOS 65+ Overactive behaviour 1-2,
HoNOS 65+ ADL 4, LOS <= 91 NO 26.9 22 51 0.0000 0.3753 8.2556 0.1847
4DS3 Psychogeriatric Care
Admitted
Psychogeriatric
HoNOS 65+ Overactive behaviour 1-2,
HoNOS 65+ ADL 0-3, LOS <= 91 NO 22.3 14 34 0.0000 0.5049 7.0685 0.2870
4DS4 Psychogeriatric Care
Admitted
Psychogeriatric
HoNOS 65+ Overactive behaviour 0,
HoNOS 65+ total 18-48, LOS <= 91 NO 22.8 24 55 0.0000 0.4300 10.3198 0.2358
4DS5 Psychogeriatric Care
Admitted
Psychogeriatric
HoNOS 65+ Overactive behaviour 0,
HoNOS 65+ total 0-17, LOS <= 91 NO 23.2 17 40 0.0000 0.4941 8.3999 0.1958
4DL1 Psychogeriatric Care
Admitted
Psychogeriatric Long term care NO 159.0 119 200 0.0000 0.2938 34.9662 0.2170
4M01 Psychogeriatric Care
Admitted
Psychogeriatric Same-Day Psychogeriatric Care YES 1.0 0 0 0.1038 0.0000 0.0000 0.0000
4ES1 Maintenance Admitted Non-Acute Age >= 60, RUG-ADL 4-11, LOS <= 91 NO 13.2 8 20 0.0000 0.3356 2.6849 0.1978
4ES2 Maintenance Admitted Non-Acute Age >= 60, RUG-ADL 12-15, LOS <= 91 NO 13.8 8 20 0.0000 0.3415 2.7317 0.2020
4ES3 Maintenance Admitted Non-Acute Age >= 60, RUG-ADL 16-18, LOS <= 91 NO 14.3 10 23 0.0000 0.3151 3.1509 0.1918
4ES4 Maintenance Admitted Non-Acute Age 18-59, LOS <= 91 NO 15.5 10 24 0.0000 0.3904 3.9041 0.2224
4ES5 Maintenance Admitted Non-Acute Age <= 17, LOS <= 91 NO 11.2 6 16 0.0000 0.6003 3.6019 0.3388
4EL1 Maintenance Admitted Non-Acute Long term care NO 185.2 123 206 0.0000 0.2362 29.0539 0.1506
For Official Use Only-I2-A2 65
5.5 Section 5: Special Grants
This table is from the 2018 19 SOYM working papers for the Casemix Pool which was approved in
the 2018-19 budget.
? 24 hour medical Emergency Care
model
? A&E Agreements
? ABSS
? Artificial Limbs Scheme
? Blood Management Program
? Brennan Review
? Carparking - Flinders Medical Centre
loan with the Treasurer
? Centre for Physical Ageing
? Child Development Unit
? Child Protection
? Child Protection Services (Nyland
Review)
? Country Outreach
? Donate Life - RAH
? DVA FFS
? FBT
? FFS Locums/Oncall Arrange
? General Practitioner Fee For Service
? GFU Transitionary Supplementation
? GNP/TPPP
? GP on call
? HAC Operating Expenses
? Heart Lung Transport
? HIV/AIDS Infectious Diseases Unit
(PHOFA)
? Home Access Assist
? Home Ventilation Funding
? Hospital Links
? JBI Evidence Based Nursing
? KI Maternity Care Team
? KidSafe SA
? Lease & Maint. Payments
? Locality & Zone Allowances
? Medical Scholarships
? Midwifery Model
? National Bowel Cancer Screening
Program
? North West Children's and Families
Integration Project
? Northern Paediatric Unit
? nRAH - Readiness and Transitionary
Cost Pressures
? Nurses PD
? Nyland Royal Commission
? Patient Transport
? Pegademese costs
? Pre-Vocational General Practice
Placement (PGPPP)
? Private Hospital Gross Up
? Radiation Oncology
? Remote Issues
? Renal Dialysis
? Residential Rent & Property Lease
? SA Multiple Births
? Spasticity Rehabilitation
? Stepdown Unit/Aboriginal Unit
? Surgery Receptionist
? TB State-wide Services
? Toxicology Services
? Weight Disorders Clinic
? Workers Comp
For Official Use Only-I2-A2 67
5.6 Section 6: Low Volume / Minimum Budget / Grant Funded Hospitals
This table is from the 2018 19 SOYM working papers for CHSA Analysis Data for Grant Funded
model and this list was approved in the 2018-19 budget.
? Booleroo
? Bordertown
? Burra
? Wudinna
? Cleve
? Coober Pedy
? Cowell
? Crystal Brook
? Cummins
? Elliston
? Eudunda
? Hawker
? Gumeracha
? Jamestown
? Kangaroo Island
? Kapunda
? Karoonda
? Kimba
? Kingston
? Lameroo
? Laura
? Tailem Bend
? Loxton
? CYP (Maitland)
? Mannum
? Meningie
? Mt Pleasant
? Ceduna
? Orroroo
? Penola
? Peterborough
? Pinnaroo
? Port Broughton
? Quorn
? Renmark
? Riverton
? Roxby Downs
? Snowtown
? Southern Yorke
? Strathalbyn
? Streaky Bay
? Tumby Bay
? Waikerie
For Official Use Only-I2-A2 68
5.7 Section 7: Non-Admitted Patients - Tier 2 Clinic v5.0
The Pricing Authority has determined the following services as eligible for Commonwealth Funding as
a public hospital service:
Category A (Specialist outpatient clinic services - Tier 2 non-admitted service class 10, 20 and 30)
Category B (Other non-admitted patient services and non-medical specialist outpatient clinics Tier 2
non-admitted services class 40)
Tier 2 Clinic
V5.0 Description Price Weights
10.01 Hyperbaric medicine 0.1033
10.02 Interventional imaging 0.4000
10.03 Minor surgical 0.0438
10.04 Dental 0.0610
10.05 Angioplasty/angiography 0.3018
10.06 Endoscopy gastrointestinal 0.3829
10.07 Endoscopy urological/gynaecological 0.0532
10.08 Endoscopy orthopaedic 0.0427
10.09 Endoscopy respiratory/ear, nose and throat (ENT) 0.0464
10.10 Renal dialysis hospital delivered 0.0575
10.11 Chemotherapy treatment 0.0420
10.12 Radiation therapy treatment 0.0732
10.13 Minor medical procedures 0.0990
10.14 Pain management interventions 0.0741
10.15* Renal dialysis haemodialysis home delivered 1.0300
10.16* Renal dialysis peritoneal dialysis home delivered 1.0614
10.17* Total parenteral nutrition home delivered 2.4334
10.18* Enteral nutrition home delivered 0.1755
10.19 Ventilation home delivered Block funded
10.20 Radiation therapy simulation and planning 0.1825
10.80 Colonoscopy Map to ABF Tier 2 10.06
10.81 Oesophagoscopy Map to ABF Tier 2 10.06
10.82 Other Endoscopy gastrointestinal Map to ABF Tier 2 10.06
10.83 Other Endoscopy respiratory / ear, nose and throat (ENT) Map to ABF Tier 2 10.09
10.84 Panedoscopy Map to ABF Tier 2 10.06
10.85 Sigmoidoscopy Map to ABF Tier 2 10.06
10.86 Bronchoscopy Map to ABF Tier 2 10.09
10.95* Home Oxygen Night 0.0472
10.96* Home Oxygen Continuous 0.0541
10.97* Home Oxygen Exercise 0.0304
10.98* Home Oxygen Unusual 0.0887
For Official Use Only-I2-A2 69
Tier 2 Clinic
V5.0 Description Price Weights
10.99* Home Oxygen Palliative 0.0375
20.01 Transplants 0.0993
20.02 Anaesthetics 0.0599
20.03 Pain management 0.0921
20.04 Developmental disabilities 0.0789
20.05 General medicine 0.0512
20.06 General practice and primary care Out of scope
20.07 General surgery 0.0530
20.08 Genetics 0.1386
20.09 Geriatric medicine 0.0703
20.10 Haematology 0.0505
20.11 Paediatric medicine 0.0643
20.12 Paediatric surgery 0.0655
20.13 Palliative care 0.0716
20.14 Epilepsy 0.0619
20.15 Neurology 0.0756
20.16 Neurosurgery 0.0508
20.17 Ophthalmology 0.0428
20.18 Ear, nose and throat (ENT) 0.0496
20.19 Respiratory 0.0682
20.20 Respiratory cystic fibrosis 0.1603
20.21 Anti-coagulant Screening and Management 0.0569
20.22 Cardiology 0.0581
20.23 Cardiothoracic 0.0833
20.24 Vascular surgery 0.0610
20.25 Gastroenterology 0.0827
20.26 Hepatobiliary 0.1073
20.27 Craniofacial 0.0560
20.28 Metabolic bone 0.0613
20.29 Orthopaedics 0.0451
20.30 Rheumatology 0.0631
20.31 Spinal 0.0804
20.32 Breast 0.0727
20.33 Dermatology 0.0487
20.34 Endocrinology 0.0598
20.35 Nephrology 0.0859
20.36 Urology 0.0578
20.37 Assisted reproductive technology 0.0702
20.38 Gynaecology 0.0580
20.39 Gynaecological oncology 0.0642
20.40 Obstetrics management of pregnancy without complications 0.0436
20.41 Immunology 0.0672
20.42 Medical oncology consultation 0.0854
For Official Use Only-I2-A2 70
Tier 2 Clinic
V5.0 Description Price Weights
20.43 Radiation therapy consultation 0.0462
20.44 Infectious diseases 0.0438
20.45 Psychiatry 0.0403
20.46 Plastic and reconstructive surgery 0.0424
20.47 Rehabilitation 0.0462
20.48 Multidisciplinary burns clinic 0.0660
20.49 Geriatric evaluation and management (GEM) 0.0928
20.50 Psychogeriatric 0.0574
20.51 Sleep disorders 0.0526
20.52 Addiction medicine 0.0512
20.53 Obstetrics management of complex pregnancy 0.0736
20.54 Maternal fetal medicine 0.0736
20.55 Telehealth patient location 0.0201
30.01 General imaging Not priced6
30.02 Magnetic resonance imaging (MRI) Not priced6
30.03 Computerised tomography (CT) Not priced6
30.04 Nuclear medicine Not priced6
30.05 Pathology (microbiology, haematology, biochemistry) Not priced6
30.06 Positron emission tomography (PET) Not priced6
30.07 Mammography screening Not priced6
30.08 Clinical measurement Not priced6
40.02 Aged care assessment Out of scope
40.03 Aids and appliances 0.0428
40.04 Clinical pharmacy 0.1083
40.05 Hydrotherapy 0.0382
40.06 Occupational therapy 0.0420
40.07 Pre-admission and pre-anaesthesia 0.0552
40.08 Primary health care Out of scope
40.09 Physiotherapy 0.0307
40.10 Sexual health 0.0312
40.11 Social work 0.0558
40.12 Rehabilitation 0.0455
40.13 Wound management 0.0326
40.14 Neuropsychology 0.1188
40.15 Optometry 0.0087
40.16 Orthoptics 0.0280
40.17 Audiology 0.0534
40.18 Speech pathology 0.0454
40.21 Cardiac rehabilitation 0.0434
40.22 Stomal therapy 0.0693
40.23 Nutrition/dietetics 0.0377
40.24 Orthotics 0.0552
40.25 Podiatry 0.0357
For Official Use Only-I2-A2 71
Tier 2 Clinic
V5.0 Description Price Weights
40.27 Family planning Out of scope
40.28 Midwifery and maternity 0.0382
40.29 Psychology 0.0246
40.30 Alcohol and other drugs 0.0402
40.31 Burns 0.0454
40.32 Continence 0.0236
40.33 General counselling Out of scope
40.34 Specialist mental health Block funded
40.35 Palliative care 0.0546
40.36 Geriatric evaluation and management (GEM) 0.0509
40.37 Psychogeriatric 0.0184
40.38 Infectious diseases 0.0834
40.39 Neurology 0.0579
40.40 Respiratory 0.0403
40.41 Gastroenterology 0.0441
40.42 Circulatory 0.0623
40.43 Hepatobiliary 0.0908
40.44 Orthopaedics 0.0297
40.45 Dermatology 0.0303
40.46 Endocrinology 0.0487
40.47 Nephrology 0.0415
40.48 Haematology and immunology 0.0606
40.49 Gynaecology 0.0506
40.50 Urology 0.0514
40.51 Breast 0.0582
40.52 Oncology 0.0276
40.53 General medicine 0.0418
40.54 General surgery 0.0362
40.55 Paediatrics 0.0416
40.56 Falls prevention 0.0134
40.57 Cognition and memory 0.0519
40.58 Hospital avoidance programs 0.0526
40.59 Post-acute care 0.0443
40.60 Pulmonary rehabilitation 0.0434
40.61 Telehealth patient location 0.0095
*Note:
The price weight for clinics 10.15, 10.16, 10.17, 10.18, 10.19, 10.95, 10.96, 10.97, 10.98, and 10.99
are priced on a per calendar month basis.
For Official Use Only-I2-A2 72
5.8 Section 8: List of hospitals by Emergency Classification type
The Department of Health and Wellbeing has determined the following public hospitals to be URG or
UDG based on IHPA s definition of emergency services.
Hospital
code
Hospital Name ED Classification
1 WCH-Children's ED URG
3 Women's and Children's Hospital URG
5 Flinders Medical Centre URG
8 Hampstead Rehabilitation Centre NA
14 The Queen Elizabeth Hospital URG
19 Royal Adelaide Hospital URG
20 Gawler Health Service URG
27 Lyell McEwin Hospital URG
29 Lyell McEwin Hospital - WAU URG
30 Modbury Hospital URG
33 Noarlunga Health Services URG
35 Pregnancy Advisory Centre NA
36 Southern Districts War Memorial Private Hospital NA
42 St. Margaret's Hospital NA
49 Barossa Area Health Services - Angaston Campus UDG
52 Balaklava & Riverton Districts Health Service - Balaklava Campus UDG
55 Barmera District Health Services UDG
58 Riverland Regional Hospital - Berri URG
67 Booleroo Centre District Hospital and Health Services UDG
70 Bordertown Memorial Hospital UDG
73 Burra; Clare & Snowtown Health Service - Burra Campus UDG
76 Central Eyre Peninsula Hospital UDG
79 Burra; Clare & Snowtown Health Service -Clare Campus UDG
82 Eastern Eyre Health and Aged Care - Cleve Campus UDG
85 Coober Pedy Hospital & Health Services UDG
88 Eastern Eyre Health and Aged Care - Cowell Campus UDG
91 Crystal Brook District Hospital UDG
94 Lower Eyre Health Services - Cummins Hospital Campus UDG
97 Elliston Hospital UDG
100 Eudunda & Kapunda Health Service - Eudunda Campus UDG
103 Hawker Memorial Hospital UDG
106 Gumeracha Hospital UDG
109 Jamestown Hospital & Health Service UDG
112 Kangaroo Island Health Service UDG
115 Eudunda & Kapunda Health Service - Kapunda Campus UDG
For Official Use Only-I2-A2 73
Hospital
code
Hospital Name ED Classification
118 Karoonda & District Soldiers' Memorial Hospital UDG
121 Eastern Eyre Health and Aged Care - Kimba Campus UDG
124 Kingston Soldiers' Memorial Hospital UDG
127 Lameroo District Health Services UDG
130 Laura & Districts Hospital UDG
133 Leigh Creek Hospital UDG
136 Tailem Bend District Hospital UDG
139 Loxton Hospital Complex UDG
142 Central Yorke Peninsula Hospital UDG
145 The Mannum District Hospital UDG
151 Meningie & Districts Memorial Hospital & Health Services UDG
154 Millicent & District Hospital & Health Services UDG
160 Mount Barker District Soldiers' Memorial Hospital UDG
163 Mount Gambier and Districts Health Service URG
166 Mt Pleasant Hospital UDG
169 Ceduna Hospital UDG
172 Murray Bridge Soldiers' Memorial Hospital UDG
175 Naracoorte Health Service UDG
181 Oodnadatta Hospital UDG
184 Orroroo & District Health Service UDG
187 Penola War Memorial Hospital UDG
190 Peterborough Soldiers' Memorial Hospital UDG
193 Pinnaroo Soldiers' Memorial Hospital UDG
196 Port Augusta Hospital & Regional Health Services URG
199 Port Broughton District Hospital & Health Services UDG
202 Port Lincoln Health Services URG
205 Port Pirie Regional Health Service URG
208 Quorn & District Memorial Hospital UDG
211 Renmark Paringa District Hospital UDG
214 Balaklava & Riverton Districts Health Service-Riverton Campus UDG
217 Roxby Downs Health Centre UDG
220 Burra; Clare & Snowtown Health Service - Snowtown Campus UDG
223 South Coast District Hospital UDG
226 Southern Yorke Peninsula Health Service UDG
229 Strathalbyn & District Soldiers' Memorial Hospital UDG
232 Streaky Bay Hospital UDG
235 Barossa Area Health Services - Tanunda Campus UDG
241 Lower Eyre Health Services - Tumby Bay Hospital Campus UDG
244 Waikerie Hospital & Health Services UDG
247 Northern Yorke Peninsula Health Service UDG
249 Whyalla Hospital & Health Services URG
296 WCH-Family Services (Helen Mayo) NA
For Official Use Only-I2-A2 74
Hospital
code
Hospital Name ED Classification
300 Glenside Hospital NA
306 James Nash House NA
For Official Use Only-I2-A2 75
5.9 Section 9: Emergency Department Urgency Related Groups (URG) v1.4
This table is from the 2018 19 National Efficient Price Determination published by IHPA.
URG
V1.4 Description
Price
Weights
3 Adm_T1_Injury 0.4434
4 Adm_T1_Poisoning/Toxic effects of drugs 0.3214
5 Adm_T1_Respiratory system illness 0.3173
6 Adm_T1_Circulatory system and Endocrine, nutritional and metabolic illness 0.2806
7 Adm_T1_All other MDB groups 0.3333
9 Adm_T2_Poisoning 0.2183
10 Adm_T2_Injury 0.2828
11 Adm_T2_Gastrointestinal system and Digestive system illness 0.2425
12 Adm_T2_Respiratory system illness 0.2312
14 Adm_T2_Neurological illness 0.2779
15 Adm_T2_Toxic effects of drugs 0.2326
16 Adm_T2_Circulatory system and Endocrine, nutritional and metabolic illness 0.2024
17 Adm_T2_All other MDB groups 0.1938
19 Adm_T3_Blood/Immune system illness & system infection/parasites 0.1959
20 Adm_T3_Injury 0.1924
21 Adm_T3_Neurological illness 0.1990
22 Adm_T3_Obstetric/Gynaecological illness 0.1130
23 Adm_T3_Digestive system illness 0.1875
24 Adm_T3_Circulatory system illness and endocrine, nutritional and metabolic illness 0.1802
25 Adm_T3_Poisoning/Toxic effects of drugs 0.1728
26 Adm_T3_Urological illness 0.1811
27 Adm_T3_Respiratory system illness 0.1879
29 Adm_T3_All other MDB groups 0.1686
30 Adm_T4_Poisoning/Toxic effects of drugs 0.1291
31 Adm_T4_Respiratory system illness 0.1544
32 Adm_T4_Gastrointestinal system and Digestive system illness 0.1499
33 Adm_T4_All other MDB groups 0.1399
34 Adm_T4_Injury 0.1356
35 Adm_T4_Social problem/Other presentation 0.1380
37 Adm_T5_All other MDB groups 1 0.0815
38 Dead on Arrival w any Triage w any MDB 0.0464
39 N-A_T1_All MDB groups 0.3024
40 N-A_T2_Toxic effects of drugs 0.2292
43 N-A_T2_Circulatory system / Endocrine, nutritional and metabolic diseases 0.1728
44 N-A_T2_Injury 0.1685
45 N-A_T2_Poisoning 0.2102
46 N-A_T2_All other MDB groups 0.1458
48 N-A_T3_Circulatory system and Endocrine, nutritional and metabolic illness 0.1317
For Official Use Only-I2-A2 76
URG
V1.4 Description
Price
Weights
50 N-A_T3_Injury 0.1140
51 N-A_T3_Genitourinary illness 0.1324
52 N-A_T3_Gastrointestinal system and Digestive system illness 0.1285
53 N-A_T3_Neurological illness 0.1393
55 N-A_T3_Respiratory system illness 0.1149
56 N-A_T3_Musculoskeletal/connective tissue illness 0.1197
57 N-A_T3_All other MDB groups 0.1023
58 N-A_T4_Injury 0.0782
60 N-A_T4_Urological system illness 0.0969
61 N-A_T4_Circulatory system / Endocrine, nutritional and metabolic illness 0.0977
62 N-A_T4_Gastrointestinal system and Digestive system illness 0.0948
63 N-A_T4_Musculoskeletal/connective tissue illness 0.0886
65 N-A_T4_Illness of the ENT 0.0689
66 N-A_T4_Illness of the Eyes 0.0615
67 N-A_T4_Other presentation block 0.0718
68 N-A_T4_All other MDB groups 0.0839
69 N-A_T5_Poisoning/Toxic effects of drugs 0.0599
70 N-A_T5_Injury 0.0599
71 N-A_T5_Other presentation block 0.0485
72 N-A_T5_All other MDB groups 0.0627
73 Did Not Wait 0.0406
74 Transfer presentation_1, 2 0.3402
75 Died in emergency department triage 1 0.2739
76 Adm_Return visit, planned w any Triage 0.1185
77 N-A Return visit, planned Triage 1, 2 0.1359
78 N-A Return visit, planned Triage 3-5 0.0581
79 Adm_T1_Psychiatric illness 0.3775
80 Adm_T2_System infection/parasites 0.2515
81 Adm_T2_Urological system illness 0.2215
82 Adm_T2_Psychiatric illness 0.2386
83 Adm_T3_Illness of eyes, ear, nose, throat 0.1439
84 Adm_T3_Hepatobiliary system illness 0.2017
85 Adm_T3_Psychiatric illness 0.1840
86 Adm_T4_Circulatory system illness and Endocrine, nutritional and metabolic illness 0.1516
87 Adm_T4_Illness of eyes, ear nose and throat 0.1147
88 Adm_T4_Blood/immune system illness/system infection/parasites 0.1498
89 Adm_T4_Gynaecological and Male reproductive system illness 0.1285
90 Adm_T4_Psychiatric illness 0.1436
91 Adm_T5_All other MDB groups 2 0.1124
92 Adm_T5_Injury 0.0952
93 Adm_T5_Gastrointestinal system and Digestive system illness 0.1171
94 Adm_T5_Psychiatric illness 0.1118
95 N-A_T2_Respiratory system illness 0.1658
For Official Use Only-I2-A2 77
URG
V1.4 Description
Price
Weights
96 N-A_T2_Urological system illness 0.1807
97 N-A_T2_Gastrointestinal system and Digestive system illness 0.1668
98 N-A_T2_Neurological illness 0.1942
99 N-A_T2_Blood/immune system illness/system infection/parasites 0.1612
100 N-A_T2_Psychiatric illness 0.1806
101 N-A_T3_Poisoning 0.1327
102 N-A_T3_Toxic effects of drugs 0.1460
103 N-A_T3_Illness of eyes 0.0854
104 N-A_T3_Blood/immune system illness/system infection/parasites 0.1081
105 N-A_T3_Psychiatric illness 0.1358
106 N-A_T4_Poisoning 0.0803
107 N-A_T4_Toxic effects of drugs 0.0997
108 N-A_T4_Respiratory system illness 0.0853
109 N-A_T4_Blood/Immune system illness/System infection/parasites 0.0793
110 N-A_T4_Obstetric and Newborn/Neonate 0.0848
111 N-A_T4_Gynecological/Male reproductive system illness 0.0930
112 N-A_T4_Psychiatric illness 0.0959
113 N-A_T5_Circulatory system illness/Endocrine, nutritional and metabolic diseases 0.0688
114 N-A_T5_Gastrointestinal system and Digestive system illness 0.0663
115 N-A_T5_Illness of the eyes, ear, nose and throat 0.0497
116 N-A_T5_Illness of the skin, subcutaneous tissue, breast/Musculoskeletal/Connective tissue illness 0.0625
117 N-A_T5_Blood/immune system illness/system infection/parasites 0.0575
118 N-A_T5_Obstetric illness/Newborn/Neonate 0.0469
119 N-A_T5_Genitourinary system illness 0.0635
120 N-A_T5_Psychiatric illness 0.0677
121 Transfer presentation_3 0.2691
122 Transfer presentation_4 0.2153
123 Transfer presentation_5 0.1330
124 Died in emergency department triage 2-5 0.2799
125 Left at own risk_1, 2 0.1717
126 Left at own risk_3 0.1016
127 Left at own risk_4 0.0697
128 Left at own risk_5 0.0519
For Official Use Only-I2-A2 78
5.10 Section 10: Emergency Department UDG v1.3
This table is from the 2018 19 National Efficient Price Determination published by IHPA.
UDG V1.3 Description Price Weights
1 Adm_T1 0.3423
2 Adm_T2 0.2275
3 Adm_T3 0.1834
4 Adm_T4 0.1422
5 Adm_T5 0.1024
6 N-A_T1 0.3004
7 N-A_T2 0.1694
8 N-A_T3 0.1192
9 N-A_T4 0.0819
10 N-A_T5 0.0581
11 Did Not Wait 0.0406
12 Dead on Arrival w any Triage w any MDB 0.0464
13 Transfer presentation 0.2782
14 Died in emergency department 0.2761
15 Adm_Return visit, planned w any Triage 0.1185
16 N-A Return visit, planned Triage 1, 2, 3 0.1088
17 N-A Return visit, planned Triage 4,5 0.0565
For Official Use Only-I2-A2 79
5.11 Section 11: List of hospitals by Peer Group
The following hospitals are SA Health types/peer groups that applies to Emergency and Non-admitted
(except for Country Chemo)
Hosp Code Hosp Name LHN Type Peer Group
3 Women s and Children s WCHN W&CHN Metro - WCH
5 Flinders Medical Centre SALHN SALHN Metro - Large
8 Hampstead CALHN CALHN Metro - Other
14 The Queen Elizabeth Hospital CALHN CALHN Metro - Large
19 Royal Adelaide Hospital CALHN CALHN Metro - Large
20 Gawler CHSA Country - Casemix Other Country Other
27 Lyell McEwin NALHN NALHN Metro Large
30 Modbury NALHN NALHN Metro Other
33 Noarlunga SALHN SALHN Metro Other
36 Southern Districts War Memorial SALHN Other Metro Other
42 St Margaret s CALHN CALHN Metro Other
49 Angaston CHSA Country Casemix Other Country Other
52 Balaklava CHSA Country Grant Funded Country GFU
55 Barmera CHSA Country Grant Funded Country GFU
58 Riverland (Berri) CHSA Country Casemix Large Country Large
67 Booleroo CHSA Country Grant Funded Country GFU
70 Bordertown CHSA Country Grant Funded Country GFU
73 Burra CHSA Country Grant Funded Country GFU
76 Wudinna CHSA Country Grant Funded Country GFU
79 Clare CHSA Country Casemix Other Country Other
82 Cleve CHSA Country Grant Funded Country GFU
85 Coober Pedy CHSA Country Grant Funded Country GFU
88 Cowell CHSA Country Grant Funded Country GFU
91 Crystal Brook CHSA Country Grant Funded Country GFU
94 Cummins CHSA Country Grant Funded Country GFU
97 Elliston CHSA Country Grant Funded Country GFU
100 Eudunda CHSA Country Grant Funded Country GFU
103 Hawker CHSA Country Grant Funded Country GFU
106 Gumeracha CHSA Country Grant Funded Country GFU
109 Jamestown CHSA Country Grant Funded Country GFU
112 Kangaroo Island CHSA Country Grant Funded Country GFU
115 Kapunda CHSA Country Grant Funded Country GFU
118 Karoonda CHSA Country Grant Funded Country GFU
121 Kimba CHSA Country Grant Funded Country GFU
124 Kingston CHSA Country Grant Funded Country GFU
127 Lameroo CHSA Country Grant Funded Country GFU
For Official Use Only-I2-A2 80
Hosp Code Hosp Name LHN Type Peer Group
130 Laura CHSA Country Grant Funded Country GFU
136 Tailem Bend CHSA Country Grant Funded Country GFU
139 Loxton CHSA Country Grant Funded Country GFU
142 CYP (Maitland) CHSA Country Grant Funded Country GFU
145 Mannum CHSA Country Grant Funded Country GFU
151 Meningie CHSA Country Grant Funded Country GFU
154 Millicent CHSA Country Casemix Other Country Other
160 Mt Barker CHSA Country Casemix Other Country Other
163 Mt Gambier CHSA Country Casemix Large Country Large
166 Mt Pleasant CHSA Country Grant Funded Country GFU
169 Ceduna CHSA Country Grant Funded Country GFU
172 Murray Bridge CHSA Country Casemix Other Country Other
175 Naracoorte CHSA Country Casemix Other Country Other
184 Orroroo CHSA Country Grant Funded Country GFU
187 Penola CHSA Country Grant Funded Country GFU
190 Peterborough CHSA Country Grant Funded Country GFU
193 Pinnaroo CHSA Country Grant Funded Country GFU
196 Port Augusta CHSA Country Casemix Large Country Large
199 Port Broughton CHSA Country Grant Funded Country GFU
202 Port Lincoln CHSA Country Casemix Large Country Large
205 Port Pirie CHSA Country Casemix Large Country Large
208 Quorn CHSA Country Grant Funded Country GFU
211 Renmark CHSA Country Grant Funded Country GFU
214 Riverton CHSA Country Grant Funded Country GFU
217 Roxby Downs CHSA Country Grant Funded Country GFU
220 Snowtown CHSA Country Grant Funded Country GFU
223 South Coast CHSA Country Casemix Other Country Other
226 Southern Yorke CHSA Country Grant Funded Country GFU
229 Strathalbyn CHSA Country Grant Funded Country GFU
232 Streaky Bay CHSA Country Grant Funded Country GFU
235 Tanunda CHSA Country Casemix Other Country Other
241 Tumby Bay CHSA Country Grant Funded Country GFU
244 Waikerie CHSA Country Grant Funded Country GFU
247 Northern Yorke CHSA Country Casemix Other Country Other
249 Whyalla CHSA Country Casemix Large Country Large
300 Glenside CALHN NA NA
306 James Nash House NALHN NA NA
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