Independent Hospital Pricing Authority
National Efficient Price
Determination
2016-17
February 2016
© Independent Hospital Pricing Authority 2016
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Independent Hospital Pricing Authority – National Efficient Price Determination 2016-17
Table of contents
Chapter 1
Overview ......................................................................................................... 4
1.1
Independent Hospital Pricing Authority ...................................................................... 4
1.2
Data quality ............................................................................................................... 4
1.3
Determination development ....................................................................................... 5
1.4
Terminology ............................................................................................................... 5
Chapter 2
National Efficient Price 2016-17 .................................................................... 6
2.1
The NEP .................................................................................................................... 6
2.2
Calculation of the NEP............................................................................................... 6
2.3
Price of an ABF activity .............................................................................................. 7
Chapter 3
In-scope public hospital services ................................................................. 9
3.1
Overall scope............................................................................................................. 9
3.2
Non-admitted services ............................................................................................... 9
Interpretive Guidelines for Use ............................................................................................ 10
Chapter 4
Price Weights ............................................................................................... 11
4.1
Price Weights .......................................................................................................... 11
4.2
Classification systems ............................................................................................. 11
Chapter 5
Adjustments ................................................................................................. 12
5.1
Adjustments ............................................................................................................. 12
5.2
Precedence of Adjustments ..................................................................................... 12
Chapter 6
6.1
Technical specifications ........................................................................................... 15
Chapter 7
7.1
National Pricing Model technical specifications........................................ 15
Standards ..................................................................................................... 16
Coding and classification ......................................................................................... 16
7.1.1 Admitted acute patients ........................................................................................... 16
7.1.2 Admitted subacute and non-acute patients .............................................................. 16
7.1.3 Non-admitted patients.............................................................................................. 16
7.1.4 Emergency departments .......................................................................................... 16
7.1.5 Emergency services ................................................................................................ 16
7.2
Intensive Care Units ................................................................................................ 16
7.3
Costing .................................................................................................................... 16
7.4
Activity Based Funding data set specifications......................................................... 16
Chapter 8
Back-casting ................................................................................................ 17
Appendix A – General List of in-scope public hospital services eligible for
Commonwealth Funding under the National Health Reform Agreement ...................... 19
Appendix B – List of radiotherapy codes ........................................................................ 32
Appendix C – List of dialysis codes ................................................................................ 34
Appendix D – Specified Intensive Care Units (ICUs) ...................................................... 35
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Appendix E – Specialised Children’s Hospitals.............................................................. 37
Appendix F – Private Patient Adjustments...................................................................... 38
Appendix G – Provisional weights for very long stay patients ...................................... 39
Appendix H – Price weights for admitted acute patients – AR-DRG V8.0 ..................... 40
Appendix I – Price weights for admitted subacute and non-acute patients – AN-SNAP
V4.0……….......................................................................................................................... 59
Appendix J – Paediatric per diem price weights for admitted subacute and non-acute
patients .............................................................................................................................. 61
Appendix K – Price weights for non-admitted patients .................................................. 62
Appendix L – Price weights for emergency department patients – URG V1.4.............. 65
Appendix M – Price weights for emergency service patients – UDG V1.3 .................... 69
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Chapter 1
1.1
Overview
Independent Hospital Pricing Authority
The Independent Hospital Pricing Authority (Pricing Authority) is established under the
National Health Reform Act 2011 (Cth) (the Act), and by virtue of Section 131(1) of the Act is
invested with the following functions relevant to this National Efficient Price (NEP)
Determination 2016-17 (Determination):
(a)
to determine the national efficient price for health care services provided by public
hospitals where the services are funded on an activity basis;
(b)
to determine the national efficient cost for health care services provided by public
hospitals where the services are block funded;
(c)
to develop and specify classification systems for health care and other services
provided by public hospitals;
(d)
to determine adjustments to the national efficient price to reflect legitimate and
unavoidable variations in the costs of delivering health care services;
(e)
except where otherwise agreed between the Commonwealth and a state – to
determine the public hospital functions that are to be funded in the state by the
Commonwealth; and
(f)
to publish a report setting out the national efficient price for the coming year and
any other information that would support the efficient funding of public hospitals.
This Determination is an output of the performance of those functions by the Pricing Authority.
In this document, ‘Pricing Authority’ refers to the governing members and ‘IHPA’ refers to the
Agency.
1.2
Data quality
In making this Determination, the Pricing Authority has relied on a number of different data
sources.
Costing information used to determine the NEP has been drawn from the National Hospital
Cost Data Collection (NHCDC) Round 18, as provided by states and territories. Significant
improvements in the quality of this data have been noted. IHPA continues to review and
refine the classification systems used in the national pricing model.
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1.3
Determination development
In performing the functions outlined above and preparing this Determination, the Pricing
Authority has had regard, as required pursuant to Sections 131(3) and 132 of the Act, to:
(a)
relevant expertise and best practice within Australia and internationally;
(b)
submissions made at any time by the Commonwealth or a state or territory;
(c)
the need to ensure:
(i)
reasonable access to health care services;
(ii)
safety and quality in the provision of health care services;
(iii)
continuity and predictability in the cost of health care services; and
(iv)
the effectiveness, efficiency and financial sustainability of the public
hospital system;
(d)
the range of public hospitals and the variables affecting the actual cost of providing
health care services in each of those hospitals; and
(e)
relevant intergovernmental agreements (including the National Health Reform
Agreement 2011 [NHRA]).
1.4
Terminology
Although the Pricing Authority aims to use plain English to make its documents accessible to
a wide audience, the subject matter of this Determination requires the use of some specialist
terms. For ease of reference, the meaning of those terms is set out in an electronic glossary
available on the IHPA website.
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Chapter 2
2.1
National Efficient Price 2016-17
The NEP
The NEP is $4,883 per National Weighted Activity Unit 2016-17 (NWAU(16)).
2.2
Calculation of the NEP
The NEP is based on the average cost of public hospital activity in the 2013-14 financial year
of $4,588 per NWAU(16), indexed at a rate of 2.1 per cent per annum.
Consistent with Clause B12(e) of the NHRA, in calculating the NEP, the following
Commonwealth funded programs have been removed prior to determining the underlying
cost data of the 2013-14 reference cost:
•
Highly Specialised Drugs – Section 100 Funding ($821.4 million in the 2013-14
financial year);
•
Pharmaceutical Reform Agreements – Efficient Funding of Chemotherapy
(Section 100 funding) ($198.0 million in the 2013-14 financial year);
•
Trastuzumab (Herceptin ®): HER2 Early Stage Breast Cancer PBS – Herceptin:
Early Stage Breast Cancer – Section 100 Funding ($5.4 thousand in the 2013-14
financial year); and
•
Pharmaceutical Reform Agreements – PBS Access Program ($121.2 million in the
2013-14 financial year).
Where blood expenditure has been reported in the NHCDC by states and territories this has
also been removed, as Commonwealth funding for this program is provided directly to the
National Blood Authority. In 2013-14 this amounted to $37.3 million.
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2.3
Price of an ABF activity
The price of an ABF Activity is calculated using the following formula, with Adjustments
applied as applicable:
Price of an admitted acute ABF Activity =
{[PW x APaed x (1 + ASPA) x (1 + AInd + AA + ART + ADia) + (AICU x ICU hours)] - [(PW + AICU x
ICU hours) x APPS + LOS x AAcc]} x NEP
Price of an admitted subacute ABF Activity =
{[PW x (1 + AInd + AA)] - [PW x APPS + LOS x AAcc]} x NEP
Price of a non-admitted ABF Activity =
{PW x (1 + AInd) x (1 + ANMC)} x NEP
Price of an emergency department or emergency service ABF Activity =
{PW x (1 + AInd) x (1+ AECA)} x NEP
Where:
APaed
means the Paediatric Adjustment
ASPA
means the Specialist Psychiatric Age Adjustment
AA
means each or any Remoteness Area Adjustment
AInd
means the Indigenous Adjustment
ART
means the Radiotherapy Adjustment
ADia
means the Dialysis Adjustment
AICU
means the Intensive Care Unit (ICU) Adjustment
APPS
means the Private Patient Service Adjustment
AAcc
means the Private Patient Accommodation Adjustment applicable to the
state of hospitalisation and length of stay
ANMC
means the non-admitted Multidisciplinary Clinic Adjustment
AECA
means the Emergency Care Age Adjustment
ICU hours
means the number of hours spent by a person within a Specified ICU
LOS
means length of stay in hospital (in days)
NEP
National Efficient Price 2016-17
PW
means the Price Weight for an ABF Activity as set out in Appendix H
(for admitted acute), Appendix I and J (for admitted subacute and nonacute), Appendix K (for non-admitted), Appendix L (for emergency
department) or Appendix M (for emergency services)
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In the event that the application of the Private Patient Accommodation Adjustment and the
Private Patient Service Adjustment returns a negative NWAU(16) value for a particular
patient, the NWAU(16) value is held to be zero - that is, negative NWAU(16) values are not
permitted for any patients under the National Pricing Model.
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Chapter 3
3.1
In-scope public hospital services
Overall scope
In accordance with Section 131(f) of the Act and Clauses A9–A17 of the NHRA, the scope of
‘Public Hospital Services’ eligible for Commonwealth funding under the agreement are:
•
All admitted programs, including hospital in the home programs. Forensic mental
health inpatient services are included;
•
All emergency department services; and
•
Non-admitted services as defined below.
3.2
Non-admitted services
The listing of in-scope non-admitted services is independent of the service setting in which
they are provided (e.g. at a hospital, in the community, in a person's home). This means
that in-scope services can be provided on an outreach basis.
To be included as an in-scope non-admitted service, the service must meet the definition of
a Service Event which is:
“an interaction between one or more healthcare provider(s) with one non-admitted
patient, which must contain therapeutic/clinical content and result in a dated entry in
the patient’s medical record.”
Consistent with Clause A25 of the NHRA, the Pricing Authority will conduct analysis to
determine if services are transferred from the community to public hospitals for the dominant
purpose of making services eligible for Commonwealth funding.
There are two broad categories of in-scope, public hospital non-admitted services:
(a)
Specialist outpatient clinic services; and
(b)
Other non-admitted patient services.
Category A: Specialist outpatient clinic services – Tier 2
non-admitted services classification – classes 10, 20 and 30
This comprises all clinics in the Tier 2 non-admitted services classification, classes 10, 20
and 30. However, the General Practice and Primary Care (20.06) clinic is considered by the
Pricing Authority as not eligible for Commonwealth funding as a public hospital service.
Category B: Other non-admitted patient services and non-medical
specialist outpatient clinics (Tier 2 non-admitted services classification
class 40)
To be eligible for Commonwealth funding as an other non-admitted patient service or a class
40 Tier 2 non-admitted service, a service must be:
(a)
directly related to an inpatient admission or an emergency department attendance;
or
(b)
intended to substitute directly for an inpatient admission or emergency department
attendance; or
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(c)
expected to improve the health or better manage the symptoms of persons with
physical or mental health conditions who have a history of frequent hospital
attendance or admission.
Prior to preparing this Determination (2016-17), jurisdictions were invited to submit evidence
for additional services to be included or excluded from the list based on the criteria above.
The following clinics are considered by the Pricing Authority as not eligible for
Commonwealth funding as a public hospital service under this category:
•
Commonwealth funded Aged Care Assessment (40.02);
•
Family Planning (40.27);
•
General Counselling (40.33);
•
Primary Health Care (40.08).
Interpretive Guidelines for Use
In line with the criteria for Category B, community mental health, physical chronic disease
management and community based allied health programs considered in-scope will have all
or most of the following attributes:
•
Be closely linked to the clinical services and clinical governance structures of a public
hospital (for example integrated area mental health services, step-up/step-down
mental health services and crisis assessment teams);
•
Target patients with severe disease profiles;
•
Demonstrate regular and intensive contact with the target group (an average of eight
or more service events per patient per annum);
•
Demonstrate the operation of formal discharge protocols within the program; and
•
Demonstrate either regular enrolled patient admission to hospital or regular active
interventions which have the primary purpose to prevent hospital admission.
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Chapter 4
4.1
Price Weights
Price Weights
Price Weights expressed as NWAU(16), are set out at Appendices H to M, by classification.
4.2
Classification systems
The classification systems used are:
(a)
Australian Refined Diagnosis Related Groups (AR-DRG) classification version 8.0;
(b)
Australian National Subacute and Non-Acute Patient (AN-SNAP) classification
version 4.0;
(c)
Tier 2 non-admitted services classification version 4.1;
(d)
Urgency Related Groups (URG) classification version 1.4; and
(e)
Urgency Disposition Groups (UDG) classification version 1.3.
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Chapter 5
5.1
Adjustments
Adjustments
Adjustments to Price Weights (expressed as NWAU(16)) are to be applied in the manner
and in the order indicated by the formula for determining the NWAU(16) value (price) of an
ABF Activity (refer Chapter 2).
5.2
Precedence of Adjustments
To avoid doubt, Adjustments have the following order of precedence of application:
(a)
Paediatric Adjustment; then
(b)
Specialist Psychiatric Age Adjustment; then
(c)
Patient Remoteness Area Adjustment; then
(d)
Indigenous Adjustment; then
(e)
Radiotherapy Adjustment; then
(f)
Dialysis Adjustment; then
(g)
Intensive Care Unit (ICU) Adjustment; then
(h)
Private Patient Service Adjustment; then
(i)
Private Patient Accommodation Adjustment; then
(j)
Multidisciplinary Clinic Adjustment; then
(k)
Emergency Care Age Adjustment.
Circumstances in which Adjustments are to be applied are described in Table 1.
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Table 1: Adjustments
Name
Context
Paediatric Adjustment
Amount to be applied
Is in respect of a person who:
(a) is aged up to and including 17 years; and
(b) is admitted to a Specialised Children’s Hospital
(Appendix E).
Is in respect of a person who is aged 17 years or less at
the time of admission, with a mental health-related
principal diagnosis (Major Diagnostic Category [MDC] 19
or 20) and has one or more Total Psychiatric Care Days
recorded.
Refer to column headed ‘Paediatric
Adjustment’ in the tables of Admitted
Acute Price Weights (Appendix H).
Is in respect of a person who is aged 17 years or less at
the time of admission, with a principal diagnosis which is
not mental health-related (not in MDC 19 or 20) and has
one or more Total Psychiatric Care Days recorded.
Admitted Acute Patient: 24 per cent
(except patients admitted to a
Specialised Children’s Hospital, who will
receive 45 per cent)
Is in respect of a person who is aged over 17 at the time
of admission, with a principal diagnosis which is not
mental health-related (not in MDC 19 or 20) and has one
or more Total Psychiatric Care Days recorded.
Is in respect of a person whose residential address is
within an area that is classified as being Outer Regional.
Admitted Acute Patient: 32 per cent
Remote Area
Adjustment1
Very Remote Area
Adjustment1
Is in respect of a person whose residential address is
within an area that is classified as being Remote.
Is in respect of a person whose residential address is
within an area that is classified as being Very Remote.
Admitted Acute or Admitted Subacute
Patient: 18 per cent
Admitted Acute or Admitted Subacute
Patient: 23 per cent
Indigenous Adjustment
Is in respect of a person who identifies as being of
Aboriginal and/or Torres Strait Islander origin.
Admitted Acute, Admitted Subacute,
Emergency Department, Emergency
Service or Non-admitted Patient:
5 per cent
Specialist Psychiatric
Age Adjustment
(≤ 17 years, in MDC 19
or 20)
Specialist Psychiatric
Age Adjustment
(≤ 17 years, not in MDC
19 or 20)
Specialist Psychiatric
Age Adjustment
(> 17 years, not in MDC
19 or 20)
Outer Regional
Adjustment 1
Where an
ABF
Activity:
Admitted Acute Patient: 21 per cent
(except patients admitted to a
Specialised Children’s Hospital, who will
receive 10 per cent)
Admitted Acute or Admitted Subacute
Patient: 8 per cent
1 The Outer Regional Adjustment, Remote Area Adjustment and Very Remote Area Adjustment are the Remoteness Area Adjustments for the purpose of this Determination.
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Name
Context
Radiotherapy
Adjustment
Is in respect of an Admitted Acute Patient with a specified
ICD-10-AM 9th edition radiotherapy procedure code
recorded in their medical record. 2
Is in respect of an Admitted Acute Patient with a specified
ICD-10-AM 9th edition renal dialysis code who is not
assigned to the AR-DRG L61Z Haemodialysis or
AR-DRG L68Z Peritoneal Dialysis.2
(a) Is not represented by a newborn/neonate AR-DRG
identified as ‘Bundled ICU’ in the tables of Price
Weights (Appendix H); but
(b) Is in respect of a person who has spent time within a
Specified ICU. 3
Is in respect of an Eligible Admitted Private Patient.
Dialysis Adjustment
Intensive Care Unit
(ICU) Adjustment
Private Patient Service
Adjustment
Amount to be applied
Where an
ABF
Activity:
Private Patient
Accommodation
Adjustment
Is in respect of an Eligible Admitted Private Patient.
Multidisciplinary Clinic
Adjustment
Is in respect of a non-admitted service event where three
or more health care providers (each of a different
specialty) are present, as identified using the nonadmitted ‘multiple health care provider indicator’.
Is in respect of an Emergency Department or Emergency
Service patient, with the rate of adjustment dependent on
the person’s age.
Emergency Care Age
Adjustment
2 Refer to Appendices B and C for valid ICD-10-AM 9th edition codes.
3 Refer to Appendix D.
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Admitted Acute Patient: 26 per cent
Admitted Acute Patient: 26 per cent
0.0436 NWAU(16)/hour spent by that
person within the Specified ICU.
Admitted Acute Patient: Refer to column
headed ‘Private Patient Service
Adjustment’ in the table of Price Weights
at Appendix H.
Admitted Subacute Patient: Refer to
Appendix F for applicable adjustment.
Admitted Acute or Admitted Subacute
Patient: Refer to Appendix F for
applicable adjustment.
Non-admitted Patient: 55 per cent
Emergency Department or Emergency
Service Patient who is aged:
- 65 to 79 years: 14 per cent
- Over 79 years: 21 per cent
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Chapter 6
National Pricing Model technical
specifications
6.1
Technical specifications
Detailed technical specifications of the National Pricing Model are available on the IHPA
website at www.ihpa.gov.au.
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Chapter 7
Standards
The following standards apply to the use of activity based funding in the 2016-17 financial
year:
7.1
Coding and classification
7.1.1 Admitted acute patients
The International Statistical Classification of Diseases and Related Health Problems, Tenth
Revision, Australian Modification (ICD-10-AM) / Australian Classification of Health
Interventions (ACHI) / Australian Coding Standards (ACS) 9th edition
AR-DRG classification version 8.0
7.1.2 Admitted subacute and non-acute patients
AN-SNAP classification version 4.0
7.1.3 Non-admitted patients
Tier 2 non-admitted services classification version 4.1
7.1.4 Emergency departments
URG classification version 1.4
7.1.5 Emergency services
UDG classification version 1.3
These reference standards are available at www.ihpa.gov.au.
7.2
Intensive Care Units
For NEP16, IHPA has determined which specified ICUs are eligible to receive the ICU
adjustment. This list is included at Appendix D.
7.3
Costing
The version of the Australian Hospital Patient Costing Standards to be applied for the
2016-17 financial year (NHCDC Round 19) is version 3.1.
7.4
Activity Based Funding data set specifications
Full copies of these reference standards are available at www.ihpa.gov.au.
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Chapter 8
Back-casting
Clause A40 of the NHRA outlines that where the Pricing Authority makes any significant
changes to the ABF classification systems or costing methodologies, the effect of such
changes must be back-cast to the year prior to their implementation for the purpose of
calculating Commonwealth funding estimates for each ABF service category.
In accordance with Clauses A34(b) and A40 of the NHRA, the Pricing Authority has applied
the methodological changes to NEP15 and determined the back-cast NEP15 for the
purposes of determining Commonwealth growth funding estimated between 2015-16 and
2016-17 is $4,783.
In accordance with Clauses A34(c) and A40 of the NHRA, the Pricing Authority has applied
the methodological changes to NEP15 and determined the back-casting volume multipliers
for NEP15 as detailed in Table 2.
Table 2: Back-casting volume multipliers by service category and state and territory
State /
Territory
Admitted
Acute
Admitted
Subacute and
Non-acute
Emergency
Department
Non-Admitted
(patient-level
data collection)
Non-Admitted
(aggregate
data collection)
NSW
1.0048
1.0473
0.9779
0.8909
0.8906
Vic
0.9716
1.0262
0.9770
N/A
0.8906
Qld
1.0019
1.1617
0.9734
0.8930
0.8923
SA
1.0019
1.0305
0.9842
0.8914
0.8910
WA
1.0093
0.9952
0.9675
0.8920
0.8908
Tas
1.0144
1.0000
0.9761
0.8928
0.8936
NT
1.0143
1.0000
0.9517
0.8964
0.8921
ACT
1.0103
1.0000
0.9702
0.8914
0.8912
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Appendices
Appendix A – General List of in-scope public hospital services eligible for
Commonwealth Funding under the National Health Reform Agreement ...................... 19
Appendix B – List of radiotherapy codes ........................................................................ 32
Appendix C – List of dialysis codes ................................................................................ 34
Appendix D – Specified Intensive Care Units (ICUs) ...................................................... 35
Appendix E – Specialised Children’s Hospitals.............................................................. 37
Appendix F – Private Patient Adjustments...................................................................... 38
Appendix G – Provisional weights for very long stay patients ...................................... 39
Appendix H – Price weights for admitted acute patients – AR-DRG V8.0 ..................... 40
Appendix I – Price weights for admitted subacute and non-acute patients – AN-SNAP
V4.0……….......................................................................................................................... 59
Appendix J – Paediatric per diem price weights for admitted subacute and non-acute
patients .............................................................................................................................. 61
Appendix K – Price weights for non-admitted patients .................................................. 62
Appendix L – Price weights for emergency department patients – URG V1.4.............. 65
Appendix M – Price weights for emergency service patients – UDG V1.3 .................... 69
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Appendix A – General list of in-scope public hospital
services eligible for Commonwealth Funding under the
National Health Reform Agreement
In accordance with Section 131(f) of the Act and Clauses A9–A17 of the NHRA, the scope
of ‘Public Hospital Services’ eligible for Commonwealth funding under the agreement are:
•
All admitted programs, including hospital in the home programs. Forensic mental
health inpatient services are included;
•
All emergency department services; and
•
Non-admitted services that meet the criteria for inclusion on the ‘General List of
In-Scope Public Hospital Services’.
Category A: Specialist outpatient clinic services – Tier 2 non-admitted services
classification – classes 10, 20 and 30
The Pricing Authority has determined the following services as eligible for Commonwealth
funding as a public hospital service under ‘Category A: Specialist outpatient clinic services’:
10. Procedure clinics
10.01 Hyperbaric Medicine
10.02 Interventional Imaging
10.03 Minor Surgical
10.04 Dental
10.05 Angioplasty/Angiography
10.06 Endoscopy – Gastrointestinal
10.07 Endoscopy – Urological/Gynaecological
10.08 Endoscopy – Orthopaedic
10.09 Endoscopy – Respiratory/Ear, Nose and Throat (ENT)
10.10 Renal Dialysis – Hospital Delivered
10.11 Chemotherapy treatment
10.12 Radiation Therapy – Treatment
10.13 Minor Medical Procedures
10.14 Pain Management Interventions
10.15 Renal Dialysis – Haemodialysis – Home Delivered
10.16 Renal Dialysis – Peritoneal Dialysis – Home Delivered
10.17 Total Parenteral Nutrition – Home Delivered
10.18 Enteral Nutrition – Home Delivered
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10.19 Ventilation – Home Delivered
10.20 Radiation Therapy – Simulation and Planning
20. Medical consultation clinics
20.01 Transplants
20.02 Anaesthetics
20.03 Pain Management
20.04 Developmental Disabilities
20.05 General Medicine
20.07 General Surgery
20.08 Genetics
20.09 Geriatric Medicine
20.10 Haematology
20.11 Paediatric Medicine
20.12 Paediatric Surgery
20.13 Palliative Care
20.14 Epilepsy
20.15 Neurology
20.16 Neurosurgery
20.17 Ophthalmology
20.18 Ear, Nose and Throat (ENT)
20.19 Respiratory
20.20 Respiratory – Cystic Fibrosis
20.21 Anti-coagulant Screening and Management
20.22 Cardiology
20.23 Cardiothoracic
20.24 Vascular Surgery
20.25 Gastroenterology
20.26 Hepatobiliary
20.27 Craniofacial
20.28 Metabolic Bone
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20.29 Orthopaedics
20.30 Rheumatology
20.31 Spinal
20.32 Breast
20.33 Dermatology
20.34 Endocrinology
20.35 Nephrology
20.36 Urology
20.37 Assisted Reproductive Technology
20.38 Gynaecology
20.39 Gynaecological Oncology
20.40 Obstetrics – Management of Pregnancy Without Complications
20.41 Immunology
20.42 Medical Oncology – Consultation
20.43 Radiation Therapy – Consultation
20.44 Infectious Diseases
20.45 Psychiatry
20.46 Plastic and Reconstructive Surgery
20.47 Rehabilitation
20.48 Multidisciplinary Burns Clinic
20.49 Geriatric Evaluation and Management (GEM)
20.50 Psychogeriatric
20.51 Sleep Disorders
20.52 Addiction Medicine
20.53 Obstetrics – Management of Complex Pregnancy
20.54 Maternal Fetal Medicine
20.55 Telehealth – Patient Location
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30. Stand-alone diagnostic clinics1
30.01 General Imaging
30.02 Magnetic Resonance Imaging (MRI)
30.03 Computerised Tomography (CT)
30.04 Nuclear Medicine
30.05 Pathology (Microbiology, Haematology, Biochemistry)
30.06 Positron Emission Tomography (PET)
30.07 Mammography Screening
30.08 Clinical Measurement
(1) These services are not priced as they are bundled to the originating service.
Category B: Other non-admitted patient services and non-medical specialist
outpatient clinics (Tier 2 non-admitted services class 40)
40. Allied health &/or clinical nurse specialist interventions clinics
40.03 Aids and Appliances
40.04 Clinical Pharmacy
40.05 Hydrotherapy
40.06 Occupational Therapy
40.07 Pre-Admission and Pre-Anaesthesia
40.09 Physiotherapy
40.10 Sexual Health
40.11 Social Work
40.12 Rehabilitation
40.13 Wound Management
40.14 Neuropsychology
40.15 Optometry
40.16 Orthoptics
40.17 Audiology
40.18 Speech Pathology
40.21 Cardiac Rehabilitation
40.22 Stomal Therapy
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40.23 Nutrition/Dietetics
40.24 Orthotics
40.25 Podiatry
40.28 Midwifery and Maternity
40.29 Psychology
40.30 Alcohol and Other Drugs
40.31 Burns
40.32 Continence
40.34 Specialist Mental Health
40.35 Palliative Care
40.36 Geriatric Evaluation and Management (GEM)
40.37 Psychogeriatric
40.38 Infectious Diseases
40.39 Neurology
40.40 Respiratory
40.41 Gastroenterology
40.42 Circulatory
40.43 Hepatobiliary
40.44 Orthopaedics
40.45 Dermatology
40.46 Endocrinology
40.47 Nephrology
40.48 Haematology and Immunology
40.49 Gynaecology
40.50 Urology
40.51 Breast
40.52 Oncology
40.53 General Medicine
40.54 General Surgery
40.55 Paediatrics
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40.56 Falls Prevention
40.57 Cognition and Memory
40.58 Hospital Avoidance Programs
40.59 Post-acute Care
40.60 Pulmonary Rehabilitation
40.61 Telehealth – Patient Location
Other non-admitted public hospital services for 2016-17 (excluding mental health
services)
1 Home and community-based chemotherapy services
2 Chronic disease management / hospital avoidance programs targeting:
2.1
Renal impairment
2.2
Respiratory disease
2.3
Cardio vascular disease
2.4
Oncology
2.5
Stroke
2.6
Cystic Fibrosis ambulatory care
2.7
Hepatitis C services
3 Early discharge program services including:
3.1
Postnatal care early discharge programs
3.2
Anti-coagulant post-acute hospital event
4 Falls prevention services targeting patients at high risk of falls
5 Hospital Admission risk screening services targeting patients at high risk of hospital
admission
6 Home and community-based lymphoedema services
7 Home dialysis
8 Home and community-based palliative care services including palliative care day hospices
9 Intense home and community-based nutrition support services including:
9.1
Home parenteral nutrition services
9.2
Home-based patients on nasogastric or percutaneous endoscopic gastrostomy (PEG)
tube feeding
10 Home and community peri and postnatal assessment services
11 Post-Acute Care services including:
11.1
48-hour follow-up services targeting aboriginal patients recently discharged from
hospital
11.2
Stroke post-acute care programs
12 Home and community-based rehabilitation services including:
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12.1
Trauma rehabilitation services
12.2
Pulmonary rehabilitation services
12.3
Cardiac rehabilitation services
12.4
Stroke rehabilitation services
14 Sexual assault services
15 Speech pathology services targeting immediate post discharge patients
16 Stomal therapy
Other non-admitted community-based mental health services for 2016-17
MH1
Adult integrated specialised community mental health services
MH2
Mental health crisis assessment and treatment (including telephone-based
services)
MH3
Dual diagnosis services for patients with co-morbid conditions
MH4
Home and community-based eating disorders programs
MH5
Mental health hospital avoidance programs
MH6
Ambulatory mental health care services
MH7
Perinatal and infant mental health services
MH8
Mental health step up/step down services
MH9
Mental health telephone triage services
MH10
Older persons community mental health service
A17 List
Under Clause A17 of the NHRA, IHPA has also determined a list of services (the ‘A17 list’),
which would not normally be considered a public hospital service, but which IHPA is satisfied
were provided by a particular hospital in 2010. The services on this list are eligible for
Commonwealth funding only at the Local Hospital Network (LHN) indicated in the list.
State/
Territory
LHN
Service Type
NSW
Central Coast
Allergy
NSW
Central Coast
Child Protection
NSW
Central Coast
Dementia
NSW
Central Coast
Dental - adult
NSW
Central Coast
Developmental disabilities
NSW
Central Coast
Diabetes
NSW
Central Coast
Sexual Health
NSW
Far West
Aboriginal Health
NSW
Far West
Drug and Alcohol
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State/
Territory
LHN
Service Type
NSW
Hunter New England
Aboriginal Health
NSW
Hunter New England
Audiology
NSW
Hunter New England
Diabetes
NSW
Hunter New England
Drug and Alcohol
NSW
Hunter New England
Occupational Therapy
NSW
Hunter New England
Optometry
NSW
Hunter New England
Physiotherapy
NSW
Hunter New England
Podiatry
NSW
Hunter New England
Prosthetics
NSW
Hunter New England
Speech Pathology
NSW
Illawarra Shoalhaven
Child and Adolescent MHS
NSW
Illawarra Shoalhaven
Diabetes
NSW
Illawarra Shoalhaven
Nutrition/Dietetics
NSW
Illawarra Shoalhaven
Occupational Therapy - General
NSW
Illawarra Shoalhaven
Optometry
NSW
Illawarra Shoalhaven
Physiotherapy
NSW
Illawarra Shoalhaven
Podiatry
NSW
Illawarra Shoalhaven
Prosthetics
NSW
Illawarra Shoalhaven
Speech Pathology
NSW
Justice Forensic MHSN
Optometry
NSW
Justice Forensic MHSN
Child and Adolescent MHS
NSW
Justice Forensic MHSN
Community Forensic Mental Health
NSW
Mid North Coast
Aboriginal Health
NSW
Mid North Coast
Occupational Therapy - General
NSW
Mid North Coast
Optometry
NSW
Mid North Coast
Physiotherapy
NSW
Mid North Coast
Prosthetics
NSW
Murrumbidgee
Aboriginal Health Clinics
NSW
Murrumbidgee
Child and Adolescent MHS
NSW
Murrumbidgee
Dental - adult
NSW
Murrumbidgee
Dental - child
NSW
Murrumbidgee
Diabetes
NSW
Murrumbidgee
Occupational Therapy - General
NSW
Murrumbidgee
Optometry
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State/
Territory
LHN
Service Type
NSW
Murrumbidgee
Physiotherapy
NSW
Murrumbidgee
Prosthetics
NSW
Murrumbidgee
Sexual Health
NSW
Murrumbidgee
Speech Pathology
NSW
Nepean Blue Mountains
Aboriginal Health
NSW
Nepean Blue Mountains
Adolescent/youth health
NSW
Nepean Blue Mountains
Alcohol and Drug - Hawkesbury
NSW
Nepean Blue Mountains
Child and Adolescent MHS
NSW
Nepean Blue Mountains
Diabetes
NSW
Nepean Blue Mountains
Early intervention
NSW
Nepean Blue Mountains
Maintenance care
NSW
Nepean Blue Mountains
Nutrition/Dietetics
NSW
Nepean Blue Mountains
Occupational Therapy
NSW
Nepean Blue Mountains
Occupational Therapy - General
NSW
Nepean Blue Mountains
Optometry
NSW
Nepean Blue Mountains
Orthoptics
NSW
Nepean Blue Mountains
Physiotherapy
NSW
Nepean Blue Mountains
Podiatry
NSW
Nepean Blue Mountains
Prosthetics
NSW
Nepean Blue Mountains
Speech Pathology
NSW
Northern NSW
Nutrition/Dietetics
NSW
Northern NSW
Occupational Therapy - General
NSW
Northern NSW
Optometry
NSW
Northern NSW
Physiotherapy
NSW
Northern NSW
Prosthetics
NSW
Northern NSW
Speech Pathology
NSW
Northern Sydney
Audiology
NSW
Northern Sydney
Child and Adolescent MHS
NSW
Northern Sydney
Diabetes
NSW
Northern Sydney
Occupational Therapy - General
NSW
Northern Sydney
Optometry
NSW
Northern Sydney
Orthoptics
NSW
Northern Sydney
Orthotics
NSW
Northern Sydney
Physiotherapy
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State/
Territory
LHN
Service Type
NSW
Northern Sydney
Podiatry
NSW
Northern Sydney
Prosthetics
NSW
Northern Sydney
Speech Pathology
NSW
St Vincent’s SHN
Aboriginal Health
NSW
St Vincent’s SHN
Audiology
NSW
St Vincent’s SHN
Diabetes
NSW
St Vincent’s SHN
Neuropsychology
NSW
St Vincent’s SHN
Nutrition/Dietetics
NSW
St Vincent’s SHN
Occupational Therapy - General
NSW
St Vincent’s SHN
Podiatry
NSW
St Vincent’s SHN
Prosthetics
NSW
St Vincent’s SHN
Physiotherapy
NSW
St Vincent’s SHN
Speech Pathology
NSW
South Eastern Sydney
Aboriginal Health
NSW
South Eastern Sydney
Audiology
NSW
South Eastern Sydney
Child and Adolescent MHS
NSW
South Eastern Sydney
Diabetes
NSW
South Eastern Sydney
Nutrition/Dietetics
NSW
South Eastern Sydney
Occupational Therapy - General
NSW
South Eastern Sydney
Optometry
NSW
South Eastern Sydney
Orthoptics
NSW
South Eastern Sydney
Orthotics
NSW
South Eastern Sydney
Physiotherapy
NSW
South Eastern Sydney
Prosthetics
NSW
South Eastern Sydney
Speech Pathology
NSW
South West Sydney
Aboriginal Health
NSW
South West Sydney
Child and Adolescent MHS
NSW
South West Sydney
Diabetes
NSW
South West Sydney
Drug and Alcohol
NSW
South West Sydney
Nutrition/Dietetics
NSW
South West Sydney
Occupational Therapy - General
NSW
South West Sydney
Optometry
NSW
South West Sydney
Orthoptics
NSW
South West Sydney
Orthotics
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State/
Territory
LHN
Service Type
NSW
South West Sydney
Physiotherapy
NSW
South West Sydney
Podiatry
NSW
South West Sydney
Prosthetics
NSW
South West Sydney
Speech Pathology
NSW
Sydney Children's HN
Aboriginal Health
NSW
Sydney Children's HN
Audiology
NSW
Sydney Children's HN
Child and Adolescent MHS
NSW
Sydney Children's HN
Diabetes
NSW
Sydney Children's HN
Newborn screening assessment
NSW
Sydney Children's HN
Nutrition/Dietetics
NSW
Sydney Children's HN
Occupational Therapy - General
NSW
Sydney Children's HN
Optometry
NSW
Sydney Children's HN
Orthoptics
NSW
Sydney Children's HN
Orthotics
NSW
Sydney Children's HN
Physiotherapy
NSW
Sydney Children's HN
Prosthetics
NSW
Sydney Children's HN
Speech Pathology
NSW
Sydney
Aboriginal Health
NSW
Sydney
Audiology
NSW
Sydney
Diabetes
NSW
Sydney
Nutrition/Dietetics
NSW
Sydney
Occupational Therapy - General
NSW
Sydney
Optometry
NSW
Sydney
Orthoptics
NSW
Sydney
Orthotics
NSW
Sydney
Physiotherapy
NSW
Sydney
Podiatry
NSW
Sydney
Prosthetics
NSW
Sydney
Speech Pathology
NSW
Southern NSW
Child and Adolescent MHS
NSW
Southern NSW
Diabetes
NSW
Southern NSW
Drug and Alcohol
NSW
Southern NSW
Nutrition/Dietetics
NSW
Southern NSW
Occupational Therapy - General
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State/
Territory
LHN
Service Type
NSW
Southern NSW
Optometry
NSW
Southern NSW
Physiotherapy
NSW
Southern NSW
Podiatry
NSW
Southern NSW
Prosthetics
NSW
Southern NSW
Speech Pathology
NSW
Western NSW
Aboriginal Health
NSW
Western NSW
Child and Adolescent MHS
NSW
Western NSW
Diabetes
NSW
Western NSW
Drug and Alcohol
NSW
Western NSW
Nutrition/Dietetics
NSW
Western NSW
Occupational Therapy - General
NSW
Western NSW
Optometry
NSW
Western NSW
Physiotherapy
NSW
Western NSW
Podiatry
NSW
Western NSW
Prosthetics
NSW
Western NSW
Speech Pathology
NSW
Western Sydney
Aboriginal Health
NSW
Western Sydney
Child and Adolescent MHS
NSW
Western Sydney
Diabetes
NSW
Western Sydney
Nutrition/Dietetics
NSW
Western Sydney
Occupational Therapy - General
NSW
Western Sydney
Optometry
NSW
Western Sydney
Orthoptics
NSW
Western Sydney
Physiotherapy
NSW
Western Sydney
Podiatry
NSW
Western Sydney
Prosthetics
NSW
Western Sydney
Speech Pathology
Qld
Central West
Child health
Qld
Central West
Echo-cardiology
Qld
Central West
Physician
Qld
Central West
Women's Health (Well Women program)
Qld
Metro South
Alternate Site Infusion Service (ASIS)
Qld
Metro South
Mental Health home visits
Qld
North West
Emergency services
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State/
Territory
LHN
Service Type
Vic
Austin Health
Family Planning Clinics
Vic
Bendigo Health Care Group
Family Planning Clinics
Vic
Eastern Health
Family Planning Clinics
Vic
Mercy Public Hospitals Inc.
Family Planning Clinics
Vic
Mildura Base Hospital
Family Planning Clinics
Vic
North East Health Wangaratta
Family Planning Clinics
Vic
Peninsula Health
Family Planning Clinics
Vic
The Royal Children’s Hospital
Ventilation services in the home
Vic
Southern Health
Family Planning Clinics
Vic
The Royal Women’s Hospital
Family Planning Clinics
Vic
Western Health
Family Planning Clinics
Vic
All LHNs
Child and adolescent community-based
mental health services (CAMHS)
Vic
All LHNs
Alcohol and Drug Services
Vic
All LHNs
Adult Continuing Care
SA
All LHNs
Home Oxygen Services
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Appendix B - List of radiotherapy codes
Table 3: Radiotherapy ICD-10-AM 9th edition codes
Procedure
Codes
15000-00
15003-00
15100-00
15103-00
15224-00
15239-00
15254-00
15269-00
15600-00
15600-01
15600-02
15600-03
15600-04
15303-00
15304-00
15311-00
15312-00
15319-00
15320-00
90764-00
90764-01
15327-00
15327-01
15327-02
15327-03
15327-04
15327-05
15327-06
15327-07
15338-00
15360-00
15339-00
15012-00
90766-00
16003-00
16009-00
16012-00
16015-00
16018-00
90960-00
15342-00
15351-00
90765-00
90765-01
90765-02
90765-03
90765-04
15500-00
15503-00
15506-00
15506-01
15506-02
15509-00
15550-00
15518-00
15521-00
15524-00
15524-01
15527-00
15530-00
15533-00
15536-00
15536-01
15536-02
Description
Radiation treatment, superficial, 1 field
Radiation treatment, superficial, >= 2 fields
Radiation treatment, orthovoltage, 1 field
Radiation treatment, orthovoltage, >= 2 fields
Radiation treatment, megavoltage, 1 field, single modality linear accelerator
Radiation treatment, megavoltage, >= 2 fields, single modality linear accelerator
Radiation treatment, megavoltage, 1 field, dual modality linear accelerator
Radiation treatment, megavoltage, >= 2 fields, dual modality linear accelerator
Stereotactic radiation treatment, single dose
Stereotactic radiation treatment, fractionated
Hemi body irradiation
Total body irradiation
Total skin irradiation
Brachytherapy, intrauterine, low dose rate
Brachytherapy, intrauterine, high dose rate
Brachytherapy, intravaginal, low dose rate
Brachytherapy, intravaginal, high dose rate
Brachytherapy, combined intrauterine and intravaginal, low dose rate
Brachytherapy, combined intrauterine and intravaginal, high dose rate
Brachytherapy, intracavitary, low dose rate
Brachytherapy, intracavitary, high dose rate
Brachytherapy with implantation of removable single plane, low dose rate
Brachytherapy with implantation of removable single plane, pulsed dose rate
Brachytherapy with implantation of removable multiple planes or volume implant, low dose rate
Brachytherapy with implantation of removable multiple planes or volume implant, pulsed dose rate
Brachytherapy with implantation of permanent implant, < 10 sources
Brachytherapy with implantation of permanent implant, >= 10 sources
Brachytherapy with implantation of removable single plane, high dose rate
Brachytherapy with implantation of removable multiple planes or volume implant, high dose rate
Brachytherapy, prostate
Brachytherapy, intravascular
Removal of sealed radioactive source
Brachytherapy, eye
Brachytherapy using surface applicators, other sites
Administration of a therapeutic dose of Yttrium 90
Administration of a therapeutic dose of Iodine 131
Administration of a therapeutic dose of Phosphorous 32
Administration of a therapeutic dose of Strontium 89
Administration of a therapeutic dose of 153 SM-Lexidronan
Administration of a therapeutic dose of other unsealed radioisotope
Construction and application of radioactive surface mould
Construction and application of eye applicator
Construction and fitting of immobilisation device, simple
Construction and fitting of immobilisation device, intermediate
Construction and fitting of immobilisation device, complex
Construction and fitting of customised blocks
Construction and fitting of treatment accessories
Radiation field setting using simulator, simple
Radiation field setting using simulator, intermediate
Radiation field setting using simulator, complex
Radiation field setting using dedicated CT scanner
Radiation field setting for intensity modulated radiation therapy [IMRT]
Radiation field setting using diagnostic x-ray unit
Radiation field setting for three dimensional conformal radiation therapy [3DCRT]
Dosimetry by CT interfacing computer, simple
Dosimetry by CT interfacing computer, intermediate
Dosimetry by CT interfacing computer, complex
Dosimetry by CT interfacing computer for intensity modulated radiation therapy [IMRT]
Dosimetry by non-CT interfacing computer, simple
Dosimetry by non-CT interfacing computer, intermediate
Dosimetry by non-CT interfacing computer, complex
Brachytherapy planning, simple
Brachytherapy planning, intermediate
Brachytherapy planning, complex
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Procedure
Codes
15539-00
15541-00
15556-00
15556-01
37217-01
Description
Brachytherapy planning, prostate
Brachytherapy planning, intravascular
Dosimetry by CT interfacing computer for three dimensional conformal radiation therapy [3DCRT]
Dosimetry by non-CT interfacing computer for three dimensional conformal radiation therapy [3DCRT]
Implantation of fiducial markers
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Appendix C - List of dialysis codes
Table 4: Dialysis ICD-10-AM 9th edition codes
Procedure
Codes
13100-00
13100-01
13100-02
13100-03
13100-04
13100-05
13100-06
13100-07
13100-08
Description
Haemodialysis
Intermittent haemofiltration
Continuous haemofiltration
Intermittent haemodiafiltration
Continuous haemodiafiltration
Haemoperfusion
Peritoneal dialysis, short term
Intermittent peritoneal dialysis, long term
Continuous peritoneal dialysis, long term
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Appendix D - Specified Intensive Care Units (ICUs)
Table 5: Specified ICUs
State/Territory
NSW
NSW
NSW
NSW
NSW
NSW
NSW
NSW
NSW
NSW
NSW
NSW
NSW
NSW
NSW
NSW
NSW
NSW
NSW
NSW
NSW
NSW
NSW
NSW
NSW
NSW
Vic
Vic
Vic
Vic
Vic
Vic
Vic
Vic
Vic
Vic
Vic
Vic
Vic
Vic
Vic
Qld
Qld
Qld
Qld
Qld
Qld
Qld
Qld
Qld
Qld
Qld
Qld
Qld
Qld
Qld
Qld
Qld
SA
SA
SA
SA
SA
WA
Name
Bankstown-Lidcombe Hospital
Blacktown Hospital
Calvary Mater Newcastle
Coffs Harbour Health Campus
Concord Repatriation General Hospital
Gosford Hospital
Hornsby Ku-Ring-Gai Hospital
John Hunter Hospital
Lismore Base Hospital
Liverpool Hospital
Nepean Hospital
Orange Base Hospital
Port Macquarie Base Hospital
Prince of Wales Hospital
Royal North Shore Hospital
Royal Prince Alfred Hospital
St George Hospital (NSW)
St Vincent's Hospital (Darlinghurst)
Sydney Children's Hospital
Tamworth Hospital
The Children's Hospital At Westmead
The Sutherland Hospital
The Tweed Hospital
Wagga Wagga Base Hospital
Westmead Hospital
Wollongong Hospital
Austin Hospital (Heidelberg)
Ballarat Health Services (Base Campus)
Box Hill Hospital
Dandenong Campus
Frankston Hospital
Maroondah Hospital (East Ringwood)
Monash Medical Centre (Clayton)
Royal Children's Hospital (Parkville)
Royal Melbourne Hospital (Parkville)
St Vincent's Hospital (Fitzroy)
The Alfred
The Bendigo Hospital
The Northern Hospital (Epping)
University Hospital Geelong
Western Hospital (Footscray)
Bundaberg Hospital
Cairns Base Hospital
Gold Coast University Hospital
Ipswich Hospital
Lady Cilento Children's Hospital
Logan Hospital
Mackay Base Hospital
Mater Adult Hospital
Nambour Hospital
Princess Alexandra Hospital
Redcliffe Hospital
Robina Hospital
Rockhampton Base Hospital
Royal Brisbane & Women's Hospital
The Prince Charles Hospital
The Townsville Hospital
Toowoomba Hospital
Flinders Medical Centre
Lyell Mcewin Hospital
Royal Adelaide Hospital
The Queen Elizabeth Hospital
Women's And Children's Hospital
Armadale-Kelmscott Memorial Hospital
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State/Territory
WA
WA
WA
WA
WA
WA
Tas
Tas
NT
NT
ACT
Name
Fiona Stanley Hospital
Joondalup Health Campus
Princess Margaret Hospital For Children
Rockingham General Hospital
Royal Perth Hospital Wellington Street Campus
Sir Charles Gairdner Hospital
Launceston General Hospital
Royal Hobart Hospital
Alice Springs Hospital
Royal Darwin Hospital
Canberra Hospital & Health Services
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Appendix E - Specialised Children's Hospital
Table 6: Specialised Children's Hospitals
State/Territory
NSW
NSW
NSW
Vic
Vic
Qld
Qld
SA
WA
Name
John Hunter Hospital
Sydney Children's Hospital
The Children's Hospital At Westmead
Monash Medical Centre (Clayton)
Royal Children's Hospital (Parkville)
Lady Cilento Children's Hospital
The Townsville Hospital
Women's And Children's Hospital
Princess Margaret Hospital For Children
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Appendix F - Private Patient Adjustments
Table 7: Private patient accommodation adjustment (admitted acute and subacute
patients)
Private Patient Accommodation Per Diem Price Weights
State/Territory
Same Day
Overnight
NSW
0.0508
0.0700
Vic
0.0498
0.0665
Qld
0.0518
0.0714
SA
0.0508
0.0700
WA
0.0576
0.0700
Tas
0.0493
0.0672
NT
0.0508
0.0700
ACT
0.0508
0.0700
Table 8: Private patient service adjustment (admitted subacute and non-acute
patients)
Care Type
Palliative Care
Rehabilitation
Psychogeriatric Care
GEM
Maintenance
Private Patient
Service Adjustment
3.1%
3.6%
3.4%
3.4%
1.6%
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Appendix G - Provisional weights for very long stay
patients
These price weights are used to calculate NWAU for patients who are not discharged at
30 June 2017 and have a length of stay on the date of 200 days or more.
The Administrator of the National Health Funding Pool will advise the business rules that
will apply for reporting this activity.
Table 9: Price weights for very long stay patients
Care Type
Admitted Acute
Admitted Subacute and Non-Acute
Independent Hospital Pricing Authority
NWAU/Day
0.2359
0.1843
Page 39 of 70
Independent Hospital Pricing Authority - National Efficient Price Determination 2016-17
Appendix H - Price weights for admitted acute patients - AR-DRG V8.0
The admitted acute price weights are available as an Excel spreadsheet on the IHPA website.
Table 10: Admitted acute price weights - AR-DRG V8.0
Inlier Bounds
AR-DRG
V8.0
Description
Same-Day
Payment
List
Bundled
ICU
ALOS (excluding
designated SD and
unbundled ICU)
Lower
Bound
Upper
Bound
Adjustments
Private
Patient
Paediatric
Service Adj.
Adj.
Price Weights
Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
801A
OR Procedures Unrelated to Principal Diagnosis, Major Complexity
25.5
8
77
14%
158%
0.7515
1.0161
8.8803
0.2580
801B
OR Procedures Unrelated to Principal Diagnosis, Intermediate Complexity
9.3
3
28
17%
85%
0.5805
1.1819
4.1262
0.2635
801C
OR Procedures Unrelated to Principal Diagnosis, Minor Complexity
2.5
1
7
13%
80%
1.2440
0.3320
A01Z
Liver Transplant
23.4
16
37
10%
111%
3.9604
1.3139
24.9824
0.4634
A03Z
Lung or Heart-Lung Transplant
21.6
10
98
10%
100%
3.0390
1.7192
20.2309
0.4554
A05Z
Heart Transplant
24.6
13
121
10%
100%
4.8062
1.8238
28.5155
0.4882
A06A
Tracheostomy and/or Ventilation >=96hours, Major Complexity
35.2
23
53
9%
119%
2.8362
1.1808
29.9951
0.3499
A06B
Tracheostomy and/or Ventilation >=96hours, Intermediate Complexity
20.3
13
31
12%
100%
1.6286
1.2500
17.8782
0.3703
A06C
Tracheostomy and/or Ventilation >=96hours, Minor Complexity
11.0
7
16
11%
100%
0.7168
1.3033
9.8399
0.3829
A07A
Allogeneic Bone Marrow Transplant, Age <=16 Years or Major Complexity
42.3
14
127
6%
200%
0.1856
1.4766
20.8579
0.4906
A07B
Allogeneic Bone Marrow Transplant, Age >=17 Years and Minor Complexity
20.4
6
61
6%
100%
0.0153
1.9613
11.7834
0.4294
A08A
Autologous Bone Marrow Transplant, Major Complexity
21.3
7
64
10%
171%
0.0131
1.0547
7.3963
0.3414
A08B
Autologous Bone Marrow Transplant, Minor Complexity
6.8
2
20
9%
100%
0.0208
1.3349
2.6906
0.2268
A09A
Kidney Transplant, Age <=16 Years or Major Complexity
13.0
4
39
10%
108%
1.6216
2.2225
10.5116
0.5125
A09B
Kidney Transplant, Age >=17 Years and Minor Complexity
8.0
2
24
6%
100%
1.5897
3.0669
7.7235
0.3987
A10Z
Insertion of Ventricular Assist Device
42.0
25
58
10%
100%
25.4400
1.5262
63.5960
0.6943
A11A
Insertion of Implantable Spinal Infusion Device, Major Complexity
16.1
5
48
10%
100%
2.8006
1.3998
9.7993
0.4834
A11B
Insertion of Implantable Spinal Infusion Device, Minor Complexity
2.8
1
8
10%
100%
3.5975
0.5399
A12Z
Insertion of Neurostimulator Device
2.8
1
8
10%
100%
5.0980
0.8786
A40A
ECMO, Major Complexity
16.0
5
48
17%
126%
3.3255
6.2606
34.6287
0.5742
A40B
ECMO, Minor Complexity
8.7
2
26
17%
100%
1.5114
5.6902
12.8918
0.6831
B01A
Ventricular Shunt Revision, Major Complexity
10.3
3
31
15%
83%
1.1358
1.3155
5.0824
0.3209
B01B
Ventricular Shunt Revision, Minor Complexity
4.9
1
15
17%
90%
2.7165
0.2911
B02A
Cranial Procedures, Major Complexity
19.5
6
59
18%
116%
1.6836
1.4735
10.5248
0.2980
B02B
Cranial Procedures, Intermediate Complexity
9.9
3
30
21%
107%
1.5192
1.3987
5.7152
0.2787
B02C
Cranial Procedures, Minor Complexity
6.5
2
19
24%
93%
1.1869
1.3748
3.9365
0.2608
B03A
Spinal Procedures, Major Complexity
15.2
5
45
19%
111%
2.0534
0.8859
6.4828
0.2412
B03B
Spinal Procedures, Intermediate Complexity
4.2
1
13
31%
100%
3.4741
0.2602
B03C
Spinal Procedures, Minor Complexity
3.0
1
9
31%
100%
2.5017
0.2937
B04A
Extracranial Vascular Procedures, Major Complexity
13.2
4
40
16%
100%
5.9097
0.2736
B04B
Extracranial Vascular Procedures, Intermediate Complexity
5.6
1
17
15%
100%
3.2651
0.2475
B04C
Extracranial Vascular Procedures, Minor Complexity
2.5
1
8
15%
100%
2.1764
0.2987
B05Z
Carpal Tunnel Release
1.1
1
3
26%
100%
0.4455
0.1305
B06A
Procedures for Cerebral Palsy, Muscular Dystrophy and Neuropathy, Major Comp
15.0
4
45
16%
80%
1.2022
1.3066
6.4286
0.2365
B06B
Procedures for Cerebral Palsy, Muscular Dystrophy and Neuropathy, Interm Comp
6.2
2
19
9%
86%
0.6461
1.2612
3.1685
0.2128
B06C
Procedures for Cerebral Palsy, Muscular Dystrophy and Neuropathy, Minor Comp
2.6
1
8
24%
171%
1.4090
0.2703
Independent Hospital Pricing Authority
YES
Page 40 of 70
1.2862
0.6061
1.1559
Independent Hospital Pricing Authority - National Efficient Price Determination 2016-17
Inlier Bounds
AR-DRG
V8.0
Description
B07A
Cranial or Peripheral Nerve and Other Nervous System Procedures, Major Comp
B07B
Cranial or Peripheral Nerve and Other Nervous System Procedures, Minor Comp
B40Z
Plasmapheresis W Neurological Disease, Sameday
Same-Day
Payment
List
Bundled
ICU
ALOS (excluding
designated SD and
unbundled ICU)
YES
Lower
Bound
Upper
Bound
Adjustments
Private
Patient
Paediatric
Service Adj.
Adj.
11.0
3
33
14%
100%
2.1
1
6
16%
110%
1.0
1
1
15%
155%
Price Weights
Same Day
Short-Stay
Outlier
Base
0.8115
Short-Stay
Outlier Per
Diem
1.0515
0.6483
Inlier
Long-Stay
Outlier Per
Diem
3.9660
0.2041
1.3503
0.3401
0.1679
B41Z
Telemetric EEG Monitoring
4.2
1
14
14%
84%
B42A
Nervous System Disorders W Ventilator Support, Major Complexity
12.8
4
39
8%
135%
1.4776
0.3013
5.8733
B42B
Nervous System Disorders W Ventilator Support, Minor Complexity
3.5
1
10
11%
160%
0.2953
1.7935
B60A
Acute Paraplegia and Quadriplegia W or W/O OR Procedures, Major Complexity
45.7
15
137
10%
100%
0.3426
0.3191
1.0796
16.5361
B60B
Acute Paraplegia and Quadriplegia W or W/O OR Procedures, Minor Complexity
10.9
3
33
10%
100%
0.3060
0.0000
1.2820
3.8459
B61A
Spinal Cord Conditions W or W/O OR Procedures, Major Complexity
20.8
13
31
12%
0.2545
100%
0.9786
0.5376
7.9680
B61B
Spinal Cord Conditions W or W/O OR Procedures, Minor Complexity
6.9
2
21
0.2866
17%
100%
0.1748
1.2947
2.7642
B62Z
Apheresis
1.0
1
0.2763
3
6%
105%
0.2433
B63A
Dementia and Other Chronic Disturbances of Cerebral Function, Major Complexity
21.4
0.1875
7
64
4%
100%
0.0000
0.6742
4.7192
B63B
Dementia and Other Chronic Disturbances of Cerebral Function, Minor Complexity
0.1876
9.8
3
29
4%
100%
0.0000
0.7401
2.2202
B64A
Delirium, Major Complexity
0.1631
10.2
3
31
8%
100%
0.0000
0.7970
2.3911
B64B
Delirium, Minor Complexity
0.2042
YES
3.7
1
11
11%
100%
0.0940
0.8127
B65A
Cerebral Palsy, Major Complexity
0.2159
YES
9.2
3
27
18%
80%
0.4370
3.6705
B65B
Cerebral Palsy, Minor Complexity
0.2919
1.1
1
3
19%
122%
0.2671
B66A
Nervous System Neoplasms, Major Complexity
0.1700
10.4
3
31
6%
90%
2.9503
B66B
Nervous System Neoplasms, Minor Complexity
0.2313
4.9
1
15
11%
119%
1.2921
B67A
Degenerative Nervous System Disorders, Major Complexity
0.2234
11.8
3
36
6%
130%
2.7986
B67B
Degenerative Nervous System Disorders, Intermediate Complexity
0.2120
5.0
1
15
9%
140%
1.0737
B67C
Degenerative Nervous System Disorders, Minor Complexity
0.2231
1.1
1
3
6%
192%
0.1489
B68A
Multiple Sclerosis and Cerebellar Ataxia, Major Complexity
0.1035
8.2
2
24
7%
134%
2.0405
B68B
0.2330
Multiple Sclerosis and Cerebellar Ataxia, Minor Complexity
1.1
1
3
2%
200%
0.3333
0.2632
B69A
TIA and Precerebral Occlusion, Major Complexity
4.5
1
14
16%
100%
1.0784
0.2225
B69B
TIA and Precerebral Occlusion, Minor Complexity
2.0
1
6
18%
100%
0.4719
0.2317
B70A
Stroke and Other Cerebrovascular Disorders, Major Complexity
21.2
7
64
8%
100%
0.0000
0.7852
5.4964
0.2310
B70B
Stroke and Other Cerebrovascular Disorders, Intermediate Complexity
8.3
2
25
9%
100%
0.0000
1.0752
2.1505
0.2302
B70C
Stroke and Other Cerebrovascular Disorders, Minor Complexity
YES
4.6
1
14
13%
153%
0.2087
1.1870
0.2469
B70D
Stroke and Other Cerebrovascular Disorders, Transferred <5 Days
YES
2.3
1
4
14%
100%
0.1715
0.7215
B71A
Cranial and Peripheral Nerve Disorders, Major Complexity
YES
6.5
2
19
9%
138%
0.1783
B71B
Cranial and Peripheral Nerve Disorders, Minor Complexity
1.2
1
4
8%
200%
B72A
Nervous System Infection Except Viral Meningitis, Major Complexity
13.1
4
39
10%
106%
B72B
Nervous System Infection Except Viral Meningitis, Minor Complexity
4.4
1
13
10%
B73Z
Viral Meningitis
2.9
1
10
B74A
Nontraumatic Stupor and Coma, Major Complexity
5.9
1
B74B
Nontraumatic Stupor and Coma, Minor Complexity
1.8
B75Z
Febrile Convulsions
B76A
Seizures, Major Complexity
B76B
YES
YES
YES
0.0620
0.0000
0.0000
1.4528
1.2235
0.9834
0.3029
0.0000
0.9329
0.1617
0.2450
0.0000
1.7456
0.2323
0.1701
0.1123
4.0201
0.2381
171%
0.9813
0.2245
10%
126%
0.7362
0.2273
18
9%
100%
1.4790
0.2653
1
5
12%
100%
0.3590
0.2423
1.3
1
4
11%
100%
0.3411
0.2492
YES
5.1
1
15
8%
126%
0.1641
1.3011
0.2587
Seizures, Minor Complexity
YES
1.9
1
6
12%
168%
0.1300
0.4884
0.2461
B77A
Headaches, Major Complexity
YES
3.3
1
10
13%
127%
0.1252
0.8020
0.2331
B77B
Headaches, Minor Complexity
1.3
1
4
16%
167%
0.2087
0.1393
B78A
Intracranial Injuries, Major Complexity
12.5
4
38
8%
100%
3.3015
0.2457
Independent Hospital Pricing Authority
Page 41 of 70
0.0000
1.0203
0.0000
0.0000
0.8728
1.0050
0.8254
Independent Hospital Pricing Authority - National Efficient Price Determination 2016-17
Inlier Bounds
AR-DRG
V8.0
Description
Same-Day
Payment
List
Bundled
ICU
ALOS (excluding
designated SD and
unbundled ICU)
Lower
Bound
Upper
Bound
Adjustments
Private
Patient
Paediatric
Service Adj.
Adj.
Price Weights
Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
B78B
Intracranial Injuries, Minor Complexity
3.7
1
11
10%
131%
0.9071
B78C
Intracranial Injuries, Transferred <5 Days
1.6
1
4
17%
100%
0.4316
B79A
Skull Fractures, Major Complexity
4.2
1
13
9%
113%
1.0530
0.2466
B79B
Skull Fractures, Minor Complexity
1.5
1
5
10%
153%
0.3641
0.2396
B80A
Other Head Injuries, Major Complexity
4.0
1
12
13%
86%
0.8309
0.2090
B80B
Other Head Injuries, Minor Complexity
1.1
1
3
14%
80%
0.1678
0.1259
B81A
Other Disorders of the Nervous System, Major Complexity
9.4
3
28
9%
128%
2.4680
0.2097
B81B
Other Disorders of the Nervous System, Minor Complexity
3.8
1
11
13%
128%
0.8608
0.2068
B82A
Chronic & Unspec Para/Quadriplegia W or W/O OR Proc, Major Complexity
36.9
12
111
10%
100%
0.2730
0.9534
11.7143
0.2559
B82B
Chronic & Unspec Para/Quadriplegia W or W/O OR Proc, Intermediate Complexity
9.1
6
14
10%
186%
0.1172
0.4745
2.9639
0.2375
B82C
Chronic & Unspec Para/Quadriplegia W or W/O OR Proc, Minor Complexity
4.4
1
13
10%
94%
0.9452
0.2926
C01A
Procedures for Penetrating Eye Injury, Major Complexity
4.5
1
13
10%
100%
2.5882
0.3887
C01B
Procedures for Penetrating Eye Injury, Minor Complexity
2.1
1
6
10%
171%
1.2575
0.3936
C02Z
Enucleations and Orbital Procedures
4.1
1
12
19%
129%
2.0840
0.3205
C03A
Retinal Procedures, Major Complexity
1.4
1
4
64%
123%
0.8915
0.3049
C03B
Retinal Procedures, Minor Complexity
1.0
1
3
68%
200%
0.3497
0.1450
C04A
Major Corneal, Scleral and Conjunctival Procedures, Major Complexity
4.5
1
14
26%
100%
2.0614
0.3386
C04B
Major Corneal, Scleral and Conjunctival Procedures, Minor Complexity
1.3
1
4
30%
100%
1.2506
0.3544
C05Z
Dacryocystorhinostomy
1.1
1
3
40%
90%
0.9789
0.3324
C10Z
Strabismus Procedures
1.0
1
3
25%
100%
0.8012
0.2437
C11Z
Eyelid Procedures
2.0
1
6
29%
100%
1.0960
0.3554
C12Z
Other Corneal, Scleral and Conjunctival Procedures
1.5
1
4
26%
108%
0.7101
0.2493
C13Z
Lacrimal Procedures
1.3
1
3
24%
80%
0.4942
0.1672
C14A
Other Eye Procedures, Major Complexity
3.8
1
11
7%
80%
1.2194
0.2812
C14B
Other Eye Procedures, Minor Complexity
1.0
1
3
30%
111%
0.4117
0.1647
C15Z
Glaucoma and Complex Cataract Procedures
1.4
1
4
40%
142%
0.7743
0.2421
C16Z
Lens Procedures
1.0
1
4
68%
155%
0.5573
0.2170
C60A
Acute and Major Eye Infections, Major Complexity
8.3
2
25
5%
100%
2.3246
0.2694
C60B
Acute and Major Eye Infections, Minor Complexity
3.7
1
11
3%
125%
1.0642
0.3006
C61A
Neurological and Vascular Disorders of the Eye, Major Complexity
YES
4.8
1
14
15%
139%
0.2380
1.1983
0.2471
C61B
Neurological and Vascular Disorders of the Eye, Minor Complexity
YES
2.7
1
8
14%
173%
0.1533
0.7031
0.2172
C62A
Hyphaema and Medically Managed Trauma to the Eye, Major Complexity
YES
3.8
1
11
9%
200%
0.1189
0.8393
0.2114
C62B
Hyphaema and Medically Managed Trauma to the Eye, Minor Complexity
1.2
1
4
15%
167%
0.2041
0.1448
C63A
Other Disorders of the Eye, Major Complexity
YES
4.8
1
15
7%
100%
0.2192
1.3093
0.2536
C63B
Other Disorders of the Eye, Intermediate Complexity
YES
2.5
1
8
13%
175%
0.2257
0.6706
0.2502
C63C
Other Disorders of the Eye, Minor Complexity
YES
2.2
1
6
37%
200%
0.1324
0.5352
0.2337
D01Z
Cochlear Implant
1.2
1
3
78%
128%
6.0382
0.8311
D02A
Head and Neck Procedures, Major Complexity
11.6
3
35
17%
100%
6.6946
0.3696
D02B
Head and Neck Procedures, Intermediate Complexity
4.8
1
14
18%
100%
3.2490
0.4498
D02C
Head and Neck Procedures, Minor Complexity
2.3
1
7
13%
90%
1.8589
0.4670
D03Z
Surgical Repair for Cleft Lip and Palate Disorders
2.2
1
7
11%
115%
1.6172
0.4169
D04A
Maxillo Surgery, Major Complexity
2.6
1
8
19%
100%
2.1763
0.3287
D04B
Maxillo Surgery, Minor Complexity
1.6
1
5
14%
113%
1.4493
0.4011
Independent Hospital Pricing Authority
YES
YES
YES
YES
Page 42 of 70
0.1156
0.0000
0.8227
0.2972
0.6760
0.6114
0.0000
1.2564
1.1623
1.8127
0.2508
Independent Hospital Pricing Authority - National Efficient Price Determination 2016-17
Inlier Bounds
AR-DRG
V8.0
Description
Same-Day
Payment
List
Bundled
ICU
ALOS (excluding
designated SD and
unbundled ICU)
Lower
Bound
Upper
Bound
Adjustments
Private
Patient
Paediatric
Service Adj.
Adj.
Price Weights
Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
D05Z
Parotid Gland Procedures
2.4
1
7
17%
100%
2.2386
0.3776
D06Z
Sinus and Complex Middle Ear Procedures
1.2
1
4
26%
100%
1.2258
0.4031
D10Z
Nasal Procedures
1.1
1
3
26%
89%
0.9772
0.3626
D11Z
Tonsillectomy and Adenoidectomy
1.1
1
3
18%
100%
0.7131
0.3482
D12A
Other Ear, Nose, Mouth and Throat Procedures, Major Complexity
5.4
1
16
10%
125%
2.0595
0.2806
D12B
Other Ear, Nose, Mouth and Throat Procedures, Minor Complexity
1.2
1
4
20%
100%
0.7450
0.3290
D13Z
Myringotomy W Tube Insertion
1.1
1
3
34%
89%
0.4162
0.1348
D14A
Mouth and Salivary Gland Procedures, Major Complexity
1.9
1
6
11%
105%
1.0415
0.3303
D14B
Mouth and Salivary Gland Procedures, Minor Complexity
1.1
1
3
18%
100%
0.5493
0.1782
D15Z
Mastoid Procedures
1.9
1
6
34%
100%
1.9192
0.4997
D40Z
Dental Extractions and Restorations
1.1
1
3
15%
109%
0.5628
0.1461
D60A
Ear, Nose, Mouth and Throat Malignancy, Major Complexity
9.5
3
29
6%
122%
3.2607
0.2547
D60B
Ear, Nose, Mouth and Throat Malignancy, Minor Complexity
YES
2.8
1
8
13%
130%
0.3366
0.9452
0.2252
D61A
Dysequilibrium, Major Complexity
YES
3.8
1
11
13%
100%
0.0795
0.8429
0.2076
D61B
Dysequilibrium, Minor Complexity
1.5
1
4
17%
159%
0.2538
0.1823
D62A
Epistaxis, Major Complexity
3.8
1
12
7%
100%
0.9592
0.2428
D62B
Epistaxis, Minor Complexity
1.5
1
4
8%
126%
0.2875
0.1790
D63A
Otitis Media and Upper Respiratory Infections, Major Complexity
3.1
1
9
8%
111%
0.8133
0.2502
D63B
Otitis Media and Upper Respiratory Infections, Minor Complexity
1.4
1
4
8%
108%
0.2917
0.2107
D64A
Laryngotracheitis and Epiglottitis, Major Complexity
1.8
1
5
9%
100%
0.5992
0.3060
D64B
Laryngotracheitis and Epiglottitis, Minor Complexity
1.1
1
3
7%
80%
0.2317
0.1798
D65A
Nasal Trauma and Deformity, Major Complexity
2.7
1
8
12%
100%
0.5488
0.2213
D65B
Nasal Trauma and Deformity, Minor Complexity
1.1
1
3
18%
100%
0.2887
0.1241
D66A
Other Ear, Nose, Mouth and Throat Disorders, Major Complexity
3.7
1
11
10%
100%
0.9770
0.2406
D66B
Other Ear, Nose, Mouth and Throat Disorders, Minor Complexity
1.3
1
4
15%
100%
0.3006
0.2343
D67A
Oral and Dental Disorders, Major Complexity
4.1
1
12
8%
129%
0.9962
0.2438
D67B
Oral and Dental Disorders, Minor Complexity
1.3
1
4
16%
125%
0.2766
0.1309
E01A
Major Chest Procedures, Major Complexity
19.1
6
57
16%
86%
1.1213
1.1638
8.1040
0.2649
E01B
Major Chest Procedures, Intermediate Complexity
10.8
3
32
19%
100%
0.7119
1.3436
4.7428
0.2545
E01C
Major Chest Procedures, Minor Complexity
6.3
2
19
17%
116%
0.3456
1.4510
3.2476
0.2789
E02A
Other Respiratory System OR Procedures, Major Complexity
12.8
4
39
13%
132%
0.5719
1.0020
4.5797
0.2499
E02B
Other Respiratory System OR Procedures, Intermediate Complexity
3.5
1
11
14%
80%
1.8695
0.2935
E02C
Other Respiratory System OR Procedures, Minor Complexity
1.1
1
3
18%
95%
0.7909
0.3087
E40A
Respiratory System Disorders W Ventilator Support, Major Complexity
10.3
3
31
11%
92%
5.2677
0.2938
E40B
Respiratory System Disorders W Ventilator Support, Minor Complexity
5.1
1
15
9%
80%
2.6918
0.3424
E41A
Respiratory System Disorders W Non-Invasive Ventilation, Major Complexity
11.4
3
34
8%
84%
0.0000
1.5371
4.6114
0.3038
E41B
Respiratory System Disorders W Non-Invasive Ventilation, Minor Complexity
6.9
2
21
8%
80%
0.0334
1.3165
2.6664
0.2809
E42A
Bronchoscopy, Major Complexity
8.8
5
13
12%
133%
0.2257
0.5636
3.0438
0.2540
E42B
Bronchoscopy, Minor Complexity
3.8
1
11
24%
106%
1.3762
0.2182
E60A
Cystic Fibrosis, Major Complexity
11.9
3
36
3%
126%
0.0000
1.2850
3.8551
0.2533
E60B
Cystic Fibrosis, Minor Complexity
8.3
2
25
4%
121%
0.0000
1.2934
2.5869
0.1918
E61A
Pulmonary Embolism, Major Complexity
7.7
2
23
13%
100%
0.0000
0.9667
1.9334
0.2106
E61B
Pulmonary Embolism, Minor Complexity
4.3
1
13
17%
100%
0.9223
0.1517
Independent Hospital Pricing Authority
YES
YES
YES
YES
YES
YES
YES
Page 43 of 70
0.6039
0.1674
1.0311
0.1666
0.2990
0.1772
0.5462
0.0390
1.7429
0.3633
0.1733
Independent Hospital Pricing Authority - National Efficient Price Determination 2016-17
Inlier Bounds
AR-DRG
V8.0
Description
E62A
Respiratory Infections and Inflammations, Major Complexity
E62B
Respiratory Infections and Inflammations, Minor Complexity
E63A
Same-Day
Payment
List
Bundled
ICU
ALOS (excluding
designated SD and
unbundled ICU)
Lower
Bound
Upper
Bound
Adjustments
Private
Patient
Paediatric
Service Adj.
Adj.
7.0
2
21
9%
91%
3.3
1
10
10%
81%
Sleep Apnoea, Major Complexity
3.0
1
9
13%
E63B
Sleep Apnoea, Minor Complexity
1.2
1
4
E64A
Pulmonary Oedema and Respiratory Failure, Major Complexity
6.6
2
E64B
Pulmonary Oedema and Respiratory Failure, Minor Complexity
3.0
E65A
Chronic Obstructive Airways Disease, Major Complexity
E65B
Price Weights
Same Day
Short-Stay
Outlier
Base
Inlier
0.2299
0.8098
0.2176
118%
0.6370
0.2121
34%
100%
0.2633
0.1579
20
10%
100%
1.9166
0.2184
1
9
6%
100%
0.8104
0.2466
7.1
2
21
9%
200%
1.7089
0.2179
Chronic Obstructive Airways Disease, Minor Complexity
3.4
1
10
9%
186%
0.7447
0.2145
E66A
Major Chest Trauma, Major Complexity
7.4
2
22
9%
100%
1.8674
0.2082
E66B
Major Chest Trauma, Minor Complexity
2.3
1
7
12%
100%
0.5318
0.2393
E67A
Respiratory Signs and Symptoms, Major Complexity
3.8
1
11
15%
86%
0.9304
0.2242
E67B
Respiratory Signs and Symptoms, Minor Complexity
1.3
1
4
15%
80%
0.2774
0.2102
E68A
Pneumothorax, Major Complexity
5.8
1
17
10%
100%
1.5703
0.2553
E68B
Pneumothorax, Minor Complexity
2.6
1
8
10%
109%
0.6859
0.2640
E69A
Bronchitis and Asthma, Major Complexity
3.5
1
10
9%
87%
0.8813
0.2339
E69B
Bronchitis and Asthma, Minor Complexity
1.5
1
5
7%
80%
0.3640
0.2584
E70A
Whooping Cough and Acute Bronchiolitis, Major Complexity
3.3
1
10
6%
100%
1.1117
0.3393
E70B
Whooping Cough and Acute Bronchiolitis, Minor Complexity
1.8
1
6
5%
83%
0.6283
0.3629
E71A
Respiratory Neoplasms, Major Complexity
9.7
3
29
7%
100%
2.6958
0.2302
E71B
Respiratory Neoplasms, Minor Complexity
4.5
1
14
11%
154%
1.1252
0.2266
E72Z
Respiratory Problems Arising from Neonatal Period
2.9
1
11
2%
89%
0.7314
0.3048
E73A
Pleural Effusion, Major Complexity
10.2
3
31
11%
100%
2.6905
0.2356
E73B
Pleural Effusion, Intermediate Complexity
5.0
1
15
12%
100%
1.2113
0.2230
E73C
Pleural Effusion, Minor Complexity
3.2
1
10
17%
100%
0.8135
0.2199
E74A
Interstitial Lung Disease, Major Complexity
7.0
2
21
9%
100%
1.7848
0.2102
E74B
Interstitial Lung Disease, Minor Complexity
3.8
1
11
11%
83%
0.9536
0.2365
E75A
Other Respiratory System Disorders, Major Complexity
4.7
1
14
9%
113%
1.1153
0.2316
E75B
Other Respiratory System Disorders, Minor Complexity
2.1
1
6
10%
100%
0.5490
0.2309
E76A
Respiratory Tuberculosis, Major Complexity
19.9
6
60
9%
100%
0.0000
0.8031
4.8188
0.2120
E76B
Respiratory Tuberculosis, Minor Complexity
6.5
2
20
9%
100%
0.0000
0.8172
1.6344
0.1662
F01A
Implantation and Replacement of AICD, Total System, Major Complexity
12.1
4
36
48%
100%
5.2935
1.1009
9.6970
0.2853
F01B
Implantation and Replacement of AICD, Total System, Minor Complexity
2.9
1
9
86%
100%
5.0883
0.2683
F02Z
Other AICD Procedures
3.6
1
12
32%
100%
2.6324
0.3121
F03A
Cardiac Valve Procedures W CPB Pump W Invasive Cardiac Investigation, Major Comp
21.0
6
63
13%
100%
4.7494
1.3985
13.1403
0.2726
F03B
Cardiac Valve Procedures W CPB Pump W Invasive Cardiac Investigation, Minor Comp
10.3
3
31
13%
100%
4.5165
1.3965
8.7061
0.2241
F04A
Cardiac Valve Procedures W CPB Pump W/O Invasive Cardiac Invest, Major Comp
19.8
6
59
19%
109%
4.4295
1.4739
13.2727
0.2830
F04B
Cardiac Valve Procedures W CPB Pump W/O Invasive Cardiac Invest, Interm Comp
9.3
3
28
27%
100%
4.5829
1.1863
8.1419
0.3152
F04C
Cardiac Valve Procedures W CPB Pump W/O Invasive Cardiac Invest, Minor Comp
7.0
2
21
23%
110%
4.8880
0.7412
6.3704
0.2900
F05A
Coronary Bypass W Invasive Cardiac Investigation, Major Complexity
18.0
6
54
21%
100%
3.0205
1.1889
10.1537
0.3212
F05B
Coronary Bypass W Invasive Cardiac Investigation, Minor Complexity
12.1
4
36
19%
100%
2.5927
1.2132
7.4457
0.3065
F06A
Coronary Bypass W/O Invasive Cardiac Investigation, Major Complexity
12.3
4
37
18%
100%
2.9284
1.2225
7.8185
0.3152
F06B
Coronary Bypass W/O Invasive Cardiac Investigation, Minor Complexity
7.0
2
21
18%
100%
2.3213
1.4608
5.2430
0.3147
F07A
Other Cardiothoracic/Vascular Procedures W CPB Pump, Major Complexity
13.3
4
40
21%
100%
3.3995
2.1364
11.9452
0.4129
Independent Hospital Pricing Authority
YES
YES
YES
YES
YES
YES
Page 44 of 70
0.9062
Long-Stay
Outlier Per
Diem
1.8125
YES
0.0000
Short-Stay
Outlier Per
Diem
0.1009
0.0000
0.0000
0.0000
0.9583
0.8545
0.9337
0.1963
0.0000
0.8986
0.2545
0.0000
0.8968
0.1706
0.0000
0.8924
0.2531
0.1060
3.1642
Independent Hospital Pricing Authority - National Efficient Price Determination 2016-17
Inlier Bounds
AR-DRG
V8.0
Description
Same-Day
Payment
List
Bundled
ICU
ALOS (excluding
designated SD and
unbundled ICU)
Lower
Bound
Upper
Bound
Adjustments
Private
Patient
Paediatric
Service Adj.
Adj.
Price Weights
Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
F07B
Other Cardiothoracic/Vascular Procedures W CPB Pump, Intermediate Complexity
7.6
2
23
24%
100%
2.3392
2.5706
7.4805
0.4742
F07C
Other Cardiothoracic/Vascular Procedures W CPB Pump, Minor Complexity
6.6
2
20
20%
109%
1.9800
1.8759
5.7317
0.3201
F08A
Major Reconstructive Vascular Procedures W/O CPB Pump, Major Complexity
18.3
6
55
17%
100%
3.3436
1.0540
9.6676
0.2838
F08B
Major Reconstructive Vascular Procedures W/O CPB Pump, Intermediate Complexity
8.8
2
26
25%
100%
2.6794
1.4904
5.6601
0.2579
F08C
Major Reconstructive Vascular Procedures W/O CPB Pump, Minor Complexity
4.2
1
13
31%
100%
3.8307
0.3221
F09A
Other Cardiothoracic Procedures W/O CPB Pump, Major Complexity
11.1
3
33
17%
100%
1.4921
1.8276
6.9750
0.3259
F09B
Other Cardiothoracic Procedures W/O CPB Pump, Intermediate Complexity
7.5
2
23
18%
100%
0.9238
1.7724
4.4686
0.3266
F09C
Other Cardiothoracic Procedures W/O CPB Pump, Minor Complexity
2.7
1
8
17%
100%
2.1068
0.3372
F10A
Interventional Coronary Procedures, Admitted for AMI, Major Complexity
7.2
2
21
23%
100%
3.5147
0.2733
F10B
Interventional Coronary Procedures, Admitted for AMI, Minor Complexity
3.2
1
9
33%
100%
2.0892
0.3036
F11A
Amputation, Except Upper Limb and Toe, for Circulatory Disorders, Major Comp
35.8
11
107
10%
100%
0.8334
1.0809
12.7234
0.2875
F11B
Amputation, Except Upper Limb and Toe, for Circulatory Disorders, Minor Comp
18.0
5
54
10%
100%
0.7797
1.1983
6.7714
0.3208
F12A
Implantation and Replacement of Pacemaker, Total System, Major Complexity
7.6
2
23
41%
100%
1.4219
1.3142
4.0503
0.2749
F12B
Implantation and Replacement of Pacemaker, Total System, Minor Complexity
2.7
1
8
62%
100%
2.2839
0.2793
F13A
Amputation, Upper Limb and Toe, for Circulatory Disorders, Major Complexity
17.9
5
54
10%
100%
0.4950
1.1578
6.2839
0.2880
F13B
Amputation, Upper Limb and Toe, for Circulatory Disorders, Minor Complexity
7.4
2
22
10%
100%
0.3632
1.2462
2.8556
0.2888
F14A
Vascular Procedures, Except Major Reconstruction, W/O CPB Pump, Major Complexity
12.9
4
39
13%
119%
1.0907
1.1085
5.5246
0.2693
F14B
Vascular Procedures, Except Major Reconstruction, W/O CPB Pump, Interm Comp
4.5
1
14
27%
116%
2.3913
0.2863
F14C
Vascular Procedures, Except Major Reconstruction, W/O CPB Pump, Minor Complexity
2.0
1
6
33%
127%
1.5246
0.2901
F15A
Interventional Coronary Procs, Not Adm for AMI, W Stent Implant, Major Comp
5.4
1
16
28%
100%
2.8057
0.2794
F15B
Interventional Coronary Procs, Not Adm for AMI, W Stent Implant, Minor Comp
1.7
1
5
47%
100%
1.6567
0.2753
F16A
Interventional Coronary Procs, Not Adm for AMI, W/O Stent Implant, Major Comp
6.8
2
20
24%
100%
3.0000
0.2446
F16B
Interventional Coronary Procs, Not Adm for AMI, W/O Stent Implant, Minor Comp
1.9
1
6
28%
100%
1.4399
0.2026
F17A
Insertion and Replacement of Pacemaker Generator, Major Complexity
4.9
1
15
75%
100%
2.6965
0.2759
F17B
Insertion and Replacement of Pacemaker Generator, Minor Complexity
1.1
1
3
74%
100%
1.3479
0.2209
F18A
Other Pacemaker Procedures, Major Complexity
8.2
2
25
13%
100%
3.4855
0.2909
F18B
Other Pacemaker Procedures, Minor Complexity
2.3
1
7
20%
100%
1.4600
0.2996
F19A
Trans-Vascular Percutaneous Cardiac Intervention, Major Complexity
6.4
2
19
14%
87%
4.8586
0.2831
F19B
Trans-Vascular Percutaneous Cardiac Intervention, Minor Complexity
1.6
1
5
28%
135%
2.1855
0.2008
F20Z
Vein Ligation and Stripping
1.2
1
4
23%
86%
1.0036
0.3322
F21A
Other Circulatory System OR Procedures, Major Complexity
19.5
6
59
10%
100%
F21B
Other Circulatory System OR Procedures, Intermediate Complexity
YES
6.7
2
20
10%
100%
0.6199
F21C
Other Circulatory System OR Procedures, Minor Complexity
YES
2.2
1
6
16%
100%
0.7755
F40A
Circulatory Disorders W Ventilator Support, Major Complexity
9.7
6
15
13%
100%
F40B
Circulatory Disorders W Ventilator Support, Minor Complexity
2.8
1
8
13%
100%
F41A
Circulatory Disorders, Adm for AMI W Invasive Cardiac Inves Proc, Major Comp
6.9
2
21
15%
100%
F41B
Circulatory Disorders, Adm for AMI W Invasive Cardiac Inves Proc, Minor Comp
YES
3.7
1
11
16%
100%
F42A
Circulatory Dsrds, Not Adm for AMI W Invasive Cardiac Inves Proc, Major Comp
YES
5.9
1
18
19%
F42B
Circulatory Dsrds, Not Adm for AMI W Invasive Cardiac Inves Proc, Minor Comp
YES
2.5
1
8
F43A
Circulatory Disorders W Non-Invasive Ventilation, Major Complexity
14.1
4
F43B
Circulatory Disorders W Non-Invasive Ventilation, Minor Complexity
8.2
F60A
Circulatory Dsrd, Adm for AMI W/O Invas Card Inves Proc
F60B
Circulatory Dsrd, Adm for AMI W/O Invas Card Inves Proc, Transf <5 Days
Independent Hospital Pricing Authority
YES
YES
Page 45 of 70
0.9516
1.2815
1.3226
0.8372
0.6391
0.4247
1.3642
1.1804
1.5304
1.7472
0.4297
0.9349
6.0388
0.2565
0.7639
0.8852
2.5343
0.1860
1.5231
0.2271
5.4206
0.3168
1.9441
0.3491
2.7465
0.2838
0.6395
1.6250
0.2963
139%
0.7076
2.2415
0.2460
28%
197%
0.5806
1.2564
0.2081
42
9%
100%
0.0319
1.3187
5.3066
0.2423
2
25
8%
100%
0.0468
1.5448
3.1364
0.2701
5.4
1
16
10%
100%
1.3770
0.2341
1.6
1
4
20%
100%
0.5401
0.0890
0.3045
0.8886
1.2210
Independent Hospital Pricing Authority - National Efficient Price Determination 2016-17
Inlier Bounds
AR-DRG
V8.0
Description
Same-Day
Payment
List
Bundled
ICU
ALOS (excluding
designated SD and
unbundled ICU)
Lower
Bound
Upper
Bound
Adjustments
Private
Patient
Paediatric
Service Adj.
Adj.
Price Weights
Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
F61A
Infective Endocarditis, Major Complexity
21.0
7
63
7%
100%
0.0000
0.9527
6.6686
0.2148
F61B
Infective Endocarditis, Minor Complexity
11.0
3
33
15%
100%
0.0000
0.9704
2.9112
0.1457
F62A
Heart Failure and Shock, Major Complexity
9.1
3
27
8%
100%
0.0000
0.7792
2.3377
0.2250
F62B
Heart Failure and Shock, Minor Complexity
4.0
1
12
10%
100%
0.9567
0.2244
F62C
Heart Failure and Shock, Transferred <5 Days
1.5
1
4
15%
100%
0.3724
F63A
Venous Thrombosis, Major Complexity
6.3
2
19
13%
100%
F63B
Venous Thrombosis, Minor Complexity
5.1
1
15
14%
100%
F64A
Skin Ulcers in Circulatory Disorders, Major Complexity
12.7
4
38
7%
100%
F64B
Skin Ulcers in Circulatory Disorders, Intermediate Complexity
YES
6.7
2
20
6%
100%
0.1573
F64C
Skin Ulcers in Circulatory Disorders, Minor Complexity
YES
4.8
1
14
11%
100%
0.2021
F65A
Peripheral Vascular Disorders, Major Complexity
6.9
2
21
11%
100%
F65B
Peripheral Vascular Disorders, Minor Complexity
YES
3.1
1
9
16%
123%
F66A
Coronary Atherosclerosis, Major Complexity
YES
4.1
1
12
12%
100%
F66B
Coronary Atherosclerosis, Minor Complexity
1.5
1
4
17%
F67A
Hypertension, Major Complexity
4.5
1
13
F67B
Hypertension, Minor Complexity
2.0
1
F68A
Congenital Heart Disease, Major Complexity
3.4
F68B
Congenital Heart Disease, Minor Complexity
F69A
Valvular Disorders, Major Complexity
F69B
Valvular Disorders, Minor Complexity
F72A
Unstable Angina, Major Complexity
F72B
Unstable Angina, Minor Complexity
F73A
Syncope and Collapse, Major Complexity
F73B
Syncope and Collapse, Minor Complexity
F74A
YES
0.0000
0.7184
0.1123
1.4367
0.1766
0.7460
0.0988
0.0000
0.7591
3.0364
0.2266
0.0000
0.8002
1.6005
0.2005
0.9985
0.1726
1.9076
0.2086
0.2890
0.8405
0.2115
0.1493
1.0311
0.2268
100%
0.3217
0.2424
12%
100%
1.1000
0.2465
6
15%
80%
0.4642
0.2305
1
10
10%
132%
1.1150
0.3374
1.1
1
3
18%
134%
0.3612
0.2770
6.6
2
20
11%
100%
1.8350
0.2327
1.4
1
4
18%
162%
0.2557
0.1852
YES
3.9
1
12
16%
100%
0.1440
1.0189
0.2298
YES
2.0
1
6
17%
100%
0.1062
0.5318
0.2290
5.2
1
15
10%
100%
1.1463
0.2224
1.9
1
6
16%
137%
0.4561
0.2217
Chest Pain, Major Complexity
2.0
1
6
17%
123%
0.4585
0.2300
F74B
Chest Pain, Minor Complexity
1.1
1
3
20%
170%
0.1777
0.1304
F75A
Other Circulatory Disorders, Major Complexity
9.8
3
29
10%
164%
3.1202
0.2534
F75B
Other Circulatory Disorders, Intermediate Complexity
4.7
1
14
11%
145%
1.3078
0.2565
F75C
Other Circulatory Disorders, Minor Complexity
2.8
1
8
12%
185%
0.7536
0.2322
F76A
Arrhythmia, Cardiac Arrest and Conduction Disorders, Major Complexity
4.6
1
14
12%
100%
1.1611
0.2260
F76B
Arrhythmia, Cardiac Arrest and Conduction Disorders, Minor Complexity
2.1
1
6
17%
184%
0.5253
0.2056
G01A
Rectal Resection, Major Complexity
27.3
9
82
15%
100%
2.2538
1.0237
11.4672
0.2602
G01B
Rectal Resection, Intermediate Complexity
14.0
4
42
18%
100%
1.8553
1.1947
6.6343
0.2733
G01C
Rectal Resection, Minor Complexity
8.5
2
25
19%
100%
1.3311
1.6103
4.5517
0.2718
G02A
Major Small and Large Bowel Procedures, Major Complexity
25.8
8
77
12%
100%
1.6574
1.0929
10.4004
0.3017
G02B
Major Small and Large Bowel Procedures, Intermediate Complexity
11.2
3
34
14%
114%
1.1617
1.2790
4.9988
0.2768
G02C
Major Small and Large Bowel Procedures, Minor Complexity
6.0
2
18
17%
94%
0.6825
1.1997
3.0818
0.2866
G03A
Stomach, Oesophageal and Duodenal Procedures, Major Complexity
18.4
6
55
15%
100%
2.0364
1.1953
9.2083
0.3280
G03B
Stomach, Oesophageal and Duodenal Procedures, Intermediate Complexity
8.8
2
27
14%
108%
1.0849
1.6652
4.4154
0.3090
G03C
Stomach, Oesophageal and Duodenal Procedures, Minor Complexity
3.8
1
11
14%
113%
2.2562
0.3165
G04A
Peritoneal Adhesiolysis, Major Complexity
15.1
5
45
14%
100%
1.0961
0.9501
5.8467
0.2997
G04B
Peritoneal Adhesiolysis, Intermediate Complexity
6.9
2
21
15%
120%
0.7944
1.0823
2.9591
0.2767
G04C
Peritoneal Adhesiolysis, Minor Complexity
2.9
1
9
15%
118%
1.6432
0.3229
Independent Hospital Pricing Authority
YES
YES
YES
YES
YES
Page 46 of 70
0.0000
0.9538
0.0912
0.2404
0.0000
0.9175
0.1129
0.0000
1.0401
0.2205
0.1680
Independent Hospital Pricing Authority - National Efficient Price Determination 2016-17
Inlier Bounds
AR-DRG
V8.0
Description
Same-Day
Payment
List
Bundled
ICU
ALOS (excluding
designated SD and
unbundled ICU)
Lower
Bound
Upper
Bound
Adjustments
Private
Patient
Paediatric
Service Adj.
Adj.
Price Weights
Same Day
Short-Stay
Outlier
Base
Inlier
Minor Small and Large Bowel Procedures, Major Complexity
10.5
3
32
13%
100%
3.9003
0.2994
G05B
Minor Small and Large Bowel Procedures, Minor Complexity
3.7
1
11
13%
80%
1.8236
0.3450
G06Z
Pyloromyotomy
3.8
1
11
11%
100%
1.7684
0.3440
G07A
Appendicectomy, Major Complexity
4.5
1
13
13%
139%
1.8274
0.2988
G07B
Appendicectomy, Minor Complexity
2.2
1
7
14%
118%
1.1862
0.2649
G10A
Hernia Procedures, Major Complexity
4.1
1
12
15%
80%
1.8992
0.2569
G10B
Hernia Procedures, Minor Complexity
1.3
1
4
21%
80%
0.9902
0.2938
G11A
Anal and Stomal Procedures, Major Complexity
4.2
1
13
10%
173%
1.3790
0.2264
G11B
Anal and Stomal Procedures, Minor Complexity
1.5
1
4
16%
100%
0.6640
0.2294
G12A
Other Digestive System OR Procedures, Major Complexity
16.6
5
50
16%
100%
0.4906
1.0372
5.6768
0.2450
G12B
Other Digestive System OR Procedures, Intermediate Complexity
7.2
2
22
14%
128%
0.4655
1.0237
2.5129
0.2249
G12C
Other Digestive System OR Procedures, Minor Complexity
YES
3.3
1
10
18%
119%
0.6528
1.4840
0.2619
G46A
Complex Endoscopy, Major Complexity
YES
7.1
2
21
14%
160%
0.3410
2.2096
0.2618
G46B
Complex Endoscopy, Minor Complexity
1.1
1
3
35%
169%
0.3721
0.2872
G47A
Gastroscopy, Major Complexity
6.2
2
19
13%
175%
1.8526
0.2375
G47B
Gastroscopy, Intermediate Complexity
2.5
1
7
18%
116%
0.7966
0.2049
G47C
Gastroscopy, Minor Complexity
1.1
1
3
30%
127%
0.2931
0.2258
G48A
Colonoscopy, Major Complexity
6.1
2
18
14%
192%
1.8487
0.2185
G48B
Colonoscopy, Minor Complexity
1.1
1
3
36%
193%
0.3284
0.2565
G60A
Digestive Malignancy, Major Complexity
8.6
2
26
7%
100%
2.2064
0.2190
G60B
Digestive Malignancy, Minor Complexity
3.7
1
11
9%
100%
0.7608
0.1916
G61A
Gastrointestinal Haemorrhage, Major Complexity
4.4
1
13
12%
100%
0.9812
0.2272
G61B
Gastrointestinal Haemorrhage, Minor Complexity
YES
2.1
1
6
15%
134%
0.1093
0.4762
0.2016
G64A
Inflammatory Bowel Disease, Major Complexity
YES
5.6
1
17
10%
194%
0.2815
1.2626
0.2329
G64B
Inflammatory Bowel Disease, Minor Complexity
YES
2.9
1
9
4%
94%
0.3816
0.7487
0.2370
G65A
Gastrointestinal Obstruction, Major Complexity
6.3
2
19
11%
91%
1.6014
0.2320
G65B
Gastrointestinal Obstruction, Minor Complexity
2.7
1
8
13%
86%
0.6299
0.2240
G66A
Abdominal Pain and Mesenteric Adenitis, Major Complexity
2.8
1
8
14%
110%
0.6272
0.2122
G66B
Abdominal Pain and Mesenteric Adenitis, Minor Complexity
1.3
1
4
17%
127%
0.2284
0.1674
G67A
Oesophagitis and Gastroenteritis, Major Complexity
4.2
1
13
10%
100%
0.9838
0.2397
G67B
Oesophagitis and Gastroenteritis, Minor Complexity
1.4
1
4
12%
105%
0.2590
0.1937
G70A
Other Digestive System Disorders, Major Complexity
4.5
1
13
11%
163%
0.9758
0.2313
G70B
Other Digestive System Disorders, Minor Complexity
1.4
1
4
14%
143%
0.2578
0.1900
H01A
Pancreas, Liver and Shunt Procedures, Major Complexity
24.1
8
72
17%
100%
2.8923
1.0378
11.1948
0.2777
H01B
Pancreas, Liver and Shunt Procedures, Intermediate Complexity
9.2
3
27
16%
100%
0.7839
1.4756
5.2108
0.3069
H01C
Pancreas, Liver and Shunt Procedures, Minor Complexity
3.3
1
10
18%
100%
2.0710
0.4719
H02A
Major Biliary Tract Procedures, Major Complexity
14.6
4
44
12%
100%
5.8403
0.2808
H02B
Major Biliary Tract Procedures, Minor Complexity
5.4
1
16
16%
100%
2.3398
0.2876
H05A
Hepatobiliary Diagnostic Procedures, Major Complexity
8.9
2
27
17%
100%
3.9161
0.2707
H05B
Hepatobiliary Diagnostic Procedures, Minor Complexity
2.1
1
6
23%
100%
0.8427
0.3101
H06A
Other Hepatobiliary and Pancreas OR Procedures, Major Complexity
20.2
6
61
13%
100%
0.4092
1.0178
6.5162
0.2352
H06B
Other Hepatobiliary and Pancreas OR Procedures, Intermediate Complexity
6.8
2
20
13%
100%
0.2090
1.1897
2.5885
0.2159
H06C
Other Hepatobiliary and Pancreas OR Procedures, Minor Complexity
1.5
1
5
31%
100%
1.0919
0.2629
Independent Hospital Pricing Authority
YES
YES
YES
YES
YES
Page 47 of 70
1.0445
Long-Stay
Outlier Per
Diem
G05A
YES
0.7667
Short-Stay
Outlier Per
Diem
0.4919
0.2881
0.2161
0.9607
0.8182
0.2932
0.2885
0.2289
0.0000
0.8099
1.1032
0.2463
0.0000
0.8007
0.1085
0.1590
0.9887
0.5786
1.2129
1.6688
Independent Hospital Pricing Authority - National Efficient Price Determination 2016-17
Inlier Bounds
AR-DRG
V8.0
Description
H07A
Open Cholecystectomy, Major Complexity
H07B
Same-Day
Payment
List
Bundled
ICU
ALOS (excluding
designated SD and
unbundled ICU)
Lower
Bound
Upper
Bound
Adjustments
Private
Patient
Paediatric
Service Adj.
Adj.
Price Weights
Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
14.2
4
42
18%
100%
1.0817
1.1587
5.7165
0.2514
Open Cholecystectomy, Intermediate Complexity
8.3
2
25
10%
100%
1.0063
1.3233
3.6529
0.2449
H07C
Open Cholecystectomy, Minor Complexity
4.9
1
15
12%
100%
2.5443
0.2688
H08A
Laparoscopic Cholecystectomy, Major Complexity
5.9
1
18
17%
100%
2.6093
0.2751
H08B
Laparoscopic Cholecystectomy, Minor Complexity
1.9
1
6
21%
116%
1.4330
0.2606
H40A
Endoscopic Procedures for Bleeding Oesophageal Varices, Major Complexity
9.9
3
30
9%
100%
3.8594
0.3089
H40B
Endoscopic Procedures for Bleeding Oesophageal Varices, Intermediate Complexity
4.2
1
13
8%
100%
1.6831
0.2860
H40C
Endoscopic Procedures for Bleeding Oesophageal Varices, Minor Complexity
2.5
1
8
9%
100%
1.0278
0.3379
H43A
ERCP Procedures, Major Complexity
10.6
3
32
16%
100%
H43B
ERCP Procedures, Intermediate Complexity
YES
6.1
2
18
19%
100%
0.4873
H43C
ERCP Procedures, Minor Complexity
YES
3.6
1
11
28%
100%
0.4440
H60A
Cirrhosis and Alcoholic Hepatitis, Major Complexity
10.4
3
31
9%
100%
H60B
Cirrhosis and Alcoholic Hepatitis, Intermediate Complexity
YES
4.4
1
13
11%
100%
H60C
Cirrhosis and Alcoholic Hepatitis, Minor Complexity
YES
3.2
1
9
15%
100%
H61A
Malignancy of Hepatobiliary System and Pancreas, Major Complexity
9.1
3
27
7%
100%
H61B
Malignancy of Hepatobiliary System and Pancreas, Minor Complexity
4.1
1
12
14%
124%
H62A
Disorders of Pancreas, Except Malignancy, Major Complexity
6.8
2
20
12%
100%
H62B
Disorders of Pancreas, Except Malignancy, Minor Complexity
3.1
1
9
14%
154%
H63A
Other Disorders of Liver, Major Complexity
7.2
2
21
11%
131%
H63B
Other Disorders of Liver, Intermediate Complexity
YES
3.7
1
11
15%
119%
H63C
Other Disorders of Liver, Minor Complexity
YES
2.4
1
7
22%
H64A
Disorders of the Biliary Tract, Major Complexity
YES
4.9
1
15
H64B
Disorders of the Biliary Tract, Minor Complexity
YES
2.4
1
I01A
Bilateral and Multiple Major Joint Procedures of Lower Limb, Major Complexity
19.0
I01B
Bilateral and Multiple Major Joint Procedures of Lower Limb, Minor Complexity
I02A
0.4290
1.1435
0.2986
1.0388
3.4151
0.2693
0.2914
0.8338
1.9589
0.2337
1.1991
0.2272
2.8883
0.2467
0.1912
1.0756
0.2183
0.1964
0.8660
0.1984
2.5366
0.2312
1.0190
0.2116
1.8847
0.2577
0.7628
0.2294
1.9969
0.2414
0.2166
0.9221
0.2062
128%
0.2000
0.7182
0.1890
12%
190%
0.1513
1.2342
0.2400
7
15%
200%
0.1117
0.5722
0.2149
12
29
23%
100%
3.5950
0.5711
10.4487
0.2747
6.4
2
19
23%
100%
3.3835
1.3205
6.0245
0.3305
Microvascular Tissue Transfers or Skin Grafts, Excluding Hand, Major Complexity
39.7
13
119
15%
100%
3.2880
0.9532
15.6799
0.2814
I02B
Microvascular Tissue Transfers or Skin Grafts, Excluding Hand, Intermediate Comp
17.9
5
54
17%
100%
0.9025
1.4410
8.1076
0.3010
I02C
Microvascular Tissue Transfers or Skin Grafts, Excluding Hand, Minor Complexity
5.7
1
17
21%
80%
2.7607
0.3816
I03A
Hip Replacement, Major Complexity
12.5
4
38
27%
100%
2.2682
0.8827
5.7991
0.2421
I03B
Hip Replacement, Minor Complexity
6.4
2
19
34%
100%
2.2727
0.9119
4.0965
0.2040
I04A
Knee Replacement, Major Complexity
9.2
3
27
30%
100%
2.5084
0.8471
5.0497
0.2458
I04B
Knee Replacement, Minor Complexity
5.2
1
16
37%
100%
3.9479
0.2515
I05A
Other Joint Replacement, Major Complexity
9.6
3
29
38%
100%
5.8558
0.2476
I05B
Other Joint Replacement, Minor Complexity
3.5
1
10
37%
100%
3.7483
0.2859
I06Z
Spinal Fusion for Deformity
8.4
2
26
48%
100%
0.7658
4.8306
10.4270
0.5698
I07Z
Amputation
25.7
8
73
23%
100%
0.8620
0.9784
8.6892
0.2743
I08A
Other Hip and Femur Procedures, Major Complexity
15.6
5
47
19%
88%
1.2098
0.9033
5.7265
0.2485
I08B
Other Hip and Femur Procedures, Minor Complexity
7.5
2
23
21%
87%
0.8807
1.1327
3.1461
0.2349
I09A
Spinal Fusion, Major Complexity
22.1
7
66
33%
100%
4.4721
1.1815
12.7423
0.3266
I09B
Spinal Fusion, Intermediate Complexity
8.6
2
26
30%
100%
3.2217
1.8729
6.9674
0.2937
I09C
Spinal Fusion, Minor Complexity
4.5
1
14
40%
100%
4.9754
0.3728
I10A
Other Back and Neck Procedures, Major Complexity
8.5
2
26
23%
100%
3.9126
0.2804
I10B
Other Back and Neck Procedures, Minor Complexity
3.0
1
9
27%
100%
2.0464
0.2676
Independent Hospital Pricing Authority
YES
YES
Page 48 of 70
0.0000
0.0000
0.9628
0.8455
0.2726
0.0000
0.9423
0.1841
0.0000
2.5726
1.0535
0.9984
1.0944
1.4296
Independent Hospital Pricing Authority - National Efficient Price Determination 2016-17
Inlier Bounds
AR-DRG
V8.0
Description
I11Z
Limb Lengthening Procedures
I12A
Same-Day
Payment
List
Bundled
ICU
ALOS (excluding
designated SD and
unbundled ICU)
Lower
Bound
Upper
Bound
Adjustments
Private
Patient
Paediatric
Service Adj.
Adj.
Price Weights
Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
4.6
1
14
23%
152%
3.8806
0.3607
Misc Musculoskeletal Procs for Infect/Inflam of Bone/Joint, Major Complexity
24.6
16
37
10%
112%
0.6952
0.4384
7.7101
0.2048
I12B
Misc Musculoskeletal Procs for Infect/Inflam of Bone/Joint, Intermediate Comp
11.8
3
36
11%
80%
0.5249
1.0424
3.6520
0.1781
I12C
Misc Musculoskeletal Procs for Infect/Inflam of Bone/Joint, Minor Complexity
4.2
1
13
8%
132%
1.4329
0.2032
I13A
Humerus, Tibia, Fibula and Ankle Procedures, Major Complexity
9.6
3
29
20%
83%
4.0981
0.2491
I13B
Humerus, Tibia, Fibula and Ankle Procedures, Minor Complexity
2.9
1
9
23%
80%
1.8032
0.2962
I15A
Cranio-Facial Surgery, Major Complexity
6.3
2
19
21%
111%
4.4608
0.2478
I15B
Cranio-Facial Surgery, Minor Complexity
3.7
1
11
19%
100%
2.6251
0.2805
I16Z
Other Shoulder Procedures
1.3
1
4
21%
100%
1.4782
0.4453
I17A
Maxillo-Facial Surgery, Major Complexity
4.2
1
13
15%
100%
3.0076
0.3781
I17B
Maxillo-Facial Surgery, Minor Complexity
1.6
1
5
12%
100%
1.5486
0.4458
I18A
Other Knee Procedures, Major Complexity
3.7
1
11
17%
100%
1.5849
0.2299
I18B
Other Knee Procedures, Minor Complexity
1.0
1
3
37%
156%
0.6817
0.2306
I19A
Other Elbow and Forearm Procedures, Major Complexity
6.1
2
18
21%
100%
2.9075
0.2416
I19B
Other Elbow and Forearm Procedures, Minor Complexity
1.7
1
5
30%
88%
1.4881
0.2693
I20A
Other Foot Procedures, Major Complexity
6.6
2
20
13%
100%
2.8967
0.2117
I20B
Other Foot Procedures, Minor Complexity
1.6
1
5
19%
89%
1.1966
0.2751
I21Z
Local Excision and Removal of Internal Fixation Devices of Hip and Femur
2.1
1
7
11%
88%
1.0803
0.2882
I23A
Local Excision & Removal of Internal Fixation Device, Except Hip & Fmr, Maj Comp
2.9
1
9
18%
105%
1.5312
0.2497
I23B
Local Excision & Removal of Internal Fixation Device, Except Hip & Fmr, Min Comp
1.0
1
3
12%
100%
0.5373
0.1455
I24A
Arthroscopy, Major Complexity
3.5
1
10
18%
100%
1.3534
0.2246
I24B
Arthroscopy, Minor Complexity
1.1
1
3
18%
153%
0.6447
0.2020
I25A
Bone and Joint Diagnostic Procedures Including Biopsy, Major Complexity
12.6
4
38
12%
112%
4.9110
0.2478
I25B
Bone and Joint Diagnostic Procedures Including Biopsy, Minor Complexity
4.2
1
13
14%
107%
1.5832
0.2290
I27A
Soft Tissue Procedures, Major Complexity
11.2
3
34
11%
87%
4.3103
0.2439
I27B
Soft Tissue Procedures, Minor Complexity
2.2
1
7
14%
112%
1.2223
0.2654
I28A
Other Musculoskeletal Procedures, Major Complexity
12.3
4
37
19%
100%
4.1804
0.2162
I28B
Other Musculoskeletal Procedures, Intermediate Complexity
YES
2.6
1
8
22%
138%
0.7771
1.6081
0.1823
I28C
Other Musculoskeletal Procedures, Minor Complexity
YES
1.9
1
6
12%
100%
0.5373
1.0254
0.2342
I29Z
Knee Reconstructions, and Revisions of Reconstructions
1.4
1
4
33%
106%
1.5920
0.4510
I30Z
Hand Procedures
1.3
1
4
18%
93%
0.8432
0.2494
I31A
Revision of Hip Replacement, Major Complexity
25.5
8
76
29%
100%
3.3884
0.8813
10.4390
0.2116
I31B
Revision of Hip Replacement, Intermediate Complexity
12.1
4
36
29%
100%
2.8064
0.9227
6.4971
0.2226
I31C
Revision of Hip Replacement, Minor Complexity
7.0
2
21
41%
100%
2.9627
0.8837
4.7300
0.2023
I32A
Revision of Knee Replacement, Major Complexity
18.8
6
56
23%
100%
3.2570
0.8687
8.4692
0.2193
I32B
Revision of Knee Replacement, Minor Complexity
7.0
2
21
23%
100%
2.6953
1.0983
4.8918
0.1928
I40Z
Infusions for Musculoskeletal Disorders, Sameday
1.0
1
1
5%
88%
YES
YES
YES
YES
1.0122
1.2279
1.0286
1.6164
0.6515
1.0466
0.9399
0.9304
0.9784
0.6118
0.3126
1.1496
0.5296
0.5802
1.2434
0.5484
0.8782
0.8255
0.2846
I60Z
Femoral Shaft Fractures
11.2
3
34
6%
100%
0.1941
1.0879
3.4579
0.2368
I61A
Distal Femoral Fractures, Major Complexity
21.8
7
65
7%
100%
0.0000
0.7576
5.3035
0.1902
I61B
Distal Femoral Fractures, Minor Complexity
7.4
2
22
7%
114%
0.0000
0.8696
1.7391
0.1800
I63A
Sprains, Strains and Dislocations of Hip, Pelvis and Thigh, Major Complexity
6.6
2
20
10%
100%
0.0000
0.8025
1.6050
0.1949
I63B
Sprains, Strains and Dislocations of Hip, Pelvis and Thigh, Minor Complexity
2.0
1
6
12%
100%
0.4948
0.2296
I64A
Osteomyelitis, Major Complexity
18.3
6
55
10%
100%
4.3749
0.1665
Independent Hospital Pricing Authority
Page 49 of 70
0.0000
0.7291
Independent Hospital Pricing Authority - National Efficient Price Determination 2016-17
Inlier Bounds
AR-DRG
V8.0
Description
Same-Day
Payment
List
Bundled
ICU
ALOS (excluding
designated SD and
unbundled ICU)
Lower
Bound
Upper
Bound
Adjustments
Private
Patient
Paediatric
Service Adj.
Adj.
Price Weights
Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
I64B
Osteomyelitis, Minor Complexity
10.6
3
32
9%
100%
0.0000
0.7601
2.2803
0.1126
I65A
Musculoskeletal Malignant Neoplasms, Major Complexity
12.1
4
36
8%
118%
0.0000
0.8552
3.4206
0.2360
I65B
Musculoskeletal Malignant Neoplasms, Minor Complexity
5.1
1
15
7%
123%
1.5143
0.2208
I66A
Inflammatory Musculoskeletal Disorders, Major Complexity
13.4
4
40
10%
100%
0.0000
1.0288
4.1153
0.2385
I66B
Inflammatory Musculoskeletal Disorders, Intermediate Complexity
6.4
2
19
9%
83%
0.0000
1.0073
2.0145
0.2473
I66C
Inflammatory Musculoskeletal Disorders, Minor Complexity
4.0
1
12
10%
110%
1.0847
0.2309
I67A
Septic Arthritis, Major Complexity
14.7
4
44
11%
100%
0.0000
0.9495
3.7979
0.1713
I67B
Septic Arthritis, Minor Complexity
7.4
2
22
12%
100%
0.0000
0.7128
1.4255
0.1093
I68A
Non-surgical Spinal Disorders, Major Complexity
8.7
2
26
10%
113%
0.0000
1.0480
2.0961
0.2113
I68B
Non-surgical Spinal Disorders, Minor Complexity
2.8
1
8
11%
125%
0.6326
0.2292
I69A
Bone Diseases and Arthropathies, Major Complexity
7.9
2
24
9%
82%
1.7866
0.2048
I69B
Bone Diseases and Arthropathies, Minor Complexity
3.5
1
10
10%
146%
0.7388
0.2100
I71A
Other Musculotendinous Disorders, Major Complexity
6.2
2
18
10%
100%
1.6189
0.2122
I71B
Other Musculotendinous Disorders, Minor Complexity
2.3
1
7
11%
129%
0.5203
0.2230
I72A
Specific Musculotendinous Disorders, Major Complexity
9.0
2
27
8%
106%
2.1309
0.2147
I72B
Specific Musculotendinous Disorders, Minor Complexity
2.9
1
9
9%
89%
0.6545
0.1947
I73A
Aftercare of Musculoskeletal Implants or Prostheses, Major Complexity
15.3
5
46
7%
100%
0.0000
0.6438
3.2190
0.1498
I73B
Aftercare of Musculoskeletal Implants or Prostheses, Minor Complexity
6.3
2
19
10%
100%
0.0000
0.6367
1.2735
0.1145
I74A
Injuries to Forearm, Wrist, Hand and Foot, Major Complexity
7.1
2
21
10%
110%
0.0000
0.8067
1.6133
0.1835
I74B
Injuries to Forearm, Wrist, Hand and Foot, Minor Complexity
1.4
1
4
23%
118%
0.4949
0.1929
I75A
Injuries to Shoulder, Arm, Elbow, Knee, Leg and Ankle, Major Complexity
11.7
3
35
8%
100%
2.5697
0.1880
I75B
Injuries to Shoulder, Arm, Elbow, Knee, Leg and Ankle, Minor Complexity
2.7
1
8
13%
117%
0.5961
0.2097
I76A
Other Musculoskeletal Disorders, Major Complexity
13.7
4
41
8%
126%
3.3318
0.1836
I76B
Other Musculoskeletal Disorders, Intermediate Complexity
5.7
1
17
9%
95%
1.2972
0.1967
I76C
Other Musculoskeletal Disorders, Minor Complexity
2.2
1
7
12%
134%
0.5200
0.2204
I77A
Fractures of Pelvis, Major Complexity
13.0
4
39
7%
100%
3.1226
0.2038
I77B
Fractures of Pelvis, Minor Complexity
5.2
1
16
9%
100%
1.1107
0.2145
I78A
Fractures of Neck of Femur, Major Complexity
16.8
5
50
6%
100%
0.0000
0.7096
3.5481
0.1768
I78B
Fractures of Neck of Femur, Minor Complexity
7.1
2
21
10%
100%
0.0000
0.7821
1.5642
0.2038
I79A
Pathological Fractures, Major Complexity
14.3
4
43
7%
100%
0.0000
0.9327
3.7310
0.2415
I79B
Pathological Fractures, Minor Complexity
6.5
2
19
8%
100%
0.0000
0.8338
1.6676
0.2086
I80Z
Femoral Fractures, Transferred to Acute Facility <2 Days
1.0
1
1
61%
100%
0.1980
I81Z
Musculoskeletal Injuries, Sameday
1.0
1
1
31%
178%
0.1351
I82Z
Other Sameday Treatment for Musculoskeletal Disorders
1.0
1
1
18%
200%
J01A
Microvas Tiss Transf for Skin, Subcut Tiss & Breast Dsrds, Major Complexity
20.9
6
63
24%
100%
3.9761
1.2943
11.7418
0.2837
J01B
Microvas Tiss Transf for Skin, Subcut Tiss & Breast Dsrds, Minor Complexity
8.4
2
25
26%
100%
2.3273
2.1708
6.6690
0.3653
J06A
Major Procedures for Breast Disorders, Major Complexity
5.7
1
17
27%
100%
2.2816
0.1661
J06B
Major Procedures for Breast Disorders, Minor Complexity
2.5
1
8
28%
100%
1.5043
0.1674
J07A
Minor Procedures for Breast Disorders, Major Complexity
1.2
1
4
27%
100%
0.7964
0.2992
J07B
Minor Procedures for Breast Disorders, Minor Complexity
1.0
1
3
26%
100%
0.6179
0.2050
J08A
Other Skin Grafts and Debridement Procedures, Major Complexity
11.0
3
33
10%
94%
3.4585
0.2403
J08B
Other Skin Grafts and Debridement Procedures, Intermediate Complexity
YES
4.0
1
12
14%
108%
0.5746
1.4925
0.2113
J08C
Other Skin Grafts and Debridement Procedures, Minor Complexity
YES
2.5
1
7
24%
123%
0.5444
1.3160
0.2247
Independent Hospital Pricing Authority
Page 50 of 70
0.0000
0.0000
0.0000
0.0000
0.0000
0.0000
0.8933
0.8094
1.0654
0.8566
0.8329
0.7807
0.1423
0.4018
1.0189
Independent Hospital Pricing Authority - National Efficient Price Determination 2016-17
Inlier Bounds
AR-DRG
V8.0
Description
Same-Day
Payment
List
Bundled
ICU
ALOS (excluding
designated SD and
unbundled ICU)
Adjustments
Private
Patient
Paediatric
Service Adj.
Adj.
Lower
Bound
Upper
Bound
2.2
1
7
15%
113%
3.6
1
11
23%
100%
1.1
1
3
27%
100%
4.4
1
13
16%
93%
1.0
1
3
22%
100%
Price Weights
Same Day
Short-Stay
Outlier
Base
J09Z
Perianal and Pilonidal Procedures
J10A
Plastic OR Procs for Skin, Subcutaneous Tissue and Breast Disorders, Major Comp
J10B
Plastic OR Procs for Skin, Subcutaneous Tissue and Breast Disorders, Minor Comp
J11A
Other Skin, Subcutaneous Tissue and Breast Procedures, Major Complexity
J11B
Other Skin, Subcutaneous Tissue and Breast Procedures, Minor Complexity
J12A
Lower Limb Procedures W Ulcer or Cellulitis, Major Complexity
20.7
6
62
11%
100%
0.3475
J12B
Lower Limb Procedures W Ulcer or Cellulitis, Minor Complexity
7.9
2
24
9%
100%
J13A
Lower Limb Procedures W/O Ulcer or Cellulitis, Major Complexity
8.1
2
24
8%
100%
J13B
Lower Limb Procedures W/O Ulcer or Cellulitis, Minor Complexity
4.1
1
12
16%
100%
J14Z
Major Breast Reconstructions
7.4
2
23
30%
100%
1.0753
J60A
Skin Ulcers, Major Complexity
12.7
8
19
6%
100%
J60B
Skin Ulcers, Intermediate Complexity
YES
6.2
2
18
8%
100%
0.1525
J60C
Skin Ulcers, Minor Complexity
YES
4.9
1
15
9%
100%
0.1636
J62A
Malignant Breast Disorders, Major Complexity
10.6
3
32
6%
100%
J62B
Malignant Breast Disorders, Minor Complexity
YES
5.4
1
16
7%
100%
J63A
Non-Malignant Breast Disorders, Major Complexity
YES
3.1
1
9
9%
J63B
Non-Malignant Breast Disorders, Minor Complexity
YES
2.1
1
6
J64A
Cellulitis, Major Complexity
6.2
2
J64B
Cellulitis, Minor Complexity
YES
3.0
J65A
Trauma to Skin, Subcutaneous Tissue and Breast, Major Complexity
YES
J65B
Trauma to Skin, Subcutaneous Tissue and Breast, Minor Complexity
J67A
Minor Skin Disorders, Major Complexity
J67B
Minor Skin Disorders, Minor Complexity
J68A
Major Skin Disorders, Major Complexity
J68B
Major Skin Disorders, Minor Complexity
J69A
Skin Malignancy, Major Complexity
J69B
Skin Malignancy, Intermediate Complexity
J69C
Skin Malignancy, Minor Complexity
K01A
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
0.7827
0.1182
1.7894
0.2670
0.6383
0.1972
1.3245
0.2103
0.4151
0.1342
0.9681
6.1559
0.2439
0.2748
1.0054
2.2855
0.2045
0.5306
1.1092
2.7491
0.2391
1.5510
0.2181
1.8152
4.7058
0.2978
0.0000
0.3707
2.9658
0.1860
0.0000
0.6261
1.2523
0.1569
0.7412
0.1297
2.6902
0.2012
0.1949
1.0859
0.1734
95%
0.2044
0.7572
0.1790
10%
100%
0.3042
0.6000
0.1303
18
9%
100%
1.5074
0.2024
1
9
8%
118%
0.1510
0.6905
0.1557
5.9
1
18
10%
80%
0.1128
1.2561
0.2141
1.3
1
4
14%
120%
0.2303
0.1679
4.2
1
13
7%
108%
1.0295
0.2222
1.2
1
4
12%
95%
0.2847
0.2187
YES
5.0
1
15
7%
100%
0.1796
1.2857
0.2479
YES
3.3
1
10
5%
110%
0.1532
0.8226
0.2294
10.2
3
31
7%
100%
2.9967
0.2447
5.7
1
17
4%
100%
1.2445
0.1990
1.3
1
4
6%
100%
0.2376
0.1670
OR Procedures for Diabetic Complications, Major Complexity
35.7
11
107
8%
100%
0.8347
0.9848
11.6676
0.2571
K01B
OR Procedures for Diabetic Complications, Intermediate Complexity
20.2
6
61
10%
100%
0.3256
0.9898
6.2642
0.2308
K01C
OR Procedures for Diabetic Complications, Minor Complexity
10.4
3
31
7%
100%
0.3100
0.9660
3.2079
0.2292
K02A
Pituitary Procedures, Major Complexity
13.7
4
41
34%
100%
1.9160
1.3178
7.1873
0.3417
K02B
Pituitary Procedures, Minor Complexity
5.8
1
17
34%
100%
3.4664
0.3340
K03Z
Adrenal Procedures
4.8
2
20
17%
100%
3.3758
0.3893
K05A
Parathyroid Procedures, Major Complexity
4.6
1
14
21%
100%
2.4154
0.2738
K05B
Parathyroid Procedures, Minor Complexity
1.3
1
4
30%
100%
1.3029
0.3024
K06A
Thyroid Procedures, Major Complexity
3.9
1
12
20%
100%
2.6598
0.3446
K06B
Thyroid Procedures, Minor Complexity
1.6
1
5
23%
100%
1.6736
0.4211
K08Z
Thyroglossal Procedures
1.3
1
4
16%
83%
1.2418
0.4005
K09A
Other Endocrine, Nutritional and Metabolic OR Procedures, Major Complexity
17.0
5
51
13%
100%
6.1702
0.2616
K09B
Other Endocrine, Nutritional and Metabolic OR Procedures, Minor Complexity
4.7
1
14
13%
100%
1.9702
0.2750
K10A
Revisional and Open Bariatric Procedures, Major Complexity
10.2
3
31
16%
100%
4.3148
0.2670
K10B
Revisional and Open Bariatric Procedures, Minor Complexity
2.4
1
7
16%
100%
2.7135
0.5602
Independent Hospital Pricing Authority
YES
YES
YES
YES
YES
Page 51 of 70
0.6169
0.4534
0.5330
0.0000
0.0000
0.8967
0.7537
0.2084
0.0000
0.9989
0.2085
1.0672
0.8103
1.5536
1.1543
1.0720
0.9204
Independent Hospital Pricing Authority - National Efficient Price Determination 2016-17
Inlier Bounds
AR-DRG
V8.0
Description
Same-Day
Payment
List
Bundled
ICU
ALOS (excluding
designated SD and
unbundled ICU)
Lower
Bound
Upper
Bound
Adjustments
Private
Patient
Paediatric
Service Adj.
Adj.
Price Weights
Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
K11A
Major Laparoscopic Bariatric Procedures, Major Complexity
3.6
1
11
16%
100%
2.4882
0.3865
K11B
Major Laparoscopic Bariatric Procedures, Minor Complexity
2.5
1
7
16%
100%
1.8271
0.4118
K12A
Other Bariatric Procedures, Major Complexity
2.0
1
6
16%
100%
1.7266
0.3374
K12B
Other Bariatric Procedures, Minor Complexity
1.2
1
4
16%
100%
1.5590
0.2962
K13Z
Plastic OR Procedures for Endocrine, Nutritional and Metabolic Disorders
4.2
1
12
16%
100%
2.0917
0.3866
K40A
Endoscopic and Investigative Procedures for Metabolic Disorders, Major Comp
11.4
3
34
10%
106%
3.6919
0.2430
K40B
Endoscopic and Investigative Procedures for Metabolic Disorders, Minor Comp
1.1
1
3
35%
200%
0.2965
0.2293
K60A
Diabetes, Major Complexity
5.9
1
18
9%
116%
1.5500
0.2315
K60B
Diabetes, Minor Complexity
3.4
1
10
37%
172%
0.8485
0.2054
K61A
Severe Nutritional Disturbance, Major Complexity
12.4
4
37
7%
100%
0.0000
0.9232
3.6929
0.2555
K61B
Severe Nutritional Disturbance, Minor Complexity
6.3
2
19
7%
100%
0.0000
0.9406
1.8813
0.2660
K62A
Miscellaneous Metabolic Disorders, Major Complexity
7.8
2
23
9%
135%
0.0000
1.0212
2.0424
0.2214
K62B
Miscellaneous Metabolic Disorders, Intermediate Complexity
YES
3.6
1
11
10%
133%
0.1196
0.9010
0.2359
K62C
Miscellaneous Metabolic Disorders, Minor Complexity
YES
2.4
1
7
10%
162%
0.1090
0.5898
0.2434
K63A
Inborn Errors of Metabolism, Major Complexity
3.0
1
9
11%
149%
0.6610
0.3015
K63B
Inborn Errors of Metabolism, Minor Complexity
1.1
1
3
4%
110%
0.1925
0.1406
K64A
Endocrine Disorders, Major Complexity
YES
4.6
1
14
10%
174%
0.2567
1.2657
0.2483
K64B
Endocrine Disorders, Minor Complexity
YES
2.3
1
7
12%
191%
0.1580
0.6615
0.1626
L02A
Operative Insertion of Peritoneal Catheter for Dialysis, Major Complexity
9.1
3
27
10%
100%
3.9271
0.2997
L02B
Operative Insertion of Peritoneal Catheter for Dialysis, Minor Complexity
1.6
1
5
9%
100%
1.0343
0.3211
L03A
Kidney, Ureter and Major Bladder Procedures for Neoplasm, Major Complexity
16.4
5
49
14%
100%
1.8243
1.2577
8.1127
0.3265
L03B
Kidney, Ureter and Major Bladder Procedures for Neoplasm, Intermediate Comp
6.4
2
19
15%
100%
0.7685
1.6924
4.1532
0.3791
L03C
Kidney, Ureter and Major Bladder Procedures for Neoplasm, Minor Complexity
3.6
1
11
19%
100%
2.7382
0.4900
L04A
Kidney, Ureter and Major Bladder Procedures for Non-Neoplasm, Major Complexity
12.8
4
38
11%
81%
5.4158
0.2964
L04B
Kidney, Ureter and Major Bladder Procedures for Non-Neoplasm, Intermediate Comp
YES
4.5
1
13
17%
93%
0.6981
2.2745
0.2708
L04C
Kidney, Ureter and Major Bladder Procedures for Non-Neoplasm, Minor Complexity
YES
2.0
1
6
21%
131%
0.6467
1.4141
0.3395
L05A
Transurethral Prostatectomy for Urinary Disorder, Major Complexity
9.2
3
28
17%
100%
3.1601
0.2251
L05B
Transurethral Prostatectomy for Urinary Disorder, Minor Complexity
2.5
1
7
20%
100%
1.2973
0.2346
L06A
Minor Bladder Procedures, Major Complexity
11.7
3
35
13%
100%
4.4144
0.2845
L06B
Minor Bladder Procedures, Intermediate Complexity
3.9
1
12
12%
100%
1.6977
0.2498
L06C
Minor Bladder Procedures, Minor Complexity
2.2
1
6
20%
100%
1.0967
0.2061
L07A
Other Transurethral Procedures, Major Complexity
5.3
1
16
17%
100%
1.8901
0.2328
L07B
Other Transurethral Procedures, Minor Complexity
1.3
1
4
27%
100%
0.7503
0.2661
L08A
Urethral Procedures, Major Complexity
4.0
1
12
15%
100%
1.7001
0.2897
L08B
Urethral Procedures, Minor Complexity
1.3
1
4
17%
87%
0.7802
0.2485
L09A
Other Procedures for Kidney and Urinary Tract Disorders, Major Complexity
19.1
6
57
10%
100%
0.4607
1.0748
6.9094
0.2915
L09B
Other Procedures for Kidney and Urinary Tract Disorders, Intermediate Complexity
6.0
2
18
15%
100%
0.6369
1.0226
2.6820
0.2825
L09C
Other Procedures for Kidney and Urinary Tract Disorders, Minor Complexity
1.3
1
4
19%
80%
1.0377
0.3379
L40Z
Ureteroscopy
1.4
1
6
26%
100%
0.7008
0.1745
L41Z
Cystourethroscopy for Urinary Disorder, Sameday
1.0
1
1
24%
200%
0.2173
L42Z
ESW Lithotripsy
L60A
Kidney Failure, Major Complexity
L60B
Kidney Failure, Intermediate Complexity
Independent Hospital Pricing Authority
YES
YES
YES
YES
Page 52 of 70
1.1
1
3
42%
100%
11.2
3
34
10%
100%
4.8
1
15
10%
163%
0.2222
1.1566
0.1410
0.5428
1.0034
0.5138
0.6719
1.1281
1.1031
0.8821
1.2475
0.5177
0.5527
0.0000
0.1815
1.0556
0.7397
0.1596
3.1669
0.2565
1.1946
0.2373
Independent Hospital Pricing Authority - National Efficient Price Determination 2016-17
Inlier Bounds
AR-DRG
V8.0
Description
Same-Day
Payment
List
Bundled
ICU
ALOS (excluding
designated SD and
unbundled ICU)
Private
Patient
Paediatric
Service Adj.
Adj.
Lower
Bound
Upper
Bound
2.9
1
9
12%
133%
L60C
Kidney Failure, Minor Complexity
L61Z
Haemodialysis
1.0
1
3
6%
163%
L62A
Kidney and Urinary Tract Neoplasms, Major Complexity
9.3
3
28
6%
115%
L62B
Kidney and Urinary Tract Neoplasms, Minor Complexity
2.4
1
7
12%
L63A
Kidney and Urinary Tract Infections, Major Complexity
6.0
1
18
L63B
Kidney and Urinary Tract Infections, Minor Complexity
YES
2.6
1
L64A
Urinary Stones and Obstruction, Major Complexity
YES
2.6
L64B
Urinary Stones and Obstruction, Minor Complexity
L65A
Kidney and Urinary Tract Signs and Symptoms, Major Complexity
L65B
Kidney and Urinary Tract Signs and Symptoms, Minor Complexity
L66Z
Urethral Stricture
L67A
Other Kidney and Urinary Tract Disorders, Major Complexity
L67B
Other Kidney and Urinary Tract Disorders, Intermediate Complexity
L67C
Price Weights
Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
0.2521
0.1062
0.0849
2.5688
0.2092
119%
0.5976
0.2137
9%
89%
1.3799
0.2238
8
10%
113%
0.0945
0.6270
0.2071
1
8
17%
184%
0.1253
0.8251
0.2471
1.2
1
4
26%
200%
0.2602
0.1696
YES
5.6
1
17
10%
134%
0.1522
1.3770
0.2294
YES
2.3
1
7
12%
152%
0.1169
0.5247
0.1866
1.6
1
5
12%
80%
0.5959
0.2511
YES
5.5
1
16
10%
130%
0.2109
1.4142
0.2451
YES
2.3
1
7
13%
154%
0.1572
0.6517
0.2335
Other Kidney and Urinary Tract Disorders, Minor Complexity
1.1
1
3
12%
200%
0.1526
0.1142
L68Z
Peritoneal Dialysis
1.0
1
3
4%
200%
0.1660
0.1313
M01A
Major Male Pelvic Procedures, Major Complexity
6.8
2
20
21%
100%
4.4581
0.3200
M01B
Major Male Pelvic Procedures, Minor Complexity
3.5
1
10
23%
100%
3.3459
0.1556
M02A
Transurethral Prostatectomy for Reproductive System Disorder, Major Complexity
6.0
2
18
26%
100%
2.2817
0.2398
M02B
Transurethral Prostatectomy for Reproductive System Disorder, Minor Complexity
2.5
1
7
27%
100%
1.3042
0.2180
M03A
Penis Procedures, Major Complexity
3.1
1
9
22%
80%
1.6942
0.3793
M03B
Penis Procedures, Minor Complexity
1.2
1
4
17%
100%
0.8453
0.2506
M04Z
Testes Procedures
1.2
1
4
19%
81%
0.7357
0.2033
M05Z
Circumcision
1.1
1
3
13%
81%
0.6173
0.1954
M06A
Other Male Reproductive System OR Procedures, Major Complexity
5.8
1
17
11%
100%
2.2452
0.2353
M06B
Other Male Reproductive System OR Procedures, Minor Complexity
1.3
1
4
22%
100%
0.9805
0.2653
M40Z
Cystourethroscopy for Male Reproductive System Disorder, Sameday
1.0
1
1
47%
100%
0.2176
M60A
Male Reproductive System Malignancy, Major Complexity
8.1
2
24
5%
80%
2.1705
0.2105
M60B
Male Reproductive System Malignancy, Minor Complexity
1.2
1
4
18%
100%
0.3405
0.2354
M61A
Benign Prostatic Hypertrophy, Major Complexity
3.5
1
11
16%
100%
0.8184
0.2039
M61B
Benign Prostatic Hypertrophy, Minor Complexity
1.2
1
4
17%
100%
0.3584
0.1651
M62A
Male Reproductive System Inflammation, Major Complexity
5.1
1
15
10%
100%
1.1298
0.2237
M62B
Male Reproductive System Inflammation, Minor Complexity
2.4
1
7
9%
130%
0.5762
0.1926
M63Z
Male Sterilisation Procedures
1.0
1
3
23%
100%
0.4101
0.1138
M64A
Other Male Reproductive System Disorders, Major Complexity
2.2
1
7
16%
100%
0.5855
0.2402
M64B
Other Male Reproductive System Disorders, Minor Complexity
1.2
1
3
14%
113%
0.2633
0.1498
N01A
Pelvic Evisceration and Radical Vulvectomy, Major Complexity
14.5
4
43
18%
100%
6.4049
0.3032
N01B
Pelvic Evisceration and Radical Vulvectomy, Minor Complexity
4.4
1
13
18%
100%
3.1372
0.2637
N04A
Hysterectomy for Non-Malignancy, Major Complexity
4.5
1
13
15%
100%
2.7307
0.3364
N04B
Hysterectomy for Non-Malignancy, Minor Complexity
2.7
1
8
16%
100%
1.9708
0.2510
N05A
Oophorectomy and Complex Fallopian Tube Procedures for Non-Malignancy, Maj Comp
4.5
1
14
11%
100%
2.6076
0.3217
N05B
Oophorectomy and Complex Fallopian Tube Procedures for Non-Malignancy, Min Comp
1.7
1
5
17%
100%
1.4659
0.3347
N06A
Female Reproductive System Reconstructive Procedures, Major Complexity
3.8
1
11
17%
100%
2.2186
0.3079
N06B
Female Reproductive System Reconstructive Procedures, Minor Complexity
1.9
1
6
23%
100%
1.3731
0.3490
YES
YES
Page 53 of 70
0.1957
Long-Stay
Outlier Per
Diem
0.8173
Independent Hospital Pricing Authority
YES
Adjustments
0.0000
2.3342
0.5720
0.8563
1.0619
0.8549
0.8342
0.0000
1.0853
0.1432
1.4122
1.2482
Independent Hospital Pricing Authority - National Efficient Price Determination 2016-17
Inlier Bounds
AR-DRG
V8.0
Description
Same-Day
Payment
List
Bundled
ICU
ALOS (excluding
designated SD and
unbundled ICU)
Private
Patient
Paediatric
Service Adj.
Adj.
Lower
Bound
Upper
Bound
2.0
1
6
18%
108%
1.0
1
3
32%
100%
2.0
1
6
17%
112%
N07A
Other Uterus and Adnexa Procedures for Non-Malignancy, Major Complexity
N07B
Other Uterus and Adnexa Procedures for Non-Malignancy, Minor Complexity
N08Z
Endoscopic and Laparoscopic Procedures, Female Reproductive System
N09Z
Other Vagina, Cervix and Vulva Procedures
1.2
1
3
17%
N10Z
Diagnostic Curettage and Diagnostic Hysteroscopy
1.1
1
3
N11A
Other Female Reproductive System OR Procedures, Major Complexity
7.7
2
N11B
Other Female Reproductive System OR Procedures, Minor Complexity
1.0
N12A
Uterus and Adnexa Procedures for Malignancy, Major Complexity
N12B
Price Weights
Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
0.2706
0.5270
0.1851
1.2913
0.2499
134%
0.5333
0.1784
20%
100%
0.4806
0.1469
23
16%
100%
2.9932
0.2674
1
3
12%
100%
0.3466
0.2769
10.4
3
31
17%
100%
5.4065
0.3065
Uterus and Adnexa Procedures for Malignancy, Intermediate Complexity
4.8
1
14
17%
100%
3.1788
0.3453
N12C
Uterus and Adnexa Procedures for Malignancy, Minor Complexity
2.7
1
8
20%
100%
2.2076
0.3650
N60A
Female Reproductive System Malignancy, Major Complexity
10.5
3
31
7%
100%
3.0385
0.2322
N60B
Female Reproductive System Malignancy, Minor Complexity
3.2
1
10
7%
157%
0.8120
0.2199
N61A
Female Reproductive System Infections, Major Complexity
3.5
1
11
9%
100%
0.8626
0.2381
N61B
Female Reproductive System Infections, Minor Complexity
1.7
1
5
10%
178%
0.3800
0.2501
N62A
Menstrual and Other Female Reproductive System Disorders, Major Complexity
2.1
1
6
12%
112%
0.4758
0.2346
N62B
Menstrual and Other Female Reproductive System Disorders, Minor Complexity
1.2
1
4
13%
135%
0.2468
0.1533
O01A
Caesarean Delivery, Major Complexity
7.5
2
23
11%
100%
3.2273
0.2483
O01B
Caesarean Delivery, Intermediate Complexity
4.3
1
13
15%
100%
2.2395
0.2424
O01C
Caesarean Delivery, Minor Complexity
3.2
1
10
18%
100%
1.8692
0.2644
O02A
Vaginal Delivery W OR Procedures, Major Complexity
4.2
1
13
12%
100%
2.2820
0.3298
O02B
Vaginal Delivery W OR Procedures, Minor Complexity
2.9
1
9
11%
100%
1.5944
0.3190
O03A
Ectopic Pregnancy, Major Complexity
2.1
1
6
12%
100%
1.3578
0.2737
O03B
Ectopic Pregnancy, Minor Complexity
1.5
1
5
13%
100%
0.8918
0.2974
O04A
Postpartum and Post Abortion W OR Procedures, Major Complexity
5.1
1
15
13%
100%
2.3813
0.2680
O04B
Postpartum and Post Abortion W OR Procedures, Minor Complexity
2.2
1
7
13%
100%
1.0596
0.2614
O05Z
Abortion W OR Procedures
1.1
1
3
19%
100%
0.4551
0.1758
O60A
Vaginal Delivery, Major Complexity
3.9
1
12
13%
100%
1.6848
0.2763
O60B
Vaginal Delivery, Intermediate Complexity
2.5
1
8
16%
113%
1.1480
0.3058
O60C
Vaginal Delivery, Minor Complexity
1.8
1
5
17%
100%
0.8127
0.3260
O61A
Postpartum and Post Abortion W/O OR Procedures, Major Complexity
4.1
1
12
8%
100%
1.0754
0.2521
O61B
Postpartum and Post Abortion W/O OR Procedures, Minor Complexity
2.3
1
7
9%
100%
0.5923
0.1995
O63A
Abortion W/O OR Procedures, Major Complexity
1.5
1
4
18%
100%
0.5728
0.3593
O63B
Abortion W/O OR Procedures, Minor Complexity
1.1
1
3
11%
100%
0.1929
0.1488
O66A
Antenatal and Other Obstetric Admissions, Major Complexity
2.9
1
9
6%
100%
0.7299
0.2081
O66B
Antenatal and Other Obstetric Admissions, Minor Complexity
1.2
1
4
7%
143%
0.1947
0.1355
P01Z
Neonate W Sig OR Proc/Vent>=96hrs, Died or Transfer to Acute Facility <5Days
YES
1.5
1
4
12%
100%
1.2283
0.3844
P02Z
Cardiothoracic and Vascular Procedures for Neonates
YES
28.8
21
48
12%
100%
2.5794
1.1238
26.1801
0.6412
P03A
Neonate, AdmWt 1000-1499g W Significant OR Proc/Vent>=96hrs, Major Complexity
YES
64.7
21
194
11%
100%
0.1274
1.2477
26.3295
0.3976
P03B
Neonate, AdmWt 1000-1499g W Significant OR Proc/Vent>=96hrs, Minor Complexity
YES
36.6
12
110
8%
100%
0.1133
1.2604
15.2386
0.3544
P04A
Neonate, AdmWt 1500-1999g W Significant OR Proc/Vent>=96hrs, Major Complexity
YES
50.9
33
76
9%
100%
0.3661
0.6377
21.4095
0.3491
P04B
Neonate, AdmWt 1500-1999g W Significant OR Proc/Vent>=96hrs, Minor Complexity
YES
25.1
8
75
10%
100%
0.1053
1.1402
9.2269
0.3158
P05A
Neonate, AdmWt 2000-2499g W Significant OR Proc/Vent>=96hrs, Major Complexity
YES
48.2
32
72
15%
100%
0.4346
0.6952
22.6804
0.3469
P05B
Neonate, AdmWt 2000-2499g W Significant OR Proc/Vent>=96hrs, Minor Complexity
YES
20.7
6
62
15%
100%
0.2008
1.4167
8.7009
0.3553
YES
YES
YES
YES
Page 54 of 70
0.7652
Long-Stay
Outlier Per
Diem
1.4875
Independent Hospital Pricing Authority
YES
Adjustments
0.7102
0.3887
1.3435
0.0000
0.9566
1.3022
1.3543
1.0128
1.1353
0.5025
0.1160
0.1354
Independent Hospital Pricing Authority - National Efficient Price Determination 2016-17
Inlier Bounds
AR-DRG
V8.0
Description
Same-Day
Payment
List
Bundled
ICU
ALOS (excluding
designated SD and
unbundled ICU)
Lower
Bound
Upper
Bound
Adjustments
Private
Patient
Paediatric
Service Adj.
Adj.
Price Weights
Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
P06A
Neonate, AdmWt >=2500g W Significant OR Proc/Vent>=96hrs, Major Complexity
YES
35.6
23
53
11%
100%
0.5932
0.7967
18.9168
0.4139
P06B
Neonate, AdmWt >=2500g W Significant OR Proc/Vent>=96hrs, Minor Complexity
YES
12.1
8
18
10%
100%
0.3414
0.6792
5.7751
0.3576
P07Z
Neonate, AdmWt <750g W Significant OR Procedures
YES
119.6
39
358
12%
100%
0.4806
1.6798
65.9916
0.5082
P08Z
Neonate, AdmWt 750-999g W Significant OR Procedures
YES
89.3
32
297
12%
100%
0.3746
1.4515
46.8242
0.4170
P60A
Neonate W/O Sig OR/Vent>=96hrs, Died/Transfer Acute Facility <5 Days, MajC
YES
2.5
1
4
18%
100%
P60B
Neonate W/O Sig OR/Vent>=96hrs, Died/Transfer Acute Facility <5 Days, MinC
YES
1.9
1
4
12%
100%
P61Z
Neonate, AdmWt <750g W/O Significant OR procedure
YES
77.6
53
121
9%
100%
0.0000
0.8750
46.3748
0.4023
P62A
Neonate, AdmWt 750-999g W/O Significant OR Procedures, Major Complexity
YES
79.3
26
238
8%
100%
0.0000
1.4895
38.7269
0.4229
P62B
Neonate, AdmWt 750-999g W/O Significant OR Procedures, Minor Complexity
YES
45.9
15
138
8%
100%
0.0000
1.4761
22.1417
0.3546
P63A
Neonate, AdmWt 1000-1249g W/O Significant OR Proc/Vent>=96hrs, Major Complexity
YES
36.6
12
110
8%
100%
0.0000
1.0329
12.3947
0.2887
P63B
Neonate, AdmWt 1000-1249g W/O Significant OR Proc/Vent>=96hrs, Minor Complexity
YES
10.6
3
32
8%
100%
0.0000
1.6383
4.9149
0.2523
P64A
Neonate, AdmWt 1250-1499g W/O Significant OR Proc/Vent>=96hrs, Major Complexity
YES
33.3
11
100
8%
100%
0.0000
0.9399
10.3384
0.2559
P64B
Neonate, AdmWt 1250-1499g W/O Significant OR Proc/Vent>=96hrs, Minor Complexity
YES
22.2
7
67
8%
100%
0.0000
0.9852
6.8966
0.2499
P65A
Neonate, AdmWt 1500-1999g W/O Significant OR Proc/Vent>=96hrs, Extreme Comp
YES
28.6
9
86
6%
100%
0.0000
0.9330
8.3970
0.2682
P65B
Neonate, AdmWt 1500-1999g W/O Significant OR Proc/Vent>=96hrs, Major Complexity
YES
21.1
7
63
6%
100%
0.0000
0.8836
6.1853
0.2622
P65C
Neonate, AdmWt 1500-1999g W/O Significant OR Proc/Vent>=96hrs, Intermediate Comp
YES
16.7
5
50
8%
100%
0.0000
0.9606
4.8030
0.2521
P65D
Neonate, AdmWt 1500-1999g W/O Significant OR Proc/Vent>=96hrs, Minor Complexity
YES
13.0
4
39
7%
100%
0.0000
0.9927
3.9708
0.2625
P66A
Neonate, AdmWt 2000-2499g W/O Significant OR Proc/Vent>=96hrs, Extreme Comp
YES
17.8
5
53
9%
100%
0.0000
1.0190
5.0951
0.2690
P66B
Neonate, AdmWt 2000-2499g W/O Significant OR Proc/Vent>=96hrs, Major Complexity
YES
12.8
4
38
6%
100%
0.0000
0.9266
3.7062
0.2426
P66C
Neonate, AdmWt 2000-2499g W/O Significant OR Proc/Vent>=96hrs, Intermediate Comp
YES
8.8
2
26
8%
100%
0.0000
1.2512
2.5023
0.2512
P66D
Neonate, AdmWt 2000-2499g W/O Significant OR Proc/Vent>=96hrs, Minor Complexity
YES
4.2
1
13
10%
100%
1.2220
0.2521
P67A
Neonate, AdmWt >=2500g W/O Sig OR Proc/Vent>=96hrs, <37 Comp Wks Gest, Extr Comp
YES
13.9
4
42
9%
100%
0.0000
1.0756
4.3024
0.2776
P67B
Neonate, AdmWt >=2500g W/O Sig OR Proc/Vent>=96hrs, <37 Comp Wks Gest, Maj Comp
YES
9.1
3
27
9%
100%
0.0000
0.9121
2.7364
0.2645
P67C
Neonate, AdmWt >=2500g W/O Sig OR Proc/Vent>=96hrs, <37 Comp Wks Gest, Int Comp
YES
7.0
2
21
12%
100%
0.0000
1.0561
2.1122
0.2562
P67D
Neonate, AdmWt >=2500g W/O Sig OR Proc/Vent>=96hrs, <37 Comp Wks Gest, Min Comp
YES
4.9
1
15
6%
100%
1.4263
0.2425
P68A
Neonate, AdmWt >=2500g W/O Sig OR Proc/Vent>=96hrs, >=37 Comp Wks Gest, Ext Comp
YES
9.2
3
28
11%
100%
3.0883
0.2940
P68B
Neonate, AdmWt >=2500g W/O Sig OR Proc/Vent>=96hrs, >=37 Comp Wks Gest, Maj Comp
YES
4.6
1
14
10%
100%
1.4124
0.2982
P68C
Neonate, AdmWt >=2500g W/O Sig OR Proc/Vent>=96hrs, >=37 Comp Wks Gest, Int Comp
YES
3.3
1
10
11%
100%
1.0298
0.2612
P68D
Neonate, AdmWt >=2500g W/O Sig OR Proc/Vent>=96hrs, >=37 Comp Wks Gest, Min Comp
YES
2.2
1
7
11%
100%
0.6941
0.2352
Q01A
Splenectomy, Major Complexity
15.4
5
46
14%
100%
6.0984
0.2587
Q01B
Splenectomy, Minor Complexity
5.6
1
17
14%
100%
3.0611
0.2974
Q02A
Blood and Immune System Disorders W Other OR Procedures, Major Complexity
12.4
4
37
12%
123%
4.9375
0.2600
Q02B
Blood and Immune System Disorders W Other OR Procedures, Minor Complexity
YES
3.6
1
11
20%
100%
0.5057
1.6089
0.2415
Q60A
Reticuloendothelial and Immunity Disorders, Major Complexity
YES
5.7
1
17
9%
143%
0.1645
1.5350
0.2949
Q60B
Reticuloendothelial and Immunity Disorders, Minor Complexity
1.1
1
3
13%
170%
0.1517
0.1091
Q61A
Red Blood Cell Disorders, Major Complexity
YES
4.7
1
14
12%
142%
0.2106
1.1434
0.2298
Q61B
Red Blood Cell Disorders, Intermediate Complexity
YES
1.9
1
6
17%
144%
0.1810
0.4886
0.2212
Q61C
Red Blood Cell Disorders, Minor Complexity
1.0
1
3
25%
100%
0.0480
0.0384
Q62A
Coagulation Disorders, Major Complexity
YES
5.6
1
17
11%
100%
0.1612
1.3205
0.2399
Q62B
Coagulation Disorders, Minor Complexity
YES
2.4
1
7
10%
112%
0.1667
0.6254
0.2416
R01A
Lymphoma and Leukaemia W Major OR Procedures, Major Complexity
23.3
15
35
19%
100%
10.3782
0.3101
R01B
Lymphoma and Leukaemia W Major OR Procedures, Minor Complexity
4.0
1
12
19%
100%
1.9868
0.3919
R02A
Other Neoplastic Disorders W Major OR Procedures, Major Complexity
15.5
10
23
15%
100%
6.9264
0.2211
Independent Hospital Pricing Authority
YES
Page 55 of 70
1.0414
0.2851
0.7788
0.0000
1.1085
0.5341
1.1479
1.9146
1.0294
0.9980
1.1008
0.6153
0.5012
Independent Hospital Pricing Authority - National Efficient Price Determination 2016-17
Inlier Bounds
AR-DRG
V8.0
Description
Same-Day
Payment
List
Bundled
ICU
ALOS (excluding
designated SD and
unbundled ICU)
Lower
Bound
Upper
Bound
Adjustments
Private
Patient
Paediatric
Service Adj.
Adj.
Price Weights
Same Day
Short-Stay
Outlier
Base
R02B
Other Neoplastic Disorders W Major OR Procedures, Intermediate Complexity
7.0
2
21
15%
100%
R02C
Other Neoplastic Disorders W Major OR Procedures, Minor Complexity
4.2
1
13
16%
100%
R03A
Lymphoma and Leukaemia W Other OR Procedures, Major Complexity
27.4
9
82
13%
100%
0.3346
R03B
Lymphoma and Leukaemia W Other OR Procedures, Intermediate Complexity
8.4
2
25
12%
100%
0.5049
R03C
Lymphoma and Leukaemia W Other OR Procedures, Minor Complexity
3.3
1
10
24%
136%
R04A
Other Neoplastic Disorders W Other OR Procedures, Major Complexity
8.3
2
25
14%
100%
R04B
Other Neoplastic Disorders W Other OR Procedures, Minor Complexity
3.0
1
9
19%
100%
R60A
Acute Leukaemia, Major Complexity
16.0
10
24
9%
118%
R60B
Acute Leukaemia, Minor Complexity
4.3
1
13
10%
141%
R61A
Lymphoma and Non-Acute Leukaemia, Major Complexity
8.5
2
26
10%
147%
R61B
Lymphoma and Non-Acute Leukaemia, Minor Complexity
3.4
1
10
13%
173%
R62A
Other Neoplastic Disorders, Major Complexity
7.4
2
22
7%
84%
R62B
Other Neoplastic Disorders, Intermediate Complexity
YES
3.7
1
11
8%
82%
R62C
Other Neoplastic Disorders, Minor Complexity
YES
2.8
1
9
9%
106%
R63Z
Chemotherapy
1.0
1
3
9%
100%
S65A
Human Immunodeficiency Virus, Major Complexity
18.9
6
57
7%
100%
S65B
Human Immunodeficiency Virus, Intermediate Complexity
YES
6.0
2
18
7%
100%
0.3458
S65C
Human Immunodeficiency Virus, Minor Complexity
YES
4.3
1
13
7%
100%
0.2748
T01A
Infectious and Parasitic Diseases W OR Procedures, Major Complexity
25.4
8
76
13%
119%
0.7324
T01B
Infectious and Parasitic Diseases W OR Procedures, Intermediate Complexity
11.6
3
35
11%
108%
T01C
Infectious and Parasitic Diseases W OR Procedures, Minor Complexity
6.4
2
19
12%
T40Z
Infectious and Parasitic Diseases W Ventilator Support
8.2
2
24
T60A
Septicaemia, Major Complexity
14.1
4
T60B
Septicaemia, Intermediate Complexity
7.6
T60C
Septicaemia, Minor Complexity
T61A
YES
YES
YES
YES
0.7700
Short-Stay
Outlier Per
Diem
1.4291
Inlier
Long-Stay
Outlier Per
Diem
3.6281
0.2116
2.0698
0.1993
1.1322
10.5244
0.3436
1.5798
3.6644
0.3056
1.5709
0.2673
3.5058
0.2132
1.6220
0.2707
6.9627
0.3275
1.4586
0.2636
2.7850
0.2747
1.1797
0.2660
2.4863
0.2313
0.7793
1.0168
0.2305
0.5815
0.8061
0.1967
0.2223
0.1397
0.5116
0.5791
1.4633
0.8127
0.0000
0.6963
0.2269
0.0000
1.3925
0.1992
0.0965
1.1949
0.0000
1.1476
6.8855
0.2812
0.0000
1.0433
2.0866
0.2912
1.2646
0.2979
1.0484
9.1195
0.2819
0.4073
1.1238
3.7787
0.2192
110%
0.3469
0.9707
2.2884
0.2250
11%
100%
0.0433
2.2229
4.4890
0.2839
42
10%
108%
0.0000
1.0813
4.3252
0.2519
2
23
12%
100%
0.0000
1.0556
2.1112
0.2207
4.5
1
14
11%
106%
1.1223
0.2288
Postoperative and Post-Traumatic Infections, Major Complexity
7.6
2
23
10%
131%
1.6903
0.1811
T61B
Postoperative and Post-Traumatic Infections, Minor Complexity
3.5
1
10
9%
145%
0.6792
0.1804
T62A
Fever of Unknown Origin, Major Complexity
5.6
1
17
11%
100%
1.4563
0.2589
T62B
Fever of Unknown Origin, Minor Complexity
2.2
1
7
12%
100%
0.5416
0.2666
T63A
Viral Illnesses, Major Complexity
4.4
1
13
9%
115%
1.1012
0.2501
T63B
Viral Illnesses, Minor Complexity
1.5
1
5
10%
100%
0.3527
0.2657
T64A
Other Infectious and Parasitic Diseases, Major Complexity
17.9
5
54
8%
100%
0.0000
1.1703
5.8515
0.2539
T64B
Other Infectious and Parasitic Diseases, Intermediate Complexity
8.0
2
24
9%
100%
0.0000
1.0494
2.0989
0.1999
T64C
Other Infectious and Parasitic Diseases, Minor Complexity
4.9
1
15
9%
117%
1.0553
0.1780
U40Z
Mental Health Treatment W ECT, Sameday
1.0
1
1
9%
100%
0.1622
U60A
Mental Health Treatment W/O ECT, Sameday, Major Complexity
1.0
1
1
6%
182%
0.0938
U60B
Mental Health Treatment W/O ECT, Sameday, Minor Complexity
1.0
1
1
20%
200%
U61A
Schizophrenia Disorders, Major Complexity
45.3
30
68
1%
100%
0.0000
0.3305
9.9143
0.1855
U61B
Schizophrenia Disorders, Minor Complexity
20.4
13
31
1%
158%
0.0000
0.3654
4.7497
0.1913
U62A
Paranoia and Acute Psychotic Disorders, Major Complexity
25.1
16
38
3%
100%
0.0000
0.4079
6.5265
0.2026
U62B
Paranoia and Acute Psychotic Disorders, Minor Complexity
12.4
8
19
2%
161%
0.0000
0.4032
3.2258
0.2039
U63A
Major Affective Disorders, Major Complexity
29.4
19
44
2%
193%
0.0000
0.3945
7.4948
0.2103
U63B
Major Affective Disorders, Minor Complexity
13.7
9
20
2%
164%
0.0000
0.4042
3.6379
0.2069
Independent Hospital Pricing Authority
YES
YES
Page 56 of 70
0.0000
0.8451
0.1226
0.2500
0.0725
Independent Hospital Pricing Authority - National Efficient Price Determination 2016-17
Inlier Bounds
AR-DRG
V8.0
Description
Same-Day
Payment
List
Bundled
ICU
ALOS (excluding
designated SD and
unbundled ICU)
Lower
Bound
Upper
Bound
Adjustments
Private
Patient
Paediatric
Service Adj.
Adj.
Price Weights
Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
U64A
Other Affective and Somatoform Disorders, Major Complexity
15.6
10
23
3%
148%
0.0000
0.4008
4.0078
0.2012
U64B
Other Affective and Somatoform Disorders, Minor Complexity
6.4
4
10
3%
155%
0.0000
0.4221
1.6884
0.2061
U65A
Anxiety Disorders, Major Complexity
8.1
5
12
5%
139%
0.0000
0.4478
2.2392
0.2270
U65B
Anxiety Disorders, Minor Complexity
4.0
2
6
8%
179%
0.0000
0.4781
0.9562
0.1901
U66A
Eating and Obsessive-Compulsive Disorders, Major Complexity
27.9
18
42
3%
109%
0.0000
0.4570
8.2256
0.2152
U66B
Eating and Obsessive-Compulsive Disorders, Minor Complexity
15.2
10
23
3%
121%
0.0000
0.4855
4.8547
0.2463
U67A
Personality Disorders and Acute Reactions, Major Complexity
11.4
7
17
2%
190%
0.0000
0.4371
3.0594
0.2196
U67B
Personality Disorders and Acute Reactions, Minor Complexity
4.7
3
7
2%
170%
0.0000
0.4404
1.3213
0.2229
U68A
Childhood Mental Disorders, Major Complexity
11.0
7
16
1%
130%
0.0000
0.5620
3.9338
0.2455
U68B
Childhood Mental Disorders, Minor Complexity
7.1
4
11
1%
149%
0.0000
0.5700
2.2799
0.2621
V60A
Alcohol Intoxication and Withdrawal, Major Complexity
5.1
3
8
7%
100%
0.0000
0.4313
1.2939
0.2141
V60B
Alcohol Intoxication and Withdrawal, Minor Complexity
2.0
1
3
8%
80%
0.3252
0.2192
V61A
Drug Intoxication and Withdrawal, Major Complexity
11.2
7
17
4%
100%
0.0000
0.4446
3.1119
0.2099
V61B
Drug Intoxication and Withdrawal, Minor Complexity
6.2
4
9
2%
200%
0.0000
0.4174
1.6698
0.2147
V62A
Alcohol Use and Dependence, Major Complexity
10.3
6
15
5%
100%
0.0000
0.4036
2.4214
0.2025
V62B
Alcohol Use and Dependence, Minor Complexity
6.0
4
9
2%
100%
0.0000
0.3718
1.4871
0.2036
V63Z
Opioid Use and Dependence
5.8
3
8
5%
100%
0.0000
0.3618
1.0854
0.1780
V64Z
Other Drug Use and Dependence
5.5
3
8
4%
100%
0.0000
0.3680
1.1039
0.1649
V65Z
Treatment for Alcohol Disorders, Sameday
1.0
1
1
7%
123%
0.1017
V66Z
Treatment for Drug Disorders, Sameday
1.0
1
1
5%
100%
W01A
Vent, Trac & Cran Procs for Mult Sig Trauma, Major Complexity
37.0
12
111
13%
100%
3.6802
1.9428
26.9944
0.3779
W01B
Vent, Trac & Cran Procs for Mult Sig Trauma, Intermediate Complexity
21.0
6
63
13%
100%
2.3533
2.3368
16.3740
0.3624
W01C
Vent, Trac & Cran Procs for Mult Sig Trauma, Minor Complexity
13.2
4
40
13%
100%
2.1400
1.9307
9.8628
0.3217
W02A
Hip, Femur and Lower Limb Procedures for Multiple Sig Trauma, Major Complexity
20.3
6
61
16%
100%
1.7536
1.4436
10.4155
0.2993
W02B
Hip, Femur and Lower Limb Procedures for Multiple Sig Trauma, Minor Complexity
12.4
4
37
16%
100%
1.3655
0.9716
5.2520
0.2564
W03Z
Abdominal Procedures for Multiple Significant Trauma
10.3
3
35
13%
100%
0.9710
1.4193
5.2288
0.3262
W04A
Multiple Significant Trauma W Other OR Procedures, Major Complexity
22.0
7
66
13%
100%
2.3983
1.1860
10.7002
0.2918
W04B
Multiple Significant Trauma W Other OR Procedures, Minor Complexity
9.4
3
28
13%
100%
1.1111
1.3303
5.1019
0.3502
W60A
Multiple Sig Trauma, Died or Transferred to Acute Facility <5 Days, Major Comp
1.7
1
4
22%
100%
W60B
Multiple Sig Trauma, Died or Transferred to Acute Facility <5 Days, Minor Comp
1.5
1
4
22%
100%
W61A
Multiple Significant Trauma W/O OR Procedures, Major Complexity
16.9
5
51
6%
100%
0.0000
0.9118
4.5588
0.2230
W61B
Multiple Significant Trauma W/O OR Procedures, Minor Complexity
7.2
2
22
7%
114%
0.0000
1.0120
2.0240
0.2288
X02A
Microvascular Tissue Transfer and Skin Grafts for Injuries to Hand, Major Comp
6.6
2
20
15%
100%
0.4328
1.7485
3.9299
0.3641
X02B
Microvascular Tissue Transfer and Skin Grafts for Injuries to Hand, Minor Comp
1.7
1
5
28%
126%
0.9529
0.4523
X04A
Other Procedures for Injuries to Lower Limb, Major Complexity
11.3
3
34
10%
100%
4.0891
0.2558
X04B
Other Procedures for Injuries to Lower Limb, Minor Complexity
2.4
1
7
13%
106%
1.0482
0.2740
X05A
Other Procedures for Injuries to Hand, Major Complexity
2.6
1
8
15%
110%
1.1348
0.2920
X05B
Other Procedures for Injuries to Hand, Minor Complexity
1.2
1
4
20%
95%
0.5675
0.2066
X06A
Other Procedures for Other Injuries, Major Complexity
12.8
4
38
14%
130%
4.5752
0.2206
X06B
Other Procedures for Other Injuries, Intermediate Complexity
4.6
1
14
12%
112%
1.6327
0.2224
X06C
Other Procedures for Other Injuries, Minor Complexity
1.9
1
6
13%
94%
0.8368
0.2806
X07A
Skin Grafts for Injuries Excluding Hand, Major Complexity
22.8
7
68
10%
100%
0.5401
1.0468
7.8679
0.2730
X07B
Skin Grafts for Injuries Excluding Hand, Intermediate Complexity
10.7
3
32
9%
100%
0.4580
1.0760
3.6860
0.2523
Independent Hospital Pricing Authority
YES
Page 57 of 70
0.0923
1.8792
1.0604
0.5699
1.1731
0.4634
0.7020
0.9683
Independent Hospital Pricing Authority - National Efficient Price Determination 2016-17
Inlier Bounds
AR-DRG
V8.0
Description
Same-Day
Payment
List
Bundled
ICU
ALOS (excluding
designated SD and
unbundled ICU)
Lower
Bound
Upper
Bound
Adjustments
Private
Patient
Paediatric
Service Adj.
Adj.
X07C
Skin Grafts for Injuries Excluding Hand, Minor Complexity
4.8
1
14
10%
110%
X40A
Injuries, Poisoning and Toxic Effects of Drugs W Ventilator Support, Major Comp
8.3
2
25
8%
100%
X40B
Injuries, Poisoning and Toxic Effects of Drugs W Ventilator Support, Minor Comp
3.4
1
10
12%
100%
X60A
Injuries, Major Complexity
5.8
1
17
11%
100%
X60B
Injuries, Minor Complexity
1.4
1
4
15%
X61A
Allergic Reactions, Major Complexity
1.8
1
5
X61B
Allergic Reactions, Minor Complexity
1.0
1
X62A
Poisoning/Toxic Effects of Drugs and Other Substances, Major Complexity
YES
5.8
X62B
Poisoning/Toxic Effects of Drugs and Other Substances, Minor Complexity
YES
X63A
Sequelae of Treatment, Major Complexity
X63B
Sequelae of Treatment, Minor Complexity
X64A
Price Weights
Same Day
Short-Stay
Outlier
Base
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
1.6982
0.2296
3.5468
0.2512
1.7301
0.2710
1.1344
0.2070
137%
0.2477
0.1863
11%
135%
0.4158
0.2682
3
9%
111%
0.1358
0.0971
1
17
8%
132%
0.1534
1.2427
0.2212
2.0
1
6
9%
117%
0.0933
0.4217
0.2176
YES
5.8
1
17
10%
135%
0.1870
1.3018
0.2081
YES
2.4
1
7
9%
100%
0.1533
0.5369
0.1781
Other Injuries, Poisonings and Toxic Effects, Major Complexity
6.5
2
19
10%
146%
1.6081
0.1989
X64B
Other Injuries, Poisonings and Toxic Effects, Minor Complexity
1.3
1
4
13%
125%
0.2353
0.1717
Y01Z
Vent >=96hrs or Trach for Burns or OR Procs for Severe Full Thickness Burns
33.7
18
164
6%
100%
2.3377
1.9649
37.7053
0.6514
Y02A
Skin Grafts for Other Burns, Major Complexity
16.8
5
50
5%
100%
0.6184
1.5951
8.5942
0.4654
Y02B
Skin Grafts for Other Burns, Intermediate Complexity
6.1
2
18
5%
100%
0.3722
1.4421
3.2564
0.3230
Y02C
Skin Grafts for Other Burns, Minor Complexity
2.4
1
7
6%
92%
1.1407
0.4912
Y03A
Other OR Procedures for Other Burns, Major Complexity
4.6
1
14
7%
116%
1.7060
0.3276
Y03B
Other OR Procedures for Other Burns, Minor Complexity
2.7
1
8
9%
100%
1.0155
0.3536
Y60Z
Burns, Transferred to Acute Facility <5 Days
1.2
1
4
4%
100%
0.4056
YES
0.0530
1.7469
0.1141
0.0000
0.8041
Y61Z
Severe Burns
3.7
1
10
6%
115%
0.9100
0.3125
Y62A
Other Burns, Major Complexity
YES
4.6
1
14
4%
123%
0.1155
1.2406
0.2702
Y62B
Other Burns, Minor Complexity
YES
2.0
1
6
4%
127%
0.1327
0.5359
0.3126
Z01A
Other Contacts W Health Services W OR Procedures, Major Complexity
24.6
8
74
13%
80%
7.9812
0.2291
Z01B
Other Contacts W Health Services W OR Procedures, Minor Complexity
3.0
1
9
38%
93%
1.1647
0.3645
Z40Z
Other Contacts W Health Services W Endoscopy, Sameday
1.0
1
1
41%
136%
Z60A
Rehabilitation, Major Complexity
Z60B
Rehabilitation, Minor Complexity
Z61A
Signs and Symptoms, Major Complexity
6.5
2
20
9%
135%
1.5993
0.2017
Z61B
Signs and Symptoms, Intermediate Complexity
YES
3.1
1
9
12%
136%
0.1547
0.6812
0.2081
Z61C
Signs and Symptoms, Minor Complexity
YES
2.6
1
8
14%
93%
0.1877
0.5116
0.2222
Z63A
Other Follow Up After Surgery or Medical Care, Major Complexity
11.1
3
33
9%
157%
2.4227
0.1861
Z63B
Other Follow Up After Surgery or Medical Care, Minor Complexity
3.4
1
10
19%
80%
0.6591
0.1683
Z64A
Other Factors Influencing Health Status, Major Complexity
YES
10.3
3
31
14%
113%
0.2252
2.6204
0.1756
Z64B
Other Factors Influencing Health Status, Minor Complexity
YES
4.4
1
13
53%
107%
0.2174
0.7229
0.1759
Z65Z
Congenital Anomalies and Problems Arising from Neonatal Period
2.9
1
12
16%
100%
0.7144
0.3228
Z66Z
Sleep Disorders
2.7
1
8
8%
116%
0.4999
0.2454
Independent Hospital Pricing Authority
YES
Page 58 of 70
0.7145
0.9083
0.4412
0.2290
0.0000
0.0000
0.0000
0.7996
0.8076
0.8735
Independent Hospital Pricing Authority - National Efficient Price Determination 2016-17
Appendix I - Price weights for admitted subacute and non-acute patients - AN-SNAP V4.0
The admitted subacute and non-acute price weights are available as an Excel spreadsheet on the IHPA website.
Table 11: Admitted subacute and non-acute price weights - AN-SNAP V4.0
Inlier Bounds
AN-SNAP V4.0
Care Type
Episode Type
Description
Same Day
ALOS
Lower
Bound
Price Weights
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
63.8
42
84
0.3478
14.6076
0.2629
4AZ2
Rehabilitation
Admitted Adult Rehabilitation
Weighted FIM motor score 13-18, Brain, Spine, MMT, Age <= 48
87.7
58
108
0.4002
23.2096
0.2792
4AZ3
Rehabilitation
Admitted Adult Rehabilitation
Weighted FIM motor score 13-18, All other impairments, Age >= 65
30.0
19
45
0.3223
6.1233
0.1901
4AZ4
Rehabilitation
Admitted Adult Rehabilitation
Weighted FIM motor score 13-18, All other impairments, Age <= 64
45.5
30
66
0.3094
9.2821
0.1802
4AA1
Rehabilitation
Admitted Adult Rehabilitation
Stroke, weighted FIM motor 51-91, FIM cognition 29-35
15.2
10
23
0.3125
3.1252
0.1699
4AA2
Rehabilitation
Admitted Adult Rehabilitation
Stroke, weighted FIM motor 51-91, FIM cognition 19-28
18.5
12
28
0.3235
3.8815
0.1860
4AA3
Rehabilitation
Admitted Adult Rehabilitation
Stroke, weighted FIM motor 51-91, FIM cognition 5-18
23.9
15
36
0.3254
4.8805
0.1793
4AA4
Rehabilitation
Admitted Adult Rehabilitation
Stroke, weighted FIM motor 36-50, Age >= 68
26.9
17
41
0.3151
5.3573
0.1777
4AA5
Rehabilitation
Admitted Adult Rehabilitation
Stroke, weighted FIM motor 36-50, Age <= 67
35.0
23
53
0.3107
7.1468
0.1867
4AA6
Rehabilitation
Admitted Adult Rehabilitation
Stroke, weighted FIM motor 19-35, Age >= 68
37.7
25
57
0.3045
7.6122
0.1724
4AA7
Rehabilitation
Admitted Adult Rehabilitation
Stroke, weighted FIM motor 19-35, Age <= 67
47.3
31
68
0.3191
9.8906
0.2011
4AB1
Rehabilitation
Admitted Adult Rehabilitation
Brain dysfunction, weighted FIM motor 71-91, FIM cognition 26-35
13.3
8
20
0.4021
3.2170
0.2379
4AB2
Rehabilitation
Admitted Adult Rehabilitation
Brain dysfunction, weighted FIM motor 71-91, FIM cognition 5-25
20.6
13
31
0.4037
5.2478
0.2561
4AB3
Rehabilitation
Admitted Adult Rehabilitation
Brain dysfunction, weighted FIM motor 41-70, FIM cognition 26-35
19.5
13
30
0.3098
4.0271
0.1849
4AB4
Rehabilitation
Admitted Adult Rehabilitation
Brain dysfunction, weighted FIM motor 41-70, FIM cognition 17-25
24.8
16
38
0.3552
5.6830
0.1722
4AB5
Rehabilitation
Admitted Adult Rehabilitation
Brain dysfunction, weighted FIM motor 41-70, FIM cognition 5-16
32.9
21
50
0.3449
7.2422
0.2297
4AB6
Rehabilitation
Admitted Adult Rehabilitation
Brain dysfunction, weighted FIM motor 29-40
31.8
21
48
0.3144
6.6019
0.1969
4AB7
Rehabilitation
Admitted Adult Rehabilitation
Brain dysfunction, weighted FIM motor 19-28
39.7
26
60
0.3534
9.1886
0.2570
4AC1
Rehabilitation
Admitted Adult Rehabilitation
Neurological conditions, weighted FIM motor 62-91
15.4
10
24
0.3186
3.1865
0.1884
4AC2
Rehabilitation
Admitted Adult Rehabilitation
Neurological conditions, weighted FIM motor 43-61
20.2
13
31
0.3046
3.9594
0.1864
4AC3
Rehabilitation
Admitted Adult Rehabilitation
Neurological conditions, weighted FIM motor 19-42
32.9
21
50
0.2981
6.2602
0.1638
4AD1
Rehabilitation
Admitted Adult Rehabilitation
Spinal cord dysfunction, Age >= 50, weighted FIM motor 42-91
25.2
16
38
0.3560
5.6959
0.2551
4AD2
Rehabilitation
Admitted Adult Rehabilitation
Spinal cord dysfunction, Age >= 50, weighted FIM motor 19-41
48.2
32
69
0.3299
10.5578
0.2108
4AD3
Rehabilitation
Admitted Adult Rehabilitation
Spinal cord dysfunction, Age <= 49, weighted FIM motor 34-91
31.5
21
48
0.4125
8.6635
0.2754
4AD4
Rehabilitation
Admitted Adult Rehabilitation
Spinal cord dysfunction, Age <= 49, weighted FIM motor 19-33
76.0
50
97
0.4118
20.5900
0.2876
4AE1
Rehabilitation
Admitted Adult Rehabilitation
Amputation of limb, Age >= 54, weighted FIM motor 68-91
23.2
15
35
0.3379
5.0692
0.2008
4AE2
Rehabilitation
Admitted Adult Rehabilitation
Amputation of limb, Age >= 54, weighted FIM motor 31-67
27.2
18
41
0.3219
5.7939
0.1853
4AE3
Rehabilitation
Admitted Adult Rehabilitation
Amputation of limb, Age >= 54, weighted FIM motor 19-30
30.6
20
46
0.3246
6.4921
0.1645
4AE4
Rehabilitation
Admitted Adult Rehabilitation
Amputation of limb, Age <= 53, weighted FIM motor 19-91
21.6
14
33
0.3519
4.9267
0.2131
4AH1
Rehabilitation
Admitted Adult Rehabilitation
Orthopaedic conditions, fractures, weighted FIM motor 49-91, FIM cognition 33-35
16.2
10
25
0.3068
3.0676
0.1702
4AH2
Rehabilitation
Admitted Adult Rehabilitation
Orthopaedic conditions, fractures, weighted FIM motor 49-91, FIM cognition 5-32
19.7
13
30
0.2838
3.6898
0.1615
4AH3
Rehabilitation
Admitted Adult Rehabilitation
Orthopaedic conditions, fractures, weighted FIM motor 38-48
22.9
15
35
0.2856
4.2840
0.1667
4AH4
Rehabilitation
Admitted Adult Rehabilitation
Orthopaedic conditions, fractures, weighted FIM motor 19-37
27.6
18
42
0.2867
5.1598
0.1666
4A21
Rehabilitation
Admitted Adult Rehabilitation
Orthopaedic conditions, all other (including replacements), weighted FIM motor 68-91
11.3
7
17
0.2955
2.0682
0.1652
4A22
Rehabilitation
Admitted Adult Rehabilitation
Orthopaedic conditions, all other (including replacements), weighted FIM motor 50-67
13.8
9
21
0.2888
2.5994
0.1683
4A23
Rehabilitation
Admitted Adult Rehabilitation
Orthopaedic conditions, all other (including replacements), weighted FIM motor 19-49
20.3
13
31
0.2935
3.8151
0.1683
4A31
Rehabilitation
Admitted Adult Rehabilitation
Cardiac, Pain syndromes, Pulmonary, weighted FIM motor 72-91
10.5
7
16
0.2933
2.0529
0.1109
4A32
Rehabilitation
Admitted Adult Rehabilitation
Cardiac, Pain syndromes, Pulmonary, weighted FIM motor 55-71
14.1
9
22
0.3053
2.7474
0.1585
4A33
Rehabilitation
Admitted Adult Rehabilitation
Cardiac, Pain syndromes, Pulmonary, weighted FIM motor 34-54
18.8
12
29
0.3088
3.7052
0.1702
4A34
Rehabilitation
Admitted Adult Rehabilitation
Cardiac, Pain syndromes, Pulmonary, weighted FIM motor 19-33
22.5
14
34
0.3323
4.6523
0.1843
Independent Hospital Pricing Authority
Page 59 of 70
Independent Hospital Pricing Authority - National Efficient Price Determination 2016-17
Inlier Bounds
AN-SNAP V4.0
Care Type
Episode Type
Description
Same Day
Lower
Bound
ALOS
Price Weights
Upper
Bound
Same Day
Short-Stay
Outlier Per
Diem
Inlier
Long-Stay
Outlier Per
Diem
4AP1
Rehabilitation
Admitted Adult Rehabilitation
Major Multiple Trauma, weighted FIM motor 19-91
25.0
16
38
0.3603
5.7649
0.2446
4AR1
Rehabilitation
Admitted Adult Rehabilitation
Reconditioning, weighted FIM motor 67-91
13.1
8
20
0.3192
2.5532
0.1731
4AR2
Rehabilitation
Admitted Adult Rehabilitation
Reconditioning, weighted FIM motor 50-66, FIM cognition 26-35
16.7
11
25
0.2985
3.2840
0.1743
4AR3
Rehabilitation
Admitted Adult Rehabilitation
Reconditioning, weighted FIM motor 50-66, FIM cognition 5-25
17.9
11
27
0.3197
3.5169
0.1742
4AR4
Rehabilitation
Admitted Adult Rehabilitation
Reconditioning, weighted FIM motor 34-49, FIM cognition 31-35
21.2
14
32
0.3061
4.2860
0.1738
4AR5
Rehabilitation
Admitted Adult Rehabilitation
Reconditioning, weighted FIM motor 34-49, FIM cognition 5-30
20.5
13
31
0.3197
4.1562
0.1796
4AR6
Rehabilitation
Admitted Adult Rehabilitation
Reconditioning, weighted FIM motor 19-33
24.4
16
37
0.3226
5.1608
0.1819
4A91
Rehabilitation
Admitted Adult Rehabilitation
All other impairments, weighted FIM motor 55-91
15.5
10
24
0.3050
3.0504
0.1776
4A92
Rehabilitation
Admitted Adult Rehabilitation
All other impairments, weighted FIM motor 33-54
20.8
13
32
0.3086
4.0116
0.1712
4A93
Rehabilitation
Admitted Adult Rehabilitation
All other impairments, weighted FIM motor 19-32
24.9
16
38
0.3369
5.3907
0.1809
4J01
Rehabilitation
Admitted Adult Rehabilitation
Adult Same-Day Rehabilitation
4BS1
Palliative Care
Admitted Adult Palliative Care
Stable phase, RUG-ADL 4-5
7.6
5
12
0.3146
1.5731
0.1580
4BS2
Palliative Care
Admitted Adult Palliative Care
Stable phase, RUG-ADL 6-16
8.2
5
13
0.3512
1.7562
0.1644
4BS3
Palliative Care
Admitted Adult Palliative Care
Stable phase, RUG-ADL 17-18
8.2
5
13
0.3354
1.6771
0.1669
4BU1
Palliative Care
Admitted Adult Palliative Care
Unstable phase, First Phase in Episode, RUG-ADL 4-13
2.6
1
4
0.3429
0.2019
4BU2
Palliative Care
Admitted Adult Palliative Care
Unstable phase, First Phase in Episode, RUG-ADL 14-18
2.7
1
5
0.3672
0.2077
4BU3
Palliative Care
Admitted Adult Palliative Care
Unstable phase, Not first Phase in Episode, RUG-ADL 4-5
2.3
1
4
0.7525
0.1585
4BU4
Palliative Care
Admitted Adult Palliative Care
Unstable phase, Not first Phase in Episode, RUG-ADL 6-18
2.3
1
4
0.7307
0.2419
4BD1
Palliative Care
Admitted Adult Palliative Care
Deteriorating phase, RUG-ADL 4-14
6.2
4
10
0.3563
1.4251
0.1467
4BD2
Palliative Care
Admitted Adult Palliative Care
Deteriorating phase, RUG-ADL 15-18, Age >= 75
4.1
2
7
0.4150
0.8300
0.1801
4BD3
Palliative Care
Admitted Adult Palliative Care
Deteriorating phase, RUG-ADL 15-18, Age 55-74
4.2
2
7
0.4567
0.9134
0.1894
4BD4
Palliative Care
Admitted Adult Palliative Care
Deteriorating phase, RUG-ADL 15-18, Age <= 54
5.8
3
9
0.3953
1.1860
0.1847
4BT1
Palliative Care
Admitted Adult Palliative Care
Terminal phase
2.0
1
4
0.6202
0.2245
4K01
Palliative Care
Admitted Adult Palliative Care
Adult Same-Day Palliative Care
4CH1
GEM
Admitted GEM
FIM motor 57-91 with Delirium or Dementia
21.6
14
33
0.2700
3.7804
0.1660
4CH2
GEM
Admitted GEM
FIM motor 57-91 without Delirium or Dementia
14.2
9
22
0.2854
2.5689
0.1479
4CM1
GEM
Admitted GEM
FIM motor 18-56 with Delirium or Dementia
25.6
17
39
0.2608
4.4333
0.1524
4CM2
GEM
Admitted GEM
FIM motor 18-56 without Delirium or Dementia
21.3
14
32
0.2650
3.7107
0.1597
4CL1
GEM
Admitted GEM
FIM motor 13-17 with Delirium or Dementia
28.2
18
43
0.2683
4.8298
0.1584
4CL2
GEM
Admitted GEM
FIM motor 13-17 without Delirium or Dementia
24.7
16
38
0.2836
4.5380
0.1600
4L01
GEM
Admitted GEM
Same-Day GEM
4DS1
Psychogeriatric Care
Admitted Psychogeriatric
HoNOS 65+ Overactive behaviour 3-4, LOS <= 91
30.4
20
46
0.3987
7.9737
0.2287
4DS2
Psychogeriatric Care
Admitted Psychogeriatric
HoNOS 65+ Overactive behaviour 1-2, HoNOS 65+ ADL 4, LOS <= 91
33.6
22
51
0.4022
8.8480
0.2285
4DS3
Psychogeriatric Care
Admitted Psychogeriatric
HoNOS 65+ Overactive behaviour 1-2, HoNOS 65+ ADL 0-3, LOS <= 91
29.2
19
44
0.4264
8.1022
0.2596
4DS4
Psychogeriatric Care
Admitted Psychogeriatric
HoNOS 65+ Overactive behaviour 0, HoNOS 65+ total 18-48, LOS <= 91
36.2
24
55
0.3178
7.6269
0.1738
4DS5
Psychogeriatric Care
Admitted Psychogeriatric
HoNOS 65+ Overactive behaviour 0, HoNOS 65+ total 0-17, LOS <= 91
26.6
17
40
0.4372
7.4332
0.2232
4DL1
Psychogeriatric Care
Admitted Psychogeriatric
Long term care
142.0
94
162
0.2921
27.4540
0.1055
4M01
Psychogeriatric Care
Admitted Psychogeriatric
Same-Day Psychogeriatric Care
4ES1
Maintenance
Admitted Non-Acute
Age >= 60, RUG-ADL 4-11, LOS <= 91
14.9
9
23
0.3261
2.9347
0.1765
4ES2
Maintenance
Admitted Non-Acute
Age >= 60, RUG-ADL 12-15, LOS <= 91
15.3
10
23
0.2868
2.8684
0.1618
4ES3
Maintenance
Admitted Non-Acute
Age >= 60, RUG-ADL 16-18, LOS <= 91
15.0
10
23
0.2930
2.9299
0.1728
4ES4
Maintenance
Admitted Non-Acute
Age 18-59, LOS <= 91
15.4
10
24
0.3655
3.6554
0.2097
4EL1
Maintenance
Admitted Non-Acute
Long term care
246.6
164
267
0.2274
37.2887
0.1807
Independent Hospital Pricing Authority
Yes
Yes
Yes
Yes
Page 60 of 70
1.0
0.1005
1.0
0.2514
0.0844
1.0
0.1349
1.0
0.1072
Independent Hospital Pricing Authority - National Efficient Price Determination 2016-17
Appendix J - Paediatric per diem price weights for
admitted subacute and non-acute patients
The paediatric admitted subacute and non-acute price weights are available as an Excel
spreadsheet on the IHPA website. These price weights apply to admitted subacute
and non-acute patients aged up to and including 17 years.
Table 12: Paediatric admitted subacute and non-acute per diem price weights
Paediatric Patient Per Diem Price Weights
Care Type
Same Day Overnight
Palliative Care
0.4978
0.4978
Rehabilitation
0.3158
0.3475
Maintenance
0.0956
0.3325
Independent Hospital Pricing Authority
Page 61 of 70
Independent Hospital Pricing Authority - National Efficient Price Determination 2016-17
Appendix K - Price weights for non-admitted patients
The non-admitted price weights are available as an Excel spreadsheet on the IHPA website.
Table 13: Non-admitted price weights - Tier 2 non-admitted services classification V4.1
Tier 2 Clinic v4.1
10.01
10.02
10.03
10.04
10.05
10.06
10.07
10.08
10.09
10.10
10.11
10.12
10.13
10.14
10.154
10.164
10.174
10.184
10.194
10.20
20.01
20.02
20.03
20.04
20.05
20.06
20.07
20.08
20.09
20.10
20.11
20.12
20.13
20.14
20.15
20.16
20.17
20.18
20.19
20.20
20.21
20.22
20.23
20.24
20.25
Description
Hyperbaric medicine
Interventional imaging
Minor surgical
Dental
Angioplasty/angiography
Endoscopy – gastrointestinal
Endoscopy – urological/gynaecological
Endoscopy – orthopaedic
Endoscopy – respiratory/ear, nose and throat (ENT)
Renal dialysis – hospital delivered
Chemotherapy treatment
Radiation therapy – treatment
Minor medical procedures
Pain management interventions
Renal dialysis – haemodialysis – home delivered
Renal dialysis – peritoneal dialysis – home delivered
Total parenteral nutrition – home delivered
Enteral nutrition – home delivered
Ventilation – home delivered
Radiation therapy – simulation and planning
Transplants
Anaesthetics
Pain management
Developmental disabilities
General medicine
General practice and primary care
General surgery
Genetics
Geriatric medicine
Haematology
Paediatric medicine
Paediatric surgery
Palliative care
Epilepsy
Neurology
Neurosurgery
Ophthalmology
Ear, nose and throat (ENT)
Respiratory
Respiratory – cystic fibrosis
Anti-coagulant Screening and Management
Cardiology
Cardiothoracic
Vascular surgery
Gastroenterology
Independent Hospital Pricing Authority
Price Weights
0.1614
0.3694
0.0478
0.0488
0.2450
0.3332
0.0369
0.0534
0.0506
0.0627
0.0459
0.0550
0.1080
0.0733
1.1241
1.1560
2.8869
0.2082
4.5037
0.1831
0.0981
0.0416
0.0697
0.0665
0.0356
Out of scope
0.0528
0.1628
0.0525
0.0551
0.0447
0.0516
0.0653
0.0430
0.0646
0.0554
0.0501
0.0400
0.0596
0.1749
0.0651
0.0515
0.0806
0.0853
0.0614
Page 62 of 70
Independent Hospital Pricing Authority - National Efficient Price Determination 2016-17
Tier 2 Clinic v4.1
20.26
20.27
20.28
20.29
20.30
20.31
20.32
20.33
20.34
20.35
20.36
20.37
20.38
20.39
20.40
20.41
20.42
20.43
20.44
20.45
20.46
20.47
20.48
20.49
20.50
20.51
20.52
20.53
20.54
20.55
30.01
30.02
30.03
30.04
30.05
30.06
30.07
30.08
40.02
40.03
40.04
40.05
40.06
40.07
40.08
40.09
40.10
40.11
40.12
40.13
40.14
Description
Hepatobiliary
Craniofacial
Metabolic bone
Orthopaedics
Rheumatology
Spinal
Breast
Dermatology
Endocrinology
Nephrology
Urology
Assisted reproductive technology
Gynaecology
Gynaecological oncology
Obstetrics – management of pregnancy without
complications
Immunology
Medical oncology – consultation
Radiation therapy – consultation
Infectious diseases
Psychiatry
Plastic and reconstructive surgery
Rehabilitation
Multidisciplinary burns clinic
Geriatric evaluation and management (GEM)
Psychogeriatric
Sleep disorders
Addiction medicine
Obstetrics – management of complex pregnancy
Maternal fetal medicine
Telehealth – patient location
General imaging
Magnetic resonance imaging (MRI)
Computerised tomography (CT)
Nuclear medicine
Pathology (microbiology, haematology, biochemistry)
Positron emission tomography (PET)
Mammography screening
Clinical measurement
Aged care assessment
Aids and appliances
Clinical pharmacy
Hydrotherapy
Occupational therapy
Pre-admission and pre-anaesthesia
Primary health care
Physiotherapy
Sexual health
Social work
Rehabilitation
Wound management
Neuropsychology
Independent Hospital Pricing Authority
Price Weights
0.0949
0.0389
0.0958
0.0457
0.0438
0.0882
0.0722
0.0448
0.0521
0.0876
0.0422
0.0674
0.0414
0.0700
0.0484
0.0648
0.1044
0.0321
0.0478
0.0440
0.0461
0.0504
0.0721
0.0644
0.0754
0.0365
0.0356
0.0803
0.0803
0.0220
Out of scope
Out of scope
Out of scope
Out of scope
Out of scope
Out of scope
Out of scope
Out of scope
Out of scope
0.0484
0.1497
0.0417
0.0356
0.0863
Out of scope
0.0325
0.0341
0.0434
0.0404
0.0463
0.1080
Page 63 of 70
Independent Hospital Pricing Authority - National Efficient Price Determination 2016-17
Tier 2 Clinic v4.1
40.15
40.16
40.17
40.18
40.21
40.22
40.23
40.24
40.25
40.27
40.28
40.29
40.30
40.31
40.32
40.33
40.34
40.35
40.36
40.37
40.38
40.39
40.40
40.41
40.42
40.43
40.44
40.45
40.46
40.47
40.48
40.49
40.50
40.51
40.52
40.53
40.54
40.55
40.56
40.57
40.58
40.59
40.60
40.61
Description
Optometry
Orthoptics
Audiology
Speech pathology
Cardiac rehabilitation
Stomal therapy
Nutrition/dietetics
Orthotics
Podiatry
Family planning
Midwifery and maternity
Psychology
Alcohol and other drugs
Burns
Continence
General counselling
Specialist mental health
Palliative care
Geriatric evaluation and management (GEM)
Psychogeriatric
Infectious diseases
Neurology
Respiratory
Gastroenterology
Circulatory
Hepatobiliary
Orthopaedics
Dermatology
Endocrinology
Nephrology
Haematology and immunology
Gynaecology
Urology
Breast
Oncology
General medicine
General surgery
Paediatrics
Falls prevention
Cognition and memory
Hospital avoidance programs
Post-acute care
Pulmonary rehabilitation
Telehealth – patient location
Price Weights
0.0095
0.0194
0.0418
0.0429
0.0678
0.0757
0.0429
0.0383
0.0419
Out of scope
0.0410
0.0268
0.0305
0.0315
0.0257
Out of scope
Block funded
0.0596
0.0556
0.0201
0.0838
0.0400
0.0280
0.0481
0.0680
0.0631
0.0464
0.0474
0.0411
0.0453
0.0421
0.0552
0.0464
0.0635
0.0302
0.0456
0.0395
0.0446
0.0147
0.0396
0.0476
0.0639
0.0678
0.0104
4
The price weight for clinics 10.15, 10.16, 10.17, 10.18 and 10.19 are priced on a per calendar
month basis - see the NEP and NEC Glossary for further information.
Independent Hospital Pricing Authority
Page 64 of 70
Independent Hospital Pricing Authority - National Efficient Price Determination 2016-17
Appendix L - Price weights for emergency department patients - URG V1.4
The emergency department price weights are available as an Excel spreadsheet on the IHPA website.
Table 14: Emergency Department price weights - URG V1.4
URG v1.4
3
4
5
6
7
9
10
11
12
14
15
16
17
19
20
21
22
23
24
25
26
27
29
30
31
32
Description
Adm_T1_Injury
Adm_T1_Poisoning/Toxic effects of drugs
Adm_T1_Respiratory system illness
Adm_T1_Circulatory system and Endocrine, nutritional and metabolic illness
Adm_T1_All other MDB groups
Adm_T2_Poisoning
Adm_T2_Injury
Adm_T2_Gastrointestinal system and Digestive system illness
Adm_T2_Respiratory system illness
Adm_T2_Neurological illness
Adm_T2_Toxic effects of drugs
Adm_T2_Circulatory system and Endocrine, nutritional and metabolic illness
Adm_T2_All other MDB groups
Adm_T3_Blood/Immune system illness & system infection/parasites
Adm_T3_Injury
Adm_T3_Neurological illness
Adm_T3_Obstetric/Gynaecological illness
Adm_T3_Digestive system illness
Adm_T3_Circulatory system illness and endocrine, nutritional and metabolic illness
Adm_T3_Poisoning/Toxic effects of drugs
Adm_T3_Urological illness
Adm_T3_Respiratory system illness
Adm_T3_All other MDB groups
Adm_T4_Poisoning/Toxic effects of drugs
Adm_T4_Respiratory system illness
Adm_T4_Gastrointestinal system and Digestive system illness
Independent Hospital Pricing Authority
Page 65 of 70
Price Weights
0.4392
0.3443
0.3533
0.3224
0.3650
0.2222
0.2774
0.2590
0.2412
0.2821
0.2223
0.2125
0.1990
0.2117
0.1984
0.2175
0.1128
0.2064
0.1961
0.1794
0.1966
0.2024
0.1825
0.1320
0.1670
0.1696
Independent Hospital Pricing Authority - National Efficient Price Determination 2016-17
URG v1.4
33
34
35
37
38
39
40
43
44
45
46
48
50
51
52
53
55
56
57
58
60
61
62
63
65
66
67
68
69
70
71
72
Description
Adm_T4_All other MDB groups
Adm_T4_Injury
Adm_T4_Social problem/Other presentation
Adm_T5_All other MDB groups 1
Dead on Arrival w any Triage w any MDB
N-A_T1_All MDB groups
N-A_T2_Toxic effects of drugs
N-A_T2_Circulatory system / Endocrine, nutritional and metabolic diseases
N-A_T2_Injury
N-A_T2_Poisoning
N-A_T2_All other MDB groups
N-A_T3_Circulatory system and Endocrine, nutritional and metabolic illness
N-A_T3_Injury
N-A_T3_Genitourinary illness
N-A_T3_Gastrointestinal system and Digestive system illness
N-A_T3_Neurological illness
N-A_T3_Respiratory system illness
N-A_T3_Musculoskeletal/connective tissue illness
N-A_T3_All other MDB groups
N-A_T4_Injury
N-A_T4_Urological system illness
N-A_T4_Circulatory system / Endocrine, nutritional and metabolic illness
N-A_T4_Gastrointestinal system and Digestive system illness
N-A_T4_Musculoskeletal/connective tissue illness
N-A_T4_Illness of the ENT
N-A_T4_Illness of the Eyes
N-A_T4_Other presentation block
N-A_T4_All other MDB groups
N-A_T5_Poisoning/Toxic effects of drugs
N-A_T5_Injury
N-A_T5_Other presentation block
N-A_T5_All other MDB groups
Independent Hospital Pricing Authority
Page 66 of 70
Price Weights
0.1538
0.1465
0.1465
0.1025
0.0501
0.3001
0.2002
0.1668
0.1572
0.1769
0.1387
0.1273
0.1127
0.1292
0.1241
0.1306
0.1069
0.1141
0.0992
0.0739
0.0881
0.0895
0.0869
0.0791
0.0628
0.0572
0.0702
0.0772
0.0536
0.0511
0.0449
0.0538
Independent Hospital Pricing Authority - National Efficient Price Determination 2016-17
URG v1.4
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
Description
Did Not Wait
Transfer presentation_1, 2
Died in emergency department_triage 1
Adm_Return visit, planned w any Triage
N-A Return visit, planned – Triage 1, 2
N-A Return visit, planned – Triage 3-5
Adm_T1_Psychiatric illness
Adm_T2_System infection/parasites
Adm_T2_Urological system illness
Adm_T2_Psychiatric illness
Adm_T3_Illness of eyes, ear, nose, throat
Adm_T3_Hepatobiliary system illness
Adm_T3_Psychiatric illness
Adm_T4_Circulatory system illness and Endocrine, nutritional and metabolic illness
Adm_T4_Illness of eyes, ear nose and throat
Adm_T4_Blood/immune system illness/system infection/parasites
Adm_T4_Gynaecological and Male reproductive system illness
Adm_T4_Psychiatric illness
Adm_T5_All other MDB groups 2
Adm_T5_Injury
Adm_T5_Gastrointestinal system and Digestive system illness
Adm_T5_Psychiatric illness
N-A_T2_Respiratory system illness
N-A_T2_Urological system illness
N-A_T2_Gastrointestinal system and Digestive system illness
N-A_T2_Neurological illness
N-A_T2_Blood/immune system illness/system infection/parasites
N-A_T2_Psychiatric illness
N-A_T3_Poisoning
N-A_T3_Toxic effects of drugs
N-A_T3_Illness of eyes
N-A_T3_Blood/immune system illness/system infection/parasites
Independent Hospital Pricing Authority
Page 67 of 70
Price Weights
0.0330
0.2362
0.2624
0.1181
0.1289
0.0616
0.3887
0.2670
0.2378
0.2476
0.1519
0.2204
0.1910
0.1654
0.1240
0.1685
0.1363
0.1511
0.1261
0.1076
0.1361
0.1245
0.1502
0.1759
0.1575
0.1751
0.1457
0.1599
0.1198
0.1342
0.0791
0.0995
Independent Hospital Pricing Authority - National Efficient Price Determination 2016-17
URG v1.4
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
Description
N-A_T3_Psychiatric illness
N-A_T4_Poisoning
N-A_T4_Toxic effects of drugs
N-A_T4_Respiratory system illness
N-A_T4_Blood/Immune system illness/System infection/parasites
N-A_T4_Obstetric and Newborn/Neonate
N-A_T4_Gynecological/Male reproductive system illness
N-A_T4_Psychiatric illness
N-A_T5_Circulatory system illness/Endocrine, nutritional and metabolic diseases
N-A_T5_Gastrointestinal system and Digestive system illness
N-A_T5_Illness of the eyes, ear, nose and throat
N-A_T5_Illness of the skin, subcutaneous tissue, breast/Musculoskeletal/Connective tissue illness
N-A_T5_Blood/immune system illness/system infection/parasites
N-A_T5_Obstetric illness/Newborn/Neonate
N-A_T5_Genitourinary system illness
N-A_T5_Psychiatric illness
Transfer presentation_3
Transfer presentation_4
Transfer presentation_5
Died in emergency department_triage 2-5
Left at own risk_1, 2
Left at own risk_3
Left at own risk_4
Left at own risk_5
Independent Hospital Pricing Authority
Page 68 of 70
Price Weights
0.1169
0.0698
0.0879
0.0741
0.0709
0.0773
0.0833
0.0818
0.0584
0.0561
0.0412
0.0508
0.0468
0.0423
0.0520
0.0531
0.2159
0.1588
0.1004
0.2715
0.1551
0.0975
0.0650
0.0466
Independent Hospital Pricing Authority - National Efficient Price Determination 2016-17
Appendix M - Price weights for emergency service patients - UDG V1.3
The emergency service price weights are available as an Excel spreadsheet on the IHPA website.
Table 15: Emergency Service price weights - UDG V1.3
UDG v1.3
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Description
Adm_T1
Adm_T2
Adm_T3
Adm_T4
Adm_T5
N-A_T1
N-A_T2
N-A_T3
N-A_T4
N-A_T5
Did Not Wait
Dead on Arrival w any Triage w any MDB
Transfer presentation
Died in emergency department
Adm_Return visit, planned w any Triage
N-A Return visit, planned – Triage 1, 2, 3
N-A Return visit, planned – Triage 4,5
Independent Hospital Pricing Authority
Price Weights
0.3694
0.2351
0.1978
0.1563
0.1181
0.2988
0.1586
0.1141
0.0756
0.0492
0.0330
0.0501
0.2122
0.2656
0.1181
0.1087
0.0590
Page 69 of 70
Independent Hospital Pricing Authority - National Efficient Price Determination 2016-17
Independent Hospital Pricing Authority
Level 6, 1 Oxford Street Sydney NSW 2000 PO Box 483 Darlinghurst NSW 1300
P +61 2 8215 1100 F+61 2 8215 1111
Independent Hospital Pricing Authority
Page 70 of 70