Guideline
Ministry of Health, NSW
73 Miller Street North Sydney NSW 2060
Locked Mail Bag 961 North Sydney NSW 2059
Telephone (02) 9391 9000 Fax (02) 9391 9101
http://www.health.nsw.gov.au/policies/
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Costs of Care Standards 2009/10
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Document Number GL2011_007
Publication date 26-May-2011
Functional Sub group Corporate Administration - Information and data
Corporate Administration - Finance
Summary The 2009/10 NSW Costs of Care Standards are a guide to estimating the
costs of health services. The services covered by the Standards are
acute admitted care, mental health care, sub- and non-acute care,
intensive care, emergency department care and outpatient services. The
guidelines assist various initiatives such as Episode Funding, the
contractual arrangement between NSW Health and the Department of
Veterans' Affairs, planning health services, and cost benchmarking.
Replaces Doc. No. Cost of Care Standards 2006/07- NSW [GL2007_021]
Author Branch Inter-Government and Funding Strategies
Branch contact Chee Cheong 9391 9296
Applies to Speciality Network Governed Statutory Health Corporations, Local Health
Networks, Board Governed Statutory Health Corporations, Chief
Executive Governed Statutory Health Corporations, Public Health Units,
Public Hospitals
Audience All staff
Distributed to Public Health System, NSW Ambulance Service, Ministry of Health
Review date 26-Jul-2012
Policy Manual Not applicable
File No. H11/22988
Status Active
Director-General
GUIDELINE SUMMARY
NSW COSTS OF CARE STANDARDS 2009-2010
PURPOSE
The NSW Costs of Care Standards are a guide to estimating the costs of outputs of
health services using data from the most up-to-date sources available. The service
areas currently covered by the Standards are acute care, emergency department care,
outpatient care, sub- and non-acute care and mental health.
KEY PRINCIPLES
The 2009/10 Standards uses the Australian Refined Diagnosis Related Group Version
5.0 for the acute admitted care cost weights. There have been other changes from the
2006/07 Standards. These are:
Acute Admitted Care
 Average costs with data from the 2006/07 NSW Hospital Cost Data Collection,
escalated to 2009/10 prices.
Emergency Department Care
 Updating of average costs to reflect 2009/10 prices.
Intensive Care
 Updating of intensive care costs to reflect 2009/10 prices.
Outpatient Care
 Updating of outpatient average costs to reflect 2009/10 prices.
Sub- and Non-Acute Care
 Updating of average sub- and non-acute costs to reflect 2009/10 prices.
Mental Health Care
 Average costs uses data from the 2006-07 data for the Mental Health
Establishments NMDS, escalated to reflect 2009/10 prices.
USE OF THE GUIDELINE
The Standards have several applications:
 Weighting activity in output-based funding models;
 Contracting between purchasers and providers of health care, for example, between
NSW Health and the Department of Veterans’ Affairs;
 Determining population health needs using age/sex weighted utilisation of health
services by geographic region;
 Planning health services to meet the future health needs of populations;
 Quantifying the costs for the treatment of specific diseases (e.g. cancer) or for
specific services (e.g. pharmacy costs); and
 Cost comparisons.
GL2011_007
Issue date: May 2011
Page 1 of 2
GUIDELINE SUMMARY
REVISION HISTORY
Version
May 2011
(GL2011_007)
August 2009
(GL2007_021)
Approved by
Deputy DirectorGeneral Strategic
Development
Director-General
Amendment notes
Issues 2009-2010 Costs of Care Standards. Replaced
GL2007_021.
Published 2006-07 Costs of Care Standards. Replaced
GL2005_071 (Costs of Care Standards 2005-06)
ATTACHMENTS
1. NSW COSTS OF CARE STANDARDS 2009-2010
GL2011_007
Issue date: May 2011
Page 2 of 2
NSW Costs of Care Standards
2009/10
INTER-GOVERNMENT & FUNDING STRATEGIES BRANCH
Standards Version
2009/2010
Effective From
01/07/2009
Effective To
30/06/2010
For further information contact:
Casemix Policy Unit
Inter-Government & Funding Strategies Branch
NSW Health Department
Phone (02) 9391 9296
Fax
(02) 9391 9994
Email Chee Cheong
[email protected]
The report is available on the NSW Internet site at http://www.health.nsw.gov.au/
Summary of the 2009/10 Standards
SUMMARY OF THE 2009/10 STANDARDS
The NSW Costs of Care Standards are a guide to
estimating the costs of outputs of health services
using data from the most up-to-date sources
available.
The Standards have several applications:
• Weighting activity in output-based funding
models;
• Contracting between purchasers and providers
of health care, for example, between NSW Health
and the Department of Veterans’ Affairs;
• Determining population health needs using
age/sex weighted utilisation of health services
by geographic region;
• Planning health services to meet the future
health needs of populations;
• Quantifying the costs for the treatment of
specific diseases (eg cancer) or for specific
services (eg pharmacy costs); and
• Cost comparisons.
The Standards are published annually, and include
guidelines for estimating the costs of a range of
admitted and non-admitted services. The service
areas currently covered by the Standards are
acute care, emergency department care, outpatient
care, sub- and non-acute care and mental health.
The 2009/10 Standards uses the Australian Refined
Diagnosis Related Group Version 5.0 for the acute
admitted care cost weights. There have been other
changes from the 2006/07 Standards (last published
version).
These are:
Acute Admitted Care
• Average costs data from the 2006/07 NSW
Hospital Cost Data Collection, escalated
to 2009/10 prices.
Emergency Department Care
• Updating of average costs to reflect
2009/10 prices.
Intensive Care
• Updating of intensive care costs to reflect
2009/10 prices.
Outpatient Care
• Updating of outpatient average costs to
reflect 2009/10 prices.
Sub- and Non-Acute Care
• Updating of average sub- and non-acute costs
to reflect 2009/10 prices.
Mental Health Care
• Average costs data from the 2006-07 Mental
Health Establishments NMDS, escalated to reflect
2009/10 prices.
3
Table of Contents
INTRODUCTION
6
INTENSIVE CARE
16
Purpose
6
Scope of Intensive Care
16
Background
6
Classification of Intensive Care
16
Scope of the Costs of Care Standards
6
Source of Data for Intensive Care Standards
16
Using Cost Weights
6
Intensive Care Standards
16
NSW Funding Guidelines
7
Average Costs
16
Escalation factors
7
OUTPATIENT CARE
17
ACUTE ADMITTED CARE
8
Scope of Outpatient Care
17
Scope of Acute Admitted Care
8
Classification of Outpatient Care
17
Classification of Acute admitted Care
8
Source of Data for Outpatient Care Standards 17
Source of Data for Acute Care Standards
8
Outpatient Care Standards
Features of the Acute Care Standards
8
Acute Admitted Care Cost Weights
8
SUB- AND NON-ACUTE CARE
21
Acute Costs of Care Standards
9
Scope of Sub- and Non-Acute Care
21
9
Source of Data for SNAP Care Standards
21
SNAP Care Standards
21
17
Same day episodes
Transfer episodes
10
Long stay outlier episodes
10
Indigenous Episodes
11
Neonates
11
Cost Weights
21
Private episodes
12
Outlier Episodes / Phases
21
Error DRGs
12
Deaths
12
Average Costs
13
Admitted SNAP Care in Designated Units
(excluding same day care)
21
Non-Admitted and Same Day SNAP Care 21
Average Cost
21
MENTAL HEALTH CARE
22
EMERGENCY DEPARTMENT CARE
14
Scope of Mental Health Care
22
Scope of Emergency Department Care
14
Classification of Mental Health Care
22
Classification of Emergency Department Care 14
Cost Estimates
23
Source of Data for Emergency
Department Standards
14
REFERENCES
Emergency Department Care Standards
14
Average Costs
15
24
4
Table of Appendices
APPENDIX 1:
ACUTE CARE COST WEIGHTS
Part 1: General cost Weights
26
Part 2: Same day Cost Weights for Selected DRGs 50
APPENDIX 1A:
ACUTE CARE COST WEIGHTS (REBASED)
Part 1: General cost Weights (Rebased)
57
Part 2: Same day Cost Weights for Selected DRGs
(Rebased)
80
APPENDIX 2:
AVERAGE ACUTE COST BY COST
GROUP AND DRG, NSW 2006/07 HCDC
Part 1: General Acute Cost Averages
86
Part 2: Same Day Acute Averages for Selected
AR-DRGs
109
APPENDIX 3:
SUB- AND NON-ACUTE CARE
CLASSIFICATION AND WEIGHTS
114
APPENDIX 4:
COST GROUP INCLUSIONS AND EXCLUSIONS117
Clinical Department Cost Group
117
Invasive Procedure Cost Groups
118
Pathology Cost Group
119
Imaging Cost Group
120
Ward Cost Group
121
Emergency Department Cost Group
121
Intensive Care Cost Group 122
Allied Health Cost Group
122
Pharmacy/Drugs Cost Group
123
Prostheses Cost Group 124
Depreciation Cost Group 124
Employee Related On costs Cost Group 124
APPENDIX 5:
METHODOLOGY TO DETERMINE
TRANSFER COST WEIGHTS 126
APPENDIX 6:
METHODOLOGY TO DETERMINE AR-DRGS TO
HAVE SEPARATE SAME DAY COST WEIGHTS 129
5
Introduction
PURPOSE
SCOPE OF THE COSTS OF CARE STANDARDS
The Cost of Care Standards 2009/10 provides details
of the approaches to estimating standard costs of
admitted and selected non-admitted services in
acute public hospitals. It contains relativities of costs
(or cost weights) as well as average costs of the
major types of health service product classifications
available.
Some specific applications of the Standards are:
The Standards relate to acute public hospitals of
district level and above, including specialist hospitals.
As defined by the NSW Peer Hospital Group 2009/10
classification (NSW Health Department, 2009), these
are hospitals of peer group C2 and larger. Note, from
2008/09 only facilities up to C1 were included in
Episode Funding. The data have not been validated
for other hospital peer groups.
• Weighting activity in output-based funding
models;
The services for which costs and guidelines
are provided are:
• Contracting between purchasers and providers of
health care, for example, between NSW Health
and the Department of Veterans’ Affairs;
• Acute admitted care (including mental health
care in non-designated mental health units);
• Determining population health need using
age/sex weighted utilisation of health services by
geographic region;
• Intensive care;
• Planning health services to meet the future health
needs of populations;
• Quantifying the costs for the treatment of specific
diseases (eg cancer) or for specific services (eg
pharmacy costs); and
• Cost comparisons.
BACKGROUND
The Standards were previously known as the
Casemix Standards for NSW. The first publication
was produced in 1996 and related to acute care
costs only, derived from data from a national study.
A process of annual costing of acute care services
also began in that year in NSW. The results of these
annual studies are used to determine the acute care
standard costs and guidelines for their application.
The scope of the Standards was expanded in 1997/98
to include estimates of costs of mental health
services, sub- and non-acute care and emergency
department services. In 1999/00 guidelines for
outpatient services were included and the 2000/01
Standards introduced guidelines for intensive care.
Revised sub- and non-acute care standards were
introduced in 2004/05. It is intended that the scope
be further expanded as output measures become
available for other types of services.
• Emergency department care;
• Outpatient care;
• Sub- and non-acute care; and
• Mental health care delivered in designated
mental health units.
USING COST WEIGHTS
Cost weights represent the relative value of classes
within a classification. Within any classification, a
base or reference value is selected, which has a value
of 1. The usual base value selected is the average
cost of care across all classes. Each value within the
class is then expressed relative to the base value.
For example, a cost weight of 1.89 means that the
particular class of patients is 89% more costly on
average than the base cost. Similarly, a cost weight
of 0.34 indicates that the class is 66% less costly on
average than the base cost.
Cost weights cannot be compared across different
classifications if the reference value for the cost
weight is different. For example, a cost weight of
1.48 represents a different value when the reference
is $2,525 versus when the reference $3,375. This also
applies to the same classification if more than one
set of cost weights is produced with a different base.
The actual values of each class within the
classification are the average cost of treatment of all
cases grouped to the particular class. The averages
are derived from the NSW Hospital Cost Data
Collection or cost studies that either cost individual
patients or produce a total cost for the class, which
is then divided by the number of patients grouped
to the class to obtain an average. The source of the
averages is described in each of the sections covering
the different types of care in this report.
6
Introduction
NSW FUNDING GUIDELINES
ESCALATION FACTORS
The NSW Episode Funding Policy 2009/10 (NSW
Health Department 2009a) sets out guidelines for the
implementation of an output-based funding model
for acute inpatient, emergency department and
intensive care services. The model for rehabilitation
and extended care services came into operation
from 1 July 2007 (see NSW Funding Guidelines
Addendum: Rehabilitation and Extended Care
Services 2007/08 (NSW Health Department 2007b).
In several sections of the Standards costs have been
escalated to reflect 2009/10 prices.
The Standards complement the policy and guidelines,
specifically providing details on how the activity
components of the allocations are determined.
Consistent with the design of the funding models,
the acute care standards set out in this document
include sets of cost weights excluding the costs of
emergency department and intensive care services
that are in-scope of the ED and ICU funding models.
There are also cost weights for emergency care and
rehabilitation and extended care services, and cost
data for intensive care.
The annual escalation factors are shown in
Table 1 below.
Table 1 Annual escalation by year
Year
% Rate
2003/04
4.61%
2004/05
2.90%
2005/06
3.20%
2006/07
3.64%
2007/08
3.41%
2008/09
3.55%
2009/10
3.38%
The escalations provided by NSW Health Finance
& Business Management Division in March 2009
have been adopted for escalations of baseline costs
in these Standards.
7
Acute Admitted Care
SCOPE OF ACUTE ADMITTED CARE
FEATURES OF THE ACUTE CARE STANDARDS
Acute admitted care covers admitted inpatient
episodes that meet the following criteria:
Analysis of cost data shows that DRGs are not
uniform with respect to cost. Even though the
classification accounts for the major part of the
variability, there are other factors that have been
identified that lead to cost differences within DRGs.
• Service category is acute care or newborn care;
and
• Zero days in a designated psychiatric unit; and
• Episode is not grouped to the rehabilitation
AR-DRGs Z60A Rehabilitation W Catastrophic or
Severe CC, Z60B Rehabilitation W/O Catastrophic
or Severe CC or Z60C Rehabilitation, Sameday.
The costs of patients admitted and discharged from
the emergency department (i.e. not transferred to
a ward) are excluded altogether (for all EDs). Also
excluded are the portion of costs relating to the
ED part of a patient’s stay when they are admitted
through ED and then transferred to a ward (for EDs
in-scope of the ED funding model). These costs
are dealt with under the ‘Emergency Department’
standards provided in this report.
CLASSIFICATION OF ACUTE ADMITTED CARE
The classification used to describe acute hospital
activity and report costs in this publication is the
Australian Refined Diagnosis Related Groups (ARDRG) classification, Version 5.0. This classification
was implemented in NSW on 1 July 2006. Further
details of this classification can be found in the
Australian Refined Diagnosis Related Groups Version
5.0 (Commonwealth Department of Health and
Ageing, 2002).
SOURCE OF DATA FOR ACUTE CARE STANDARDS
The results of the 2006/07 NSW Hospital Cost
Data Collection (HCDC) were used to develop cost
weights and average costs for acute care for these
Standards. The number of hospitals contributing to
the NSW HCDC in 2006/07 was 83 with a total of
1,230,651 episodes.
These are:
• Same day care (for selected AR-DRGs);
• Transfer out (on the day of admission or the
subsequent day);
• Aboriginal and Torres Strait Islander status;
• Long stay; and
• Private financial status.
The Standards aim to further account for this
variability.
ACUTE ADMITTED CARE COST WEIGHTS
Four cost weight sets have been produced to cater
for the different needs of users of the cost weights.
These are based on whether or not ED and/or ICU
costs are estimated separately from all other costs.
For all cost weights the costs of patients treated
and discharged from the ED are excluded. The cost
weight sets are:
(1) Cost weights with the emergency department
and intensive care unit cost groups both
excluded;
(2)Cost weights with the emergency department
cost group excluded only;
(3)Cost weights with the intensive care unit cost
group excluded only; and
(4) Cost weights with all cost groups included.
The cost weights are contained in Appendix 1.
8
Acute Admitted Care
Rationale
The AR-DRG system groups patients admitted and
separated on the same calendar day together with
longer stay patients. This is not an issue where the
AR-DRG predominantly includes patients of one
type because the majority of the patients within the
AR-DRG will have similar costs. However, problems
arise when there are substantial proportions of
patients of both types in the same AR-DRG because
the average cost of the AR-DRG will not reflect the
costs of either type of patient. If cases of one type
or the other are concentrated in particular hospitals,
funding inequities can emerge.
ACUTE COSTS OF CARE STANDARDS
All acute care episodes in scope are initially allocated
an ‘inlier’ cost weight. This inlier weight is dependent
upon whether the emergency department and
intensive care component are included as part of the
cost estimation. That is, one of the four cost weight
sets described above is selected. Once selected, the
inlier weight is modified according to the standards
below. The logic of allocating the appropriate cost
weight to each episode is shown in Figure 1.
SAME DAY EPISODES
Standard
There are separate, discounted, cost weights for
some AR-DRGs when occurring on a same day basis.
This does not include patients transferred out, or
patients who die on the day of admission. There
are provisions for these patients elsewhere in the
Standards. The same day cost weights are shown in
Part 2 of Appendix 1 in this report.
The AR-DRGs selected to have separate same day
weights are those where there is evidence of a
different type of service being delivered when the
episode is a same day episode. The indicators are
AR-DRGs with a bi-modal length of stay pattern
and substantial cost differences between the
same day and longer stay cases. The ARDRGs are
mostly medical in nature. See Appendix 6 for the
methodology for determining which AR-DRGs have
separate same day weights.
FIGURE 1 ALLOCATION LOGIC FOR ACUTE ADMITTED CARE STANDARDS
ALL ACUTE ADMITTED
EPISODES
Notes: *Discount private episodes by 9%, inflate Aboriginal and TorresStrait Islander episodes by 10%
† Use cost weights without ICU and/or emergency cost component where these services are
considered separately from the AR-DRG system.
YES
Has the episode occurred in a
designated mental health unit?
Mental Health guidelines
NO
YES
Is the episode grouped to AR-DRG
Z60A, Z60B or Z60C?
SNAP guidelines
NO
Is the episode grouped to an ‘error’
AR-DRG?
NO
YES
Remove from analysis,
re-code and re-group
Is the episode still grouped
to AR-DRG 960Z Ungroupable?
Assign ‘Error’
DRG Cost Weight
NO
YES
Is the mode of discharge a transfer occurring
on the day of admission or subsequent day?
Transfer Weight*
NO
Is the episode a same day episode?
YES
Is the mode of
discharge death?
NO
Is the LOS of the episode less than the
trim point for the AR-DRG?
NO
NO
Same Day Cost Weight*†
YES
YES
Inlier Cost Weight*†
YES
Inlier cost weight plus per diem rate for number
of days between trim point and length of stay*
NO
Inlier cost weight plus per diem rate to 120 days
plus step-down per diem rate until max 365 days*
Is the LOS less than the high cut-off
point for the AR-DRG?
9
Acute Admitted Care
TRANSFER EPISODES
Standard
A discounted cost weight applies to episodes
transferred to another acute care facility on the day
of admission or the following day. The discounts are
based on the same day weight (where one exists),
the cost of surgical procedures (for surgical DRGs),
the per diem rates and the weights for any adjacent
DRGs. The methodology is shown in Appendix 5.
Rationale
An analysis of costs showed that patients transferred
on the day of admission or the following day are
generally less costly than non-transferred patients
or patients transferred after a longer length of stay.
This is because the transferring hospital has usually
not provided full treatment for the patient.
For surgical DRGs the current method ensures that
the costs of the theatre and prostheses are covered.
Analysis showed that two thirds of the transfers on
the day of admission or following day were same
day separations. Thus the current method uses the
same day weight as a base for the transfer weight
while adding some per diem costs to allow for the
transfers on the day after the admission.
Separate transfer weights do not apply where the
DRG has a defined maximum length of stay (e.g.
G46C Complex Gastroscopy , Sameday; and Y60Z
Burns, Transferred to Another Acute Care Facility <
5 Days) as these DRGs are dominated by same day
separations.
For any one episode, the maximum length of stay
is considered to be 365 days. For patients staying
in an acute care hospital longer than this period
an alternative method of estimating their costs is
required, as well as an assessment of whether the
patient is still acute.
For patients staying longer than 120 days, other than
those grouped to selected tracheostomy, neonates
and burns AR-DRGs, the outlier component should
cease at 120 days of stay. For days between 120
days and 365 days, a flat-rate per diem amount of
$200 is applied. For patients in the selected ARDRGs, the outlier per diem amounts should continue
to be added until discharge or 365 days. The
selected AR-DRGs are:
Tracheostomies
A06Z Tracheostomy or Ventilation >95 hours
Neonates
P02Z Cardiothoracic/Vascular Procedures for
Neonates
P03Z Neonate, AdmWt 1000-1499 g W Significant
O.R. Procedure
P04Z Neonate, AdmWt 1500-1999 g W Significant
O.R. Procedure
P05Z Neonate, AdmWt 2000-2499 g W Significant
O.R. Procedure
P06A Neonate, AdmWt > 2499 g W Significant O.R.
Procedure W Multi Major Problems
P06B Neonate, Adm Wt > 2499 g W Significant
O.R. Proc W/O Multi Major Problems
LONG STAY OUTLIER EPISODES
P61Z Neonate, AdmWt < 750 g
Standard
An outlier component is added to the inlier
component to meet the cost of the additional length
of stay for long stay patients. The outlier component
is AR-DRG-based, and is dependent on the number
of days of stay above the ‘trim point’ for the ARDRG. The trim point is a set value calculated by NSW
Health. The trim points, and the values for each
AR-DRG can be found at Appendix 1, Part 1 of this
report.
P62Z Neonate, AdmWt 750-999 g
The outlier amount is only added to AR-DRGs that
are not defined by a maximum length of stay.
For example, AR-DRGs such as G46C Complex
Gastroscopy, Sameday; and Y60Z Burns, Transferred
to Another Acute Care Facility < 5 Days will not have
outlier amounts added. There are twenty three such
AR-DRGs in Version 5.0
P66A Neonate, AdmWt 2000-2499 g W/O
Significant O.R. Proc W Multi Major Problems
P63Z Neonate, AdmWt 1000-1249 g W/O
Significant O.R. Procedure
P64Z Neonate, AdmWt 1250-1499 g W/O
Significant O.R. Procedure
P65A Neonate, AdmWt 1500-1999 g W/O
Significant O.R. Proc W Multi Major Problems
P65B Neonate, AdmWt 1500-1999 g W/O
Significant O.R. Procedure W Major Problem
10
Acute Admitted Care
Burns
Y01Z Severe Full Thickness Burns
Y02A Other Burns W Skin Graft Age>64 or W Cat/
Sev CC or W Complicating Proc
Y03Z Other O.R. Procedures for Other Burns
Y02B Other Burns W Skin Grft Age<65 W/O Cat or
Sev CC W/O ComplicatingProc
Y61Z Severe Burns
Rationale
There is clear evidence in the literature, and in the
analysis of the NSW data that stays in hospital
significantly beyond the average is costly to hospitals.
The decision to apply an additional amount for
funding purposes needs to be balanced with the
goal of discouraging excessive length of stay.
NEONATES
Standard
Intensive care costs are to be retained in cost weight
sets excluding ICU costs for hospitals with specialist
Neonatal ICUs (NICUs), for all neonatal AR-DRGs.
The cost weight is reduced by 30% for the following
AR-DRGs when they do not occur in a designated
NICU:
P02Z Cardiothoracic/Vascular Procedures for
Neonates
P03Z Neonate, AdmWt 1000-1499 g W Significant
O.R. Procedure
P04Z Neonate, AdmWt 1500-1999 g W Significant
O.R. Procedure
P05Z Neonate, AdmWt 2000-2499 g W Significant
O.R. Procedure
NSW uses a non-parametric approach to determining
the trim point for long stay outlier episodes. This is
because AR-DRGs generally do not have a normal
distribution. The method used relies on the quartiles
of the length of stay distribution, that is:
P06A Neonate, AdmWt > 2499 g W Significant O.R.
Procedure W Multi Major Problems
P62Z Neonate, AdmWt 750-999 g
3rd quartile of LOS distribution for ARDRG + (1.5 x interquartile range for the
AR-DRG)
INDIGENOUS EPISODES
Standard
The cost weights of indigenous episodes are to be
given an additional weighting of 10%.
Rationale
There is evidence in the literature that there are
increased costs associated with indigenous patients.
An analysis of the clinical costing data from NSW
hospitals showed costs to be approximately 10%
higher for indigenous people, after taking into
account other casemix factors.
P06B Neonate, AdmWt > 2499 g W Significant O.R.
Proc W/O Multi Major Problems
P61Z Neonate, AdmWt < 750 g
P63Z Neonate, AdmWt 1000-1249 g W/O
Significant O.R. Procedure
P64Z Neonate, AdmWt 1250-1499 g W/O
Significant O.R. Procedure
P65A Neonate, AdmWt 1500-1999 g W/O
Significant O.R. Proc W Multi Major Problems
P65B Neonate, AdmWt 1500-1999 g W/O
Significant O.R. Procedure W Major Problem
P66A Neonate, AdmWt 2000-2499 g W/O
Significant O.R. Proc W Multi Major Problems
The cost weight excluding ICU costs is applied to all
AR-DRGs other than the above when the episode
does not occur in a designated NICU.
Rationale
NICUs are within the scope of the Acute Inpatient
funding model, and not the Intensive Care funding
model. Therefore, ICU costs should be retained for
all neonatal DRGs for these hospitals.
The 30% discount recognises that hospitals without
dedicated NICUs do not incur the same costs as
hospitals with NICUs when they encounter specialist
neonatal DRGs. The costs of these specialist DRGs
are partially covered by the Intensive Care funding
model as neonates are likely to be treated in general
ICUs when no specialist unit is available (unless
transferred for higher level care).
11
Acute Admitted Care
PRIVATE EPISODES
Standard
Private patient episodes are to be discounted by 9%.
Rationale
The cost of providing care to private patients in
public hospitals is different from that of public
patients, even after accounting for casemix. Clinical
costing data were used to test this assumption.
Previous analyses have shown that for most ARDRGs, a private patient staying a given number of
days will cost between 90 and 92% as much as a
public patient in the same AR-DRG staying the same
number of days, in the same hospital, with the same
mode of discharge etc. This is because the medical
costs of private patients are funded from other
sources.
ERROR DRGS
Standard
The following AR-DRGs are considered ‘Error’ DRGs
and are assigned a zero cost weight:
901Z Extensive O.R. Procedure Unrelated to
Principal Diagnosis;
902Z Non-Extensive O.R. Procedure Unrelated to
Principal Diagnosis;
903Z Prostatic O.R. Procedure Unrelated to Principal
Diagnosis;
Rationale
The AR-DRG system includes classes that do not
describe clinically and/or resource homogenous groups
(referred to as error DRGs). These are of three types:
Group 1
When all the operating room procedures are
unrelated to the MDC of the patient’s principal
diagnosis (AR-DRGs 901Z Extensive O.R.
Procedure Unrelated to Principal Diagnosis,
902Z Non-Extensive O.R. Procedure Unrelated
to Principal Diagnosis and 903Z Prostatic O.R.
Procedure Unrelated to Principal Diagnosis);
Group 2
When the principal diagnosis will not allow the
episode to be assigned to a clinically coherent
DRG (for example, an ICD-10-AM code may be
given as a principal diagnosis, when Australian
Coding Standards state that the code is
unacceptable as a principal diagnosis) (AR-DRGs
961Z Unacceptable Principal Diagnosis and
963Z Neonatal Diagnosis Not Consistent W
Age/Weight)
Group 3
When the principal diagnosis is invalid, or when
other essential information is missing or incorrect
(AR-DRG 960Z Ungroupable).
AR-DRGs in groups 2 and 3 are considered as
containing cases that can be re-coded and regrouped to a non-error AR-DRG.
961Z Unacceptable Principal Diagnosis;
963Z Neonatal Diagnosis Not Consistent W Age/
Weight; and
960Z Ungroupable.
It is recognised that AR-DRG 960Z may contain
genuine cases that fall through the AR-DRG logic
despite valid coding of the record. These cases
should generally be reviewed with the intention of
selecting the closest possible AR-DRG (clinically and
resource-wise), and applying the cost weight of that
AR-DRG to the episode.
DEATHS
Standard
The cost weight for patients dying in hospital should
not be discounted when the death occurs on the day
of admission, if a discounted same day cost weight
would normally apply to the episode.
Rationale
This standard recognises that there are additional
costs associated with hospital deaths that are above
those associated with regular same day care.
12
Acute Admitted Care
AVERAGE COSTS
The average cost for each cost weight set for
2009/10 is set out below in Table 2. These were
calculated using the 2006/07 NSW Hospital Cost
Data Collection and have been escalated to 2009/10.
Table 2 Cost Weight sets and average costs
Cost Weight Set
Average Cost
2009/10* ($)
Excluding emergency
department and intensive
care cost groups
3,840
Including all cost groups
4,280
Excluding emergency
department cost group only
4,092
Excluding intensive care cost
group only
4,028
Source: NSW Hospital Cost Data Collection 2006/07. * See note on
indexation applied under ‘Escalation factors’ on page 7.
Appendix 2 contains more detailed information on
average costs.
To calculate the current set of cost weights, the
base is set to $3,375. This reflects the average cost
per separation (excluding emergency department
and intensive care costs). The base costs have been
kept constant from 2006/07 (using 2004/05 data) to
allow for comparability of cost weights over time.
Cost weights cannot be compared across time if the
reference values for the cost weights are different.
Consequently, the cost weights set out in Appendix
1 are relative to the base cost of $3,375. From Table
2, the average cost of an acute episode is equivalent
to $3,840 in 2009/10 prices.
The 2009/10 costs in this document are not
comparable with the 2005/06 costs (using 2003/04
data) due to use of a later version of the Australian
Refined Diagnosis Related Groups (DRG) classification
and the use of a different base for the cost weights.
As directed by the Commonwealth Department of
Health & Ageing, the 2006/07 HCDC used the DRG
Version 5.0 (compared with DRG Version 4.2 in the
previous year’s HCDC).
To enable comparison with 2005/06 costs or to use
the cost weights within funding arrangements such
as purchaser provider arrangements, the weights
within the 2009/10 NSW Cost of Care Standards
must be rebased by a factor of 7.8%. The rebased
weights are set out in Appendix 1A.
13
Emergency Department Care
SCOPE OF EMERGENCY DEPARTMENT CARE EMERGENCY DEPARTMENT CARE STANDARDS Emergency department care includes all care
provided within designated emergency departments.
Standard
The emergency department cost weights provided
below are to be used to weight emergency
department activity for hospitals within scope
of the ED funding model. For patients that are
admitted and transferred to a ward/inpatient unit,
the emergency department component should be
excluded from the AR-DRG cost weights so as not to
double count the costs of this service.
The costs of emergency department patients that are
subsequently admitted to a ward can be represented
in two ways: as part of AR-DRG costs, or separately.
The AR-DRG cost weights included in the ‘Acute
Admitted Care’ section cater for the inclusion or
exclusion of these costs.
CLASSIFICATION OF EMERGENCY
DEPARTMENT CARE
The classification adopted to describe emergency
department care in NSW is a modification of the
Urgency and Disposition Groups (UDG) classification
developed in Western Australia (Jelinek, 1992).
The initial split in UDGs is disposition, and then
triage. The original classification developed by
Western Australia involved splitting into four
disposition groups (admitted, discharged, DOA and
did not wait), and five urgency (triage) categories,
yielding a total of 12 UDGs. The classification was
modified for the introduction of the Emergency
Department Funding Model in 2001/02. The
modified version contains 11 categories made up of
three disposition splits (subsequently admitted, ED
only, and did not wait), and the five triage categories
applied to the subsequently admitted and ED only
disposition categories. The classes and their cost
weights are shown in Table 3.
Service weights to cost emergency department
services were created jointly by the Department
of Human Services South Australia and the
Commonwealth for the 2004-05 National Hospital
Cost Data Collection.
SOURCE OF DATA FOR EMERGENCY
DEPARTMENT STANDARDS
The cost weights were based on the Round 11
(2006-07) NHCDC National Cost Weights.
ED attendances are allocated to classes using the
following algorithm:
1. If the mode of separation = 8 or visit type is 10
(dead on arrival), the episode is assigned a cost
weight equivalent to ‘Subsequently Admitted,
Triage Category 5’.
2. If the disposition status is ‘Did Not Wait’, the
episode is classified as ‘Did Not Wait’.
3. If a record has missing data, the episode is
classified as ‘ED Only, Triage Category 5’.
4. If the visit_type is ‘02’ (return visit – planned
ED), ‘04’ Outpatient Clinic, ‘06’, ‘07’, ‘08’
(various types of pre-arranged admissions) then
the episode is reclassified as ‘ED Only, Triage
Category 5’.
5. If the visit type is ‘01’ (Emergency Presentation),
‘03’ (Unplanned Return Visit for continuing
condition), ‘05’ (Referred, non-admitted person)
or ‘09’ (Person in transit) the episode is classified
according to the triage score and the disposition
class recorded for the visit. In this case:
• The disposition is Subsequently Admitted if the
mode of separation is ‘01’, ‘03’, ‘10’, ‘11’ or ‘12’
(admitted to another part of the hospital or died
in ED);
• Otherwise the disposition is ED Only.
It should be noted that the above algorithm is only
for the purpose of assigning ED attendances to a
UDG class and may not reflect the actual admission
status of the individual patient.
14
Emergency Department Care
Table 3Emergency department cost weights
by disposition and triage
Rationale
The modified UDG classification has been adopted
for these Standards for two reasons:
Urgency and Disposition Group
(UDG)
Cost Weight
Subsequently Admitted Triage 1
2.96
Subsequently Admitted Triage 2
1.78
Subsequently Admitted Triage 3
1.53
Subsequently Admitted Triage 4
1.33
Subsequently Admitted Triage 5
0.91
ED Only Triage 1
1.62
ED Only Triage 2
1.24
ED Only Triage 3
1.08
ED Only Triage 4
0.81
AVERAGE COSTS
ED Only Triage 5
0.50
Did not wait
0.18
The average cost of an emergency department
presentation applicable in 2009/10 is $396
(escalation of 2006-07 cost from the Round 11
NHCDC to 2009/10).
• Currently, there is no consistency across NSW
in whether patients treated solely within the
ED are admitted or not. Thus a split based on
subsequent admission / ED only is preferable to
one based on admitted / not admitted; and
• Service weights for costing emergency
department services are only available at the level
of UDGs at this stage. The service weights for the
2004-05 NHCDC were developed jointly by the
Commonwealth and the Department of Human
Services, South Australia.
15
Intensive Care
SCOPE OF INTENSIVE CARE
INTENSIVE CARE STANDARDS
Intensive care costs of patients can be represented
in two ways: as part of AR-DRG costs, or separately.
The AR-DRG cost weights included in the ‘Acute
Admitted Care’ section cater for the inclusion or
exclusion of these costs. Intensive care services are
accounted for separately from AR-DRGs for funding
purposes in NSW.
Standard
The intensive care costs provided in Table 4 below
are to be used for intensive care activity for hospitals
with intensive care units within scope of the ICU
funding model. For patients that are treated as an
intensive care patient in an intensive care unit that is
in the scope of the intensive care funding model, the
intensive care component should be excluded from
the AR-DRG cost weights so as not to double count
the costs of this service.
CLASSIFICATION OF INTENSIVE CARE
There are two types of patients that are covered
by the NSW Funding Guidelines. Firstly, there
are ‘Intensive Care Patients’ who are treated in
an intensive care unit of role delineation 5 or
6 (including specialist ICUs and paediatric ICUs
but excluding neonatal ICUs) or ICUs with a role
delineation of 4 meeting the following criteria:
Rationale
There is no nationally accepted classification system
for costing intensive care patients. Consequently they
are to be costed on a bed day basis. The ICU costing
is expected to be progressively refined as data quality
improves and further analysis is undertaken.
• Be staffed to provide a minimum nursing ratio of
1:2 for a minimum of 6 beds, and
AVERAGE COSTS
• Have a minimum throughput of 150 ventilated
patients or 600 IC bed-days per year.
The average cost for intensive care patient days for
use in the ICU funding model are set out below:
Secondly, there are patients receiving mechanical
ventilation in hospitals with a level 3 or 4 ICU not
in the scope of the ICU funding model. These
patients receive a co-payment for each hour of
their ventilation in addition to their acute inpatient
episode funding.
Table 4
SOURCE OF DATA FOR INTENSIVE
CARE STANDARDS
Cost estimates for the intensive care standards are
based on 2000/01 information provided by Area
Health Services and hospitals in a special ICU cost
data collection undertaken in the first half of 2002,
escalated to 2009/10 prices.
Patient Type
Average Cost per IC
patient day*($) 2009/10
Chargeable patients
4,028
Non chargeable patients
4,427
Source: 2004/05 NSW ICU cost data collection. * See note on indexation
applied under ‘Escalation factors’ on page 7.
The average cost for mechanical ventilation in a
hospital with a level 3 or 4 intensive care unit not in
scope of the ICU funding model has been set at $95
for each hour of ventilation.
16
Outpatient Care
SCOPE OF OUTPATIENT CARE
Outpatient care refers to hospital-based outpatient
care, i.e. excluding community-based services.
These standards do not include non-admitted care
provided in designated mental health units, which
are included in a separate section in this report.
CLASSIFICATION OF OUTPATIENT CARE
The National Health Data Dictionary (NHDD) Version
13 (AIHW, 2006) includes a classification of nonadmitted patient service types based on the clinic
attended by the patient during the service event.
The classification is in two tiers: Tier 1, providing a
lower level of detail of non-admitted patient service
types, and Tier 2, providing a greater level of detail.
Either classification can be used, depending on the
level at which data are available locally. The NHDD
includes a total of 11 classes at the Tier 1 level, and
does not provide a definitive number of classes at
the Tier 2 level, just examples of the types of clinics
that may be included under each of the Tier 1
categories.
The Tier 1 and Tier 2 patient service type categories
are shown in tables 5 and 6 below.
The service weights used to cost the Tier 1 and
Tier 2 services were developed jointly by the
Commonwealth and Department of Human Services
South Australia for the 2004-05 National Hospital
Cost Data Collection.
SOURCE OF DATA FOR OUTPATIENT
CARE STANDARDS
Cost estimates for the outpatient care standards are
based on the 2006-07 NHCDC (Commonwealth
Department of Health and Aged Care, 2008),
escalated to reflect 2009/10 prices. The data for
the outpatient costs were obtained from 170 sites
contributing data to the 2006-07 NHCDC. Whilst
some NSW sites are represented, the quality and
comparability of these data are questionable.
Therefore, these estimates which are based on
sample data should be used with caution. In
particular, they should not be used to estimate costs
for resource allocation.
Further work is being conducted to determine more
specific NSW costs and these will be reported in a
future version of the Standards.
OUTPATIENT CARE STANDARDS
Standard
The relative costs in Tables 5 and 6 are applied to
estimate outpatient clinic costs for planning and
comparison purposes (see note under ‘Sources
of data for Outpatient Care Standards’ above).
Wherever possible Tier 2 should be used. Note: costs
from the Round 11 NHCDC are escalated to 2009/10
costs only, other items such as occasions of service or
cost weights are not altered.
Table 5 Non-admitted care cost and relative weights, Tier 1 classification
Tier 1 Clinics
Occasions of Service
Average Cost per
Occasion of Service
Cost Weight
Allied Health
1,327,894
126
0.5
Dental
15,719
229
0.92
Medical
1,841,634
349
1.39
Obstetrics & Gynaecology
718,055
250
1
Paediatric
179,148
266
1.06
Psychiatric
78,058
271
1.08
1,041,200
229
0.92
Surgical
Source: Commonwealth Department of Health and Aged Care, National Hospital Cost Data Collection Round 11 (2006-07). See note on indexation
applied under ‘Escalation factors’ on page 7. Psychiatric costs are dealt with under Mental Health Care.
17
Outpatient Care
Table 6Non-admitted care cost and relative weights, Tier 2 classification
Tier 2 Clinics
Occasions of Service
Average Cost per
Occasion of Service
Cost Weight
Audiology
22,205
313
1.20
Diabetes Education
52,895
179
0.69
Nutrition / dietetics
61,514
220
0.84
Occupational therapy
114,199
110
0.42
Optometry
1,290
61
0.23
Orthoptics
10,884
186
0.71
Orthotics
12,928
276
1.06
Physiotherapy
474,650
118
0.45
Podiatry
72,028
141
0.54
Prosthetics
3,517
365
1.40
Psychology
7,133
91
0.35
Social Work
74,349
173
0.66
Speech pathology
48,695
252
0.97
Stomal therapy
10,896
463
1.77
Wound management
58,370
108
0.42
Aged Care
13,677
415
1.59
Alcohol and other drug
85,013
292
1.12
535
95
0.36
6,313
387
1.48
Cardiology
122,600
248
0.95
Clinical Measurement
254,487
180
0.69
Dermatology
53,927
278
1.06
Developmental Disabilities
9,307
217
0.83
Diabetes
67,604
228
0.87
Endocrine
36,332
396
1.52
91
91
0.35
964
418
1.60
Gastroenterology
53,764
518
1.98
General Medicine
127,102
192
0.73
7,232
696
2.67
0
-
-
Haematology
68,493
530
2.03
Hepatobiliary
9,134
337
1.29
Hypertension
8,849
262
1.00
Immunology
38,997
224
0.86
Infectious diseases
75,786
590
2.26
Medical Oncology
134,250
446
1.71
3,098
469
1.80
Allied Health &/or Clinical
Nurse Spec
Medical
Anti-Coagulant
Asthma
Epilepsy
Falls
Genetic
^
Geriatric
Metabolic bone
18
Outpatient Care
Tier 2 Clinics
Occasions of Service
Average Cost per
Occasion of Service
Cost Weight
Nephrology
115,838
637
2.44
Neurology
40,188
327
1.25
Occupational medicine
10,216
285
1.09
Pain management
28,858
356
1.36
8,276
594
2.28
Radiation oncology
174,421
356
1.36
Rehabilitation
20,272
256
0.98
Medical (cont)
Palliative care
Respiratory
69,131
401
1.53
Rheumatology
29,472
380
1.45
Spinal
3,049
568
2.17
Transplants
17,197
598
2.29
Family Planning
10,057
123
0.47
Gynaecology
77,759
245
0.94
7,112
441
1.69
558,655
247
0.94
Adolescent Health
3,622
369
1.41
Neonatal
47,365
169
0.65
Paediatric Medicine
55,267
272
1.04
Paediatric Surgery
12,813
314
1.20
Breast
29,536
449
1.73
Burns
11,766
209
0.80
Cardiac surgery
7,312
360
1.38
Colorectal
14,975
319
1.22
Craniofacial
5,967
231
0.89
Ear, nose and throat
46,374
216
0.83
Fracture
91,125
252
0.97
General surgery
103,449
189
0.72
Neurosurgery
19,250
375
1.44
Ophthalmology
160,117
180
0.69
Orthopaedics
160,112
207
0.79
Plastic surgery
58,937
176
0.67
Pre-admission
119,566
242
0.93
Pre-anaesthesia
56,152
223
0.85
Thoracic surgery
3,286
445
1.70
Urology
46,053
270
1.03
Vascular surgery
25,496
239
0.92
4,585,989
261
1
Obstetrics and Gynaecology
Gynaecology oncology
Obstetrics
Paediatric
Surgical
Total
1
Source: Commonwealth Department of Health and Aged Care, National Hospital Cost Data Collection Round 11 (2006-07).
See note on indexation applied under ‘Escalation factors’ on page 7. Psychiatric costs are dealt with under Mental Health Care.
19
Outpatient Care
Rationale
The NHDD classification of non-admitted patient
care clinics is the first attempt at a national
classification that is reasonable for States/Territories
to adopt. Further work is being conducted to
determine more specific NSW costs and these will be
reported in a future version of the Standards.
Even though the costs from the NHCDC presented in
the tables above are not representative of all States/
Territories, the data are the most recent cost data on
non-admitted care available. The use of these data
will assist NSW to move forward in implementing
classification and costing of non-admitted patient
service events.
1 Note, this total is from the Round 11, NHCDC 2006-07 which
includes several clinics which are not included in table 6
20
Sub- and Non-Acute Care
SCOPE OF SUB- AND NON-ACUTE CARE
SOURCE OF DATA FOR SNAP CARE STANDARDS
Sub- and non-acute (SNAP) care includes
Rehabilitation, Palliative Care, Psycho-Geriatric
Care, Geriatric Evaluation & Management and
Maintenance Care provided on both an admitted
and non-admitted patient basis. It also includes
residential aged care nursing home and hostel
residents, Home and Community Care (HACC) and
Community Aged Care (CACP) services.
The cost weights were derived from the Australian
National Sub-acute and Non acute Patient (ANSNAP) Classification study conducted by the Centre
for Health Service Development in 1996.
Admitted episodes coded as acute but grouped to
the rehabilitation AR-DRGs are also considered as
sub- and non-acute care. The rehabilitation ARDRGs are:
• Z60A Rehabilitation W Catastrophic or Severe CC;
• Z60B Rehabilitation W/O Catastrophic or Severe
CC; and
• Z60C Rehabilitation, Sameday.
Case Type
Class
Palliative Care
2105
Rehabilitation
Average costs have been based on 2005/06 SNAP
costing data and the 2005/06 NSW Unaudited
Annual Return (UAR) (revised where appropriate),
together with activity collected by relevant sites
using SNAPShot.
SNAP CARE STANDARDS
Admitted SNAP Care in Designated Units
(excluding same day care)
The different SNAP case types are subject to
different units of counting. The funding model
payment structure also varies by case type. The
following table summarises these differences:
Description
Per Diem
Weight
Per Diem
Rate ($)
Unstable, RUG-ADL 4-17
0.0708
820
2244
Other Impairments,FIM motor 25-52
0.0616
713
Psychogeriatric
2305
HoNOS Overactive behaviour 0, HoNOS total>=18
0.0658
762
GEM
2405
Cognition 16-35, motor 13-50
0.0565
654
Maintenance
2506
Nursing Home Type, RUG 4-10
0.0541
627
Source: Weights from Australian National Sub-acute and Non acute Patient (AN-SNAP) Classification study, prices from the 2008/09 NSW EF Policy.
See note on indexation under ‘Escalation factors’ on page 7.
Cost Weights
Appendix 3 contains the cost weights required for
the above funding model implementation.
Outlier Episodes / Phases
‘Trim points’ are required for the palliative care and
rehabilitation case types. They are not required for
the other case types as these are funded on a bed
day basis. The trim points used are as follows:
• Rehabilitation – the short stay outlier threshold
is 7 days or the average length of stay minus 13,
whichever is the larger value and average length
of stay plus 13 days defines the high outlier
threshold.
• Palliative care – the short stay outlier threshold
is the average length of stay minus 7 days and
the average length of stay plus 7 days defines
the high outlier threshold. Only 1 day of a
Bereavement episode (Class 111) is included in the
blended payment model. Any days beyond one
are excluded for funding purposes.
• Assessment only episodes - only 3 days of an
Assessment Only episode (Classes 100, 201, 300
and 400) are included in the blended payment
model. Any days beyond three are treated as
outlier days.
Non-Admitted and Same Day SNAP Care
For non-admitted and same day SNAP patients
refer to the section on Outpatient care.
Rationale
From 1 July 2005 a new SNAP funding model was
introduced. Further detail may be found in the
NSW Episode Funding Policy 2008/09 (NSW Health
2008a).
AVERAGE COST
The average cost per weighted SNAP activity unit for
2009/10 is $11,582.
21
Mental Health Care
SCOPE OF MENTAL HEALTH CARE
Mental health care is care provided in designated
mental health units. Other admitted mental health
(i.e. care provided in general wards) should be treated
as acute admitted care and the cost weights for acute
care should be used to estimate these costs.
CLASSIFICATION OF MENTAL HEALTH CARE
The National Survey of Mental Health Services
(NSMHS) is used to classify and cost mental
health services in NSW. The classification is twodimensional. One dimension describes the type of
unit/service and the other the type of treatment.
The definitions are as follows:
Type of Unit/Service
The NSMHS categorises the service and this can be
applied to inpatient or noninpatient facilities or to
an individual staff person employed or acting in this
context. The following categories are service/staff
related and are not derived from the age of the client:
• Child and adolescent. A specialist psychiatric/
mental health unit/staff person that principally
targets children and young people up to the age
of 18 years. Classification of services into this
category requires recognition by the regional or
central funding authority of the special focus of
the service on children and adolescents.
• General/Adult. A specialist psychiatric/mental
health unit/staff person that provides general
psychiatry services to the general adult
population but may provide services to children,
adolescents or the aged in special circumstances
when more appropriate service provision is
unavailable. They are psychiatric/mental health
services/staff, which cannot be described as
specialist child, and adolescent, geriatric or
forensic services.
• Older people (psychogeriatric). A specialist
psychiatric/mental health unit/staff person that
principally targets people in the age group 65
years and over. Classification of services into this
category requires recognition by the regional or
central funding authority of the special focus of
the service on aged persons. This service category
does not include the treatment of older people by
general psychiatry services.
• Forensic. A specialist psychiatric/mental health
unit/staff person that assesses, treats or cares for
mentally disordered individuals whose condition
has led them to commit criminal offences or
makes it likely that they will offend in the future if
not adequately treated or contained.
These services will mainly be associated with
Corrections Health Service or the secure units
at Cumberland and James Fletcher Hospitals.
Forensic legal status of a patient does not
determine the forensic specialty of the service.
Type of Treatment
The NSMHS uses standard definitions that distinguish
acute and non-acute beds. These are based on
the expectation of significant clinical change, in
the short term, of patients in acute beds. The type
of care provided is defined by the designation of
the bed that the patient occupies rather than the
classification of the actual patient.
The definitions for each bed type are as follows:
• Acute. Care is provided for people who present
with acute episodes of mental illness. These
episodes are characterised by recent onset of
severe clinical symptoms of mental illness, which
have potential for prolonged dysfunction or risk to
self and/or others. The key characteristic of acute
services is that the treatment effort is focused on
symptom reduction with a reasonable expectation
of substantial improvement. In general, acute
psychiatric services provide short-term treatment.
Some acute care patients may have an acute
exacerbation of symptoms due to a continuing
psychiatric disorder, while other acute care patients
may have had no prior contact with a psychiatric
service nor a history of psychiatric illness.
• Rehabilitation. A specialist inpatient psychiatric
unit, which has a primary focus on intervention
to reduce functional impairments resulting from
psychiatric disorders that limit the independence
of patients. Psychiatric rehabilitation services
are focused on disability and the promotion of
personal recovery. They are characterised by an
expectation of substantial improvement over the
short to mid term. Patients treated by psychiatric
rehabilitation services usually have a relatively
stable pattern of clinical symptoms. Treatment is
focused on preventing any relapse of the illness
and reducing disability.
• Extended Care. A specialist inpatient psychiatric
unit which provides care over an indefinite period
for patients who have a stable but severe level
of functional impairment and an inability to
function independently, thus requiring extensive
care and support. Patients of extended care
services present a stable pattern of clinical
symptoms, which may include high levels of
severe unremitting symptoms of mental illness.
Treatment is focused on preventing deterioration
and reducing impairment; improvement is
expected to occur slowly.
22
Mental Health Care
COST ESTIMATES
Cost estimates for Mental Health Bed Days and
ambulatory care are derived from data published
in the National Mental Health Report. The costs
presented are from the NSW submission to the
Australian Department of Health and Aging and
AIHW for the 2007/08 Mental Health Establishments
NMDS.
These are the average costs for these service units2:
Admitted patient service setting
• Inpatient services
Average cost
per patient ($)
Average cost
per bed day ($)
–
745
Ambulatory
Patients
1,727
–
Residential
Patients
–
224
Admitted
Patients
Source: Establishments National Minimum Data Set 2006/07 and
escalated to 2009/10
Ambulatory service setting
• Mobile Acute Assessment & Treatment:
• Mobile Intensive Treatment or Assertive Case
Management
• Outpatient Services – Hospital Based
• Outpatient Services – Community Based
• Day or Partial Day Programs
• Rural Outreach Service
Residential service setting
• Respite
• Acute
• Rehabilitation
• Extended Care
• Crisis Accommodation
2 Service units relate to the minimum reporting that is required for National Minimum Data Sets (NMDS)
23
References
Australian Institute of Health and
Welfare (2006).
National Health Data Dictionary Version 13.
Canberra: AIHW.
Jelinek, G. (1992).
A casemix information system for Australian
hospital emergency departments Perth.
W.A: W.A. Commissioner of Health.
Bond, Erwich-Nijhout, Phillips & Baggoley (1998)
Costings in the Emergency Department.
Adelaide: Flinders Medical Centre.
NSW Health Department. (2009a).
NSW Episode Funding Policy 2009/10
Sydney: NSW Health Department.
Buckingham, B., Burgess, P., Solomon,
S., Pirkis, J. & Eagar, K. (1998).
Developing a Casemix Classification for
Mental Health Services: Summary.
Canberra: Commonwealth Department of
Health and Family Services.
NSW Health Department. (2007b).
NSW Funding Guidelines Addendum:
Rehabilitation and Extended Care Services 2007/08.
Sydney: NSW Health Department.
Centre for Health Services Development,
University of Wollongong. (1997).
The Australian National Sub-Acute and NonAcute Patient Classification (AN-SNAP): Report
of the National Sub-Acute and Non-Acute
Casemix Classification Study.
Wollongong: Centre for Health Services
Development, University of Wollongong.
Commonwealth Department of Health
and Aged Care. (2007).
National Hospital Cost Data Collection Cost
Report Round 10 (2005-06) Draft Report.
Canberra: Commonwealth Department of
Health and Aged Care.
NSW Health Department. (2008b).
NSW Program and Product Data Collection
Standards Manual 2007-08.
Sydney: Casemix Policy Unit, Inter-Government &
Funding Strategies Branch, NSW Health Department.
NSW Health Department. (2009).
NSW Peer Hospital Groups 2009/10.
Sydney: Casemix Policy Unit, Inter-Government &
Funding Strategies Branch, NSW Health Department.
NSW Health Department. (1999b).
Refinement of the NSW Health Program Structure.
Sydney: Structural and Funding Policy Branch,
NSW Health Department.
Commonwealth Department of Health
and Aged Care. (2002).
Australian Refined Diagnosis Related Groups
Version 5.0.
Canberra: Commonwealth Department of
Health and Aged Care.
24
Appendix 1: Acute Care Cost Weights
Part 1: General Cost Weights
Overnight
ACUTE CARE COST WEIGHTS
Appendix 1: Acute Care Cost Weights
Part 1: General Cost Weights
Descriptions of the abbreviations shown
in tables are as follows:
AR-DRG No.
AR-DRG V5.0 number
AR-DRG Title
AR-DRG V5.0 description
Seps (No.)
Total separations
Seps w/o same day ED cases (No)
Separations excluding same day cases treated in ED
Standard error
Standard error of the cost weight
Cost Weight w/o ED & ICU
Cost weight excluding ED and ICU cost groups
Cost Weight w all cost groups
Cost weight including all cost groups
Cost Weight w/o ED
Cost weight excluding ED cost group
Cost Weight w/o ICU
Cost weight excluding ICU cost group
Transfer cost weight
Same day and one day overnight transfer cost
weight, based on base cost of cost weights with
ED and ICU cost groups excluded
Outlier per diem weight
Long stay outlier per diem weight, based on base
cost of cost weights with ED and ICU cost groups
excluded
Outlier per diem amount ($)
Long stay outlier per diem payment ($)
High trim point (days)
AR-DRG trim point in days
In the following tables:
* = Recommended cost weight
26
Peripheral and Cranial Nerve & Other Nervous System Procedure
Peripheral and Cranial Nerve & Other Nervous System Procedure
Plasmapheresis W Neurological Disease
Telemetric EEG Monitoring
Established Paraplegia/Quadriplegia W or W/O O.R. Procs W Cat
Established Paraplegia/Quadriplegia W or W/O O.R. Procs W/O C
B07A
B07B
B40Z
B41Z
B60A
B60B
Craniotomy W Severe or Moderate CC
B02B
Procs for Cerebral Palsy, Muscular Dystrophy, Neuropathy W/O
Craniotomy W Catastrophic CC
B02A
Procs for Cerebral Palsy, Muscular Dystrophy, Neuropathy W C
Ventricular Shunt Revision
B01Z
B06B
Intubation Age<16 W/O CC
A41B
B06A
Intubation Age<16 W CC
A41A
Carpal Tunnel Release
ECMO W/O Cardiac Surgery
A40Z
Extracranial Vascular Procedures W/O Catastrophic or Severe C
Renal Transplant W/O Pancreas Transplant W/O Catastrophic CC
A09B
B05Z
Renal Transplant W Pancreas Transplant or Catastrophic CC
A09A
B04B
Autologous Bone Marrow Transplant W/O Catastrophic CC
A08B
Extracranial Vascular Procedures W Catastrophic or Severe CC
Autologous Bone Marrow Transplant W Catastrophic CC
A08A
Spinal Procedures W/O Catastrophic or Severe CC
Allogeneic Bone Marrow Transplant
A07Z
B04A
Tracheostomy Any Age, Any Condition
A06Z
B03B
1,029
Heart Transplant
A05Z
Craniotomy W/O CC
Lung or Heart/Lung Transplant
A03Z
Spinal Procedures W Catastrophic or Severe CC
Liver Transplant
A01Z
B02C
Prostatic O.R. Procedure Unrelated to Principal Diagnosis
903Z
B03A
716
Non-Extensive O.R. Procedure Unrelated to Principal Diagnosis
902Z
1,008
374
252
88
956
153
292
74
2,859
424
228
325
81
577
93
154
145
22
109
78
122
139
119
2,814
18
36
57
15
268
893
Extensive O.R. Procedure Unrelated to Principal Diagnosis
901Z
Seps
AR-DRG Title
AR-DRG
V5.0 No.
0.19
0.32
0.11
0.24
0.15
0.08
0.11
0.31
0.06
0.05
0.14
0.19
0.31
0.35
0.23
0.54
0.06
0.12
0.43
1.48
0.64
0.51
0.43
1.08
1.62
2.01
0.71
1.72
0.33
1.25
0.17
0.19
Standard
error
2.34
6.75
1.99
1.17
1.10
2.32
2.26
6.11
0.54
1.80
3.58
2.74
6.67
3.48
4.84
8.22
2.61
1.23
4.84
17.70
10.42
16.85
6.61
13.75
25.14
14.74
19.30
19.33
29.43
6.87
2.42
4.83
Cost
Weight w/o
Emerg &
ICU
2.40
7.45
2.01
1.31
1.10
2.50
2.28
6.31
0.54
1.96
3.99
2.81
6.89
3.91
5.50
9.78
2.70
2.20
6.19
29.34
10.53
17.77
6.61
14.42
27.50
30.86
32.60
25.70
33.35
7.36
2.56
5.13
Cost
Weight w/o
Emerg
2.44
6.96
2.02
1.21
1.18
2.47
2.27
6.19
0.54
1.82
3.61
2.76
6.74
3.53
4.89
8.30
2.70
1.49
5.02
17.72
10.44
16.88
6.61
13.78
25.14
14.85
19.42
19.45
29.49
7.07
2.49
4.92
Cost
Weight w/o
ICU
2.51
7.67
2.04
1.35
1.19
2.65
2.29
6.39
0.54
1.97
4.02
2.83
6.95
3.95
5.55
9.85
2.79
2.46
6.37
29.36
10.56
17.79
6.61
14.45
27.50
30.97
32.72
25.82
33.41
7.57
2.62
5.22
Cost
weight w
all cost
groups
0.87
0.37
0.29
0.88
0.23
0.34
1.19
0.61
0.36
0.36
0.11
1.91
0.70
0.61
0.58
0.78
0.60
1.00
1.06
0.15
1.33
0.36
0.26
0.31
0.25
0.19
0.44
0.15
0.24
0.30
0.40
0.24
0.24
0.07
0.44
0.44
0.40
0.39
0.44
0.40
0.44
0.44
0.10
0.44
0.24
0.18
0.44
0.44
1.07
0.09
0.37
0.44
0.44
0.43
0.16
0.40
Outlier per
diem as a
weight
1.28
0.13
0.56
0.78
0.92
0.64
0.25
2.24
Transfer
cost weight
1,050
850
650
1,500
500
800
1000
1,350
800
800
250
1,500
20
48
15
35
4
27
10
60
3
7
24
13
19
45
1,350
30
55
17
17
34
60
18
41
44
45
60
60
60
60
60
60
35
47
High trim
point (days)
1,500
1,300
1,500
1,350
1,500
1,500
350
1,500
800
600
1,500
1,500
300
1,250
1,500
1,500
1,450
550
1,350
Outlier
per diem
amount ($)
Appendix 1: Acute Care Cost Weights Part 1: General Cost weights (Overnight)
27
771
Cranial and Peripheral Nerve Disorders W CC
Cranial and Peripheral Nerve Disorders W/O CC
Nervous System Infection Except Viral Meningitis W Cat or Sev
Nervous System Infection Except Viral Meningitis W/O Cat or S
Viral Meningitis
Nontraumatic Stupor and Coma
Febrile Convulsions
Seizure or W Catastrophic or Severe CC
Seizure W/O Catastrophic or Severe CC
Headache
Intracranial Injury W Catastrophic or Severe CC
Intracranial Injury W/O Catastrophic or Severe CC
B71A
B71B
B72A
B72B
B73Z
B74Z
B75Z
B76A
B76B
B77Z
B78A
B78B
2,458
Stroke W Catastrophic CC
Stroke W Severe CC
B70A
B70B
Stroke W/O Catastrophic or Severe CC
TIA and Precerebral Occlusion W/O Catastrophic or Severe CC
B69B
Stroke, Died or Transferred < 5 days
TIA and Precerebral Occlusion W Catastrophic or Severe CC
B69A
B70C
Multiple Sclerosis and Cerebellar Ataxia W/O CC
B68B
B70D
2,649
Multiple Sclerosis and Cerebellar Ataxia W CC
B68A
1,028
430
2521
4,537
1,273
1,097
282
526
539
172
746
559
1,934
2,223
2,555
1,042
338
185
434
644
622
648
Degenerative Nervous System Disorders Age <60 W/O Catastrophi
Nervous System Neoplasm W/O Catastrophic or Severe CC
B66B
B67C
Nervous System Neoplasm W Catastrophic or Severe CC
B66A
93
1,490
Degenerative Nervous System Disorders W Catastrophic or Sever
Cerebral Palsy
B65Z
Degenerative Nervous System Disorders Age >59 W/O Catastr or
Delirium W/O Catastrophic CC
B64B
456
1,942
B67A
Delirium W Catastrophic CC
B64A
B67B
Dementia and Other Chronic Disturbances of Cerebral Function
B63Z
471
257
Spinal Cord Conditions W or W/O O.R. Procedures W/O Catastrop
Admit for Apheresis
B61B
B62Z
116
Spinal Cord Conditions W or W/O O.R. Procedures W Catastrophic
B61A
Seps
AR-DRG Title
AR-DRG
V5.0 No.
0.05
0.14
0.02
0.02
0.07
0.01
0.03
0.05
0.05
0.17
0.06
0.10
0.02
0.06
0.07
0.15
0.02
0.06
0.03
0.12
0.09
0.08
0.15
0.04
0.11
0.07
0.14
0.08
0.11
0.01
0.21
0.40
Standard
error
1.12
2.97
0.47
0.53
1.49
0.39
0.82
0.82
1.66
3.50
0.85
2.18
0.45
1.51
2.49
4.90
0.72
1.40
0.91
2.23
1.15
1.44
3.29
1.17
2.33
1.78
1.19
2.67
2.30
0.20
1.93
6.64
Cost
Weight w/o
Emerg &
ICU
1.21
3.30
0.48
0.55
1.63
0.40
0.87
0.83
1.76
3.70
0.86
2.22
0.49
1.55
2.54
5.01
0.72
1.41
0.91
2.30
1.17
1.45
3.42
1.19
2.35
1.80
1.20
2.71
2.31
0.20
1.97
7.11
Cost
Weight w/o
Emerg
1.37
3.16
0.59
0.63
1.66
0.49
0.97
0.97
1.79
3.62
0.95
2.33
0.68
1.62
2.61
5.03
0.84
1.54
0.98
2.34
1.24
1.55
3.41
1.29
2.43
1.80
1.37
2.81
2.45
0.20
2.03
6.81
Cost
Weight w/o
ICU
1.47
3.50
0.60
0.66
1.79
0.50
1.01
0.98
1.89
3.83
0.96
2.37
0.72
1.65
2.66
5.14
0.84
1.55
0.98
2.41
1.25
1.56
3.55
1.31
2.45
1.82
1.38
2.85
2.45
0.20
2.07
7.28
Cost
weight w
all cost
groups
0.44
0.54
0.39
0.54
0.36
0.39
0.27
0.44
0.73
0.70
0.37
0.18
0.35
0.38
0.30
0.33
0.28
0.30
0.37
0.46
0.25
0.47
0.30
0.36
0.33
0.44
0.24
0.44
0.18
0.30
0.44
0.44
0.25
0.12
0.24
0.25
0.21
0.22
0.18
0.19
0.21
0.31
0.10
0.16
0.15
0.19
0.23
0.28
0.42
0.13
0.31
0.24
0.25
0.19
0.44
0.44
Outlier per
diem as a
weight
0.62
0.89
0.47
0.35
0.38
0.20
0.75
1.72
Transfer
cost weight
1,000
1,200
1,100
1,500
800
1,500
600
1,000
1,500
1,500
850
15
34
7
7
17
4
15
10
19
38
14
24
5
400
17
850
23
42
11
18
14
25
15
24
37
14
27
7
21
33
36
3
18
51
High trim
point (days)
800
700
750
600
650
700
1,050
350
550
500
650
950
450
1,050
800
850
650
1,500
1,500
Outlier
per diem
amount ($)
Appendix 1: Acute Care Cost Weights Part 1: General Cost weights (Overnight)
28
Lacrimal Procedures
Other Eye Procedures
Glaucoma And Complex Cataract Procedures
Glaucoma And Complex Cataract Procedures, Sameday
Lens Procedures
Lens Procedures, Sameday
Acute and Major Eye Infections Age >54 or W Catastrophic or S
Acute and Major Eye Infections Age <55 W/O Catastrophic or Se
Neurological & Vascular Disorders of the Eye
Hyphema and Medically Managed Trauma to the Eye
Other Disorders of the Eye W CC
Other Disorders of the Eye W/O CC
Cochlear Implant
Head and Neck Procedures W Catastrophic or Severe CC
Head and Neck Procedures W Moderate CC or Malignancy
Head and Neck Procedures W/O CC W/O Malignancy
Surgical Repair for Cleft Lip or Palate Diagnosis
C13Z
C14Z
C15A
C15B
C16A
C16B
C60A
C60B
C61Z
C62Z
C63A
C63B
D01Z
D02A
D02B
D02C
D03Z
Parotid Gland Procedures
Other Corneal, Scleral and Conjunctival Procedures
C12Z
D05Z
Eyelid Procedures
C11Z
Maxillo Surgery W CC
Strabismus Procedures
C10Z
Maxillo Surgery W/O CC
Dacryocystorhinostomy
C05Z
D04A
Major Corneal, Scleral and Conjunctival Procedures
C04Z
D04B
Enucleations and Orbital Procedures
Retinal Procedures
C02Z
C03Z
Other Disorders of the Nervous System W/O Catastrophic or Sev
Other Disorders of the Nervous System W Catastrophic or Sever
B81A
Procedures for Penetrating Eye Injury
Other Head Injury
B80Z
B81B
Skull Fractures
B79Z
C01Z
AR-DRG Title
AR-DRG
V5.0 No.
198
703
286
194
111
96
85
102
464
275
802
293
198
186
17,546
578
405
273
719
200
95
1,144
496
105
274
1,758
144
170
1,779
1,057
1,854
728
Seps
0.08
0.10
0.11
0.07
0.09
0.13
0.39
0.50
0.12
0.05
0.02
0.04
0.08
0.15
0.06
0.05
0.04
0.09
0.04
0.03
0.10
0.06
0.03
0.08
0.11
0.04
0.11
0.28
0.09
0.07
0.01
0.04
Standard
error
1.65
1.76
2.30
1.45
1.70
3.18
4.85
6.22
0.58
0.99
0.51
0.91
1.27
2.78
0.79
1.01
0.77
1.51
0.58
0.53
1.13
0.82
0.75
0.82
1.45
0.92
1.46
2.25
0.90
2.02
0.35
0.90
Cost
Weight w/o
Emerg &
ICU
1.66
1.78
2.40
1.47
1.74
3.31
5.09
6.22
0.58
0.99
0.52
0.92
1.27
2.79
0.79
1.01
0.77
1.51
0.58
0.53
1.13
0.82
0.76
0.82
1.45
0.92
1.49
2.25
0.90
2.05
0.39
0.98
Cost
Weight w/o
Emerg
1.66
1.80
2.36
1.45
1.72
3.19
4.87
6.22
0.67
1.07
0.63
1.01
1.35
2.90
0.79
1.01
0.77
1.51
0.58
0.54
1.14
0.84
0.76
0.83
1.46
0.92
1.48
2.30
1.03
2.17
0.45
1.09
Cost
Weight w/o
ICU
1.66
1.82
2.46
1.47
1.76
3.32
5.11
6.22
0.67
1.08
0.65
1.01
1.35
2.92
0.79
1.01
0.77
1.52
0.58
0.54
1.15
0.84
0.76
0.83
1.46
0.92
1.51
2.31
1.04
2.20
0.49
1.17
Cost
weight w
all cost
groups
0.80
1.45
0.22
0.29
0.66
0.70
0.46
0.11
0.42
0.32
0.18
0.46
0.64
0.55
0.27
0.37
0.28
0.22
0.11
0.14
1.04
0.25
0.14
0.44
0.19
0.15
0.19
0.44
0.44
0.31
0.07
0.22
0.21
0.12
0.36
0.43
0.37
0.18
0.25
0.19
0.15
0.07
0.09
0.40
0.16
0.09
0.10
0.30
0.16
0.13
0.34
0.07
0.18
0.15
0.10
0.28
Outlier per
diem as a
weight
0.96
0.19
1.10
0.12
0.56
0.22
0.26
0.42
Transfer
cost weight
1,500
650
500
650
1,500
1,500
1,050
250
750
700
400
5
6
9
4
8
17
25
3
8
13
9
11
12
1,200
18
1,250
3
3
3
9
5
9
13
4
3
3
13
4
11
11
14
28
4
11
High trim
point (days)
1,450
600
850
650
500
250
300
1,350
550
300
1,000
350
450
1,150
250
600
500
350
950
Outlier
per diem
amount ($)
Appendix 1: Acute Care Cost Weights Part 1: General Cost weights (Overnight)
29
Dental Extractions and Restorations
Ear, Nose, Mouth and Throat Malignancy W Catastrophic or Seve
Ear, Nose, Mouth and Throat Malignancy W/O Catastrophic or Se
Dysequilibrium
Epistaxis
D40Z
D60A
D60B
D61Z
D62Z
Other Ear, Nose, Mouth and Throat Diagnoses W CC
Other Ear, Nose, Mouth and Throat Diagnoses W/O CC
Oral and Dental Disorders Except Extractions and Restorations
Oral and Dental Disorders Except Extractions and Restorations
Major Chest Procedures W Catastrophic CC
Major Chest Procedures W/O Catastrophic CC
Other Respiratory System O.R. Procedures W Catastrophic CC
Other Respiratory System O.R. Procedures W Severe CC
Other Respiratory System O.R. Procedures W/O Catastrophic or
Respiratory System Diagnosis W Ventilator Support
Respiratory System Diagnosis W Non-invasive Ventilation
Cystic Fibrosis W Catastrophic or Severe CC
Cystic Fibrosis W/O Catastrophic or Severe CC
Pulmonary Embolism W Catastrophic or Severe CC
Pulmonary Embolism W/O Catastrophic or Severe CC
Respiratory Infections/Inflammations W Catastrophic CC
D66A
D66B
D67A
D67B
E01A
E01B
E02A
E02B
E02C
E40Z
E41Z
E60A
E60B
E61A
E61B
E62A
Nasal Trauma and Deformity
Mouth & Salivary Gland Procedures
D14Z
Laryngotracheitis and Epiglottitis
Myringotomy W Tube Insertion
D13Z
D65Z
Other Ear, Nose, Mouth & Throat Procedures
D12Z
D64Z
Tonsillectomy or Adenoidectomy
D11Z
Otitis Media and URI W CC
Nasal Procedures
D10Z
Otitis Media and URI W/O CC
Miscellaneous Ear, Nose, Mouth & Throat Procedures
D09Z
D63A
Sinus, Mastoid and Complex Middle Ear Procedures
D06Z
D63B
AR-DRG Title
AR-DRG
V5.0 No.
4,179
1,507
932
473
150
880
362
895
101
158
905
451
1,346
1,647
1,043
429
1,019
1,413
6,247
1,601
768
2,467
362
241
533
428
1,492
592
4,416
1,660
1,697
1,348
Seps
0.05
0.02
0.07
0.12
0.28
0.29
0.12
0.05
0.09
0.28
0.12
0.23
0.01
0.04
0.02
0.03
0.02
0.01
0.02
0.02
0.01
0.02
0.04
0.18
0.06
0.06
0.02
0.05
0.04
0.03
0.03
0.05
Standard
error
2.31
1.00
1.98
4.13
5.63
3.42
2.81
0.99
2.29
4.99
3.11
6.31
0.23
0.67
0.54
0.78
0.42
0.30
0.42
0.72
0.40
0.51
1.05
2.85
0.87
1.10
0.55
0.99
0.85
0.97
1.00
1.30
Cost
Weight w/o
Emerg &
ICU
2.41
1.01
2.07
4.14
5.67
4.70
4.80
1.05
2.49
5.30
3.29
6.99
0.23
0.69
0.54
0.83
0.42
0.32
0.43
0.73
0.42
0.51
1.06
2.90
0.91
1.19
0.55
1.00
0.86
0.97
1.01
1.31
Cost
Weight w/o
Emerg
2.45
1.10
2.11
4.16
5.68
3.56
2.88
1.00
2.35
5.11
3.15
6.38
0.30
0.77
0.61
0.89
0.47
0.41
0.52
0.83
0.52
0.63
1.07
2.92
0.91
1.13
0.55
1.04
0.86
0.97
1.01
1.30
Cost
Weight w/o
ICU
2.55
1.12
2.20
4.18
5.71
4.83
4.87
1.06
2.55
5.42
3.33
7.05
0.30
0.78
0.62
0.94
0.47
0.43
0.52
0.83
0.53
0.63
1.07
2.97
0.95
1.21
0.55
1.05
0.87
0.97
1.02
1.31
Cost
weight w
all cost
groups
0.38
0.48
0.62
1.02
0.57
0.47
0.71
0.37
0.44
0.36
1.09
0.34
0.23
0.34
0.39
0.41
0.14
0.27
0.42
0.42
0.33
0.25
0.82
0.25
0.37
0.41
0.37
0.39
0.31
0.44
0.25
0.30
0.24
0.44
0.22
0.18
0.22
0.12
0.28
0.09
0.18
0.44
0.28
0.24
0.18
0.22
0.19
0.25
0.62
0.39
0.07
0.16
0.24
0.24
0.06
0.44
Outlier per
diem as a
weight
0.38
0.91
0.11
0.25
0.34
0.36
0.09
0.84
Transfer
cost weight
850
1,250
1,400
1,250
1,300
1,050
1,500
850
1,000
800
1,500
750
26
14
22
27
26
27
29
3
21
43
18
40
7
3
750
6
11
6
3
5
8
6
10
11
32
6
6
9
5
3
3
3
3
High trim
point (days)
600
400
950
300
600
1,500
950
800
600
750
850
650
1,300
250
550
800
800
200
1,500
Outlier
per diem
amount ($)
Appendix 1: Acute Care Cost Weights Part 1: General Cost weights (Overnight)
30
Interstitial Lung Disease W/O Catastrophic or Severe CC
Other Respiratory System Diagnosis Age>64 W CC
Other Respiratory System Diagnosis (Age<65 W CC) or (Age>64 W
Other Respiratory System Diagnosis Age<65 W/O CC
Implantation or Replacement of AICD, Total System W Catastr o
Implantation or Replacement of AICD, Total System W/O Catastr
E74C
E75A
E75B
E75C
F01A
F01B
Respiratory Neoplasms W Catastrophic CC
E71A
Interstitial Lung Disease W Severe CC
Whooping Cough and Acute Bronchiolitis W/O CC
E70B
Interstitial Lung Disease W Catastrophic CC
Whooping Cough and Acute Bronchiolitis W CC
E70A
E74B
Bronchitis and Asthma Age<50 W/O CC
E69C
E74A
Bronchitis and Asthma (Age<50 W CC) or (Age>49 W/O CC)
E69B
Pleural Effusion W/O Catastrophic or Severe CC
Bronchitis and Asthma Age>49 W CC
E69A
Pleural Effusion W Severe CC
Pneumothorax
E68Z
E73C
Respiratory Signs and Symptoms W/O Catastrophic or Severe CC
E67B
E73B
Respiratory Signs and Symptoms W Catastrophic or Severe CC
E67A
Pleural Effusion W Catastrophic CC
Major Chest Trauma Age<70 W/O CC
E66C
Respiratory Problems Arising from Neonatal Period
Major Chest Trauma (Age<70 W CC) or (Age>69 W/O CC)
E66B
E73A
Major Chest Trauma Age>69 W CC
E66A
E72Z
1,557
Chronic Obstructive Airways Disease W/O Catastrophic or Sever
E65B
Respiratory Neoplasms W Severe or Moderate CC
Chronic Obstructive Airways Disease W Catastrophic or Severe
E65A
Respiratory Neoplasms W/O CC
Pulmonary Oedema and Respiratory Failure
E64Z
E71B
Sleep Apnoea
E63Z
E71C
924
Respiratory Infections/Inflammations W/O CC
E62C
305
355
1,697
1,731
2,111
218
177
120
584
382
285
65
427
4,185
425
8,239
1,834
869
1,018
2,370
579
379
571
374
6,909
6,609
751
876
7,032
6,174
Respiratory Infections/Inflammations W Severe or Moderate CC
E62B
Seps
AR-DRG Title
AR-DRG
V5.0 No.
0.69
1.34
0.04
0.03
0.05
0.03
0.07
0.08
0.04
0.07
0.13
0.04
0.09
0.07
0.07
0.03
0.06
0.02
0.02
0.03
0.03
0.02
0.04
0.02
0.05
0.10
0.04
0.05
0.03
0.01
0.07
0.04
Standard
error
6.32
10.56
0.53
0.93
1.30
1.02
1.62
2.34
0.84
1.59
2.59
0.99
0.84
1.43
2.44
0.76
1.46
0.42
0.74
0.99
0.99
0.46
0.97
0.53
1.01
2.10
0.90
1.56
1.23
0.34
0.74
1.29
Cost
Weight w/o
Emerg &
ICU
6.33
11.01
0.54
0.94
1.32
1.03
1.67
2.40
0.84
1.59
2.62
1.01
0.85
1.44
2.48
0.77
1.49
0.43
0.79
1.00
1.03
0.47
0.98
0.54
1.08
2.18
0.91
1.60
1.41
0.35
0.75
1.32
Cost
Weight w/o
Emerg
6.33
10.61
0.61
1.04
1.42
1.09
1.71
2.44
0.93
1.69
2.68
1.03
0.91
1.53
2.57
0.85
1.58
0.54
0.85
1.09
1.11
0.55
1.10
0.67
1.15
2.24
1.00
1.68
1.38
0.34
0.85
1.42
Cost
Weight w/o
ICU
6.34
11.06
0.62
1.05
1.44
1.10
1.76
2.50
0.93
1.69
2.72
1.05
0.92
1.54
2.60
0.87
1.61
0.55
0.90
1.11
1.15
0.55
1.12
0.67
1.22
2.32
1.02
1.72
1.56
0.36
0.86
1.45
Cost
weight w
all cost
groups
0.76
0.87
0.27
0.68
0.29
0.61
0.29
0.63
0.48
0.50
0.26
0.28
0.79
0.83
0.51
0.54
0.64
0.42
0.37
0.36
0.51
0.24
0.44
0.44
0.18
0.18
0.19
0.21
0.19
0.41
0.31
0.34
0.18
0.19
0.30
0.34
0.34
0.36
0.43
0.44
0.25
0.24
0.34
0.16
0.16
0.37
0.24
0.28
0.53
0.22
0.37
0.24
0.31
0.13
0.27
0.34
Outlier per
diem as a
weight
0.42
0.33
0.56
0.37
0.48
0.19
0.41
0.52
Transfer
cost weight
1,500
1,500
600
600
650
700
650
1,400
1,050
1,150
600
650
11
36
6
12
17
16
22
33
15
20
28
20
21
14
1,150
31
6
10
4
10
15
12
7
15
8
13
28
14
20
19
3
10
16
High trim
point (days)
1,000
1,150
1,200
1,450
1,500
850
800
1,150
550
550
1,250
950
750
1,250
800
1,050
450
900
1,150
Outlier
per diem
amount ($)
Appendix 1: Acute Care Cost Weights Part 1: General Cost weights (Overnight)
31
372
265
Cardiac Valve Proc W CPB Pump W Invasive Cardiac Inves
Cardiac Valve Proc W CPB Pump W/O Invasive Cardiac Inves W Ca
F03Z
F04A
136
247
Coronary Bypass W Invasive Cardiac Inves W/O Catastrophic CC
Coronary Bypass W/O Invasive Cardiac Inves W Catastr or Sever
Coronary Bypass W/O Invasive Cardiac Inves W/O Catastr or Sev
Other Cardiothoracic/Vascular Procedures W CPB Pump W Catastr
F05B
F06A
F06B
F07A
Vascular Procs Except Major Reconstruction W/O CPB Pump W Sev
Vascular Procs Except Major Reconstruction W/O CPB Pump W/O C
Percutaneous Coronary Intervention W/O AMI W Stent Implantati
Percutaneous Coronary Intervention W/O AMI W/O Stent Implanta
Cardiac Pacemaker Replacement
Cardiac Pacemaker Revision Except Device Replacement
Other Trans-Vascular Percutaneous Cardiac Intervention
Vein Ligation and Stripping
Other Circulatory System O.R. Procedures W Catastrophic CC
Other Circulatory System O.R. Procedures W/O Catastrophic CC
Circulatory System Diagnosis W Ventilator Support
Circulatory Disorders W AMI W Invasive Cardiac Inves Proc W C
F15Z
F16Z
F17Z
F18Z
F19Z
F20Z
F21A
F21B
F40Z
F41A
Cardiac Pacemaker Implantation
F12Z
F14C
Amputation for Circ System Except Upper Limb and Toe W/O Cata
F11B
F14B
147
Amputation for Circ System Except Upper Limb and Toe W Catast
F11A
Upper Limb and Toe Amputation for Circulatory System Disorder
Percutaneous Coronary Intervention W AMI
F10Z
Vascular Procs Except Major Reconstruction W/O CPB Pump W Cat
Other Cardiothoracic Procedures W/O CPB Pump W/O Catastrophic
F09B
F13Z
Other Cardiothoracic Procedures W/O CPB Pump W Catastrophic C
F09A
F14A
1,486
Major Reconstruct Vascular Procedures W/O CPB Pump W/O
Catast
F08B
919
249
326
163
1,653
137
121
572
200
2,854
1,003
656
493
82
139
3,041
163
115
1,076
587
Other Cardiothoracic/Vascular Procedures W CPB Pump W/O Catas
Major Reconstruct Vascular Procedures W/O CPB Pump W Catastro
F07B
F08A
504
884
376
350
Cardiac Valve Proc W CPB Pump W/O Invasive Cardiac Inves W/O
Coronary Bypass W Invasive Cardiac Inves W Catastrophic CC
F04B
F05A
138
89
AICD Component Implantation/Replacement
F02Z
Seps
AR-DRG Title
AR-DRG
V5.0 No.
0.13
0.15
0.14
0.25
0.06
0.08
0.25
0.17
0.16
0.10
0.06
0.08
0.13
0.17
0.21
0.39
0.56
0.12
0.17
0.39
0.22
0.35
0.27
0.37
0.31
0.44
0.55
0.52
0.23
0.66
0.73
0.30
Standard
error
2.34
2.51
1.95
5.53
0.94
2.41
1.69
1.67
1.43
1.76
1.31
1.92
4.78
3.64
2.85
5.08
9.00
2.20
3.08
4.72
4.07
8.50
5.46
9.12
4.92
6.28
7.10
9.31
5.99
9.19
12.59
5.21
Cost
Weight w/o
Emerg &
ICU
2.45
5.50
1.97
5.86
0.94
2.47
1.72
1.67
1.43
1.77
1.35
1.98
5.27
3.70
2.90
5.19
9.52
2.24
3.59
6.51
4.39
10.18
6.48
11.35
5.75
7.52
8.54
12.14
6.78
11.74
15.35
5.55
Cost
Weight w/o
Emerg
2.43
2.57
1.98
5.62
0.94
2.42
1.71
1.69
1.47
1.79
1.32
1.95
4.84
3.69
2.90
5.15
9.08
2.25
3.12
4.77
4.09
8.58
5.47
9.16
4.93
6.29
7.16
9.37
6.00
9.22
12.65
5.26
Cost
Weight w/o
ICU
2.54
5.57
1.99
5.96
0.95
2.47
1.74
1.69
1.47
1.80
1.36
2.01
5.33
3.74
2.95
5.27
9.60
2.30
3.63
6.57
4.41
10.25
6.49
11.38
5.76
7.54
8.60
12.20
6.78
11.77
15.41
5.61
Cost
weight w
all cost
groups
0.56
0.67
1.24
0.53
0.11
0.29
0.22
0.18
0.44
0.49
1.03
0.59
0.26
0.60
2.15
0.34
0.60
0.57
0.43
0.44
0.26
0.86
0.37
0.44
0.31
0.36
0.07
0.19
0.15
0.12
0.30
0.33
0.19
1,250
1,500
1,050
1,200
250
650
500
400
1,000
1,100
650
1,350
600
0.40
1,350
0.18
1,500
750
1,350
1,250
950
1,000
600
1,500
1,300
1,400
1,500
650
600
1,000
950
600
1,500
250
Outlier
per diem
amount ($)
0.40
0.44
0.22
0.40
0.37
0.28
0.30
0.18
0.44
0.39
0.41
0.58
0.44
0.76
0.19
0.18
0.30
0.28
0.18
0.44
0.07
Outlier per
diem as a
weight
0.62
0.29
0.27
0.44
0.41
0.28
1.33
0.12
Transfer
cost weight
19
25
18
44
3
4
16
17
8
7
6
16
38
44
19
45
60
11
12
29
19
50
14
36
12
18
23
39
15
27
53
30
High trim
point (days)
Appendix 1: Acute Care Cost Weights Part 1: General Cost weights (Overnight)
32
Congenital Heart Disease
Valvular Disorders W Catastrophic or Severe CC
Valvular Disorders W/O Catastrophic or Severe CC
Major Arrhythmia and Cardiac Arrest W Catastrophic or Severe
Major Arrhythmia and Cardiac Arrest W/O Catastrophic or Sever
Non-Major Arrhythmia and Conduction Disorders W Catastrophic
Non-Major Arrhythmia and Conduction Disorders W/O Catastrophi
Unstable Angina W Catastrophic or Severe CC
F68Z
F69A
F69B
F70A
F70B
F71A
F71B
F72A
Other Circulatory System Diagnoses W Severe CC
Hypertension W/O CC
F67B
F75B
Hypertension W CC
F67A
Other Circulatory System Diagnoses W Catastrophic CC
Coronary Atherosclerosis W/O CC
F66B
Chest Pain
Coronary Atherosclerosis W CC
F66A
F75A
Peripheral Vascular Disorders W/O Catastrophic or Severe CC
F65B
F74Z
Peripheral Vascular Disorders W Catastrophic or Severe CC
F65A
Syncope and Collapse W/O Catastrophic or Severe CC
Skin Ulcers for Circulatory Disorders
F64Z
F73B
Venous Thrombosis W/O Catastrophic or Severe CC
F63B
Unstable Angina W/O Catastrophic or Severe CC
Venous Thrombosis W Catastrophic or Severe CC
F63A
Syncope and Collapse W Catastrophic or Severe CC
Heart Failure and Shock W/O Catastrophic CC
F62B
F73A
Heart Failure and Shock W Catastrophic CC
F62A
F72B
Circulatory Disorders W AMI W/O Invasive Cardiac Inves Proced
Infective Endocarditis
F60C
F61Z
Circulatory Disorders W AMI W/O Invasive Cardiac Inves Proc W
Circulatory Disorders W/O AMI W Invasive Cardiac Inves Proc W
F42B
Circulatory Disorders W AMI W/O Invasive Cardiac Inves Proc W
Circulatory Disorders W/O AMI W Invasive Cardiac Inves Proc W
F42A
F60A
Circulatory Disorders W AMI W Invasive Cardiac Inves Proc W/O
F41B
F60B
AR-DRG Title
AR-DRG
V5.0 No.
1,076
547
14,908
4,083
1,857
4,965
1,146
6,966
2,650
1,376
505
1,026
412
171
598
462
1,664
1,642
1,343
792
148
1,068
397
7,197
2,932
288
802
4,600
2,611
3,876
2,627
1,406
Seps
0.04
0.11
0.01
0.01
0.04
0.01
0.03
0.01
0.05
0.01
0.05
0.02
0.06
0.03
0.03
0.03
0.02
0.03
0.02
0.07
0.09
0.05
0.07
0.05
0.06
0.12
0.06
0.03
0.05
0.03
0.09
0.05
Standard
error
1.43
2.81
0.30
0.40
1.03
0.45
0.96
0.46
1.26
0.41
0.99
0.34
1.23
0.75
0.46
0.83
0.33
0.67
0.66
1.73
1.98
0.69
1.72
1.04
2.38
4.10
0.76
0.60
1.63
0.97
1.66
1.31
Cost
Weight w/o
Emerg &
ICU
1.50
3.13
0.31
0.41
1.05
0.48
1.01
0.48
1.32
0.46
1.17
0.35
1.30
0.78
0.47
0.87
0.34
0.69
0.66
1.80
1.99
0.70
1.73
1.06
2.48
4.34
0.85
0.65
1.79
0.97
1.69
1.35
Cost
Weight w/o
Emerg
1.55
2.93
0.41
0.54
1.18
0.55
1.07
0.54
1.38
0.57
1.17
0.44
1.34
0.79
0.55
0.93
0.41
0.76
0.74
1.84
2.09
0.81
1.84
1.15
2.52
4.17
1.01
0.71
1.76
1.03
1.74
1.37
Cost
Weight w/o
ICU
1.62
3.25
0.42
0.54
1.19
0.58
1.12
0.57
1.44
0.62
1.35
0.45
1.41
0.82
0.55
0.98
0.43
0.78
0.75
1.91
2.09
0.82
1.85
1.17
2.61
4.42
1.10
0.76
1.92
1.03
1.76
1.41
Cost
weight w
all cost
groups
0.15
0.70
0.39
0.33
0.41
0.33
0.27
0.52
0.23
0.20
0.75
0.41
0.39
0.75
0.38
0.49
0.36
0.32
0.40
0.37
0.25
0.37
0.27
0.10
0.44
0.37
0.27
0.27
0.22
0.18
0.33
0.15
0.13
0.44
0.30
0.27
0.44
0.33
0.33
0.15
0.21
0.10
0.24
0.16
0.37
0.18
0.31
0.30
0.46
0.44
0.15
0.10
0.25
0.44
0.22
0.15
Outlier per
diem as a
weight
0.44
0.81
0.23
0.16
0.39
0.73
1.22
0.22
Transfer
cost weight
350
1,500
1,250
900
900
750
600
1,100
500
450
1,500
1,000
16
29
5
7
18
8
13
8
17
6
14
6
12
20
900
9
14
6
10
14
25
31
14
22
15
30
60
8
10
20
11
17
13
High trim
point (days)
1,500
1,100
1,100
500
700
350
800
550
1,250
600
1,000
1,050
1,500
500
350
850
1,500
750
500
Outlier
per diem
amount ($)
Appendix 1: Acute Care Cost Weights Part 1: General Cost weights (Overnight)
33
Stomach, Oesophageal and Duodenal Procedures W/O Malignancy
W
G03C
Other Gastroscopy for Major Digestive Disease, Sameday
Complex Colonoscopy
G42B
G43Z
Other Gastroscopy for Non-Major Digestive Disease
Other Gastroscopy for Major Digestive Disease
G42A
Other Colonoscopy, Sameday
Other Digestive System O.R. Procedures W/O Catastr or Sev CC
G12B
G45A
Other Digestive System O.R. Procedures W Catastr or Severe CC
G12A
G44C
Anal and Stomal Procedures W/O Catastrophic or Severe CC
G11B
Other Colonoscopy W Catastrophic or Severe CC
Anal and Stomal Procedures W Catastrophic or Severe CC
G11A
Other Colonoscopy W/O Catastrophic or Severe CC
Hernia Procedures Age<1
G10Z
G44A
Inguinal and Femoral Hernia Procedures Age>0
G09Z
G44B
Abdominal and Other Hernia Procedures Age >59 or W Catastroph
Abdominal and Other Hernia Procedures Age 1 to 59 W/O Cat or
Appendicectomy W/O Catastrophic or Severe CC
G07B
G08A
Appendicectomy W Catastrophic or Severe CC
G07A
G08B
Minor Small and Large Bowel Procedures W/O CC
Pyloromyotomy Procedure
G05B
G06Z
Minor Small and Large Bowel Procedures W CC
Stomach, Oesophageal and Duodenal Procedures W/O Malignancy
W
G03B
Peritoneal Adhesiolysis Age<50 W/O CC
Stomach, Oesophageal and Duodenal Procedures W Malignancy
G03A
G04C
Major Small and Large Bowel Procedures W/O Catastrophic CC
G02B
G05A
Major Small and Large Bowel Procedures W Catastrophic CC
G02A
Peritoneal Adhesiolysis Age>49 W CC
Rectal Resection W/O Catastrophic CC
G01B
Peritoneal Adhesiolysis (Age<50 W CC) or (Age>49 W/O CC)
Rectal Resection W Catastrophic CC
G01A
G04A
Other Circulatory System Diagnoses W/O Catastrophic or Severe
F75C
G04B
AR-DRG Title
AR-DRG
V5.0 No.
2,527
14,900
1,923
578
139
1,470
2,183
600
513
2,660
397
415
3,825
1,220
1,462
6,102
485
76
313
201
503
604
475
396
327
254
2,150
1,524
1,014
568
2,016
Seps
0.06
0.01
0.06
0.08
0.03
0.02
0.08
0.04
0.12
0.02
0.04
0.04
0.13
0.03
0.05
0.04
0.08
0.05
0.14
0.13
0.07
0.09
0.17
0.09
0.25
0.24
0.10
0.21
0.13
0.18
0.03
Standard
error
1.16
0.38
1.24
2.59
0.58
0.34
1.36
1.39
3.67
0.78
1.44
0.87
0.93
1.00
1.49
1.32
2.62
1.56
1.76
3.32
1.59
2.51
4.97
2.41
5.82
6.96
3.55
7.79
4.33
8.24
0.80
Cost
Weight w/o
Emerg &
ICU
1.17
0.38
1.25
2.70
0.58
0.34
1.41
1.42
3.95
0.78
1.48
0.88
0.93
1.00
1.55
1.32
2.69
1.57
1.78
3.45
1.61
2.57
5.36
2.52
6.70
7.97
3.68
8.82
4.45
9.05
0.82
Cost
Weight w/o
Emerg
1.67
1.25
0.39
1.31
2.69
0.60
0.35
1.45
1.45
3.77
0.81
1.48
0.89
0.93
1.02
1.52
1.42
2.74
1.71
1.77
3.35
1.27
0.39
1.31
2.80
0.60
0.35
1.50
1.48
4.05
0.81
1.52
0.89
0.94
1.02
1.58
1.42
2.81
1.71
1.79
3.48
1.68
2.63
5.48
5.08
2.58
2.56
6.77
7.99
3.73
8.91
4.47
9.11
0.93
Cost
weight w
all cost
groups
2.45
5.89
6.98
3.60
7.88
4.35
8.29
0.91
Cost
Weight w/o
ICU
0.36
0.31
0.72
0.39
0.21
0.29
0.30
0.48
0.67
0.74
0.31
0.24
0.21
0.44
0.25
0.15
0.19
0.19
0.31
0.44
0.22
0.21
0.22
0.36
1.03
0.25
0.37
0.19
0.18
0.44
0.37
0.16
0.43
0.40
0.18
0.44
0.44
0.44
0.07
0.18
0.44
0.39
0.09
Outlier per
diem as a
weight
0.53
1.02
1.44
0.28
0.28
0.96
0.56
0.25
0.64
0.61
0.27
0.72
0.76
0.68
0.11
0.27
0.92
0.57
0.53
Transfer
cost weight
3
12
700
14
25
16
3
13
15
31
4
15
3
3
5
11
6
17
7
12
21
12
18
29
14
40
31
19
42
20
43
10
High trim
point (days)
800
1,500
850
500
650
650
1,050
1,500
750
700
1,200
750
850
1,250
650
600
1,500
1,250
550
1,450
1,350
600
1,500
1,500
1,500
250
600
1,500
1,300
300
Outlier
per diem
amount ($)
Appendix 1: Acute Care Cost Weights Part 1: General Cost weights (Overnight)
34
117
147
Inflammatory Bowel Disease
GI Obstruction W CC
GI Obstruction W/O CC
Abdominal Pain or Mesenteric Adenitis W CC
Abdominal Pain or Mesenteric Adenitis W/O CC
Oesophagitis, Gastroent & Misc Digestive System Disorders Age
Oesophagitis, Gastroent & Misc Digestive Systm Disorders Age>
Gastroenteritis Age<10 W CC
Gastroenteritis Age<10 W/O CC
Oesophagitis and Misc Digestive System Disorders Age<10
Other Digestive System Diagnoses W CC
Other Digestive System Diagnoses W/O CC
Pancreas, Liver and Shunt Procedures W Catastrophic CC
Pancreas, Liver and Shunt Procedures W/O Catastrophic CC
Major Biliary Tract Procedures W Malignancy or Catastrophic
Major Biliary Tract Procedures W/O Malignancy W Severe or Mod
Major Biliary Tract Procedures W/O Malignancy W/O CC
Hepatobiliary Diagnostic Procedures W Catastrophic or Severe
Hepatobiliary Diagnostic Procedures W/O Catastrophic or Sever
Other Hepatobiliary and Pancreas O.R. Procedures
Open Cholecystectomy W Closed CDE or Catastrophic CC
G64Z
G65A
G65B
G66A
G66B
G67A
G67B
G68A
G68B
G69Z
G70A
G70B
H01A
H01B
H02A
H02B
H02C
H05A
H05B
H06Z
H07A
79
136
135
229
153
139
429
285
2,436
1,475
1,284
6,957
566
11,217
3,991
6,317
1,581
2,197
1,577
768
96
Complicated Peptic Ulcer
Uncomplicated Peptic Ulcer
G62Z
913
2,190
760
1,079
8,623
1,732
1,040
8,969
Seps
G63Z
GI Haemorrhage Age<65 W/O Catastrophic or Severe CC
Digestive Malignancy W Catastrophic or Severe CC
G60A
G61B
Complex Gastroscopy, Sameday
G46C
Digestive Malignancy W/O Catastrophic or Severe CC
Complex Gastroscopy W/O Catastrophic or Severe CC
G46B
GI Haemorrhage (Age<65 W Catastrophic or Severe CC) or
Age>64
Complex Gastroscopy W Catastrophic or Severe CC
G46A
G61A
Other Gastroscopy for Non-Major Digestive Disease, Sameday
G45B
G60B
AR-DRG Title
AR-DRG
V5.0 No.
0.21
0.13
0.12
0.25
0.10
0.16
0.40
0.19
0.32
0.01
0.05
0.02
0.01
0.03
0.02
0.04
0.01
0.02
0.02
0.05
0.04
0.02
0.05
0.02
0.02
0.02
0.06
0.02
0.08
0.08
0.01
Standard
error
5.49
3.04
1.78
4.65
1.69
3.26
6.33
3.59
8.28
0.40
1.15
0.59
0.44
0.80
0.43
1.24
0.37
0.69
0.63
1.32
1.16
0.29
0.75
0.33
0.69
0.65
1.34
0.43
1.38
2.62
0.35
Cost
Weight w/o
Emerg &
ICU
6.19
3.14
1.79
4.99
1.71
3.32
6.96
3.90
9.17
0.40
1.19
0.59
0.44
0.82
0.43
1.26
0.37
0.70
0.64
1.34
1.16
0.33
0.78
0.34
0.71
0.66
1.34
0.43
1.39
2.74
0.36
Cost
Weight w/o
Emerg
5.56
3.07
1.82
4.72
1.71
3.33
6.41
3.61
8.33
0.51
1.26
0.67
0.55
0.91
0.53
1.38
0.48
0.81
0.74
1.44
1.26
0.38
0.86
0.43
0.82
0.69
1.41
0.43
1.44
2.72
0.36
Cost
Weight w/o
ICU
6.27
3.18
1.82
5.06
1.73
3.39
7.04
3.93
9.22
0.51
1.30
0.67
0.55
0.93
0.53
1.40
0.48
0.82
0.74
1.47
1.27
0.76
0.71
0.51
1.33
0.25
0.61
0.82
0.89
0.77
0.36
0.61
0.44
0.44
0.78
0.44
0.34
0.35
0.42
0.33
0.46
0.92
0.18
0.45
0.89
0.41
0.19
0.38
0.59
0.70
0.20
0.61
0.64
0.27
Transfer
cost weight
0.44
0.84
0.70
1.42
0.43
1.45
2.84
0.36
Cost
weight w
all cost
groups
0.44
0.44
0.34
0.44
0.16
0.40
0.44
0.44
0.44
0.15
1,500
1,500
1,150
1,500
550
1,350
1,500
1,500
1,500
500
550
950
0.16
1,500
0.28
1,500
1,500
750
650
1,000
750
1,050
1,100
400
1,000
450
850
750
1,500
450
1,350
1,450
600
Outlier
per diem
amount ($)
0.44
0.44
0.44
0.22
0.19
0.30
0.22
0.31
0.33
0.12
0.30
0.13
0.25
0.22
0.44
0.13
0.40
0.43
0.18
Outlier per
diem as a
weight
39
33
15
37
18
26
40
21
49
7
16
5
4
6
8
17
5
10
9
16
12
8
12
5
11
9
21
3
13
26
3
High trim
point (days)
Appendix 1: Acute Care Cost Weights Part 1: General Cost weights (Overnight)
35
Open Cholecystectomy W/O Closed CDE W/O Catastrophic CC
Laparoscopic Cholecystectomy W Closed CDE Or Catastrophic/Sev
Laparoscopic Cholecystectomy W/O Closed CDE W/O
H07B
H08A
H08B
Hip Replacement W Cat or Severe CC or Hip Revision W/O Cat or
Hip Replacement W/O Catastrophic or Severe CC
Knee Replacement and Reattachment
Other Major Joint Replacement and Limb Reattachment Procedure
Spinal Fusion W Deformity
Amputation
Other Hip and Femur Procedures W Catastrophic or Severe CC
I04Z
I05Z
I06Z
I07Z
I08A
Disorders of Liver Excep Malig, Cirrhosis, Alcoholic Hepatiti
H63B
I03C
Disorders of Liver Except Malig, Cirrhosis, Alcoholic Hepatit
H63A
I03B
Disorders of Pancreas Except for Malignancy W/O Catastrophic
H62B
Hip Revision W Catastrophic or Severe CC
Disorders of Pancreas Except for Malignancy W Catastrophic or
H62A
Skin Graft W/O Catastrophic or Severe CC, Excluding Hand
Malig Hepatobilry Sys, Pancreas (A<70 W/O Cat CC) or (A>69 W/
H61B
I03A
Malignancy of Hepatobiliary Sys, Pancreas W Catastr CC or (Ag
H61A
I02B
Cirrhosis and Alcoholic Hepatitis W/O Catastrophic or Severe
H60C
Microvascular Tissue Transfer or (Skin Graft W Cat or Sev CC)
Cirrhosis and Alcoholic Hepatitis W Severe CC
H60B
Bilateral or Multiple Major Joint Procs of Lower Extremity
Cirrhosis and Alcoholic Hepatitis W Catastrophic CC
H60A
I02A
ERCP Other Therapeutic Procedure W/O CC
H42C
I01Z
ERCP Other Therapeutic Procedure W Moderate CC
H42B
Disorders of the Biliary Tract W CC
ERCP Other Therapeutic Procedure W Catastrophic or Severe CC
H42A
Disorders of the Biliary Tract W/O CC
ERCP Complex Therapeutic Procedure W/O Catastrophic or Severe
H41B
H64A
ERCP Complex Therapeutic Procedure W Catastrophic or Severe C
H41A
H64B
Endoscopic Procedures for Bleeding Oesophageal Varices
H40Z
Catastrophic/
AR-DRG Title
AR-DRG
V5.0 No.
2,333
76
52
474
4,333
2,441
1,924
157
203
143
292
2,784
1,450
645
645
2,756
686
848
692
280
494
542
918
381
422
492
324
145
6,317
1,069
491
Seps
0.12
0.16
0.43
0.45
0.21
0.16
0.22
0.26
0.23
0.77
0.57
0.03
0.05
0.03
0.08
0.04
0.07
0.05
0.07
0.04
0.09
0.13
0.05
0.07
0.15
0.06
0.12
0.12
0.09
0.15
0.07
Standard
error
4.81
7.16
7.88
3.93
4.60
4.00
5.28
9.45
3.83
13.04
8.03
0.55
1.25
0.82
2.02
0.83
2.04
1.09
2.08
1.01
1.44
3.01
1.11
1.34
2.75
1.46
3.05
2.48
1.33
2.57
2.41
Cost
Weight w/o
Emerg &
ICU
4.94
7.26
8.15
3.94
4.63
4.01
5.38
9.60
3.88
13.48
8.06
0.55
1.28
0.83
2.15
0.84
2.27
1.09
2.10
1.02
1.48
3.24
1.12
1.35
2.90
1.46
3.20
2.80
1.33
2.68
2.48
Cost
Weight w/o
Emerg
4.93
7.26
7.89
3.96
4.61
4.03
5.35
9.51
3.88
13.13
8.05
0.65
1.36
0.92
2.15
0.95
2.16
1.14
2.20
1.08
1.54
3.14
1.16
1.38
2.84
1.52
3.14
2.56
1.34
2.63
2.45
Cost
Weight w/o
ICU
5.06
7.37
8.16
3.97
4.63
4.04
5.46
9.66
3.93
13.57
8.08
0.65
1.39
0.93
2.29
0.96
2.39
1.14
2.22
1.09
1.58
3.37
0.68
0.20
0.55
0.54
0.23
0.29
0.26
0.37
0.68
0.57
0.33
0.56
0.50
0.68
0.49
0.52
0.37
0.67
0.54
0.42
0.73
0.39
0.47
0.81
1.17
0.31
1.16
0.31
0.34
1.39
0.32
0.43
Transfer
cost weight
1.40
2.99
1.52
3.29
2.89
1.34
2.74
2.52
Cost
weight w
all cost
groups
0.44
0.13
0.37
0.36
0.15
0.19
0.18
0.25
0.44
0.39
0.22
1,500
450
1,250
1,200
500
650
600
850
1,500
1,300
750
1,150
1,450
0.43
550
1,100
1,150
850
850
1,200
400
950
900
1,050
1,050
700
1,000
700
750
600
750
950
Outlier
per diem
amount ($)
0.34
0.16
0.33
0.34
0.25
0.25
0.36
0.12
0.28
0.27
0.31
0.31
0.21
0.30
0.21
0.22
0.18
0.22
0.28
Outlier per
diem as a
weight
37
59
14
13
12
12
29
58
29
60
19
9
16
12
24
10
23
14
28
17
17
32
13
16
25
15
29
16
4
19
15
High trim
point (days)
Appendix 1: Acute Care Cost Weights Part 1: General Cost weights (Overnight)
36
Humerus, Tibia, Fibula and Ankle Procedures W Catastrophic or
Humerus, Tibia, Fibula and Ankle Procedures Age>59 W/O Catast
Humerus, Tibia, Fibula and Ankle Procedures Age<60 W/O Catast
Stump Revision
Cranio-Facial Surgery
Other Shoulder Procedures
Maxillo-Facial Surgery
Other Knee Procedures
Other Elbow or Forearm Procedures
Foot Procedures
Local Excision & Removal of Internal Fixation Devices of Hip
Local Excision & Removal of Internal Fixation Dev Ex Hip & Fm
Arthroscopy
Bone and Joint Diagnostic Procedures including Biopsy
Soft Tissue Procedures W Catastrophic or Severe CC
Soft Tissue Procedures W/O Catastrophic or Severe CC
Other Connective Tissue Procedures W CC
Other Connective Tissue Procedures W/O CC
Knee Reconstruction Or Revision
Hand Procedures
Femoral Shaft Fractures
Other Femoral Fractures
Sprains, Strains and Dislocations of Hip, Pelvis and Thigh
I13B
I13C
I14Z
I15Z
I16Z
I17Z
I18Z
I19Z
I20Z
I21Z
I23Z
I24Z
I25Z
I27A
I27B
I28A
I28B
I29Z
I30Z
I60Z
I61Z
I63Z
Infect/Inflam of Bone & Joint W Misc Musc Sys & Conn Tiss Pro
I12A
I13A
205
Limb Lengthening Procedures
I11Z
Infect/Inflam of Bone & Joint W Misc Musc Sys & Conn Tiss Pro
Other Back and Neck Procedures W/O Catastrophic or Severe CC
I10B
Infect/Inflam Bone & Joint W Misc Musc Sys & Conn Tiss Proc W
Other Back and Neck Procedures W Catastrophic or Severe CC
I10A
I12B
Spinal Fusion W/O Catastrophic or Severe CC
I09B
I12C
247
Spinal Fusion W Catastrophic or Severe CC
I09A
430
207
253
7,645
726
781
333
1,228
213
174
687
3,765
232
2,132
3,499
902
337
1,588
107
13
4,079
893
471
867
25
1,315
288
498
220
2,246
Other Hip and Femur Procedures W/O Catastrophic or Severe CC
I08B
Seps
AR-DRG Title
AR-DRG
V5.0 No.
0.03
0.06
0.19
0.08
0.06
0.06
0.17
0.05
0.15
0.19
0.05
0.02
0.04
0.06
0.04
0.04
0.10
0.07
0.11
0.11
0.34
0.07
0.16
0.08
0.20
0.44
0.13
0.27
0.13
0.32
0.76
0.19
Standard
error
0.58
1.39
3.56
1.01
1.57
1.23
3.71
1.14
4.37
3.03
0.78
0.68
1.20
1.29
1.46
1.10
2.28
1.34
2.80
1.88
1.62
2.30
5.00
2.40
4.48
8.61
2.34
2.22
4.00
4.58
8.57
3.00
Cost
Weight w/o
Emerg &
ICU
0.59
1.44
3.58
1.01
1.58
1.23
3.78
1.15
4.55
3.06
0.78
0.68
1.22
1.29
1.48
1.11
2.35
1.34
3.07
1.88
1.62
2.31
5.13
2.41
4.51
8.92
2.34
2.24
4.12
4.66
9.14
3.01
Cost
Weight w/o
Emerg
0.72
1.52
3.80
1.06
1.58
1.28
3.81
1.20
4.46
3.08
0.80
0.68
1.22
1.32
1.54
1.13
2.32
1.34
2.81
1.90
1.68
2.37
5.10
2.45
4.56
8.72
2.34
2.24
4.04
4.60
8.63
3.08
Cost
Weight w/o
ICU
0.73
1.56
3.82
1.06
1.58
1.28
3.88
1.21
4.64
3.10
0.80
0.68
1.24
1.33
1.55
1.14
2.39
1.34
3.07
1.90
1.69
2.38
5.23
2.46
4.59
9.03
2.34
2.26
4.16
4.68
9.20
3.10
Cost
weight w
all cost
groups
0.45
0.36
0.69
0.32
0.20
1.15
0.58
0.97
0.54
0.55
0.11
0.11
0.24
0.30
1.30
0.96
0.34
0.33
0.51
0.42
0.77
0.42
0.42
0.30
0.24
0.44
0.21
0.13
0.28
0.39
0.37
0.36
0.37
0.07
0.07
0.16
0.19
0.28
0.24
0.22
0.22
0.34
0.28
0.44
0.28
0.28
0.33
0.30
0.45
0.44
0.44
0.24
0.28
0.44
0.33
0.19
Outlier per
diem as a
weight
0.48
0.75
1.33
0.36
0.43
1.24
0.48
0.30
Transfer
cost weight
1,000
800
1,500
700
450
950
1,300
1,250
1,200
1,250
250
250
9
24
60
4
3
7
38
7
40
35
8
4
6
6
650
6
8
10
4
12
19
8
15
33
24
42
60
17
10
27
15
39
19
High trim
point (days)
550
950
800
750
750
1,150
950
1,500
950
950
1,000
1,100
1,500
1,500
800
950
1,500
1,100
650
Outlier
per diem
amount ($)
Appendix 1: Acute Care Cost Weights Part 1: General Cost weights (Overnight)
37
Aftercare of Connective Tissue Disorders Age<60 W/O Catastrop
Injury to Forearm, Wrist, Hand or Foot Age>74 W CC
Injury to Forearm, Wrist, Hand or Foot (Age<75 W CC) or (Age>
Injury to Forearm, Wrist, Hand or Foot Age<75 W/O CC
Injury to Shoulder, Arm, Elbow, Knee, Leg or Ankle Age>64 W C
Inj to Should, Arm, Elbow, Knee, Leg, Ankle (Age<65 W CC) or
Injury to Shoulder, Arm, Elbow, Knee, Leg or Ankle Age<65 W/O
Other Musculoskeletal Disorders Age>69 W CC
Other Musculoskeletal Disorders (Age<70 W CC) or (Age>69 W/O
Other Musculoskeletal Disorders Age<70 W/O CC
I74B
I74C
I75A
I75B
I75C
I76A
I76B
I76C
Musculotendinous Disorders Age <70 W/O CC
I71C
I74A
Musculotendinous Disorders (Age<70 W CC) or (Age>69 W/O CC)
I71B
I73C
Musculotendinous Disorders Age>69 W CC
I71A
Aftercare Conn Tiss Disorder (Age<60 W Cat/Sev CC) or (Age>59
Non-Specific Arthropathies
I70Z
Aftercare of Connective Tissue Disorders Age>59 W Catastrophi
Bone Diseases & Spec Arthropathies Age<75 W/O Catastr or Seve
I69C
I73B
Bone Diseases&Spec Arthropathies(A<75 W Cat/Sev CC) or (A>74
I69B
I73A
Bone Diseases & Spec Arthropathies Age>74 W Catastrophic or S
I69A
Tendonitis, Myositis and Bursitis (Age<80 W Catastr or Severe
Non-surgical Neck & Back Conditions, Sameday
I68C
Tendonitis, Myositis and Bursitis Age<80 W/O Catastrophic or
Non-surgical Neck & Back Cond W/O CC
I68B
I72A
Non-Surg Neck & Back Conditions W CC
I68A
I72B
Septic Arthritis W/O Catastrophic or Severe CC
I67B
908
Inflammatory Musculoskeletal Disorders W/O Cat or Sev CC
Inflammatory Musculoskeletal Disorders W Cat or Sev CC
I66A
Septic Arthritis W Catastrophic or Severe CC
Connective Tissue Malignancy, including Pathological Fx W/O C
I65B
I66B
Connective Tissue Malignancy, including Pathological Fx W Cat
I65A
I67A
342
Osteomyelitis W/O CC
I64B
615
518
222
3,852
1,877
1,247
7,407
856
387
323
715
490
779
300
674
764
487
275
786
1,144
528
2,479
4,014
2,488
308
70
800
785
271
383
Osteomyelitis W CC
I64A
Seps
AR-DRG Title
AR-DRG
V5.0 No.
0.01
0.04
0.06
0.02
0.03
0.06
0.02
0.03
0.04
0.04
0.04
0.14
0.03
0.07
0.02
0.03
0.05
0.05
0.04
0.05
0.08
0.01
0.07
0.06
0.03
0.27
0.08
0.13
0.08
0.09
0.06
0.15
Standard
error
0.51
0.88
1.53
0.45
0.77
1.92
0.45
0.60
1.48
0.71
0.86
2.90
0.58
1.54
0.47
0.63
1.13
0.87
0.73
1.11
2.23
0.22
0.84
1.99
0.99
3.80
0.99
2.84
1.51
2.50
1.53
2.54
Cost
Weight w/o
Emerg &
ICU
0.52
0.93
1.56
0.45
0.77
1.93
0.45
0.61
1.49
0.71
0.87
2.91
0.59
1.59
0.47
0.64
1.14
0.87
0.73
1.12
2.24
0.22
0.84
2.01
1.00
3.88
0.99
3.03
1.51
2.51
1.54
2.56
Cost
Weight w/o
Emerg
0.59
1.00
1.65
0.57
0.92
2.06
0.55
0.74
1.64
0.75
0.91
2.93
0.66
1.67
0.56
0.76
1.27
0.97
0.80
1.22
2.36
0.32
0.95
2.13
1.07
3.96
1.04
2.91
1.58
2.59
1.61
2.61
Cost
Weight w/o
ICU
0.59
1.04
1.69
0.57
0.92
2.08
0.55
0.75
1.65
0.75
0.93
2.94
0.67
1.71
0.56
0.77
1.28
0.97
0.80
1.23
2.38
0.32
0.95
2.15
1.08
4.03
1.05
3.10
1.58
2.61
1.61
2.63
Cost
weight w
all cost
groups
0.46
0.34
0.52
0.11
0.26
0.44
0.25
0.15
0.32
0.39
0.52
0.53
0.44
0.33
0.33
0.37
0.22
0.28
0.35
0.33
0.41
0.22
0.51
0.15
0.22
0.34
0.07
0.18
0.30
0.16
0.10
0.21
0.09
0.12
0.36
0.21
0.22
0.18
0.24
0.15
0.18
0.16
0.09
0.27
0.18
0.34
0.12
0.44
0.18
0.44
0.18
0.44
0.27
0.39
0.10
0.19
Outlier per
diem as a
weight
0.67
0.69
0.39
0.77
0.67
0.57
0.31
0.29
Transfer
cost weight
500
750
1,150
250
600
1,000
550
350
700
300
400
5
15
22
4
13
31
3
7
25
13
21
40
9
1,200
25
750
6
14
25
12
13
19
32
3
13
26
26
47
15
29
17
29
28
44
High trim
point (days)
700
600
800
500
600
550
300
900
600
1,150
1,500
400
1,500
600
1,500
900
1,300
350
650
Outlier
per diem
amount ($)
Appendix 1: Acute Care Cost Weights Part 1: General Cost weights (Overnight)
38
Fractures of Neck of Femur W/O Catastrophic or Severe CC
Microvascular Tissue Transfer for Skin, Subcutaneous Tissue &
Major Procedures for Malignant Breast Conditions
Major Procedures for Non-Malignant Breast Conditions
Minor Procedures for Malignant Breast Conditions
Minor Procedures for Non-Malignant Breast Conditions
Other Skin Graft and/or Debridement Procedures W Catastrophic
Other Skin Graft and/or Debridement Procedures W/O Catastroph
Perianal and Pilonidal Procedures
Skin, Subcutaneous Tissue and Breast Plastic O.R. Procedures
Other Skin, Subcutaneous Tissue and Breast Procedures
Lower Limb Procs W Ulcer/Cellulitis W Catastr CC
Lower Limb Procs W Ulcer/Cellulitis W/O Catastr CC W Skin Gra
Lower Limb Procs W Ulcer/Cellulitis W/O Catastr CC W/O Skin G
Lower Limb Procs W/O Ulcer/Cellulitis W Skin Graft W Catastr/
Lower Limb Procs W/O Ulcer/Cellulitis W/O (Skin Graft & Catas
Major Breast Reconstructions
Skin Ulcers
Skin Ulcers, Sameday
Malignant Breast Disorders W Catastrophic or Severe CC or (Ag
Malignant Breast Disorders (A<70 W/O Catastr or Severe CC) or
Non-Malignant Breast Disorders
Cellulitis Age>59 W Catastrophic or Severe CC
Cellulitis (Age>59 W/O Catastrophic or Severe CC) or Age<60
Trauma to the Skin, Subcutaneous Tissue and Breast Age>69
Trauma to the Skin, Subcutaneous Tissue and Breast Age<70
Minor Skin Disorders
Minor Skin Disorders, Sameday
Major Skin Disorders
I78B
J01Z
J06A
J06B
J07A
J07B
J08A
J08B
J09Z
J10Z
J11Z
J12A
J12B
J12C
J13A
J13B
J14Z
J60A
J60B
J62A
J62B
J63Z
J64A
J64B
J65A
J65B
J67A
J67B
J68A
1,290
1,882
1,250
2,251
1,374
10,192
1,665
518
146
266
75
803
67
598
164
211
145
133
1,137
2,039
729
1,147
401
1,468
662
507
2,026
97
1,059
407
873
Fractures of Pelvis W/O Catastrophic or Severe CC
Fractures of Neck of Femur W Catastrophic or Severe CC
I77B
I78A
715
Fractures of Pelvis W Catastrophic or Severe CC
I77A
Seps
AR-DRG Title
AR-DRG
V5.0 No.
0.09
0.01
0.03
0.01
0.03
0.03
0.05
0.02
0.03
0.11
0.01
0.26
0.10
0.16
0.12
0.12
0.28
0.51
0.05
0.04
0.03
0.03
0.10
0.03
0.03
0.05
0.06
0.19
0.05
0.11
0.05
0.12
Standard
error
1.26
0.24
0.68
0.38
0.82
0.79
1.90
0.54
0.57
1.34
0.15
2.04
3.55
1.82
3.14
2.43
5.20
8.67
0.82
0.81
0.76
1.24
2.98
0.64
0.88
1.53
1.55
6.37
0.43
1.62
1.12
2.79
Cost
Weight w/o
Emerg &
ICU
1.28
0.24
0.68
0.38
0.82
0.79
1.93
0.54
0.57
1.34
0.15
2.04
3.55
1.83
3.16
2.45
5.21
8.78
0.84
0.81
0.76
1.25
3.08
0.64
0.88
1.53
1.55
6.71
0.43
1.63
1.12
2.83
Cost
Weight w/o
Emerg
1.34
0.26
0.77
0.48
0.97
0.90
2.03
0.61
0.58
1.40
0.30
2.13
3.55
1.83
3.16
2.49
5.26
8.76
0.84
0.81
0.77
1.27
3.02
0.64
0.88
1.53
1.55
6.37
0.64
1.77
1.27
2.95
Cost
Weight w/o
ICU
1.37
0.26
0.78
0.48
0.98
0.90
2.06
0.61
0.58
1.40
0.30
2.14
3.55
1.83
3.18
2.50
5.27
8.86
0.86
0.81
0.77
1.27
3.12
0.64
0.88
1.53
1.56
6.71
0.64
1.79
1.27
2.99
Cost
weight w
all cost
groups
0.52
0.24
0.29
0.18
0.44
0.32
0.40
0.20
0.21
0.47
0.15
0.35
0.73
1.10
0.38
0.35
0.91
0.34
0.58
0.10
0.15
1.09
0.51
0.34
0.18
0.19
0.12
0.30
0.21
0.27
0.13
0.15
0.27
0.19
0.24
0.44
0.30
0.25
0.24
0.44
0.22
0.15
0.06
0.10
0.40
0.34
0.07
0.07
0.11
0.44
0.25
0.27
0.25
0.33
0.25
0.27
Outlier per
diem as a
weight
0.11
0.70
0.37
0.40
0.37
0.48
0.37
0.39
Transfer
cost weight
1,150
600
650
400
1,000
700
900
450
500
900
650
16
3
8
4
18
11
25
8
8
26
3
32
15
800
18
1,500
27
29
56
60
7
5
3
11
27
3
3
8
8
16
11
27
19
35
High trim
point (days)
1,000
850
800
1,500
750
500
200
350
1,350
1,150
250
250
1,500
850
900
850
1,100
850
900
Outlier
per diem
amount ($)
Appendix 1: Acute Care Cost Weights Part 1: General Cost weights (Overnight)
39
123
69
Diabetic Foot Procedures
Pituitary Procedures
K01Z
K02Z
Endocrine Disorders W Catastrophic or Severe CC
Endocrine Disorders W/O Catastrophic or Severe CC
Operative Insertion of Peritoneal Catheter for Dialysis W Cat
Operative Insertion of Peritoneal Catheter for Dialysis W/O C
Kidney, Ureter and Major Bladder Procedures for Neoplasm W Ca
Kidney, Ureter and Major Bladder Procedures for Neoplasm W/O
Kidney, Ureter and Major Bladder Procedures for Non-Neoplasm
Kidney, Ureter & Major Bladder Procedures for Non-Neoplasm W
Kidney, Ureter & Major Bladder Procedures for Non-Neoplasm W/
Transurethral Prostatectomy W Catastrophic or Severe CC
Transurethral Prostatectomy W/O Catastrophic or Severe CC
Minor Bladder Procedures W Catastrophic or Severe CC
Minor Bladder Procedures W/O Catastrophic or Severe CC
Transurethral Procedures Except Prostatectomy W Catastrophic
L02A
L02B
L03A
L03B
L04A
L04B
L04C
L05A
L05B
L06A
L06B
L07A
Miscellaneous Metabolic Disorders W Severe CC or (Age>74 W/O
K62B
K64B
Miscellaneous Metabolic Disorders W Catastrophic CC
K62A
K64A
Severe Nutritional Disturbance
K61Z
Miscellaneous Metabolic Disorders W/O Catastrophic or Severe
Diabetes W/O Catastrophic or Severe CC
K60B
Inborn Errors of Metabolism
Diabetes W Catastrophic or Severe CC
K60A
K62C
Endoscopic or Investigative Procedure for Metabolic Disorders
K40Z
K63Z
Other Endocrine, Nutritional and Metabolic O.R. Procedures
K09Z
42
Obesity Procedures
Thyroglossal Procedures
K07Z
Thyroid Procedures
K06Z
K08Z
1,403
Parathyroid Procedures
K05Z
325
303
139
191
60
1,133
393
237
401
290
152
83
977
298
139
1,257
1,602
763
111
4,135
1,525
384
189
82
285
6
Adrenal Procedures
Major Procedures for Obesity
K03Z
K04Z
734
311
Major Skin Disorders, Sameday
J68B
Seps
AR-DRG Title
AR-DRG
V5.0 No.
0.08
0.05
0.11
0.08
0.11
0.18
0.16
0.25
0.18
0.23
0.05
0.41
0.06
0.07
0.08
0.06
0.04
0.06
0.14
0.04
0.05
0.02
0.19
0.07
0.12
0.18
0.04
0.13
0.78
0.20
0.59
0.00
Standard
error
2.15
0.98
2.83
1.26
2.94
2.07
2.97
5.97
3.03
5.27
1.32
5.11
0.78
2.00
1.64
0.81
1.02
2.08
3.75
0.90
2.00
0.53
3.99
1.00
2.28
1.61
1.51
3.15
3.27
3.05
6.50
0.11
Cost
Weight w/o
Emerg &
ICU
2.20
0.99
2.97
1.27
3.01
2.09
3.03
6.45
3.15
5.95
1.33
5.19
0.79
2.07
1.68
0.82
1.04
2.18
3.84
0.95
2.14
0.53
4.21
1.01
2.38
1.63
1.58
3.16
3.59
3.57
6.64
0.11
Cost
Weight w/o
Emerg
2.19
1.00
2.89
1.28
2.99
2.09
3.01
6.09
3.03
5.30
1.34
5.14
0.81
2.09
1.75
0.88
1.13
2.20
3.85
0.99
2.12
0.54
4.04
1.01
2.28
1.61
1.51
3.15
3.29
3.05
6.59
0.14
Cost
Weight w/o
ICU
2.24
1.00
3.02
1.29
3.06
2.10
3.08
6.56
3.15
5.98
1.35
5.22
0.82
2.17
1.78
0.90
1.15
2.30
3.94
1.05
2.26
0.54
4.25
1.01
2.38
1.64
1.58
3.17
3.60
3.57
6.73
0.14
Cost
weight w
all cost
groups
0.17
0.92
1.07
0.29
0.69
0.42
1.92
0.49
0.44
0.49
0.51
0.80
0.51
0.68
0.41
0.42
0.55
0.48
0.48
0.37
0.39
0.53
0.12
0.31
0.44
0.19
0.44
0.28
0.31
0.33
0.30
0.33
0.34
0.44
0.15
0.27
0.15
0.25
0.30
0.33
0.33
0.15
0.27
0.39
0.44
0.07
1.38
0.30
0.11
0.24
0.31
0.33
0.28
0.44
0.44
0.15
Outlier per
diem as a
weight
0.45
0.35
0.46
0.48
0.42
0.68
0.95
0.11
Transfer
cost weight
400
1,050
1,500
650
1,500
950
1,050
1,100
1,000
1,100
1,150
26
6
36
7
34
10
18
45
13
31
7
59
5
1,500
24
500
13
10
15
26
37
11
25
20
41
3
13
5
7
6
18
13
59
3
High trim
point (days)
900
500
850
1,000
1,100
1,100
500
900
1,300
1,500
250
1,000
800
1,050
1,100
950
1,500
1,500
500
Outlier
per diem
amount ($)
Appendix 1: Acute Care Cost Weights Part 1: General Cost weights (Overnight)
40
Transurethral Prostatectomy W/O Catastrophic or Severe CC
Penis Procedures W CC
Penis Procedures W/O CC
M02B
M03A
M03B
571
Major Male Pelvic Procedures
Other Kidney and Urinary Tract Diagnoses W/O Catastrophic or
L67C
Transurethral Prostatectomy W Catastrophic or Severe CC
Other Kidney and Urinary Tract Diagnoses W Severe CC
L67B
M01Z
Other Kidney and Urinary Tract Diagnoses W Catastrophic CC
L67A
M02A
1,989
Urethral Stricture
L66Z
574
185
44
1,915
399
838
459
130
1,417
Kidney and Urinary Tract Signs and Symptoms W Catastrophic or
4,331
4,256
Kidney and Urinary Tract Signs and Symptoms W/O Catastrophic
Urinary Stones and Obstruction
L64Z
L65A
Kidney and Urinary Tract Infections Age<70 W/O Catastrophic o
L63C
5,221
1,226
210
342
231,439
1,028
196
307
88
165
293
98
L65B
Kidney and Urinary Tract Infections W Catastrophic CC
Kidney and Urinary Tract Infections (Age<70 W Severe CC) or A
L63A
Kidney and Urinary Tract Neoplasms W/O Catastrophic or Severe
L62B
L63B
Kidney and Urinary Tract Neoplasms W Catastrophic or Severe C
ESW Lithotripsy for Urinary Stones
Renal Failure W Catastrophic CC
L42Z
L60A
Admit for Renal Dialysis
Cystourethroscopy, Sameday
L41Z
L62A
Ureteroscopy
L40Z
L61Z
794
Other Procedures for Kidney and Urinary Tract Disorders W/O C
L09C
Renal Failure W Severe CC
Other Procedures for Kidney and Urinary Tract Disorders W Sev
L09B
Renal Failure W/O Catastrophic or Severe CC
Other Procedures for Kidney and Urinary Tract Disorders W Cat
L09A
L60B
421
670
Urethral Procedures W/O CC
L08B
L60C
5,396
Urethral Procedures W CC
L08A
990
Transurethral Procedures Except Prostatectomy W/O Catastrophi
L07B
Seps
AR-DRG Title
AR-DRG
V5.0 No.
0.06
0.06
0.07
0.06
0.15
0.03
0.06
0.14
0.03
0.03
0.03
0.02
0.02
0.03
0.07
0.03
0.10
0.01
0.08
0.08
0.13
0.03
0.02
0.04
0.12
0.19
0.86
0.05
0.06
0.06
Standard
error
1.12
1.45
1.32
2.24
3.18
0.82
1.37
3.25
0.55
0.50
1.25
0.51
0.69
1.05
2.30
0.97
1.60
0.14
1.14
1.77
3.50
0.75
0.48
0.94
1.36
3.58
9.08
0.77
1.06
0.88
Cost
Weight w/o
Emerg &
ICU
1.13
1.46
1.33
2.30
3.27
0.84
1.41
3.46
0.55
0.50
1.26
0.51
0.69
1.06
2.35
0.98
1.61
0.14
1.19
1.84
3.92
0.75
0.48
0.95
1.36
3.59
9.37
0.77
1.07
0.88
Cost
Weight w/o
Emerg
1.14
1.49
1.33
2.26
3.19
0.90
1.47
3.38
0.58
0.60
1.38
0.61
0.81
1.19
2.44
1.01
1.70
0.14
1.24
1.88
3.64
0.75
0.48
0.96
1.37
3.66
9.17
0.77
1.08
0.90
Cost
Weight w/o
ICU
1.15
1.51
1.33
2.32
3.28
0.92
1.51
3.59
0.58
0.60
1.39
0.61
0.81
1.20
2.49
1.01
1.71
0.14
1.29
1.95
4.06
0.75
0.48
0.97
1.38
3.67
9.45
0.77
1.10
0.90
Cost
weight w
all cost
groups
0.07
0.37
0.92
0.48
0.30
0.35
1.33
0.45
0.46
0.22
0.19
0.38
0.30
0.33
0.34
0.29
0.50
0.44
0.83
0.11
0.33
0.21
0.33
0.21
0.24
0.44
0.31
0.33
0.15
0.12
0.18
0.19
0.16
0.22
0.19
0.34
0.22
0.44
0.07
0.16
0.25
0.44
0.11
0.81
0.15
0.18
0.19
0.33
0.44
0.07
0.07
0.31
Outlier per
diem as a
weight
0.22
0.26
0.29
0.49
0.78
0.11
0.11
0.92
Transfer
cost weight
700
1,100
700
800
1,500
1,050
1,100
500
400
3
13
7
16
13
12
17
32
5
7
17
650
600
5
8
16
29
11
24
3
15
21
38
5
3
6
7
25
60
5
13
5
High trim
point (days)
550
750
650
1,150
750
1,500
250
550
850
1,500
250
500
600
650
1,100
1,500
250
250
1,050
Outlier
per diem
amount ($)
Appendix 1: Acute Care Cost Weights Part 1: General Cost weights (Overnight)
41
Other Male Reproductive System O.R. Procedures for Malignancy
Other Male Reproductive System O.R. Procedures Except for Mal
Cystourethroscopy W/O CC
Malignancy, Male Reproductive System W Catastrophic or Severe
Malignancy, Male Reproductive System W/O Catastrophic or Seve
Benign Prostatic Hypertrophy W Catastrophic or Severe CC
Benign Prostatic Hypertrophy W/O Catastrophic or Severe CC
Inflammation of the Male Reproductive System W CC
Inflammation of the Male Reproductive System W/O CC
Sterilisation, Male
Other Male Reproductive System Diagnoses
Pelvic Evisceration and Radical Vulvectomy
Uterine, Adnexa Proc for Ovarian or Adnexal Malignancy W CC
Uterine, Adnexa Proc for Ovarian or Adnexal Malignancy W/O CC
Uterine, Adnexa Procedure for Non-Ovarian or Adnexal Malignan
M06A
M06B
M40Z
M60A
M60B
M61A
M61B
M62A
M62B
M63Z
M64Z
N01Z
N02A
N02B
N03A
Other Female Reproductive Sys O.R. Procs Age>64 or W Malignan
Other Female Reproductive System O.R. Procs Age<65 W/O Malign
N11A
N11B
Infections, Female Reproductive System
Diagnostic Curettage or Diagnostic Hysteroscopy
N10Z
N61Z
Conisation, Vagina, Cervix and Vulva Procedures
N09Z
Malignancy, Female Reproductive System W Catastrophic or Seve
Endoscopic Procedures for Female Reproductive System
N08Z
Malignancy, Female Reproductive System W/O Catastrophic or Se
Other Uterine and Adnexa Procedures for Non-Malignancy
N07Z
N60A
Female Reproductive System Reconstructive Procedures
N06Z
N60B
Oophorectomies and Complex Fallopian Tube Procs for Non-Malig
Oophorectomies & Complex Fallopian Tube Procs for Non-Malig W
N05A
N05B
Uterine, Adnexa Procedure for Non-Ovarian or Adnexal Malignan
Circumcision
M05Z
Hysterectomy for Non-Malignancy
Testes Procedures W/O CC
M04B
N03B
Testes Procedures W CC
M04A
N04Z
AR-DRG Title
AR-DRG
V5.0 No.
505
305
317
564
48
4,753
828
3,853
1,559
1,983
879
108
3,657
219
192
129
170
66
594
1,112
729
299
426
115
232
417
430
117
147
1,222
1,839
130
Seps
0.02
0.03
0.12
0.04
0.08
0.04
0.02
0.03
0.04
0.06
0.04
0.08
0.06
0.08
0.12
0.11
0.14
0.20
0.02
0.02
0.02
0.04
0.02
0.05
0.05
0.07
0.03
0.06
0.07
0.07
0.03
0.05
Standard
error
0.49
0.93
1.62
0.55
2.74
0.57
0.58
0.87
1.11
1.33
1.45
2.55
1.73
1.91
2.83
1.91
3.24
3.75
0.31
0.49
0.44
1.00
0.46
1.35
0.65
1.28
0.44
1.01
1.26
0.63
0.74
1.34
Cost
Weight w/o
Emerg &
ICU
0.49
0.93
1.70
0.55
2.98
0.57
0.59
0.87
1.12
1.34
1.46
2.67
1.74
1.91
2.91
1.91
3.29
3.80
0.31
0.49
0.44
1.01
0.46
1.36
0.65
1.29
0.44
1.02
1.26
0.63
0.74
1.38
Cost
Weight w/o
Emerg
0.59
0.98
1.70
0.55
2.77
0.58
0.62
0.89
1.14
1.34
1.47
2.57
1.74
1.91
2.84
1.92
3.25
3.76
0.39
0.49
0.52
1.09
0.49
1.43
0.69
1.35
0.45
1.03
1.27
0.63
0.76
1.37
Cost
Weight w/o
ICU
0.59
0.98
1.77
0.55
3.00
0.58
0.62
0.89
1.15
1.34
1.47
2.69
1.74
1.92
2.92
1.93
3.30
3.80
0.39
0.49
0.52
1.10
0.49
1.44
0.69
1.36
0.45
1.03
1.27
0.64
0.77
1.41
Cost
weight w
all cost
groups
0.29
0.27
0.36
0.43
0.29
0.11
0.67
0.11
0.83
0.59
0.16
0.76
0.14
1.29
0.73
0.89
0.79
0.22
0.11
0.30
0.37
0.16
0.24
0.19
0.18
0.24
0.28
0.19
0.07
0.25
0.07
0.09
0.40
0.10
0.44
0.09
0.12
0.44
0.44
0.44
0.15
0.07
0.19
0.24
0.10
0.16
0.16
0.10
0.16
0.21
0.06
0.19
0.13
0.07
0.13
0.24
Outlier per
diem as a
weight
0.57
0.31
0.09
0.30
0.19
0.11
0.20
0.37
Transfer
cost weight
650
600
800
950
650
250
850
250
300
1,350
350
7
9
21
9
20
5
5
5
6
7
8
14
7
1,500
11
300
16
10
18
28
4
3
7
12
9
24
11
23
6
8
6
3
3
12
High trim
point (days)
400
1,500
1,500
1,500
500
250
650
800
350
550
350
550
700
200
650
450
250
450
800
Outlier
per diem
amount ($)
Appendix 1: Acute Care Cost Weights Part 1: General Cost weights (Overnight)
42
Neonate, AdmWt > 2499 g W Significant O.R. Procedure W Multi
Neonate, Adm Wt > 2499 g W Significant O.R. Proc W/O Multi Ma
Neonate Died or Transf <5 Days of Adm, W/O Significant O.R. P
Neonate Died/Transf <5 Days of Adm, W/O Significant O.R. Proc
Neonate, AdmWt < 750 g
Neonate, AdmWt 750-999 g
Neonate, AdmWt 1000-1249 g W/O Significant O.R. Procedure
Neonate, AdmWt 1250-1499 g W/O Significant O.R. Procedure
P06A
P06B
P60A
P60B
P61Z
P62Z
P63Z
P64Z
Antenatal & Other Obstetric Admission
O66A
Neonate, AdmWt 2000-2499 g W Significant O.R. Procedure
False Labour After 37 Weeks W/O Catastrophic CC
O64B
Neonate, AdmWt 1500-1999 g W Significant O.R. Procedure
False Labour Before 37 Weeks or W Catastrophic CC
O64A
P05Z
Abortion W/O O.R. Procedure
O63Z
P04Z
Postpartum and Post Abortion W/O O.R. Procedure
O61Z
Neonate, AdmWt 1000-1499 g W Significant O.R. Procedure
Single Uncomplicated Vaginal Delivery W/O Other Condition
O60C
Cardiothoracic/Vascular Procedures for Neonates
Vaginal Delivery W/O Catastrophic or Severe CC
O60B
P03Z
Vaginal Delivery W Catastrophic or Severe CC
O60A
P02Z
Abortion W OR Procedure
O05Z
Antenatal & Other Obstetric Admission, Sameday
Postpartum and Post Abortion W O.R. Procedure
O04Z
Neonate, Died or Transf <5 Days of Admission W Significant O.
Ectopic Pregnancy
O03Z
O66B
Vaginal Delivery W O.R. Procedure W/O Catastrophic or Severe
O02B
P01Z
Vaginal Delivery W O.R. Procedure W Catastrophic or Severe CC
O02A
3,118
Caesarean Delivery W Severe CC
Caesarean Delivery W/O Catastrophic or Severe CC
O01B
Caesarean Delivery W Catastrophic CC
O01A
O01C
1,025
Menstrual and Other Female Reproductive System Disorders W/O
N62B
337
253
148
4
238
480
3
125
52
37
60
53
95
8,530
10,851
1,603
1,872
1,308
3,839
9,649
34,299
4,403
7,293
487
781
1,016
669
13,716
2,630
429
Menstrual and Other Female Reproductive System Disorders W CC
N62A
Seps
AR-DRG Title
AR-DRG
V5.0 No.
0.64
0.96
3.14
24.45
0.04
0.07
0.59
1.65
1.45
1.35
3.64
1.19
0.13
0.01
0.07
0.01
0.03
0.01
0.02
0.02
0.04
0.04
0.02
0.04
0.04
0.05
0.05
0.05
0.13
0.10
0.01
0.03
Standard
error
9.05
10.71
25.39
132.91
0.28
0.41
4.75
13.44
13.25
16.03
25.36
14.39
1.16
0.11
0.48
0.21
0.44
0.30
0.55
0.73
0.92
1.24
0.63
0.83
0.96
1.09
1.36
1.65
1.88
2.31
0.26
0.56
Cost
Weight w/o
Emerg &
ICU
9.05
10.71
25.39
132.91
0.28
0.41
4.75
15.41
14.79
16.03
25.36
18.76
1.16
0.11
0.49
0.21
0.44
0.30
0.55
0.74
0.92
1.25
0.63
0.84
0.96
1.09
1.39
1.66
1.91
2.39
0.26
0.56
Cost
Weight w/o
Emerg
9.05
10.71
25.39
132.91
0.34
0.41
4.75
13.45
13.27
16.03
25.36
14.40
1.16
0.12
0.51
0.22
0.44
0.38
0.57
0.74
0.92
1.24
0.70
0.88
1.03
1.09
1.36
1.65
1.88
2.32
0.32
0.65
Cost
Weight w/o
ICU
9.05
10.71
25.39
132.91
0.34
0.41
4.75
15.42
14.81
16.03
25.36
18.76
1.16
0.12
0.51
0.22
0.44
0.38
0.58
0.74
0.92
1.25
0.70
0.90
1.03
1.09
1.39
1.66
1.91
2.40
0.32
0.65
Cost
weight w
all cost
groups
0.55
0.78
1.33
0.57
0.28
0.41
0.79
0.15
0.70
0.80
1.05
0.83
0.40
0.11
0.28
0.21
0.49
0.24
0.26
0.11
0.46
0.26
0.37
0.44
0.44
0.39
0.36
0.31
0.44
0.10
0.44
0.44
0.44
0.44
0.27
0.18
0.19
0.18
0.31
0.16
0.18
0.07
0.31
0.18
0.18
0.21
0.27
0.44
0.76
0.44
0.22
0.07
0.13
0.22
0.15
0.13
Outlier per
diem as a
weight
0.30
0.70
0.33
0.11
0.20
0.33
0.22
0.19
Transfer
cost weight
1,250
1,500
1,500
1,300
1,200
1,050
1,500
350
1,500
1,500
1,500
1,500
60
60
60
60
6
6
28
60
60
60
60
50
3
6
600
5
3
6
3
6
5
7
10
3
7
5
7
9
8
12
20
4
8
High trim
point (days)
900
650
600
1,050
550
600
250
1,050
600
600
700
1,500
1,500
750
250
450
750
500
450
Outlier
per diem
amount ($)
Appendix 1: Acute Care Cost Weights Part 1: General Cost weights (Overnight)
43
923
Neonate, AdmWt 2000-2499 g W/O Significant O.R. Procedure W
M
Neonate, AdmWt 2000-2499 g W/O Significant O.R. Procedure
WO
Neonate, AdmWt 2000-2499 g W/O Significant O.R. Procedure
W/O
Neonate, AdmWt > 2499 g W/O Significant O.R. Procedure W
Mult
Neonate, AdmWt > 2499 g W/O Significant O.R. Procedure W
Majo
Neonate, AdmWt > 2499 g W/O Significant O.R. Procedure W
Othe
Neonate, AdmWt > 2499 g W/O Significant O.R. Procedure W/O Pr
Unqualified Neonates
Splenectomy
Other O.R. Procedure of Blood & Blood Forming Organs W Catast
Other O.R. Procedure of Blood & Blood Forming Organs W/O Cata
Reticuloendothelial and Immunity Disorders W Catastrophic or
Reticuloendothelial and Immunity Disorders W/O Cat or Sev CC
Reticuloendothelial and Immunity Disorders W/O Cat or Sev CC
Red Blood Cell Disorders W Catastrophic CC
P66B
P66C
P66D
P67A
P67B
P67C
P67D
P67Z
Q01Z
Q02A
Q02B
Q60A
Q60B
Q60C
Q61A
Coagulation Disorders
Lymphoma and Leukaemia W Major O.R. Procedures W
Catastrophic
Lymphoma and Leukaemia W Major O.R. Procedures W/O
Catastroph
Other Neoplastic Disorders W Major O.R. Procedures W Catastr
Q62Z
R01A
R01B
R02A
Red Blood Cell Disorders W Severe CC
Neonate, AdmWt 2000-2499 g W/O Significant O.R. Proc W Multi
P66A
Red Blood Cell Disorders W/O Catastrophic or Severe CC
Neonate, AdmWt 1500-1999 g W/O Significant O.R. Procedure
W/O
P65D
Q61B
Neonate, AdmWt 1500-1999 g W/O Significant O.R. Procedure W
O
P65C
Q61C
720
628
Neonate, AdmWt 1500-1999 g W/O Significant O.R. Procedure W
M
P65B
152
127
114
1,167
2,468
397
1,050
444
136
94
62,068
3,977
2,963
0.35
0.20
0.60
0.03
0.02
0.04
0.07
0.04
0.04
0.13
0.04
0.41
0.14
0.03
0.02
0.05
0.10
0.24
255
1,389
0.07
0.14
0.29
0.52
0.26
0.36
0.44
0.68
Standard
error
700
967
372
73
442
349
360
67
Neonate, AdmWt 1500-1999 g W/O Significant O.R. Proc W Multi
P65A
Seps
AR-DRG Title
AR-DRG
V5.0 No.
5.61
3.06
10.76
0.86
0.50
0.97
1.70
0.82
1.21
2.78
1.05
6.12
3.28
0.42
0.60
0.90
1.62
3.30
0.97
2.23
3.29
4.66
4.03
4.53
5.00
6.38
Cost
Weight w/o
Emerg &
ICU
5.84
3.15
11.30
0.89
0.50
0.98
1.75
0.84
1.22
2.84
1.06
6.52
3.62
0.43
0.62
0.94
1.73
3.43
1.10
2.39
3.48
4.72
4.29
4.62
5.09
6.44
Cost
Weight w/o
Emerg
5.64
3.08
10.84
0.97
0.58
1.05
1.81
0.92
1.30
2.88
1.06
6.21
3.33
0.42
0.61
0.91
1.64
3.31
0.97
2.24
3.29
4.67
4.04
4.53
5.01
6.39
Cost
Weight w/o
ICU
5.87
3.17
11.38
1.00
0.58
1.06
1.86
0.94
1.31
2.94
1.08
6.61
3.67
0.43
0.64
0.95
1.76
3.45
1.11
2.39
3.49
4.72
4.30
4.62
5.10
6.45
Cost
weight w
all cost
groups
0.56
0.85
0.87
0.34
0.46
0.79
0.78
0.30
0.86
0.49
0.35
0.85
0.36
0.24
0.28
0.65
0.52
0.16
0.67
0.82
0.44
0.33
1.23
1.33
0.65
0.15
Transfer
cost weight
0.37
0.44
0.44
0.18
0.41
0.44
0.39
0.19
0.44
0.33
0.24
0.44
0.24
0.16
0.19
0.43
0.36
0.10
0.44
0.44
0.30
0.22
0.44
0.44
0.43
0.10
Outlier per
diem as a
weight
1,250
1,500
1,500
600
1,400
1,500
1,300
650
1,500
1,100
800
1,500
800
550
650
1,450
1,200
350
1,500
1,500
1,000
750
1,500
1,500
1,450
350
Outlier
per diem
amount ($)
33
24
56
13
8
14
22
10
12
19
10
43
14
7
8
11
18
27
15
29
36
45
38
44
50
57
High trim
point (days)
Appendix 1: Acute Care Cost Weights Part 1: General Cost weights (Overnight)
44
128
161
Lymphoma and Leukaemia W Other O.R. Procedures W
Catastrophic
Lymphoma and Leukaemia W Other O.R. Procedures W/O
Catastroph
Other Neoplastic Disorders W Other O.R. Procedures W Catastr
R03A
R03B
R04A
HIV-Related Diseases W/O Catastophic or Severe CC
O.R. Procedures for Infectious and Parasitic Diseases W Catas
O.R. Procedures for Infectious and Parasitic Diseases W Sever
O.R. Procedures for Infectious and Parasitic Diseases W/O CC
Septicaemia W Catastrophic or Severe CC
Septicaemia W/O Catastrophic or Severe CC
Postoperative & Post-Traumatic Infect W Cat/Sev CC or (Age>54
Postoperative & Post-Traumatic Infections Age <55 W/O Catastr
Fever of Unknown Origin W CC
Fever of Unknown Origin W/O CC
Viral Illness Age >59 or W CC
Viral Illness Age<60 W/O CC
Other Infectious and Parasitic Diseases W Catastrophic or Sev
T01B
T01C
T60A
T60B
T61A
T61B
T62A
T62B
T63A
T63B
T64A
HIV-Related Diseases W Severe CC
S65B
T01A
HIV-Related Diseases W Catastrophic CC
S65A
S65C
Radiotherapy
HIV, Sameday
R64Z
Chemotherapy
R63Z
S60Z
Other Neoplastic Disorders W/O CC
R62B
3,786
Lymphoma and Non-Acute Leukaemia, Sameday
Other Neoplastic Disorders W CC
Lymphoma and Non-Acute Leukaemia W Catastrophic CC
Lymphoma and Non-Acute Leukaemia W/O Catastrophic CC
R61A
R61B
R61C
Acute Leukaemia W/O Catastrophic or Severe CC
R60C
R62A
2,717
Acute Leukaemia W Severe CC
R60B
239
3,873
1,017
1,565
1,036
993
1,446
1,003
2,989
443
352
419
163
93
94
219
195
3,404
292
350
628
755
335
389
Other Neoplastic Disorders W Other O.R. Procedures W/O Catast
Acute Leukaemia W Catastrophic CC
R04B
R60A
354
187
362
Other Neoplastic Disorders W Major O.R. Procedures W/O Catast
R02B
Seps
AR-DRG Title
AR-DRG
V5.0 No.
0.19
0.01
0.03
0.02
0.04
0.03
0.04
0.05
0.06
0.07
0.19
0.37
0.16
0.29
0.58
0.07
0.06
0.02
0.04
0.10
0.01
0.06
0.20
0.12
0.23
0.66
0.06
0.23
0.08
0.41
0.11
Standard
error
3.14
0.46
0.78
0.47
1.25
0.85
1.26
1.10
2.49
2.01
4.13
10.11
2.96
4.10
8.59
0.60
0.78
0.17
0.73
2.04
0.19
1.46
5.20
2.23
3.43
9.99
1.17
3.37
1.62
7.77
2.30
Cost
Weight w/o
Emerg &
ICU
3.25
0.46
0.78
0.47
1.25
0.86
1.29
1.16
2.76
2.04
4.24
10.92
2.98
4.11
9.41
0.60
0.78
0.17
0.73
2.06
0.19
1.47
5.33
2.23
3.45
10.19
1.18
3.41
1.64
7.96
2.35
Cost
Weight w/o
Emerg
3.26
0.56
0.89
0.58
1.37
0.95
1.35
1.25
2.65
2.07
4.20
10.23
3.05
4.20
8.74
0.61
0.78
0.17
0.75
2.10
0.21
3.37
0.57
0.89
0.58
1.38
0.95
1.38
1.30
2.91
2.09
4.31
11.04
3.07
4.22
9.57
0.61
0.78
0.17
0.76
2.12
0.21
1.51
5.43
5.30
1.50
2.28
3.52
10.28
1.19
3.46
1.66
8.06
2.36
Cost
weight w
all cost
groups
2.27
3.50
10.08
1.18
3.41
1.65
7.88
2.31
Cost
Weight w/o
ICU
0.73
0.46
0.54
0.36
0.44
0.20
0.35
0.40
0.51
0.64
0.88
0.44
0.44
0.37
0.24
0.30
0.13
0.24
0.27
0.34
0.13
0.18
0.31
0.44
1.86
0.22
0.44
0.21
0.15
0.07
0.15
0.22
0.21
0.44
0.43
0.21
0.44
0.44
0.18
0.07
0.28
0.44
0.44
Outlier per
diem as a
weight
0.46
0.33
0.68
0.31
0.23
0.11
0.23
0.33
0.19
0.79
0.65
0.57
1.33
3.32
0.27
0.11
0.43
1.01
0.67
Transfer
cost weight
5
31
1,500
9
6
13
10
17
14
26
21
33
60
17
26
48
3
6
3
13
28
3
14
44
12
30
60
14
34
23
60
14
High trim
point (days)
1,500
1,250
800
1,000
450
800
900
1,150
450
600
1,500
1,050
750
1,500
700
500
250
500
750
700
1,500
1,450
700
1,500
1,500
600
250
950
1,500
1,500
Outlier
per diem
amount ($)
Appendix 1: Acute Care Cost Weights Part 1: General Cost weights (Overnight)
45
735
291
188
74
Alcohol Use Disorder and Dependence, Sameday
Opioid Use Disorder and Dependence
Opioid Use Disorder and Dependence, Left Against Medical Advi
Other Drug Use Disorder and Dependence
Ventilation or Craniotomy Procs for Multiple Significant Trau
Hip, Femur and Limb Procs for Multiple Significant Trauma, in
V63B
V64Z
W01Z
W02Z
Other Procedures for Injuries to Lower Limb Age<60 W/O CC
Other Procedures for Injuries to Hand
X04B
X05Z
578
Microvascular Tissue Transfer or Skin Grafts for Injuries to
Other Procedures for Injuries to Lower Limb Age>59 or W CC
X02Z
Multiple Trauma Without Significant Procedures
W61Z
X04A
295
Multiple Trauma, Died or Transf to Another Acute Care Facilit
W60Z
1,193
545
183
265
124
Abdominal Procedures for Multiple Significant Trauma
Other O.R. Procedures for Multiple Significant Trauma
W03Z
W04Z
118
333
80
1,817
409
1,529
821
87
662
V63A
Childhood Mental Disorders
U68Z
V62B
Personality Disorders and Acute Reactions
U67Z
268
Alcohol Use Disorder and Dependence
Eating and Obsessive-Compulsive Disorders
U66Z
917
963
Drug Intoxication and Withdrawal
Anxiety Disorders
U65Z
V62A
Other Affective and Somatoform Disorders
U64Z
295
566
V61Z
Major Affective Disorders Age<70 W/O Catastrophic or Severe C
U63B
Alcohol Intoxication and Withdrawal W CC
Major Affective Disorders W Cat or Sev CC or (Age>69 W/O Cat
U63A
64
276
Alcohol Intoxication and Withdrawal W/O CC
Paranoia & Acute Psych Disorder W/O Cat/Sev CC W/O Mental Hea
U62B
V60A
Paranoia & Acute Psych Disorder W Cat/Sev CC or W Mental Heal
U62A
404
69
5,122
494
517
Seps
V60B
Schizophrenia Disorders W Mental Health Legal Status
Mental Health Treatment, Sameday, W/O ECT
U60Z
Schizophrenia Disorders W/O Mental Health Legal Status
Mental Health Treatment, Sameday, W ECT
U40Z
U61A
Other Infectious and Parasitic Diseases W/O Catastrophic or S
T64B
U61B
AR-DRG Title
AR-DRG
V5.0 No.
0.03
0.03
0.14
0.05
0.11
0.08
0.35
0.21
0.32
0.52
0.03
0.10
0.10
0.03
0.08
0.02
0.01
0.03
0.09
0.02
0.40
0.04
0.04
0.02
0.17
0.01
0.13
0.03
0.06
0.01
0.02
0.04
Standard
error
0.87
0.95
2.17
1.24
2.63
1.18
6.84
3.40
7.34
13.14
0.61
0.70
1.08
0.20
1.16
0.48
0.24
0.66
1.19
0.43
5.46
0.86
0.79
0.36
2.08
0.22
1.09
0.44
0.55
0.11
0.15
0.81
Cost
Weight w/o
Emerg &
ICU
0.88
0.95
2.30
1.25
2.96
1.31
7.61
4.02
7.67
18.98
0.61
0.70
1.08
0.20
1.16
0.48
0.25
0.71
1.19
0.44
5.49
0.88
0.80
0.36
2.10
0.22
1.10
0.44
0.56
0.11
0.15
0.81
Cost
Weight w/o
Emerg
0.94
1.03
2.26
1.32
2.74
1.43
6.98
3.51
7.47
13.27
1.11
0.71
1.14
0.30
1.19
0.70
0.36
0.79
1.35
0.56
5.54
0.96
0.89
0.50
2.24
0.47
1.18
0.57
0.65
0.25
0.15
0.91
Cost
Weight w/o
ICU
0.95
1.04
2.39
1.33
3.07
1.56
7.75
4.14
7.79
19.12
1.11
0.71
1.14
0.30
1.20
0.70
0.37
0.84
1.36
0.57
5.58
0.98
0.89
0.50
2.26
0.48
1.19
0.57
0.66
0.25
0.15
0.91
Cost
weight w
all cost
groups
0.78
0.48
0.37
0.20
0.41
0.38
0.96
0.54
0.66
0.39
0.38
0.10
0.18
0.20
0.36
0.22
0.24
0.27
0.64
0.20
1.33
0.67
0.30
0.22
0.31
0.25
0.13
0.28
0.25
0.44
0.36
0.44
0.27
0.25
0.07
0.12
0.22
0.24
0.15
0.18
0.18
0.43
0.13
0.44
0.44
0.21
0.09
0.34
0.12
0.40
0.16
0.07
0.12
0.16
0.15
0.31
Outlier per
diem as a
weight
0.36
0.22
0.23
0.11
0.19
0.11
0.15
0.55
Transfer
cost weight
750
1,050
850
450
950
850
1500
1,200
1,500
900
850
250
4
5
19
4
26
3
48
18
43
60
14
14
3
14
750
13
8
7
12
9
5
60
12
14
7
41
9
18
5
3
3
3
10
High trim
point (days)
400
800
500
600
600
1,450
450
1,500
1,500
700
1,150
300
1,350
550
250
400
550
500
1,050
Outlier
per diem
amount ($)
Appendix 1: Acute Care Cost Weights Part 1: General Cost weights (Overnight)
46
Allergic Reactions
X61Z
124
Burns, Transferred to Another Acute Care Facility < 5 Days
Y60Z
Other Burns Age<65 W/O Catastr or Severe CC W/O Complicating
O.R. Procedures W Diagnoses of Other Contacts W Health Servic
O.R. Procedures W Diagnoses Other Contacts W Health Services
Follow Up After Completed Treatment W Endoscopy
Signs and Symptoms
Follow Up After Completed Treatment W/O Endoscopy
Other Aftercare W Catastrophic or Severe CC
Other Aftercare W/O Catastrophic or Severe CC
Other Factors Influencing Health Status
Y62B
Z01A
Z01B
Z40Z
Z61Z
Z62Z
Z63A
Z63B
Z64A
Severe Burns
Other O.R. Procedures for Other Burns
Y03Z
Other Burns Age>64 or W Catastr or Severe CC or W Complicatin
Other Burns W Skin Graft Age<65 W/O Cat or Sev CC W/O
Complic
Y02B
Y61Z
Other Burns W Skin Graft Age>64 or W Cat/Sev CC or W
Complicg
Y02A
Y62A
380
Severe Full Thickness Burns
Y01Z
279
1,674
883
1,216
206
1,118
7,392
444
288
729
87
72
333
107
34
649
Other Injury, Poisoning and Toxic Effect Diagnosis Age>59 or
Other Injury, Poisoning and Toxic Effect Diagnosis Age<60 W/O
X64A
2,586
754
3,561
2,600
859
4,727
1,397
2,006
208
132
1,780
498
Seps
X64B
Sequelae of Treatment W/O Catastrophic or Severe CC
Injuries Age<65
X60C
Sequelae of Treatment W Catastrophic or Severe CC
Injuries Age >64 W/O CC
X60B
X63B
Injuries Age>64 W CC
X60A
X63A
Skin Grafts for Injuries Excluding Hand W/O Cat or Sev CC
X07B
Poisoning/Toxic Effects of Drugs & Other Substances Age>59 or
Mic Tissue Transfer or (Skin Graft W Cat/Sev CC) for Injuries
X07A
Poisoning/Toxic Effects of Drugs & Other Substances Age<60 W/
Other Procedures for Other Injuries W/O Catastrophic or Sever
X06B
X62A
Other Procedures for Other Injuries W Catastrophic or Severe
X06A
X62B
AR-DRG Title
AR-DRG
V5.0 No.
0.04
0.02
0.04
0.04
0.03
0.02
0.04
0.11
0.02
0.16
0.13
0.01
0.13
0.20
0.39
2.99
0.01
0.05
0.02
0.05
0.01
0.02
0.01
0.01
0.02
0.04
0.13
0.37
0.03
0.11
Standard
error
0.86
0.51
1.41
0.51
0.66
0.35
0.86
1.58
0.44
2.00
1.21
0.15
1.63
2.56
6.04
24.77
0.25
0.77
0.58
1.38
0.27
0.62
0.23
0.34
0.44
1.17
2.43
5.49
0.95
3.07
Cost
Weight w/o
Emerg &
ICU
0.86
0.52
1.45
0.51
0.67
0.35
0.87
1.66
0.46
2.16
1.33
0.19
1.67
2.59
6.19
31.72
0.28
0.83
0.59
1.47
0.30
0.75
0.26
0.34
0.44
1.18
2.43
5.66
0.97
3.42
Cost
Weight w/o
Emerg
0.91
0.51
1.43
0.51
0.75
0.35
0.87
1.58
0.53
2.07
1.28
0.36
1.71
2.57
6.11
24.79
0.32
0.97
0.68
1.48
0.40
0.77
0.35
0.45
0.57
1.33
2.52
5.60
1.03
3.16
Cost
Weight w/o
ICU
0.91
0.52
1.47
0.52
0.76
0.35
0.87
1.67
0.54
2.22
1.40
0.40
1.75
2.60
6.26
31.73
0.34
1.03
0.69
1.57
0.43
0.90
0.38
0.45
0.58
1.34
2.52
5.76
1.05
3.51
Cost
weight w
all cost
groups
0.16
0.35
0.35
0.36
0.30
0.65
0.30
0.78
1.12
0.44
0.24
0.12
0.24
0.07
0.34
0.21
0.27
0.22
0.41
0.22
0.44
0.69
0.34
0.22
0.21
0.44
0.44
0.22
0.10
0.10
0.10
0.15
0.32
0.72
1.33
0.34
0.16
0.15
0.15
0.25
0.15
0.16
0.25
0.23
0.25
0.15
0.15
0.34
0.41
0.43
0.27
0.28
Outlier per
diem as a
weight
0.23
0.37
0.27
0.45
0.63
0.64
0.91
0.43
Transfer
cost weight
800
400
800
250
1,150
700
900
750
1,400
750
1,500
750
700
1,500
1,500
750
350
350
350
550
500
550
850
500
500
1,150
1,400
1,450
900
950
Outlier
per diem
amount ($)
16
9
23
5
13
3
4
11
5
22
16
3
17
28
41
60
3
14
7
16
3
9
3
4
10
23
27
45
6
26
High trim
point (days)
Appendix 1: Acute Care Cost Weights Part 1: General Cost weights (Overnight)
47
AR-DRG Title
Other Factors Influencing Health Status, Sameday
Multiple, Other and Unspecified Congenital Anomalies
AR-DRG
V5.0 No.
Z64B
Z65Z
79
6,255
Seps
0.15
0.02
Standard
error
1.04
0.31
Cost
Weight w/o
Emerg &
ICU
1.05
0.31
Cost
Weight w/o
Emerg
1.06
0.32
Cost
Weight w/o
ICU
1.07
0.32
Cost
weight w
all cost
groups
0.24
0.30
Transfer
cost weight
0.16
0.21
Outlier per
diem as a
weight
550
700
Outlier
per diem
amount ($)
10
3
High trim
point (days)
Appendix 1: Acute Care Cost Weights Part 1: General Cost weights (Overnight)
48
ACUTE CARE COST WEIGHTS
PART 2 SAME DAY
Appendix 1: Acute Care Cost Weights
Part 2: Same Day Cost Weights
49
Appendix 1: Acute Care Cost Weights
Part 2: Same Day Cost Weights for selected DRGS
Descriptions of the abbreviations shown
in tables are as follows:
AR-DRG No.
AR-DRG V5.0 number
AR-DRG Title
AR-DRG V5.0 description
Same day Seps (No.)
Total same day separations
Seps w/o same day ED cases (No)
Same day separations excluding same day cases
treated in ED
Standard error
Standard error of the cost weight
Cost Weight w/o ED & ICU
Cost weight excluding ED and ICU cost groups
Cost Weight w all cost groups
Cost weight including all cost groups
Cost Weight w/o ED
Cost weight excluding ED cost group
Cost Weight w/o ICU
Cost weight excluding ICU cost group
50
589
39
Spinal Procedures W/O Catastrophic or Severe CC Day Case
Procs for Cerebral Palsy, Muscular Dystrophy, Neuropathy W/O Day Case
Established Paraplegia/Quadriplegia W or W/O O.R. Procs W/O C Day Case
Cerebral Palsy Day Case
Nervous System Neoplasm W/O Catastrophic or Severe CC Day Case
Degenerative Nervous System Disorders Age >59 W/O Catastr or Day Case
Degenerative Nervous System Disorders Age <60 W/O Catastrophi Day Case
Multiple Sclerosis and Cerebellar Ataxia W/O CC Day Case
Cranial and Peripheral Nerve Disorders W/O CC Day Case
Seizure W/O Catastrophic or Severe CC Day Case
Headache Day Case
Other Head Injury Day Case
Other Disorders of the Nervous System W/O Catastrophic or Sev Day Case
Enucleations and Orbital Procedures Day Case
Dacryocystorhinostomy Day Case
B03B
B06B
B60B
B65Z
B66B
B67B
B67C
B68B
B71B
B76B
B77Z
B80Z
B81B
C02Z
C05Z
216
Ear, Nose, Mouth and Throat Malignancy W/O Catastrophic or Se Day Case
Dysequilibrium Day Case
D60B
D61Z
Cystic Fibrosis W/O Catastrophic or Severe CC Day Case
Pulmonary Embolism W/O Catastrophic or Severe CC Day Case
Respiratory Neoplasms W Severe or Moderate CC Day Case
Respiratory Neoplasms W/O CC Day Case
Interstitial Lung Disease W/O Catastrophic or Severe CC Day Case
Other Respiratory System Diagnosis (Age<65 W CC) or (Age>64 W Day Case
E60B
E61B
E71B
E71C
E74C
E75B
Epistaxis Day Case
Dental Extractions and Restorations Day Case
D40Z
Other Ear, Nose, Mouth and Throat Diagnoses W/O CC Day Case
Mouth & Salivary Gland Procedures Day Case
D14Z
D62Z
Maxillo Surgery W/O CC Day Case
D04B
D66B
314
Other Disorders of the Eye W/O CC Day Case
C63B
571
191
112
385
253
112
50
1,331
258
5,151
623
105
725
149
Other Corneal, Scleral and Conjunctival Procedures Day Case
Neurological & Vascular Disorders of the Eye Day Case
C12Z
C61Z
148
517
657
1,062
1,464
440
799
240
186
371
236
409
29
119
Extensive O.R. Procedure Unrelated to Principal Diagnosis Day Case
901Z
Same day seps
AR-DRG Title
AR-DRG
V5.0 No.
0.05
0.06
0.05
0.07
0.03
0.21
0.01
0.01
0.02
0.05
0.04
0.04
0.20
0.02
0.02
0.06
0.08
0.16
0.04
0.02
0.02
0.02
0.02
0.03
0.03
0.03
0.05
0.10
0.10
0.07
0.64
0.19
Standard
error
0.60
0.51
0.65
0.65
0.30
0.85
0.34
0.21
0.17
0.72
0.54
0.74
1.38
0.31
0.29
0.85
0.82
0.95
0.48
0.21
0.23
0.31
0.25
0.27
0.21
0.21
0.53
0.85
0.73
1.06
1.71
2.09
Cost
Weight
w/o Emerg &
ICU*
0.64
0.51
0.65
0.65
0.30
0.85
0.34
0.21
0.17
0.72
0.54
0.74
1.38
0.31
0.29
0.85
0.82
0.95
0.48
0.21
0.23
0.31
0.25
0.27
0.21
0.21
0.53
0.85
0.73
1.06
1.71
2.09
Cost
Weight
w/o
Emerg
0.69
0.53
0.68
0.68
0.39
0.87
0.36
0.32
0.34
0.73
0.55
0.74
1.44
0.34
0.30
0.86
0.83
0.95
0.57
0.34
0.39
0.44
0.26
0.28
0.22
0.22
0.55
0.85
0.82
1.07
1.71
2.16
Cost
Weight
w/o ICU
0.73
0.53
0.68
0.68
0.39
0.87
0.36
0.32
0.34
0.73
0.55
0.74
1.44
0.34
0.30
0.86
0.83
0.95
0.57
0.34
0.39
0.44
0.26
0.28
0.22
0.22
0.55
0.85
0.82
1.07
1.71
2.16
Cost
weight w
all cost
groups
Appendix 1: Acute Care Cost Weights Part 2: Same Day Cost weights for selected AR-DRGs
51
251
Digestive Malignancy W Catastrophic or Severe CC Day Case
Digestive Malignancy W/O Catastrophic or Severe CC Day Case
Inflammatory Bowel Disease Day Case
Abdominal Pain or Mesenteric Adenitis W CC Day Case
Abdominal Pain or Mesenteric Adenitis W/O CC Day Case
Oesophagitis, Gastroent & Misc Digestive Systm Disorders Age> Day Case
Oesophagitis and Misc Digestive System Disorders Age<10 Day Case
Other Digestive System Diagnoses W CC Day Case
Other Digestive System Diagnoses W/O CC Day Case
Laparoscopic Cholecystectomy W/O Closed CDE W/O Catastrophic/ Day Case
ERCP Complex Therapeutic Procedure W/O Catastrophic or Severe Day Case
ERCP Other Therapeutic Procedure W/O CC Day Case
Cirrhosis and Alcoholic Hepatitis W Severe CC Day Case
Cirrhosis and Alcoholic Hepatitis W/O Catastrophic or Severe Day Case
G60A
G60B
G64Z
G66A
G66B
G67B
G69Z
G70A
G70B
H08B
H41B
H42C
H60B
H60C
Inguinal and Femoral Hernia Procedures Age>0 Day Case
Anal and Stomal Procedures W/O Catastrophic or Severe CC Day Case
Abdominal and Other Hernia Procedures Age 1 to 59 W/O Cat or Day Case
G09Z
204
Abdominal and Other Hernia Procedures Age >59 or W Catastroph Day Case
G08A
G08B
G11B
329
222
121
419
261
220
1,163
237
175
1,865
1021
160
489
276
143
4,772
1,482
918
2,727
493
1,313
276
100
Other Circulatory System Diagnoses W/O Catastrophic or Severe Day Case
Hypertension W/O CC Day Case
F67B
Chest Pain Day Case
Coronary Atherosclerosis W/O CC Day Case
F66B
109
677
F75C
Peripheral Vascular Disorders W/O Catastrophic or Severe CC Day Case
F65B
F74Z
Venous Thrombosis W/O Catastrophic or Severe CC Day Case
F63B
345
1,892
Syncope and Collapse W/O Catastrophic or Severe CC Day Case
Circulatory Disorders W/O AMI W Invasive Cardiac Inves Proc W Day Case
F42B
F73B
Circulatory Disorders W/O AMI W Invasive Cardiac Inves Proc W Day Case
F42A
69
212
Valvular Disorders W/O Catastrophic or Severe CC Day Case
Other Circulatory System O.R. Procedures W/O Catastrophic CC Day Case
F21B
Non-Major Arrhythmia and Conduction Disorders W/O Catastrophi Day Case
Vascular Procs Except Major Reconstruction W/O CPB Pump W/O C Day Case
F14C
150
F69B
Cardiac Pacemaker Implantation Day Case
F12Z
Same day seps
F71B
AR-DRG Title
AR-DRG
V5.0 No.
0.02
0.06
0.07
0.15
0.12
0.02
0.04
0.03
0.02
0.02
0.02
0.06
0.04
0.06
0.03
0.06
0.05
0.06
0.04
0.01
0.02
0.03
0.02
0.03
0.02
0.03
0.02
0.08
0.08
0.14
0.06
0.27
Standard
error
0.37
0.37
0.67
1.03
1.33
0.30
0.30
0.30
0.22
0.26
0.26
0.78
0.49
0.49
0.64
0.94
0.91
0.91
0.50
0.21
0.20
0.36
0.27
0.22
0.29
0.36
0.18
0.52
0.52
1.11
0.95
1.74
Cost
Weight
w/o Emerg &
ICU*
0.37
0.37
0.67
1.03
1.33
0.30
0.30
0.30
0.22
0.26
0.26
0.78
0.49
0.49
0.64
0.94
0.91
0.91
0.50
0.21
0.20
0.39
0.27
0.22
0.29
0.36
0.18
0.52
0.52
1.11
0.95
1.74
Cost
Weight
w/o
Emerg
0.37
0.37
0.68
1.03
1.34
0.36
0.36
0.45
0.37
0.42
0.42
0.80
0.51
0.51
0.65
0.95
0.92
0.92
0.62
0.36
0.33
0.45
0.38
0.27
0.36
0.40
0.27
0.52
0.52
1.12
0.95
1.75
Cost
Weight
w/o ICU
0.37
0.37
0.68
1.03
1.34
0.36
0.36
0.45
0.37
0.42
0.42
0.80
0.51
0.51
0.65
0.95
0.92
0.92
0.62
0.36
0.33
0.47
0.38
0.27
0.36
0.41
0.27
0.52
0.52
1.12
0.95
1.75
Cost
weight w
all cost
groups
Appendix 1: Acute Care Cost Weights Part 2: Same Day Cost weights for selected AR-DRGs
52
Other Knee Procedures Day Case
Other Elbow or Forearm Procedures Day Case
Soft Tissue Procedures W/O Catastrophic or Severe CC Day Case
Other Connective Tissue Procedures W/O CC Day Case
I18Z
I19Z
I27B
I28B
Renal Failure W/O Catastrophic or Severe CC Day Case
Kidney, Ureter & Major Bladder Procedures for Non-Neoplasm W Day Case
L04B
L60C
Endocrine Disorders W/O Catastrophic or Severe CC Day Case
K64B
Minor Bladder Procedures W/O Catastrophic or Severe CC Day Case
Endocrine Disorders W Catastrophic or Severe CC Day Case
K64A
Transurethral Procedures Except Prostatectomy W/O Catastrophi Day Case
Inborn Errors of Metabolism Day Case
K63Z
L06B
Miscellaneous Metabolic Disorders W/O Catastrophic or Severe Day Case
K62C
L07B
Miscellaneous Metabolic Disorders W Severe CC or (Age>74 W/O Day Case
Other Skin, Subcutaneous Tissue and Breast Procedures Day Case
Lower Limb Procs W/O Ulcer/Cellulitis W/O (Skin Graft & Catas Day Case
J11Z
J13B
Diabetes W/O Catastrophic or Severe CC Day Case
Other Skin Graft and/or Debridement Procedures W/O Catastroph Day Case
J08B
K62B
76
Other Musculoskeletal Disorders Age<70 W/O CC Day Case
I76C
K60B
214
Aftercare of Connective Tissue Disorders Age<60 W/O Catastrop Day Case
Malignant Breast Disorders W Catastrophic or Severe CC or (Ag Day Case
6,815
Aftercare Conn Tiss Disorder (Age<60 W Cat/Sev CC) or (Age>59 Day Case
I73B
I73C
Other Endocrine, Nutritional and Metabolic O.R. Procedures Day Case
1,701
Tendonitis, Myositis and Bursitis Age<80 W/O Catastrophic or Day Case
I72B
J62A
99
Musculotendinous Disorders Age <70 W/O CC Day Case
I71C
K09Z
349
Bone Diseases & Spec Arthropathies Age<75 W/O Catastr or Seve Day Case
I69C
547
1,945
177
131
566
34
357
651
209
313
32
794
320
336
911
526
1,583
Inflammatory Musculoskeletal Disorders W/O Cat or Sev CC Day Case
Bone Diseases&Spec Arthropathies(A<75 W Cat/Sev CC) or (A>74 Day Case
I66B
135
67
293
730
407
3,663
438
419
154
Same day seps
I69B
Osteomyelitis W/O CC Day Case
Disorders of the Biliary Tract W/O CC Day Case
H64B
Connective Tissue Malignancy, including Pathological Fx W/O C Day Case
Disorders of Liver Excep Malig, Cirrhosis, Alcoholic Hepatiti Day Case
H63B
I64B
Malig Hepatobilry Sys, Pancreas (A<70 W/O Cat CC) or (A>69 W/ Day Case
H61B
I65B
AR-DRG Title
AR-DRG
V5.0 No.
0.02
0.04
0.07
0.24
0.02
0.09
0.06
0.02
0.03
0.03
0.20
0.07
0.05
0.02
0.04
0.02
0.03
0.03
0.03
0.02
0.03
0.03
0.03
0.05
0.04
0.06
0.03
0.07
0.04
0.03
0.06
0.06
Standard
error
0.26
0.79
0.79
1.81
0.45
0.45
0.35
0.30
0.30
0.30
1.09
0.34
0.97
0.52
0.91
0.39
0.36
0.36
0.34
0.25
0.27
0.27
0.30
0.55
0.27
1.04
0.80
1.19
0.86
0.35
0.62
0.56
Cost
Weight
w/o Emerg &
ICU*
0.26
0.79
0.79
1.81
0.45
0.45
0.35
0.30
0.30
0.32
1.09
0.34
0.97
0.52
0.91
0.39
0.36
0.36
0.34
0.25
0.27
0.27
0.30
0.55
0.27
1.04
0.80
1.19
0.86
0.35
0.62
0.56
Cost
Weight
w/o
Emerg
0.28
0.80
0.80
1.85
0.48
0.48
0.35
0.36
0.36
0.44
1.09
0.39
0.99
0.53
0.92
0.41
0.37
0.37
0.38
0.29
0.28
0.28
0.31
0.60
0.31
1.05
0.83
1.24
0.87
0.48
0.63
0.62
Cost
Weight
w/o ICU
0.28
0.80
0.80
1.85
0.48
0.48
0.35
0.36
0.36
0.46
1.09
0.39
0.99
0.53
0.92
0.41
0.37
0.37
0.38
0.29
0.28
0.28
0.31
0.60
0.31
1.05
0.83
1.24
0.87
0.48
0.63
0.62
Cost
weight w
all cost
groups
Appendix 1: Acute Care Cost Weights Part 2: Same Day Cost weights for selected AR-DRGs
53
427
217
Urinary Stones and Obstruction Day Case
Kidney and Urinary Tract Signs and Symptoms W/O Catastrophic Day Case
L64Z
L65B
3,622
4,619
Penis Procedures W/O CC Day Case
Malignancy, Male Reproductive System W/O Catastrophic or Seve Day Case
Uterine, Adnexa Procedure for Non-Ovarian or Adnexal Malignan Day Case
Other Uterine and Adnexa Procedures for Non-Malignancy Day Case
M03B
M60B
N03B
N07Z
Other Infectious and Parasitic Diseases W/O Catastrophic or S Day Case
Other Drug Use Disorder and Dependence Day Case
Other Procedures for Injuries to Hand Day Case
Other Procedures for Other Injuries W/O Catastrophic or Sever Day Case
Injuries Age>64 W CC Day Case
Injuries Age >64 W/O CC Day Case
Injuries Age<65 Day Case
O.R. Procedures W Diagnoses of Other Contacts W Health Servic Day Case
O.R. Procedures W Diagnoses Other Contacts W Health Services Day Case
Signs and Symptoms Day Case
Follow Up After Completed Treatment W/O Endoscopy Day Case
Other Aftercare W/O Catastrophic or Severe CC Day Case
X05Z
X06B
X60A
X60B
X60C
Z01A
Z01B
Z61Z
Z62Z
Z63B
Acute Leukaemia W Catastrophic CC Day Case
R60A
V64Z
Coagulation Disorders Day Case
Q62Z
T64B
169
Red Blood Cell Disorders W/O Catastrophic or Severe CC Day Case
Acute Leukaemia W Severe CC Day Case
Red Blood Cell Disorders W Severe CC Day Case
Q61B
Q61C
Acute Leukaemia W/O Catastrophic or Severe CC Day Case
51
Red Blood Cell Disorders W Catastrophic CC Day Case
Q61A
R60B
207
Reticuloendothelial and Immunity Disorders W/O Cat or Sev CC Day Case
Q60C
R60C
67
Reticuloendothelial and Immunity Disorders W/O Cat or Sev CC Day Case
Q60B
172
2,022
780
856
271
1,582
206
150
504
663
59
63
935
726
6,638
3,580
69
538
Conisation, Vagina, Cervix and Vulva Procedures Day Case
False Labour Before 37 Weeks or W Catastrophic CC Day Case
N09Z
O64A
30
328
295
2,495
Other Kidney and Urinary Tract Diagnoses W Severe CC Day Case
Other Kidney and Urinary Tract Diagnoses W/O Catastrophic or Day Case
L67B
L67C
934
195
Kidney and Urinary Tract Neoplasms W/O Catastrophic or Severe Day Case
L62B
Same day seps
AR-DRG Title
AR-DRG
V5.0 No.
0.02
0.01
0.04
0.03
0.06
0.02
0.03
0.04
0.06
0.06
0.03
0.05
0.07
0.07
0.07
0.03
0.02
0.02
0.03
0.01
0.04
0.03
0.02
0.03
0.21
0.04
0.06
0.03
0.06
0.03
0.02
0.03
Standard
error
0.30
0.27
0.49
0.66
0.66
0.30
0.30
0.30
0.79
0.68
0.26
0.40
0.47
0.47
0.47
0.26
0.26
0.26
0.26
0.21
0.21
0.33
0.56
0.80
1.26
0.50
0.83
0.30
0.30
0.29
0.26
0.34
Cost
Weight
w/o Emerg &
ICU*
0.30
0.27
0.49
0.66
0.66
0.30
0.30
0.30
0.79
0.68
0.26
0.40
0.47
0.47
0.47
0.26
0.26
0.26
0.26
0.21
0.21
0.33
0.56
0.81
1.26
0.50
0.83
0.30
0.30
0.29
0.26
0.34
Cost
Weight
w/o
Emerg
0.31
0.27
0.54
0.67
0.67
0.46
0.46
0.46
0.90
0.79
0.38
0.42
0.49
0.49
0.49
0.31
0.26
0.26
0.26
0.22
0.22
0.34
0.57
0.81
1.29
0.51
0.86
0.32
0.32
0.38
0.41
0.36
Cost
Weight
w/o ICU
0.31
0.27
0.54
0.67
0.67
0.46
0.46
0.46
0.90
0.79
0.38
0.42
0.49
0.49
0.49
0.31
0.26
0.26
0.26
0.22
0.22
0.34
0.57
0.81
1.29
0.51
0.86
0.32
0.32
0.38
0.41
0.36
Cost
weight w
all cost
groups
Appendix 1: Acute Care Cost Weights Part 2: Same Day Cost weights for selected AR-DRGs
54
ACUTE CARE COST WEIGHTS
(REBASED)
Appendix 1A: Acute Care Cost Weights
(Rebased)
55
Appendix 1a: Acute Care Cost Weights
Part 1: General Cost Weights (Rebased)
Descriptions of the abbreviations shown
in tables are as follows:
AR-DRG No.
AR-DRG V5.0 number
AR-DRG Title
AR-DRG V5.0 description
Seps (No.)
Total separations
Seps w/o same day ED cases (No)
Separations excluding same day cases treated in ED
Standard error
Standard error of the cost weight
Cost Weight w/o ED & ICU
Cost weight excluding ED and ICU cost groups
Cost Weight w all cost groups
Cost weight including all cost groups
Cost Weight w/o ED
Cost weight excluding ED cost group
Cost Weight w/o ICU
Cost weight excluding ICU cost group
Transfer cost weight
Same day and one day overnight transfer cost
weight, based on base cost of cost weights with
ED and ICU cost groups excluded
Outlier per diem weight
Long stay outlier per diem weight, based on base
cost of cost weights with ED and ICU cost groups
excluded
Outlier per diem amount ($)
Long stay outlier per diem payment ($)
High trim point (days)
AR-DRG trim point in days
56
ECMO W/O Cardiac Surgery
Intubation Age<16 W CC
A40Z
A41A
Craniotomy W/O CC
Spinal Procedures W Catastrophic or Severe CC
Spinal Procedures W/O Catastrophic or Severe CC
Extracranial Vascular Procedures W Catastrophic or Severe CC
Extracranial Vascular Procedures W/O Catastrophic or Severe C
Carpal Tunnel Release
Procs for Cerebral Palsy, Muscular Dystrophy, Neuropathy W C
Procs for Cerebral Palsy, Muscular Dystrophy, Neuropathy W/O
Peripheral and Cranial Nerve & Other Nervous System Procedure
Peripheral and Cranial Nerve & Other Nervous System Procedure
Plasmapheresis W Neurological Disease
Telemetric EEG Monitoring
Established Paraplegia/Quadriplegia W or W/O O.R. Procs W Cat
Established Paraplegia/Quadriplegia W or W/O O.R. Procs W/O C
B02C
B03A
B03B
B04A
B04B
B05Z
B06A
B06B
B07A
B07B
B40Z
B41Z
B60A
B60B
1,008
374
252
88
956
153
292
74
2,859
424
228
325
81
577
93
154
145
22
109
1,029
Renal Transplant W/O Pancreas Transplant W/O Catastrophic CC
A09B
78
122
716
Renal Transplant W Pancreas Transplant or Catastrophic CC
A09A
Craniotomy W Severe or Moderate CC
Autologous Bone Marrow Transplant W/O Catastrophic CC
A08B
119
139
Craniotomy W Catastrophic CC
Autologous Bone Marrow Transplant W Catastrophic CC
A08A
B02B
Allogeneic Bone Marrow Transplant
A07Z
18
2,814
B02A
Tracheostomy Any Age, Any Condition
A06Z
Intubation Age<16 W/O CC
Heart Transplant
A05Z
57
36
Ventricular Shunt Revision
Lung or Heart/Lung Transplant
A03Z
A41B
Liver Transplant
A01Z
15
268
893
Seps
B01Z
Non-Extensive O.R. Procedure Unrelated to Principal Diagnosis
Prostatic O.R. Procedure Unrelated to Principal Diagnosis
902Z
Extensive O.R. Procedure Unrelated to Principal Diagnosis
901Z
903Z
AR-DRG Title
AR-DRG
V5.0 No.
0.21
0.34
0.12
0.26
0.16
0.08
0.12
0.34
0.06
0.06
0.15
0.21
0.33
0.38
0.25
0.58
0.07
0.13
0.47
1.60
0.69
0.55
0.46
1.16
1.75
2.17
0.76
1.85
0.36
1.35
0.18
0.20
Standard
error
2.52
7.27
2.14
1.26
1.18
2.50
2.44
6.59
0.58
1.94
3.86
2.95
7.19
3.76
5.22
8.86
2.81
1.33
5.21
19.08
11.23
18.17
7.12
14.82
27.10
15.89
20.81
20.84
31.73
7.40
2.61
5.21
Cost
Weight w/o
Emerg &
ICU
2.59
8.03
2.17
1.42
1.19
2.69
2.46
6.80
0.58
2.11
4.30
3.03
7.43
4.21
5.92
10.54
2.91
2.37
6.67
31.62
11.36
19.15
7.12
15.54
29.64
33.27
35.14
27.70
35.95
7.94
2.76
5.53
Cost
Weight w/o
Emerg
2.63
7.50
2.17
1.30
1.27
2.67
2.44
6.68
0.59
1.96
3.89
2.97
7.26
3.81
5.27
8.94
2.91
1.61
5.41
19.10
11.25
18.20
7.12
14.85
27.11
16.01
20.94
20.97
31.80
7.62
2.68
5.30
Cost
Weight w/o
ICU
2.70
8.26
2.20
1.45
1.28
2.86
2.47
6.89
0.59
2.12
4.33
3.05
7.49
4.26
5.98
10.62
3.01
2.65
6.87
31.65
11.38
19.18
7.13
15.58
29.65
33.39
35.27
27.83
36.02
8.16
2.83
5.63
Cost
weight w
all cost
groups
0.94
0.40
0.31
0.95
0.25
0.37
1.28
0.66
0.39
0.39
0.12
2.06
0.75
0.65
0.63
0.84
0.65
1.08
1.14
0.17
1.44
0.39
0.28
0.34
0.27
0.21
0.48
0.16
0.26
0.32
0.43
0.26
0.26
0.08
0.48
0.48
0.43
0.42
0.48
0.43
0.48
0.48
0.11
0.48
0.26
0.19
0.48
0.48
1.15
0.10
0.40
0.48
0.48
0.46
0.18
0.43
Outlier per
diem as a
weight
1.38
0.14
0.60
0.85
1.00
0.69
0.27
2.42
Transfer
cost weight
1,050
850
650
1,500
500
800
1,000
1,350
800
800
250
1,500
20
48
15
35
4
27
10
60
3
7
24
13
19
45
1,350
30
55
17
17
34
60
18
41
44
45
60
60
60
60
60
60
35
47
High trim
point (days)
1,500
1,300
1,500
1,350
1,500
1,500
350
1,500
800
600
1,500
1,500
300
1,250
1,500
1,500
1,450
550
1,350
Outlier
per diem
amount ($)
Appendix 1A: Acute Care Cost Weights (Rebased)
Part 1: General Cost weights
57
Nervous System Infection Except Viral Meningitis W Cat or Sev
Viral Meningitis
Nontraumatic Stupor and Coma
Febrile Convulsions
Seizure or W Catastrophic or Severe CC
Seizure W/O Catastrophic or Severe CC
Headache
Intracranial Injury W Catastrophic or Severe CC
Intracranial Injury W/O Catastrophic or Severe CC
B73Z
B74Z
B75Z
B76A
B76B
B77Z
B78A
B78B
Cranial and Peripheral Nerve Disorders W/O CC
B71B
Nervous System Infection Except Viral Meningitis W/O Cat or S
Cranial and Peripheral Nerve Disorders W CC
B71A
B72A
Stroke, Died or Transferred < 5 days
B70D
B72B
Stroke W/O Catastrophic or Severe CC
B70C
Degenerative Nervous System Disorders Age <60 W/O Catastrophi
B67C
Stroke W Severe CC
Degenerative Nervous System Disorders Age >59 W/O Catastr or
B67B
Stroke W Catastrophic CC
Degenerative Nervous System Disorders W Catastrophic or Sever
B67A
B70B
Nervous System Neoplasm W/O Catastrophic or Severe CC
B66B
B70A
Nervous System Neoplasm W Catastrophic or Severe CC
B66A
TIA and Precerebral Occlusion W/O Catastrophic or Severe CC
Cerebral Palsy
B65Z
TIA and Precerebral Occlusion W Catastrophic or Severe CC
Delirium W/O Catastrophic CC
B64B
B69B
Delirium W Catastrophic CC
B64A
B69A
Dementia and Other Chronic Disturbances of Cerebral Function
B63Z
Multiple Sclerosis and Cerebellar Ataxia W CC
Admit for Apheresis
B62Z
Multiple Sclerosis and Cerebellar Ataxia W/O CC
Spinal Cord Conditions W or W/O O.R. Procedures W/O Catastrop
B61B
B68A
Spinal Cord Conditions W or W/O O.R. Procedures W Catastrophi
B61A
B68B
AR-DRG Title
AR-DRG
V5.0 No.
1,028
430
2,521
4,537
1,273
1,097
282
526
539
172
746
559
1,934
2,458
2,649
2,223
2,555
1,042
338
185
434
644
622
648
771
93
1,490
456
1,942
471
257
116
Seps
0.06
0.15
0.02
0.02
0.08
0.01
0.04
0.06
0.06
0.18
0.06
0.10
0.02
0.07
0.08
0.16
0.02
0.06
0.03
0.13
0.09
0.09
0.16
0.05
0.12
0.07
0.15
0.09
0.12
0.01
0.23
0.43
Standard
error
1.21
3.20
0.51
0.57
1.61
0.42
0.89
0.88
1.79
3.77
0.92
2.35
0.48
1.63
2.68
5.28
0.77
1.51
0.98
2.40
1.24
1.55
3.55
1.26
2.51
1.92
1.28
2.87
2.48
0.22
2.08
7.16
Cost
Weight w/o
Emerg &
ICU
1.31
3.56
0.52
0.60
1.75
0.43
0.94
0.90
1.90
3.99
0.93
2.40
0.52
1.67
2.73
5.40
0.78
1.53
0.98
2.48
1.26
1.57
3.69
1.28
2.53
1.94
1.30
2.92
2.49
0.22
2.12
7.66
Cost
Weight w/o
Emerg
1.48
3.41
0.64
0.68
1.79
0.53
1.04
1.05
1.93
3.91
1.02
2.51
0.73
1.74
2.82
5.43
0.90
1.66
1.06
2.52
1.33
1.67
3.68
1.39
2.62
1.94
1.47
3.03
2.64
0.22
2.19
7.34
Cost
Weight w/o
ICU
1.58
3.77
0.64
0.71
1.93
0.54
1.09
1.06
2.04
4.13
1.04
2.56
0.77
1.78
2.87
5.54
0.90
1.67
1.06
2.60
1.35
1.69
3.83
1.41
2.64
1.96
1.49
3.07
2.64
0.22
2.23
7.85
Cost
weight w
all cost
groups
0.47
0.58
0.42
0.58
0.38
0.42
0.29
0.48
0.78
0.76
0.40
0.20
0.38
0.42
0.32
0.35
0.30
0.32
0.40
0.50
0.27
0.50
0.32
0.38
0.35
0.48
0.26
0.48
0.19
0.32
0.48
0.48
0.27
0.13
0.26
0.27
0.22
0.24
0.19
0.21
0.22
0.34
0.11
0.18
0.16
0.21
0.24
0.30
0.67
0.14
0.34
0.26
0.27
0.21
0.48
0.48
Outlier per
diem as a
weight
0.46
0.96
0.50
0.38
0.41
0.22
0.81
1.85
Transfer
cost weight
1,000
1,200
1,100
1,500
800
1,500
600
1,000
1,500
1,500
850
15
34
7
7
17
4
15
10
19
38
14
24
5
400
17
850
23
42
11
18
14
25
15
24
37
14
27
7
21
33
36
3
18
51
High trim
point (days)
800
700
750
600
650
700
1,050
350
550
500
650
950
450
1,050
800
850
650
1500,
1,500
Outlier
per diem
amount ($)
Appendix 1A: Acute Care Cost Weights (Rebased)
Part 1: General Cost weights
58
Strabismus Procedures
Eyelid Procedures
Other Corneal, Scleral and Conjunctival Procedures
Lacrimal Procedures
Other Eye Procedures
Glaucoma And Complex Cataract Procedures
Glaucoma And Complex Cataract Procedures, Sameday
Lens Procedures
Lens Procedures, Sameday
Acute and Major Eye Infections Age >54 or W Catastrophic or S
Acute and Major Eye Infections Age <55 W/O Catastrophic or Se
Neurological & Vascular Disorders of the Eye
Hyphema and Medically Managed Trauma to the Eye
Other Disorders of the Eye W CC
Other Disorders of the Eye W/O CC
Cochlear Implant
Head and Neck Procedures W Catastrophic or Severe CC
Head and Neck Procedures W Moderate CC or Malignancy
Head and Neck Procedures W/O CC W/O Malignancy
Surgical Repair for Cleft Lip or Palate Diagnosis
Maxillo Surgery W CC
Maxillo Surgery W/O CC
Parotid Gland Procedures
C10Z
C12Z
C13Z
C14Z
C15A
C15B
C16A
C16B
C60A
C60B
C61Z
C62Z
C63A
C63B
D01Z
D02A
D02B
D02C
D03Z
D04A
D04B
D05Z
Dacryocystorhinostomy
C11Z
Major Corneal, Scleral and Conjunctival Procedures
C05Z
Procedures for Penetrating Eye Injury
C01Z
C04Z
Other Disorders of the Nervous System W/O Catastrophic or Sev
B81B
Enucleations and Orbital Procedures
Other Disorders of the Nervous System W Catastrophic or Sever
B81A
Retinal Procedures
Other Head Injury
B80Z
C02Z
Skull Fractures
B79Z
C03Z
AR-DRG Title
AR-DRG
V5.0 No.
198
703
286
194
111
96
85
102
464
275
802
293
198
186
17,546
578
405
273
719
200
95
1,144
496
105
274
1,758
144
170
1,779
1,057
1,854
728
Seps
0.09
0.11
0.12
0.08
0.09
0.14
0.42
0.54
0.13
0.06
0.02
0.04
0.09
0.16
0.06
0.06
0.04
0.10
0.04
0.03
0.10
0.06
0.04
0.09
0.12
0.04
0.12
0.30
0.09
0.08
0.01
0.04
Standard
error
1.78
1.90
2.48
1.57
1.83
3.43
5.23
6.70
0.62
1.07
0.55
0.99
1.37
3.00
0.85
1.08
0.83
1.62
0.62
0.57
1.21
0.88
0.81
0.88
1.57
0.99
1.58
2.42
0.97
2.18
0.38
0.97
Cost
Weight w/o
Emerg &
ICU
1.79
1.92
2.59
1.58
1.87
3.57
5.48
6.70
0.62
1.07
0.56
0.99
1.37
3.01
0.85
1.09
0.83
1.63
0.62
0.57
1.22
0.89
0.81
0.88
1.57
0.99
1.61
2.43
0.97
2.21
0.42
1.05
Cost
Weight w/o
Emerg
1.79
1.94
2.54
1.57
1.85
3.44
5.25
6.71
0.72
1.16
0.68
1.09
1.45
3.13
0.86
1.09
0.83
1.63
0.63
0.58
1.23
0.90
0.81
0.89
1.57
0.99
1.59
2.48
1.11
2.34
0.49
1.18
Cost
Weight w/o
ICU
1.79
1.96
2.65
1.58
1.89
3.58
5.51
6.71
0.72
1.16
0.70
1.09
1.45
3.14
0.86
1.09
0.83
1.64
0.63
0.58
1.24
0.91
0.82
0.89
1.57
0.99
1.62
2.49
1.12
2.37
0.53
1.27
Cost
weight w
all cost
groups
0.86
1.56
0.24
0.31
0.71
0.75
0.50
0.12
0.45
0.35
0.19
0.50
0.69
0.59
0.29
0.40
0.30
0.24
0.12
0.15
1.12
0.26
0.15
0.48
0.21
0.16
0.21
0.48
0.48
0.34
0.08
0.24
0.22
0.13
0.38
0.46
0.40
0.19
0.27
0.21
0.16
0.08
0.10
0.43
0.18
0.10
0.11
0.32
0.17
0.14
0.37
0.08
0.19
0.16
0.11
0.30
Outlier per
diem as a
weight
1.03
0.20
1.18
0.12
0.60
0.23
0.28
0.45
Transfer
cost weight
1,500
650
500
650
1,500
1,500
1,050
250
750
700
400
1,200
5
6
9
4
8
17
25
3
8
13
9
11
18
12
1,250
3
3
3
9
5
9
13
4
3
3
13
4
11
11
14
28
4
11
High trim
point (days)
1,450
600
850
650
500
250
300
1,350
550
300
1,000
350
450
1,150
250
600
500
350
950
Outlier
per diem
amount ($)
Appendix 1A: Acute Care Cost Weights (Rebased)
Part 1: General Cost weights
59
Ear, Nose, Mouth and Throat Malignancy W/O Catastrophic or Se
Epistaxis
Otitis Media and URI W CC
Otitis Media and URI W/O CC
Laryngotracheitis and Epiglottitis
Nasal Trauma and Deformity
Other Ear, Nose, Mouth and Throat Diagnoses W CC
Other Ear, Nose, Mouth and Throat Diagnoses W/O CC
Oral and Dental Disorders Except Extractions and Restorations
Oral and Dental Disorders Except Extractions and Restorations
Major Chest Procedures W Catastrophic CC
Major Chest Procedures W/O Catastrophic CC
Other Respiratory System O.R. Procedures W Catastrophic CC
Other Respiratory System O.R. Procedures W Severe CC
Other Respiratory System O.R. Procedures W/O Catastrophic or
Respiratory System Diagnosis W Ventilator Support
Respiratory System Diagnosis W Non-invasive Ventilation
Cystic Fibrosis W Catastrophic or Severe CC
Cystic Fibrosis W/O Catastrophic or Severe CC
Pulmonary Embolism W Catastrophic or Severe CC
Pulmonary Embolism W/O Catastrophic or Severe CC
Respiratory Infections/Inflammations W Catastrophic CC
D62Z
D63A
D63B
D64Z
D65Z
D66A
D66B
D67A
D67B
E01A
E01B
E02A
E02B
E02C
E40Z
E41Z
E60A
E60B
E61A
E61B
E62A
Ear, Nose, Mouth and Throat Malignancy W Catastrophic or Seve
D60A
Dysequilibrium
Dental Extractions and Restorations
D40Z
D60B
Mouth & Salivary Gland Procedures
D14Z
D61Z
Myringotomy W Tube Insertion
D13Z
4416,
Tonsillectomy or Adenoidectomy
Other Ear, Nose, Mouth & Throat Procedures
D11Z
Nasal Procedures
D10Z
D12Z
1,660
Miscellaneous Ear, Nose, Mouth & Throat Procedures
D09Z
4,179
1,507
932
473
150
880
362
895
101
158
905
451
1,346
1,647
1,043
429
1,019
1,413
6,247
1,601
768
2,467
362
241
533
428
1,492
592
1,697
1,348
Sinus, Mastoid and Complex Middle Ear Procedures
D06Z
Seps
AR-DRG Title
AR-DRG
V5.0 No.
0.05
0.02
0.07
0.13
0.30
0.31
0.13
0.05
0.10
0.31
0.13
0.25
0.02
0.04
0.02
0.04
0.02
0.01
0.02
0.02
0.01
0.02
0.04
0.19
0.07
0.06
0.03
0.06
0.04
0.03
0.03
0.05
Standard
error
2.49
1.07
2.14
4.45
6.07
3.69
3.03
1.06
2.47
5.38
3.35
6.80
0.25
0.72
0.58
0.84
0.45
0.32
0.46
0.78
0.44
0.55
1.14
3.08
0.93
1.19
0.59
1.07
0.92
1.04
1.08
1.40
Cost
Weight w/o
Emerg &
ICU
2.59
1.09
2.23
4.47
6.11
5.06
5.18
1.13
2.69
5.71
3.55
7.53
0.25
0.74
0.58
0.90
0.45
0.34
0.46
0.78
0.45
0.55
1.14
3.13
0.98
1.28
0.59
1.08
0.92
1.04
1.09
1.41
Cost
Weight w/o
Emerg
2.64
1.18
2.28
4.48
6.12
3.83
3.10
1.07
2.53
5.51
3.39
6.87
0.33
0.83
0.66
0.96
0.50
0.44
0.56
0.89
0.56
0.68
1.15
3.14
0.98
1.22
0.59
1.12
0.93
1.05
1.09
1.40
Cost
Weight w/o
ICU
2.75
1.20
2.38
4.50
6.16
5.21
5.25
1.14
2.75
5.84
3.59
7.60
0.33
0.84
0.67
1.01
0.51
0.46
0.56
0.90
0.57
0.68
1.16
3.20
1.03
1.31
0.59
1.14
0.93
1.05
1.09
1.41
Cost
weight w
all cost
groups
0.41
0.51
0.67
1.10
0.62
0.51
0.76
0.40
0.47
0.39
1.17
0.36
0.25
0.37
0.42
0.44
0.15
0.29
0.46
0.45
0.35
0.27
0.88
0.27
0.40
0.45
0.40
0.42
0.34
0.48
0.27
0.32
0.26
0.48
0.24
0.19
0.24
0.13
0.30
0.10
0.19
0.48
0.30
0.26
0.19
0.24
0.21
0.27
0.41
0.42
0.08
0.18
0.26
0.26
0.06
0.48
Outlier per
diem as a
weight
0.67
0.98
0.12
0.26
0.37
0.39
0.10
0.91
Transfer
cost weight
850
1,250
1,400
1,250
1,300
1,050
1,500
850
1,000
800
1,500
750
26
14
22
27
26
27
29
3
21
43
18
40
7
3
750
6
11
6
3
5
8
6
10
11
32
6
6
9
5
3
3
3
3
High trim
point (days)
600
400
950
300
600
1,500
950
800
600
750
850
650
1,300
250
550
800
800
200
1,500
Outlier
per diem
amount ($)
Appendix 1A: Acute Care Cost Weights (Rebased)
Part 1: General Cost weights
60
571
Pleural Effusion W/O Catastrophic or Severe CC
Interstitial Lung Disease W Catastrophic CC
Interstitial Lung Disease W Severe CC
E73C
E74A
E74B
Implantation or Replacement of AICD, Total System W/O Catastr
Pleural Effusion W Severe CC
E73B
F01B
Pleural Effusion W Catastrophic CC
E73A
Implantation or Replacement of AICD, Total System W Catastr o
Respiratory Problems Arising from Neonatal Period
E72Z
Other Respiratory System Diagnosis Age<65 W/O CC
Respiratory Neoplasms W/O CC
E71C
F01A
Respiratory Neoplasms W Severe or Moderate CC
E71B
E75C
Respiratory Neoplasms W Catastrophic CC
E71A
Other Respiratory System Diagnosis (Age<65 W CC) or (Age>64 W
Whooping Cough and Acute Bronchiolitis W/O CC
E70B
E75B
218
Whooping Cough and Acute Bronchiolitis W CC
E70A
Interstitial Lung Disease W/O Catastrophic or Severe CC
Bronchitis and Asthma Age<50 W/O CC
E69C
Other Respiratory System Diagnosis Age>64 W CC
Bronchitis and Asthma (Age<50 W CC) or (Age>49 W/O CC)
E69B
E74C
Bronchitis and Asthma Age>49 W CC
E69A
E75A
177
Pneumothorax
E68Z
579
305
355
1,697
1,731
2,111
120
584
382
285
65
427
1,557
924
4,185
425
8,239
1,834
869
1,018
2,370
Respiratory Signs and Symptoms W Catastrophic or Severe CC
Respiratory Signs and Symptoms W/O Catastrophic or Severe CC
379
E67A
Major Chest Trauma Age<70 W/O CC
E66C
374
7,032
E67B
Major Chest Trauma (Age<70 W CC) or (Age>69 W/O CC)
E66B
6,909
Chronic Obstructive Airways Disease W/O Catastrophic or Sever
Major Chest Trauma Age>69 W CC
Pulmonary Oedema and Respiratory Failure
Chronic Obstructive Airways Disease W Catastrophic or Severe
E64Z
E65A
E65B
751
6,609
Sleep Apnoea
E63Z
E66A
876
Respiratory Infections/Inflammations W/O CC
E62C
6,174
Respiratory Infections/Inflammations W Severe or Moderate CC
E62B
Seps
AR-DRG Title
AR-DRG
V5.0 No.
0.74
1.44
0.04
0.03
0.05
0.03
0.08
0.08
0.05
0.07
0.14
0.05
0.10
0.08
0.08
0.03
0.06
0.02
0.02
0.03
0.03
0.02
0.04
0.02
0.05
0.10
0.05
0.05
0.03
0.01
0.07
0.04
Standard
error
6.82
11.39
0.58
1.00
1.40
1.10
1.75
2.52
0.91
1.71
2.79
1.07
0.91
1.55
2.63
0.82
1.58
0.45
0.80
1.06
1.07
0.50
1.05
0.57
1.09
2.26
0.97
1.68
1.32
0.36
0.80
1.39
Cost
Weight w/o
Emerg &
ICU
6.82
11.87
0.58
1.02
1.42
1.11
1.80
2.58
0.91
1.72
2.82
1.08
0.91
1.56
2.67
0.83
1.61
0.47
0.85
1.08
1.11
0.50
1.06
0.58
1.17
2.35
0.98
1.72
1.52
0.37
0.80
1.42
Cost
Weight w/o
Emerg
6.83
11.44
0.66
1.12
1.53
1.18
1.84
2.63
1.00
1.82
2.89
1.11
0.99
1.65
2.77
0.92
1.70
0.59
0.92
1.17
1.20
0.59
1.19
0.72
1.24
2.42
1.08
1.81
1.49
0.37
0.92
1.53
Cost
Weight w/o
ICU
6.84
11.92
0.67
1.13
1.55
1.19
1.90
2.70
1.00
1.82
2.93
1.13
0.99
1.66
2.81
0.93
1.73
0.60
0.97
1.19
1.24
0.59
1.20
0.73
1.32
2.51
1.10
1.86
1.68
0.38
0.93
1.56
Cost
weight w
all cost
groups
0.81
0.94
0.29
0.73
0.31
0.66
0.31
0.68
0.51
0.54
0.29
0.30
0.85
0.90
0.55
0.58
0.69
0.45
0.40
0.39
0.55
0.26
0.26
0.48
0.48
0.19
0.19
0.21
0.22
0.21
0.45
0.34
0.37
0.19
0.21
0.32
0.37
0.37
0.38
0.46
0.48
0.27
0.26
0.37
0.18
0.18
0.30
0.40
0.57
0.24
0.40
0.26
0.34
0.14
0.29
0.37
Outlier per
diem as a
weight
0.45
0.36
0.60
0.40
0.51
0.21
0.44
0.56
Transfer
cost weight
1,500
1,500
600
600
650
700
650
1,400
1,050
1,150
600
11
36
6
12
17
16
22
33
15
20
28
20
14
650
21
1,150
31
6
10
4
10
15
12
7
15
8
13
28
14
20
19
3
10
16
High trim
point (days)
1,000
1,150
1,200
1,450
1,500
850
800
1,150
550
550
1250
950
750
1,250
800
1,050
450
900
1,150
Outlier
per diem
amount ($)
Appendix 1A: Acute Care Cost Weights (Rebased)
Part 1: General Cost weights
61
Major Reconstruct Vascular Procedures W/O CPB Pump W/O
Catast
Other Cardiothoracic Procedures W/O CPB Pump W Catastrophic C
Other Cardiothoracic Procedures W/O CPB Pump W/O Catastrophic
Percutaneous Coronary Intervention W AMI
Amputation for Circ System Except Upper Limb and Toe W Catast
Amputation for Circ System Except Upper Limb and Toe W/O Cata
Cardiac Pacemaker Implantation
Upper Limb and Toe Amputation for Circulatory System Disorder
Vascular Procs Except Major Reconstruction W/O CPB Pump W Cat
Vascular Procs Except Major Reconstruction W/O CPB Pump W Sev
Vascular Procs Except Major Reconstruction W/O CPB Pump W/O C
Percutaneous Coronary Intervention W/O AMI W Stent Implantati
Percutaneous Coronary Intervention W/O AMI W/O Stent Implanta
Cardiac Pacemaker Replacement
F08B
F09A
F09B
F10Z
F11A
F11B
F12Z
F13Z
F14A
F14B
F14C
F15Z
F16Z
F17Z
Circulatory System Diagnosis W Ventilator Support
Major Reconstruct Vascular Procedures W/O CPB Pump W Catastro
F08A
Other Circulatory System O.R. Procedures W/O Catastrophic CC
Other Cardiothoracic/Vascular Procedures W CPB Pump W/O Catas
F07B
F40Z
Other Cardiothoracic/Vascular Procedures W CPB Pump W Catastr
F07A
F21B
Coronary Bypass W/O Invasive Cardiac Inves W/O Catastr or Sev
F06B
Other Circulatory System O.R. Procedures W Catastrophic CC
Coronary Bypass W/O Invasive Cardiac Inves W Catastr or Sever
F06A
Vein Ligation and Stripping
Coronary Bypass W Invasive Cardiac Inves W/O Catastrophic CC
F05B
F21A
Coronary Bypass W Invasive Cardiac Inves W Catastrophic CC
F05A
F20Z
Cardiac Valve Proc W CPB Pump W/O Invasive Cardiac Inves W/O
F04B
Cardiac Pacemaker Revision Except Device Replacement
Cardiac Valve Proc W CPB Pump W/O Invasive Cardiac Inves W Ca
F04A
Other Trans-Vascular Percutaneous Cardiac Intervention
Cardiac Valve Proc W CPB Pump W Invasive Cardiac Inves
F03Z
F18Z
AICD Component Implantation/Replacement
F02Z
F19Z
AR-DRG Title
AR-DRG
V5.0 No.
249
326
163
1,653
137
121
572
200
2,854
1,003
656
493
147
1,486
82
139
3,041
163
115
1,076
587
247
136
504
884
376
350
265
372
138
89
Seps
0.17
0.15
0.27
0.07
0.09
0.27
0.18
0.18
0.11
0.06
0.09
0.14
0.19
0.23
0.42
0.60
0.13
0.18
0.42
0.24
0.38
0.29
0.40
0.33
0.48
0.59
0.56
0.24
0.71
0.79
0.33
Standard
error
2.70
2.11
5.96
1.01
2.60
1.82
1.80
1.54
1.90
1.41
2.07
5.15
3.93
3.07
5.47
9.70
2.37
3.32
5.09
4.38
9.17
5.89
9.83
5.31
6.77
7.66
10.03
6.46
9.90
13.57
5.61
Cost
Weight w/o
Emerg &
ICU
5.93
2.12
6.32
1.02
2.66
1.85
1.80
1.54
1.91
1.45
2.14
5.68
3.99
3.12
5.60
10.26
2.42
3.86
7.02
4.73
10.97
6.99
12.23
6.20
8.11
9.21
13.09
7.31
12.66
16.54
5.98
Cost
Weight w/o
Emerg
2.78
2.13
6.06
1.01
2.61
1.84
1.82
1.58
1.93
1.42
2.10
5.22
3.97
3.13
5.56
9.78
2.42
3.36
5.15
4.41
9.25
5.89
9.87
5.32
6.78
7.72
10.10
6.46
9.93
13.64
5.67
Cost
Weight w/o
ICU
6.00
2.15
6.42
1.02
2.67
1.87
1.82
1.58
1.94
1.47
2.16
5.75
4.04
3.18
5.68
10.35
2.47
3.91
7.08
4.76
11.05
7.00
12.27
6.21
8.12
9.27
13.15
7.31
12.69
16.62
6.05
Cost
weight w
all cost
groups
0.73
1.33
0.57
0.12
0.31
0.23
0.20
0.47
0.52
1.11
0.64
0.28
0.65
2.32
0.36
0.65
0.61
0.46
0.48
0.28
0.92
0.48
0.34
0.38
0.08
0.21
0.16
0.13
0.32
0.35
0.21
1,500
1,050
1,200
250
650
500
400
1,000
1,100
650
1,350
600
0.43
1,350
0.19
1,500
750
1,350
1,250
950
1,000
600
1,500
1,300
1,400
1,500
650
600
1,000
950
600
1,500
250
Outlier
per diem
amount ($)
0.43
0.48
0.24
0.43
0.40
0.30
0.32
0.19
0.48
0.42
0.45
0.62
0.48
0.67
0.21
0.19
0.32
0.30
0.19
0.48
0.08
Outlier per
diem as a
weight
0.82
0.31
0.30
0.48
0.44
0.30
1.44
0.13
Transfer
cost weight
25
18
44
3
4
16
17
8
7
6
16
38
44
19
45
60
11
12
29
19
50
14
36
12
18
23
39
15
27
53
30
High trim
point (days)
Appendix 1A: Acute Care Cost Weights (Rebased)
Part 1: General Cost weights
62
2,611
4,600
Circulatory Disorders W/O AMI W Invasive Cardiac Inves Proc W
Circulatory Disorders W AMI W/O Invasive Cardiac Inves Proc W
F60A
1,664
Venous Thrombosis W/O Catastrophic or Severe CC
Skin Ulcers for Circulatory Disorders
Peripheral Vascular Disorders W Catastrophic or Severe CC
Peripheral Vascular Disorders W/O Catastrophic or Severe CC
Coronary Atherosclerosis W CC
F63B
F64Z
F65A
F65B
F66A
Major Arrhythmia and Cardiac Arrest W Catastrophic or Severe
Major Arrhythmia and Cardiac Arrest W/O Catastrophic or Sever
Non-Major Arrhythmia and Conduction Disorders W Catastrophic
Non-Major Arrhythmia and Conduction Disorders W/O Catastrophi
Unstable Angina W Catastrophic or Severe CC
Unstable Angina W/O Catastrophic or Severe CC
Syncope and Collapse W Catastrophic or Severe CC
Syncope and Collapse W/O Catastrophic or Severe CC
Chest Pain
Other Circulatory System Diagnoses W Catastrophic CC
F71A
F71B
F72A
F72B
F73A
F73B
F74Z
F75A
Valvular Disorders W/O Catastrophic or Severe CC
F69B
F70A
Valvular Disorders W Catastrophic or Severe CC
F69A
F70B
Hypertension W/O CC
Congenital Heart Disease
F67B
F68Z
Coronary Atherosclerosis W/O CC
Venous Thrombosis W Catastrophic or Severe CC
F63A
Hypertension W CC
Heart Failure and Shock W/O Catastrophic CC
F62B
F66B
Heart Failure and Shock W Catastrophic CC
F62A
F67A
1,642
Infective Endocarditis
F61Z
547
14,908
4,083
1,857
4,965
1,146
6,966
2,650
1,376
505
1,026
412
171
598
462
1,343
792
148
1,068
397
7,197
2,932
288
802
Circulatory Disorders W AMI W/O Invasive Cardiac Inves Proc W
Circulatory Disorders W AMI W/O Invasive Cardiac Inves Proced
F60B
F60C
3,876
2,627
F42B
1,406
Circulatory Disorders W AMI W Invasive Cardiac Inves Proc W/O
Circulatory Disorders W/O AMI W Invasive Cardiac Inves Proc W
F41B
F42A
919
Circulatory Disorders W AMI W Invasive Cardiac Inves Proc W C
F41A
Seps
AR-DRG Title
AR-DRG
V5.0 No.
0.12
0.01
0.02
0.04
0.02
0.03
0.02
0.05
0.01
0.05
0.02
0.06
0.04
0.04
0.04
0.02
0.03
0.02
0.07
0.09
0.05
0.07
0.05
0.06
0.13
0.06
0.04
0.05
0.03
0.09
0.06
0.14
Standard
error
3.03
0.33
0.44
1.11
0.48
1.04
0.49
1.36
0.44
1.07
0.37
1.33
0.81
0.50
0.89
0.36
0.72
0.71
1.86
2.14
0.75
1.85
1.12
2.57
4.42
0.82
0.64
1.75
1.04
1.79
1.42
2.52
Cost
Weight w/o
Emerg &
ICU
3.38
0.33
0.44
1.13
0.51
1.09
0.52
1.42
0.50
1.26
0.38
1.40
0.84
0.51
0.94
0.37
0.74
0.72
1.94
2.14
0.75
1.87
1.14
2.67
4.68
0.91
0.70
1.93
1.05
1.82
1.46
2.64
Cost
Weight w/o
Emerg
3.16
0.44
0.58
1.27
0.59
1.16
0.59
1.48
0.62
1.26
0.48
1.44
0.85
0.59
1.01
0.45
0.82
0.80
1.99
2.25
0.88
1.98
1.24
2.71
4.50
1.09
0.76
1.90
1.11
1.87
1.48
2.62
Cost
Weight w/o
ICU
3.50
0.45
0.59
1.28
0.62
1.21
0.61
1.55
0.67
1.46
0.49
1.52
0.88
0.60
1.05
0.46
0.84
0.80
2.06
2.26
0.88
1.99
1.27
2.81
4.76
1.18
0.82
2.07
1.11
1.90
1.52
2.74
Cost
weight w
all cost
groups
0.75
0.42
0.35
0.44
0.36
0.29
0.56
0.25
0.22
0.81
0.44
0.42
0.81
0.41
0.52
0.39
0.34
0.43
0.39
0.27
0.39
0.29
0.48
0.40
0.29
0.29
0.24
0.19
0.35
0.16
0.14
0.48
0.32
0.29
0.48
0.35
0.35
0.16
0.22
0.11
0.26
0.18
0.40
0.19
0.32
0.34
0.48
0.48
0.50
0.16
0.11
0.27
0.48
0.24
0.16
0.40
Outlier per
diem as a
weight
0.88
0.24
0.17
0.42
0.79
1.31
0.24
0.60
Transfer
cost weight
1,500
1,250
900
900
750
600
1,100
500
450
1,500
1,000
900
29
5
7
18
8
13
8
17
6
14
6
20
9
12
1,100
14
6
10
14
25
31
14
22
15
30
60
8
10
20
11
17
13
19
High trim
point (days)
1,500
1,100
500
700
350
800
550
1,250
600
1,000
1,050
1,500
500
350
850
1,500
750
500
1,250
Outlier
per diem
amount ($)
Appendix 1A: Acute Care Cost Weights (Rebased)
Part 1: General Cost weights
63
1,524
2,150
Other Circulatory System Diagnoses W/O Catastrophic or Severe
Rectal Resection W Catastrophic CC
Rectal Resection W/O Catastrophic CC
Major Small and Large Bowel Procedures W Catastrophic CC
F75C
G01A
G01B
G02A
475
604
Stomach, Oesophageal and Duodenal Procedures W/O Malignancy
W
Stomach, Oesophageal and Duodenal Procedures W/O Malignancy
W
Peritoneal Adhesiolysis Age>49 W CC
G03B
G03C
G04A
Appendicectomy W/O Catastrophic or Severe CC
Abdominal and Other Hernia Procedures Age >59 or W Catastroph
Abdominal and Other Hernia Procedures Age 1 to 59 W/O Cat or
Inguinal and Femoral Hernia Procedures Age>0
Hernia Procedures Age<1
Anal and Stomal Procedures W Catastrophic or Severe CC
Anal and Stomal Procedures W/O Catastrophic or Severe CC
Other Digestive System O.R. Procedures W Catastr or Severe CC
Other Digestive System O.R. Procedures W/O Catastr or Sev CC
Other Gastroscopy for Major Digestive Disease
Other Gastroscopy for Major Digestive Disease, Sameday
Complex Colonoscopy
Other Colonoscopy W Catastrophic or Severe CC
Other Colonoscopy W/O Catastrophic or Severe CC
Other Colonoscopy, Sameday
G07B
G08A
G08B
G09Z
G10Z
G11A
G11B
G12A
G12B
G42A
G42B
G43Z
G44A
G44B
G44C
76
Pyloromyotomy Procedure
Appendicectomy W Catastrophic or Severe CC
G06Z
Minor Small and Large Bowel Procedures W/O CC
G05B
G07A
313
Minor Small and Large Bowel Procedures W CC
G05A
14,900
1,923
578
139
1,470
2,183
600
513
2,660
397
415
3,825
1,220
1,462
6,102
485
201
503
Peritoneal Adhesiolysis (Age<50 W CC) or (Age>49 W/O CC)
Peritoneal Adhesiolysis Age<50 W/O CC
G04B
G04C
396
327
254
Major Small and Large Bowel Procedures W/O Catastrophic CC
Stomach, Oesophageal and Duodenal Procedures W Malignancy
G02B
G03A
1,014
568
2,016
1,076
Other Circulatory System Diagnoses W Severe CC
F75B
Seps
AR-DRG Title
AR-DRG
V5.0 No.
0.01
0.07
0.09
0.03
0.02
0.08
0.04
0.13
0.02
0.04
0.04
0.14
0.04
0.06
0.05
0.09
0.05
0.15
0.14
0.08
0.10
0.19
0.09
0.27
0.26
0.11
0.22
0.14
0.19
0.03
0.05
Standard
error
0.41
1.34
2.79
0.63
0.37
1.47
1.50
3.96
0.84
1.55
0.94
1.00
1.08
1.61
1.42
2.83
1.69
1.90
3.58
1.72
2.71
5.35
2.60
6.27
7.50
3.83
8.40
4.67
8.88
0.87
1.54
Cost
Weight w/o
Emerg &
ICU
0.41
1.35
2.91
0.63
0.37
1.52
1.53
4.25
0.84
1.60
0.95
1.00
1.08
1.67
1.43
2.90
1.69
1.92
3.72
1.73
2.77
5.78
2.71
7.22
8.59
3.96
9.51
4.80
9.76
0.89
1.62
Cost
Weight w/o
Emerg
0.42
1.41
2.90
0.65
0.38
1.57
1.57
4.07
0.87
1.59
0.96
1.00
1.10
1.64
1.53
2.95
1.84
1.91
3.61
1.79
2.78
0.42
1.42
3.02
0.65
0.38
1.62
1.59
4.36
0.87
1.64
0.96
1.01
1.10
1.70
1.53
3.03
1.85
1.92
3.75
1.81
2.84
5.90
2.76
2.64
5.48
7.30
8.61
4.02
9.60
4.82
9.82
1.00
1.75
Cost
weight w
all cost
groups
6.35
7.53
3.88
8.50
4.69
8.94
0.98
1.67
Cost
Weight w/o
ICU
0.33
0.78
0.42
0.23
0.31
0.32
0.51
0.72
0.80
0.33
0.57
0.22
0.48
0.27
0.16
0.21
0.21
0.34
0.48
0.24
0.22
0.38
0.27
0.24
1.12
0.40
0.21
0.19
0.48
0.40
0.18
0.46
0.43
0.19
0.48
0.48
0.48
0.08
0.19
0.48
0.42
0.10
0.11
Outlier per
diem as a
weight
1.10
1.55
0.30
0.30
1.03
0.60
0.27
0.69
0.65
0.29
0.77
0.82
0.73
0.12
0.29
0.99
0.62
0.58
0.16
Transfer
cost weight
14
3
700
25
16
3
13
15
31
4
15
3
3
5
11
6
17
7
12
21
12
18
29
14
40
31
19
42
20
43
10
16
High trim
point (days)
1,500
850
500
650
650
1,050
1,500
750
700
1,200
750
850
1,250
650
600
1,500
1,250
550
1,450
1,350
600
1,500
1,500
1,500
250
600
1,500
1,300
300
350
Outlier
per diem
amount ($)
Appendix 1A: Acute Care Cost Weights (Rebased)
Part 1: General Cost weights
64
Oesophagitis and Misc Digestive System Disorders Age<10
Other Digestive System Diagnoses W CC
Other Digestive System Diagnoses W/O CC
Pancreas, Liver and Shunt Procedures W Catastrophic CC
Pancreas, Liver and Shunt Procedures W/O Catastrophic CC
Major Biliary Tract Procedures W Malignancy or Catastrophic
Major Biliary Tract Procedures W/O Malignancy W Severe or Mod
Major Biliary Tract Procedures W/O Malignancy W/O CC
Hepatobiliary Diagnostic Procedures W Catastrophic or Severe
Hepatobiliary Diagnostic Procedures W/O Catastrophic or Sever
Other Hepatobiliary and Pancreas O.R. Procedures
G70A
G70B
H01A
H01B
H02A
H02B
H02C
H05A
H05B
H06Z
Gastroenteritis Age<10 W/O CC
G69Z
Gastroenteritis Age<10 W CC
G68A
Abdominal Pain or Mesenteric Adenitis W/O CC
G66B
G68B
Abdominal Pain or Mesenteric Adenitis W CC
G66A
Oesophagitis, Gastroent & Misc Digestive System Disorders Age
GI Obstruction W/O CC
G65B
Oesophagitis, Gastroent & Misc Digestive Systm Disorders Age>
GI Obstruction W CC
G65A
G67A
Inflammatory Bowel Disease
G67B
Uncomplicated Peptic Ulcer
GI Haemorrhage (Age<65 W Catastrophic or Severe CC) or
Age>64
G61A
G64Z
Digestive Malignancy W/O Catastrophic or Severe CC
G60B
G63Z
913
Digestive Malignancy W Catastrophic or Severe CC
G60A
GI Haemorrhage Age<65 W/O Catastrophic or Severe CC
Complex Gastroscopy, Sameday
G46C
Complicated Peptic Ulcer
Complex Gastroscopy W/O Catastrophic or Severe CC
G46B
G61B
Complex Gastroscopy W Catastrophic or Severe CC
G46A
G62Z
2,190
Other Gastroscopy for Non-Major Digestive Disease, Sameday
G45B
147
117
135
229
153
139
429
285
2,436
1,475
1,284
6,957
566
11,217
3,991
6,317
1,581
2,197
1,577
768
96
79
760
1,079
8,623
1,732
1,040
8,969
2,527
Other Gastroscopy for Non-Major Digestive Disease
G45A
Seps
AR-DRG Title
AR-DRG
V5.0 No.
0.14
0.13
0.27
0.11
0.17
0.43
0.21
0.34
0.01
0.05
0.02
0.02
0.03
0.02
0.05
0.01
0.02
0.02
0.05
0.04
0.02
0.06
0.03
0.03
0.02
0.06
0.02
0.09
0.09
0.01
0.07
Standard
error
3.27
1.92
5.01
1.83
3.52
6.83
3.87
8.93
0.43
1.24
0.63
0.48
0.86
0.46
1.34
0.40
0.75
0.68
1.42
1.25
0.32
0.81
0.36
0.74
0.70
1.44
0.46
1.48
2.82
0.38
1.25
Cost
Weight w/o
Emerg &
ICU
3.39
1.93
5.38
1.84
3.58
7.50
4.21
9.88
0.43
1.28
0.63
0.48
0.88
0.46
1.36
0.40
0.75
0.68
1.45
1.25
0.35
0.84
0.37
0.77
0.71
1.45
0.46
1.50
2.95
0.38
1.26
Cost
Weight w/o
Emerg
3.31
1.96
5.08
1.84
3.59
6.91
3.90
8.98
0.55
1.36
0.72
0.59
0.98
0.57
1.49
0.51
0.87
0.79
1.55
1.36
0.41
0.93
0.46
0.88
0.74
1.52
0.46
1.55
2.93
0.39
1.35
Cost
Weight w/o
ICU
0.21
3.42
1.97
5.46
1.86
3.65
7.58
4.24
9.94
0.55
1.40
0.73
0.59
1.01
0.57
1.51
0.51
0.88
0.80
1.58
1.37
0.45
0.76
0.55
1.44
0.27
0.66
0.88
0.96
0.83
0.39
0.65
0.47
0.48
0.84
0.47
0.37
0.38
0.45
0.36
0.49
0.99
0.20
0.49
0.47
0.96
0.40
0.63
0.76
0.22
0.66
0.69
0.29
0.38
Transfer
cost weight
0.91
0.75
1.53
0.46
1.57
3.06
0.39
1.36
Cost
weight w
all cost
groups
0.48
0.37
0.48
0.18
0.43
0.48
0.48
0.48
0.16
0.18
0.30
1,500
1,150
1,500
550
1,350
1,500
1,500
1,500
500
550
950
1,500
1,500
0.48
1,500
750
650
1,000
750
1,050
1,100
400
1,000
450
850
750
1,500
450
1,350
1,450
600
800
Outlier
per diem
amount ($)
0.48
0.48
0.24
0.21
0.32
0.24
0.34
0.35
0.13
0.32
0.14
0.27
0.24
0.48
0.14
0.43
0.46
0.19
0.26
Outlier per
diem as a
weight
33
15
37
18
26
40
21
49
7
16
5
4
6
8
17
5
10
9
16
12
8
12
5
11
9
21
3
13
26
3
12
High trim
point (days)
Appendix 1A: Acute Care Cost Weights (Rebased)
Part 1: General Cost weights
65
Cirrhosis and Alcoholic Hepatitis W/O Catastrophic or Severe
Malignancy of Hepatobiliary Sys, Pancreas W Catastr CC or (Ag
Malig Hepatobilry Sys, Pancreas (A<70 W/O Cat CC) or (A>69 W/
Disorders of Pancreas Except for Malignancy W Catastrophic or
Disorders of Pancreas Except for Malignancy W/O Catastrophic
Disorders of Liver Except Malig, Cirrhosis, Alcoholic Hepatit
Disorders of Liver Excep Malig, Cirrhosis, Alcoholic Hepatiti
Disorders of the Biliary Tract W CC
Disorders of the Biliary Tract W/O CC
Bilateral or Multiple Major Joint Procs of Lower Extremity
Microvascular Tissue Transfer or (Skin Graft W Cat or Sev CC)
Skin Graft W/O Catastrophic or Severe CC, Excluding Hand
Hip Revision W Catastrophic or Severe CC
Hip Replacement W Cat or Severe CC or Hip Revision W/O Cat or
Hip Replacement W/O Catastrophic or Severe CC
Knee Replacement and Reattachment
Other Major Joint Replacement and Limb Reattachment Procedure
Spinal Fusion W Deformity
Amputation
H60C
H61B
H62A
H62B
H63A
H63B
H64A
H64B
I01Z
I02A
I02B
I03A
I03B
I03C
I04Z
I05Z
I06Z
I07Z
Cirrhosis and Alcoholic Hepatitis W Severe CC
H61A
Cirrhosis and Alcoholic Hepatitis W Catastrophic CC
ERCP Other Therapeutic Procedure W Catastrophic or Severe CC
H42A
H60B
ERCP Complex Therapeutic Procedure W/O Catastrophic or Severe
H41B
H60A
381
ERCP Complex Therapeutic Procedure W Catastrophic or Severe C
H41A
ERCP Other Therapeutic Procedure W Moderate CC
Endoscopic Procedures for Bleeding Oesophageal Varices
H40Z
ERCP Other Therapeutic Procedure W/O CC
Laparoscopic Cholecystectomy W/O Closed CDE W/O
Catastrophic/
H08B
H42B
Laparoscopic Cholecystectomy W Closed CDE Or Catastrophic/Sev
H08A
H42C
422
Open Cholecystectomy W/O Closed CDE W/O Catastrophic CC
H07B
76
52
474
4,333
2,441
1,924
157
203
143
292
2,784
1,450
645
645
2,756
686
848
692
280
494
542
918
492
324
145
6,317
1,069
491
136
Open Cholecystectomy W Closed CDE or Catastrophic CC
H07A
Seps
AR-DRG Title
AR-DRG
V5.0 No.
0.17
0.47
0.49
0.23
0.17
0.24
0.28
0.24
0.83
0.62
0.03
0.05
0.03
0.09
0.04
0.07
0.05
0.07
0.04
0.10
0.14
0.06
0.07
0.16
0.06
0.13
0.13
0.10
0.16
0.08
0.23
Standard
error
7.71
8.50
4.23
4.96
4.31
5.69
10.19
4.13
14.06
8.65
0.59
1.34
0.88
2.17
0.90
2.20
1.17
2.24
1.09
1.56
3.24
1.20
1.44
2.97
1.57
3.29
2.67
1.43
2.77
2.60
5.91
Cost
Weight w/o
Emerg &
ICU
7.83
8.79
4.25
4.99
4.32
5.80
10.35
4.18
14.54
8.69
0.59
1.38
0.89
2.32
0.91
2.45
1.17
2.27
1.10
1.60
3.49
1.21
1.46
3.12
1.58
3.45
3.02
1.43
2.89
2.67
6.68
Cost
Weight w/o
Emerg
7.83
8.50
4.27
4.97
4.34
5.77
10.25
4.18
14.16
8.68
0.70
1.46
0.99
2.32
1.02
2.33
1.23
2.37
1.17
1.66
3.38
1.25
1.49
3.07
1.63
3.38
2.76
1.45
2.83
2.64
6.00
Cost
Weight w/o
ICU
0.51
7.94
8.79
4.28
4.99
4.35
5.88
10.41
4.23
14.63
8.71
0.70
1.50
1.00
2.47
1.04
2.58
1.23
2.39
1.18
1.70
3.63
0.22
0.59
0.58
0.25
0.31
0.28
0.40
0.73
0.62
0.36
0.60
0.54
0.73
0.53
0.56
0.40
0.72
0.59
0.45
0.78
0.42
0.87
1.51
1.26
0.33
1.25
0.33
0.36
1.50
0.35
0.47
0.82
Transfer
cost weight
3.22
1.64
3.54
3.11
1.45
2.96
2.71
6.76
Cost
weight w
all cost
groups
0.14
0.40
0.38
0.16
0.21
0.19
0.27
0.48
0.42
0.24
0.46
450
1,250
1,200
500
650
600
850
1,500
1,300
750
1,450
550
1,150
0.18
1,100
1,150
850
850
1,200
400
950
900
1,050
1,050
700
1,000
700
750
600
750
950
1,500
Outlier
per diem
amount ($)
0.37
0.35
0.37
0.27
0.27
0.38
0.13
0.30
0.29
0.34
0.34
0.22
0.32
0.22
0.24
0.19
0.24
0.30
0.48
Outlier per
diem as a
weight
59
14
13
12
12
29
58
29
60
19
9
16
12
24
10
23
14
28
17
17
32
13
16
25
15
29
16
4
19
15
39
High trim
point (days)
Appendix 1A: Acute Care Cost Weights (Rebased)
Part 1: General Cost weights
66
Soft Tissue Procedures W Catastrophic or Severe CC
Soft Tissue Procedures W/O Catastrophic or Severe CC
Other Connective Tissue Procedures W CC
Other Connective Tissue Procedures W/O CC
Knee Reconstruction Or Revision
Hand Procedures
Femoral Shaft Fractures
Other Femoral Fractures
I27A
I28A
I28B
I29Z
I30Z
I60Z
I61Z
Bone and Joint Diagnostic Procedures including Biopsy
I25Z
I27B
Arthroscopy
I24Z
232
Other Elbow or Forearm Procedures
Foot Procedures
I19Z
I20Z
Local Excision & Removal of Internal Fixation Devices of Hip
Other Knee Procedures
I18Z
Local Excision & Removal of Internal Fixation Dev Ex Hip & Fm
2,132
Maxillo-Facial Surgery
I17Z
I21Z
3,499
Other Shoulder Procedures
I23Z
902
Cranio-Facial Surgery
207
253
7,645
726
781
333
1,228
213
174
687
3,765
337
1,588
107
13
4,079
893
I16Z
Humerus, Tibia, Fibula and Ankle Procedures Age>59 W/O Catast
I13B
471
867
I15Z
Humerus, Tibia, Fibula and Ankle Procedures W Catastrophic or
I13A
Humerus, Tibia, Fibula and Ankle Procedures Age<60 W/O Catast
Infect/Inflam Bone & Joint W Misc Musc Sys & Conn Tiss Proc W
I12C
247
205
Stump Revision
Infect/Inflam of Bone & Joint W Misc Musc Sys & Conn Tiss Pro
I12B
I13C
Infect/Inflam of Bone & Joint W Misc Musc Sys & Conn Tiss Pro
I12A
25
1,315
288
498
I14Z
Other Back and Neck Procedures W/O Catastrophic or Severe CC
Limb Lengthening Procedures
I10B
Other Back and Neck Procedures W Catastrophic or Severe CC
I10A
I11Z
Spinal Fusion W/O Catastrophic or Severe CC
I09B
220
2,246
Other Hip and Femur Procedures W/O Catastrophic or Severe CC
Spinal Fusion W Catastrophic or Severe CC
I08B
I09A
2,333
Other Hip and Femur Procedures W Catastrophic or Severe CC
I08A
Seps
AR-DRG Title
AR-DRG
V5.0 No.
0.06
0.20
0.09
0.06
0.07
0.18
0.05
0.16
0.21
0.05
0.02
0.05
0.07
0.05
0.04
0.11
0.07
0.12
0.12
0.37
0.08
0.17
0.08
0.22
0.48
0.14
0.29
0.14
0.35
0.82
0.21
0.13
Standard
error
1.50
3.84
1.09
1.70
1.32
4.00
1.23
4.71
3.27
0.84
0.73
1.30
1.39
1.58
1.19
2.46
1.44
3.02
2.02
1.74
2.48
5.39
2.59
4.83
9.28
2.52
2.40
4.32
4.94
9.24
3.23
5.19
Cost
Weight w/o
Emerg &
ICU
1.55
3.86
1.09
1.70
1.33
4.08
1.24
4.90
3.29
0.85
0.73
1.32
1.39
1.59
1.19
2.54
1.44
3.31
2.02
1.75
2.49
5.53
2.60
4.86
9.61
2.52
2.42
4.44
5.02
9.85
3.25
5.33
Cost
Weight w/o
Emerg
1.63
4.10
1.14
1.70
1.38
4.10
1.30
4.81
3.32
0.86
0.73
1.31
1.43
1.66
1.22
2.50
1.44
3.03
2.05
1.81
2.55
5.50
2.64
4.92
9.40
2.52
2.41
4.36
4.96
9.31
3.32
5.32
Cost
Weight w/o
ICU
1.68
4.12
1.14
1.71
1.38
4.18
1.31
5.00
3.34
0.86
0.73
1.33
1.43
1.67
1.23
2.57
1.45
3.31
2.05
1.82
2.56
5.63
2.65
4.95
9.73
2.52
2.43
4.48
5.04
9.92
3.34
5.46
Cost
weight w
all cost
groups
0.38
0.74
0.34
0.21
1.24
0.63
1.04
0.58
0.59
0.12
0.12
0.26
0.32
1.40
1.03
0.37
0.35
0.55
0.46
0.83
0.46
0.45
0.26
0.48
0.22
0.14
0.30
0.42
0.40
0.38
0.40
0.08
0.08
0.18
0.21
0.30
0.26
0.24
0.24
0.37
0.30
0.48
0.30
0.30
0.32
0.35
0.48
0.48
0.81
0.48
0.26
0.30
0.48
0.35
0.21
0.48
Outlier per
diem as a
weight
0.52
1.44
0.39
0.47
1.34
0.52
0.32
0.73
Transfer
cost weight
800
1,500
700
450
950
1,300
1,250
1,200
1,250
250
250
550
24
60
4
3
7
38
7
40
35
8
4
6
6
6
950
8
10
4
12
19
8
15
33
24
42
60
17
10
27
15
39
19
37
High trim
point (days)
650
800
750
750
1,150
950
1,500
950
950
1,000
1,100
1,500
1,500
800
950
1,500
1,100
650
1,500
Outlier
per diem
amount ($)
Appendix 1A: Acute Care Cost Weights (Rebased)
Part 1: General Cost weights
67
70
Aftercare Conn Tiss Disorder (Age<60 W Cat/Sev CC) or (Age>59
Aftercare of Connective Tissue Disorders Age<60 W/O Catastrop
Injury to Forearm, Wrist, Hand or Foot Age>74 W CC
Injury to Forearm, Wrist, Hand or Foot (Age<75 W CC) or (Age>
Injury to Forearm, Wrist, Hand or Foot Age<75 W/O CC
Injury to Shoulder, Arm, Elbow, Knee, Leg or Ankle Age>64 W C
Inj to Should, Arm, Elbow, Knee, Leg, Ankle (Age<65 W CC) or
Injury to Shoulder, Arm, Elbow, Knee, Leg or Ankle Age<65 W/O
Other Musculoskeletal Disorders Age>69 W CC
Other Musculoskeletal Disorders (Age<70 W CC) or (Age>69 W/O
I73C
I74A
I74B
I74C
I75A
I75B
I75C
I76A
I76B
Tendonitis, Myositis and Bursitis (Age<80 W Catastr or Severe
I72A
I73B
779
Musculotendinous Disorders Age <70 W/O CC
I71C
Tendonitis, Myositis and Bursitis Age<80 W/O Catastrophic or
Musculotendinous Disorders (Age<70 W CC) or (Age>69 W/O CC)
I71B
Aftercare of Connective Tissue Disorders Age>59 W Catastrophi
Musculotendinous Disorders Age>69 W CC
I71A
I72B
Non-Specific Arthropathies
I70Z
I73A
300
Bone Diseases & Spec Arthropathies Age<75 W/O Catastr or Seve
I69C
518
222
3,852
1,877
1,247
7,407
856
387
323
715
490
674
764
487
275
786
1,144
528
2,479
4,014
2,488
308
Bone Diseases&Spec Arthropathies(A<75 W Cat/Sev CC) or (A>74
Septic Arthritis W/O Catastrophic or Severe CC
I67B
Bone Diseases & Spec Arthropathies Age>74 W Catastrophic or S
Septic Arthritis W Catastrophic or Severe CC
I67A
342
908
I69B
Inflammatory Musculoskeletal Disorders W/O Cat or Sev CC
I66B
I69A
Inflammatory Musculoskeletal Disorders W Cat or Sev CC
I66A
785
800
Non-surgical Neck & Back Conditions, Sameday
Connective Tissue Malignancy, including Pathological Fx W/O C
I65B
I68C
Connective Tissue Malignancy, including Pathological Fx W Cat
I65A
271
383
Non-Surg Neck & Back Conditions W CC
Osteomyelitis W/O CC
I64B
Non-surgical Neck & Back Cond W/O CC
Osteomyelitis W CC
I64A
430
I68A
Sprains, Strains and Dislocations of Hip, Pelvis and Thigh
I63Z
Seps
I68B
AR-DRG Title
AR-DRG
V5.0 No.
0.04
0.06
0.02
0.03
0.07
0.02
0.03
0.05
0.04
0.04
0.15
0.04
0.08
0.03
0.03
0.05
0.05
0.04
0.06
0.08
0.01
0.08
0.07
0.03
0.29
0.08
0.15
0.09
0.10
0.07
0.17
0.04
Standard
error
0.95
1.65
0.49
0.83
2.07
0.49
0.65
1.59
0.76
0.92
3.13
0.63
1.67
0.51
0.68
1.22
0.94
0.79
1.20
2.40
0.24
0.90
2.15
1.07
4.10
1.07
3.06
1.62
2.69
1.65
2.73
0.63
Cost
Weight w/o
Emerg &
ICU
1.00
1.68
0.49
0.83
2.08
0.49
0.66
1.61
0.76
0.94
3.14
0.64
1.71
0.51
0.69
1.23
0.94
0.79
1.21
2.42
0.24
0.91
2.17
1.07
4.18
1.07
3.27
1.62
2.71
1.66
2.76
0.64
Cost
Weight w/o
Emerg
1.07
1.78
0.61
0.99
2.23
0.59
0.80
1.77
0.81
0.98
3.15
0.71
1.80
0.60
0.82
1.37
1.04
0.86
1.31
2.55
0.35
1.02
2.29
1.16
4.27
1.13
3.14
1.70
2.79
1.73
2.81
0.78
Cost
Weight w/o
ICU
1.12
1.82
0.61
1.00
2.24
0.59
0.81
1.78
0.81
1.00
3.17
0.72
1.85
0.60
0.83
1.38
1.04
0.86
1.32
2.56
0.35
1.03
2.31
1.16
4.35
1.13
3.35
1.70
2.81
1.74
2.84
0.78
Cost
weight w
all cost
groups
0.37
0.56
0.12
0.28
0.47
0.26
0.16
0.34
0.42
0.56
0.57
0.47
0.35
0.36
0.40
0.24
0.30
0.38
0.36
0.44
0.24
0.55
0.24
0.37
0.08
0.19
0.32
0.18
0.11
0.22
0.10
0.13
0.38
0.22
0.24
0.19
0.26
0.16
0.19
0.18
0.10
0.29
0.19
0.37
0.48
0.13
0.73
0.48
0.19
0.19
0.48
0.29
0.42
0.11
0.21
0.32
Outlier per
diem as a
weight
0.74
0.42
0.83
0.72
0.61
0.34
0.31
0.48
Transfer
cost weight
750
1,150
250
600
1,000
550
350
700
300
400
1,200
700
15
22
4
13
31
3
7
25
13
21
40
9
6
25
750
14
25
12
13
19
32
3
13
26
26
47
15
29
17
29
28
44
9
High trim
point (days)
600
800
500
600
550
300
900
600
1,150
1,500
400
1,500
600
1,500
900
1,300
350
650
1,000
Outlier
per diem
amount ($)
Appendix 1A: Acute Care Cost Weights (Rebased)
Part 1: General Cost weights
68
Other Skin Graft and/or Debridement Procedures W/O Catastroph
Perianal and Pilonidal Procedures
Skin, Subcutaneous Tissue and Breast Plastic O.R. Procedures
Other Skin, Subcutaneous Tissue and Breast Procedures
Lower Limb Procs W Ulcer/Cellulitis W Catastr CC
Lower Limb Procs W Ulcer/Cellulitis W/O Catastr CC W Skin Gra
Lower Limb Procs W Ulcer/Cellulitis W/O Catastr CC W/O Skin G
Lower Limb Procs W/O Ulcer/Cellulitis W Skin Graft W Catastr/
Lower Limb Procs W/O Ulcer/Cellulitis W/O (Skin Graft & Catas
Major Breast Reconstructions
Skin Ulcers
Skin Ulcers, Sameday
Malignant Breast Disorders W Catastrophic or Severe CC or (Ag
Malignant Breast Disorders (A<70 W/O Catastr or Severe CC) or
Non-Malignant Breast Disorders
J08B
J09Z
J10Z
J11Z
J12A
J12B
J12C
J13A
J13B
J14Z
J60A
J60B
J62A
J62B
J63Z
Minor Skin Disorders, Sameday
Other Skin Graft and/or Debridement Procedures W Catastrophic
J08A
J67B
Minor Procedures for Non-Malignant Breast Conditions
J07B
Minor Skin Disorders
Minor Procedures for Malignant Breast Conditions
J07A
Trauma to the Skin, Subcutaneous Tissue and Breast Age<70
Major Procedures for Non-Malignant Breast Conditions
J06B
J67A
Major Procedures for Malignant Breast Conditions
J06A
J65B
Microvascular Tissue Transfer for Skin, Subcutaneous Tissue &
J01Z
Trauma to the Skin, Subcutaneous Tissue and Breast Age>69
Fractures of Neck of Femur W/O Catastrophic or Severe CC
I78B
J65A
Fractures of Neck of Femur W Catastrophic or Severe CC
I78A
Cellulitis Age>59 W Catastrophic or Severe CC
Fractures of Pelvis W/O Catastrophic or Severe CC
I77B
Cellulitis (Age>59 W/O Catastrophic or Severe CC) or Age<60
Fractures of Pelvis W Catastrophic or Severe CC
I77A
J64A
Other Musculoskeletal Disorders Age<70 W/O CC
I76C
J64B
AR-DRG Title
AR-DRG
V5.0 No.
1,882
1,250
2,251
1,374
10,192
1,665
518
146
266
75
803
67
598
164
211
145
133
1,137
2,039
729
1,147
401
1,468
662
507
2,026
97
1,059
407
873
715
615
Seps
0.01
0.03
0.02
0.03
0.03
0.05
0.02
0.03
0.12
0.01
0.29
0.11
0.17
0.13
0.12
0.31
0.55
0.05
0.04
0.03
0.04
0.11
0.03
0.03
0.05
0.06
0.21
0.06
0.12
0.06
0.13
0.02
Standard
error
0.26
0.73
0.41
0.88
0.85
2.05
0.59
0.61
1.44
0.16
2.19
3.82
1.97
3.39
2.62
5.61
9.35
0.89
0.87
0.81
1.34
3.21
0.69
0.95
1.64
1.67
6.87
0.46
1.74
1.21
3.01
0.55
Cost
Weight w/o
Emerg &
ICU
0.26
0.74
0.41
0.89
0.85
2.09
0.59
0.61
1.45
0.16
2.20
3.82
1.97
3.40
2.64
5.61
9.46
0.91
0.87
0.81
1.35
3.32
0.69
0.95
1.65
1.67
7.23
0.46
1.76
1.21
3.05
0.56
Cost
Weight w/o
Emerg
0.28
0.83
0.52
1.05
0.96
2.19
0.66
0.63
1.51
0.33
2.29
3.82
1.97
3.41
2.68
5.67
9.44
0.91
0.88
0.83
1.37
3.26
0.69
0.95
1.65
1.67
6.87
0.69
1.91
1.37
3.18
0.64
Cost
Weight w/o
ICU
0.28
0.84
0.52
1.05
0.97
2.23
0.66
0.63
1.51
0.33
2.30
3.82
1.98
3.42
2.70
5.68
9.55
0.93
0.88
0.83
1.37
3.36
0.69
0.95
1.65
1.68
7.24
0.69
1.93
1.37
3.22
0.64
Cost
weight w
all cost
groups
0.26
0.31
0.19
0.47
0.34
0.43
0.22
0.23
0.50
0.16
0.38
0.78
1.19
0.41
0.38
0.98
0.37
0.62
0.11
0.16
1.17
0.55
0.19
0.21
0.13
0.32
0.22
0.29
0.14
0.16
0.29
0.21
0.26
0.48
0.32
0.27
0.26
0.48
0.24
0.16
0.06
0.11
0.43
0.37
0.08
0.08
0.12
0.48
0.12
0.27
0.29
0.27
0.35
0.27
0.29
0.16
Outlier per
diem as a
weight
0.75
0.40
0.43
0.40
0.52
0.40
0.42
0.49
Transfer
cost weight
600
650
400
1,000
700
900
450
500
900
650
800
1,500
3
8
4
18
11
25
8
8
26
3
32
15
27
18
850
29
56
60
7
5
3
11
27
3
3
8
8
16
11
27
19
35
5
High trim
point (days)
1,000
800
1,500
750
500
200
350
1,350
1,150
250
250
1,500
850
900
850
1,100
850
900
500
Outlier
per diem
amount ($)
Appendix 1A: Acute Care Cost Weights (Rebased)
Part 1: General Cost weights
69
Miscellaneous Metabolic Disorders W Severe CC or (Age>74 W/O
Miscellaneous Metabolic Disorders W/O Catastrophic or Severe
Inborn Errors of Metabolism
Endocrine Disorders W Catastrophic or Severe CC
K62B
K62C
K63Z
K64A
111
Kidney, Ureter and Major Bladder Procedures for Neoplasm W/O
Kidney, Ureter and Major Bladder Procedures for Non-Neoplasm
Kidney, Ureter & Major Bladder Procedures for Non-Neoplasm W
Kidney, Ureter & Major Bladder Procedures for Non-Neoplasm W/
Transurethral Prostatectomy W Catastrophic or Severe CC
Transurethral Prostatectomy W/O Catastrophic or Severe CC
Minor Bladder Procedures W Catastrophic or Severe CC
Minor Bladder Procedures W/O Catastrophic or Severe CC
L03B
L04A
L04B
L04C
L05A
L05B
L06A
L06B
303
139
191
60
1,133
393
237
152
83
977
298
139
1,257
1,602
763
401
Miscellaneous Metabolic Disorders W Catastrophic CC
K62A
290
Severe Nutritional Disturbance
K61Z
4,135
1,525
Kidney, Ureter and Major Bladder Procedures for Neoplasm W Ca
Diabetes W/O Catastrophic or Severe CC
K60B
Operative Insertion of Peritoneal Catheter for Dialysis W/O C
Diabetes W Catastrophic or Severe CC
K60A
384
L03A
Endoscopic or Investigative Procedure for Metabolic Disorders
K40Z
82
189
L02B
Other Endocrine, Nutritional and Metabolic O.R. Procedures
K09Z
Endocrine Disorders W/O Catastrophic or Severe CC
Thyroglossal Procedures
K08Z
42
1,403
Operative Insertion of Peritoneal Catheter for Dialysis W Cat
Obesity Procedures
K07Z
K64B
Thyroid Procedures
K06Z
285
6
69
123
L02A
Major Procedures for Obesity
Parathyroid Procedures
K04Z
K05Z
Pituitary Procedures
Adrenal Procedures
K02Z
K03Z
734
311
Major Skin Disorders, Sameday
Diabetic Foot Procedures
J68B
K01Z
1,290
Major Skin Disorders
J68A
Seps
AR-DRG Title
AR-DRG
V5.0 No.
0.06
0.12
0.08
0.12
0.19
0.17
0.27
0.20
0.25
0.05
0.44
0.06
0.08
0.08
0.06
0.05
0.07
0.15
0.04
0.06
0.02
0.20
0.08
0.13
0.19
0.04
0.15
0.85
0.22
0.64
0.00
0.09
Standard
error
1.06
3.06
1.36
3.17
2.23
3.20
6.44
3.26
5.68
1.43
5.50
0.84
2.15
1.77
0.87
1.09
2.24
4.04
0.97
2.16
0.57
4.30
1.08
2.46
1.73
1.63
3.39
3.53
3.28
7.00
0.12
1.36
Cost
Weight w/o
Emerg &
ICU
1.07
3.20
1.37
3.24
2.25
3.27
6.95
3.39
6.41
1.43
5.59
0.85
2.23
1.81
0.89
1.12
2.35
4.14
1.03
2.31
0.57
4.54
1.08
2.57
1.76
1.70
3.41
3.87
3.84
7.15
0.12
1.38
Cost
Weight w/o
Emerg
1.08
3.12
1.38
3.23
2.25
3.24
6.57
3.27
5.71
1.45
5.54
0.88
2.26
1.88
0.95
1.22
2.37
4.15
1.07
2.28
0.59
4.35
1.08
2.46
1.74
1.63
3.40
3.54
3.29
7.11
0.15
1.45
Cost
Weight w/o
ICU
1.08
3.26
1.39
3.30
2.27
3.32
7.08
3.40
6.44
1.45
5.63
0.89
2.34
1.92
0.97
1.24
2.47
4.24
1.13
2.43
0.59
4.58
1.08
2.57
1.76
1.70
3.41
3.89
3.85
7.26
0.15
1.47
Cost
weight w
all cost
groups
1.00
1.15
0.31
0.74
0.45
2.07
0.53
0.47
0.52
0.55
0.87
0.56
0.73
0.44
0.45
0.59
0.52
0.52
0.40
0.43
0.57
1.49
0.34
0.48
0.21
0.48
0.30
0.34
0.35
0.32
0.35
0.37
0.48
0.16
0.29
0.16
0.27
0.32
0.35
0.35
0.16
0.29
0.42
0.48
0.08
0.32
0.11
0.26
0.38
0.34
0.35
0.30
0.48
0.48
0.16
0.37
Outlier per
diem as a
weight
0.48
0.49
0.52
0.45
0.73
1.03
0.12
0.56
Transfer
cost weight
1,050
1,500
650
1,500
950
1,050
1,100
1,000
1,100
1,150
1,500
500
6
36
7
34
10
18
45
13
31
7
59
5
13
24
500
10
15
26
37
11
25
20
41
3
13
5
7
6
18
13
59
3
16
High trim
point (days)
900
850
1,000
1,100
1,100
500
900
1,300
1,500
250
1,000
800
1,050
1,100
950
1,500
1,500
500
1,150
Outlier
per diem
amount ($)
Appendix 1A: Acute Care Cost Weights (Rebased)
Part 1: General Cost weights
70
Transurethral Prostatectomy W Catastrophic or Severe CC
Transurethral Prostatectomy W/O Catastrophic or Severe CC
M02A
M02B
Testes Procedures W CC
Major Male Pelvic Procedures
M01Z
M04A
Other Kidney and Urinary Tract Diagnoses W/O Catastrophic or
L67C
Penis Procedures W CC
Other Kidney and Urinary Tract Diagnoses W Severe CC
L67B
Penis Procedures W/O CC
Other Kidney and Urinary Tract Diagnoses W Catastrophic CC
L67A
M03A
Urethral Stricture
L66Z
M03B
Kidney and Urinary Tract Signs and Symptoms W Catastrophic or
Kidney and Urinary Tract Signs and Symptoms W/O Catastrophic
L65A
Urinary Stones and Obstruction
L65B
Kidney and Urinary Tract Infections Age<70 W/O Catastrophic o
L64Z
Kidney and Urinary Tract Neoplasms W/O Catastrophic or Severe
L62B
L63C
Kidney and Urinary Tract Neoplasms W Catastrophic or Severe C
L62A
Kidney and Urinary Tract Infections W Catastrophic CC
Admit for Renal Dialysis
L61Z
Kidney and Urinary Tract Infections (Age<70 W Severe CC) or A
Renal Failure W/O Catastrophic or Severe CC
L60C
L63A
Renal Failure W Severe CC
L60B
L63B
Renal Failure W Catastrophic CC
Other Procedures for Kidney and Urinary Tract Disorders W/O C
L09C
ESW Lithotripsy for Urinary Stones
Other Procedures for Kidney and Urinary Tract Disorders W Sev
L09B
L60A
Other Procedures for Kidney and Urinary Tract Disorders W Cat
L09A
L42Z
Urethral Procedures W/O CC
L08B
Ureteroscopy
Urethral Procedures W CC
L08A
Cystourethroscopy, Sameday
Transurethral Procedures Except Prostatectomy W/O Catastrophi
L07B
L40Z
Transurethral Procedures Except Prostatectomy W Catastrophic
L07A
L41Z
AR-DRG Title
AR-DRG
V5.0 No.
130
185
44
1,915
399
571
1,989
838
459
130
1,417
574
4,331
4,256
5,221
1,226
210
342
231,439
1,028
794
670
421
5,396
196
307
88
165
293
98
990
325
Seps
0.05
0.07
0.06
0.08
0.07
0.16
0.03
0.06
0.15
0.03
0.03
0.04
0.02
0.03
0.03
0.07
0.04
0.11
0.01
0.08
0.08
0.14
0.04
0.03
0.04
0.13
0.20
0.92
0.05
0.06
0.07
0.08
Standard
error
1.45
1.21
1.56
1.43
2.42
3.43
0.89
1.48
3.50
0.59
0.54
1.34
0.55
0.74
1.13
2.48
1.05
1.72
0.15
1.23
1.91
3.77
0.81
0.51
1.02
1.47
3.86
9.78
0.83
1.14
0.95
2.31
Cost
Weight w/o
Emerg &
ICU
1.49
1.22
1.58
1.43
2.48
3.53
0.91
1.52
3.73
0.59
0.54
1.36
0.55
0.74
1.14
2.53
1.05
1.73
0.15
1.28
1.98
4.23
0.81
0.51
1.03
1.47
3.87
10.10
0.83
1.16
0.95
2.37
Cost
Weight w/o
Emerg
1.47
1.23
1.61
1.43
2.44
3.43
0.97
1.58
3.64
0.62
0.64
1.49
0.66
0.87
1.29
2.63
1.09
1.83
0.15
1.34
2.03
3.92
0.81
0.52
1.04
1.48
3.94
9.88
0.83
1.17
0.97
2.36
Cost
Weight w/o
ICU
1.52
1.24
1.63
1.44
2.50
3.53
0.99
1.63
3.87
0.62
0.64
1.50
0.66
0.88
1.29
2.68
1.09
1.84
0.15
1.39
2.11
4.38
0.81
0.52
1.05
1.48
3.96
10.19
0.83
1.18
0.97
2.41
Cost
weight w
all cost
groups
0.39
0.99
0.52
0.33
0.38
1.44
0.49
0.50
0.24
0.20
0.41
0.32
0.36
0.36
0.31
0.54
0.47
0.89
0.12
0.36
0.40
0.87
0.12
0.26
0.22
0.35
0.22
0.26
0.48
0.34
0.35
0.16
0.13
0.19
0.21
0.18
0.24
0.21
0.37
0.24
0.48
0.08
0.18
0.27
0.48
0.08
0.19
0.16
0.24
0.21
0.35
0.48
0.08
0.08
0.34
0.13
Outlier per
diem as a
weight
0.28
0.31
0.53
0.84
0.12
0.12
0.99
0.19
Transfer
cost weight
800
700
1,100
700
800
1,500
1,050
1,100
500
400
600
650
12
3
13
7
16
13
12
17
32
5
7
17
8
5
550
16
29
11
24
3
15
21
38
5
3
6
7
25
60
5
13
5
26
High trim
point (days)
750
650
1,150
750
1,500
250
550
850
1,500
250
500
600
650
1,100
1,500
250
250
1,050
400
Outlier
per diem
amount ($)
Appendix 1A: Acute Care Cost Weights (Rebased)
Part 1: General Cost weights
71
Oophorectomies & Complex Fallopian Tube Procs for Non-Malig W
Female Reproductive System Reconstructive Procedures
Other Uterine and Adnexa Procedures for Non-Malignancy
Endoscopic Procedures for Female Reproductive System
Conisation, Vagina, Cervix and Vulva Procedures
Diagnostic Curettage or Diagnostic Hysteroscopy
Other Female Reproductive Sys O.R. Procs Age>64 or W Malignan
Other Female Reproductive System O.R. Procs Age<65 W/O Malign
Malignancy, Female Reproductive System W Catastrophic or Seve
Malignancy, Female Reproductive System W/O Catastrophic or Se
Infections, Female Reproductive System
Menstrual and Other Female Reproductive System Disorders W CC
N06Z
N07Z
N08Z
N09Z
N10Z
N11A
N11B
N60A
N60B
N61Z
N62A
429
505
305
317
564
48
4,753
828
3,853
1,559
1,983
879
108
192
129
170
66
594
N05B
Pelvic Evisceration and Radical Vulvectomy
N01Z
3,657
Other Male Reproductive System Diagnoses
M64Z
1,112
Oophorectomies and Complex Fallopian Tube Procs for Non-Malig
Sterilisation, Male
M63Z
729
299
Hysterectomy for Non-Malignancy
Inflammation of the Male Reproductive System W/O CC
M62B
N04Z
Inflammation of the Male Reproductive System W CC
M62A
115
426
N05A
Benign Prostatic Hypertrophy W/O Catastrophic or Severe CC
M61B
219
Benign Prostatic Hypertrophy W Catastrophic or Severe CC
M61A
417
232
Uterine, Adnexa Procedure for Non-Ovarian or Adnexal Malignan
Malignancy, Male Reproductive System W/O Catastrophic or Seve
M60B
Uterine, Adnexa Procedure for Non-Ovarian or Adnexal Malignan
Malignancy, Male Reproductive System W Catastrophic or Severe
M60A
117
430
N03B
Cystourethroscopy W/O CC
M40Z
N03A
Other Male Reproductive System O.R. Procedures Except for Mal
M06B
147
1,222
Uterine, Adnexa Proc for Ovarian or Adnexal Malignancy W CC
Other Male Reproductive System O.R. Procedures for Malignancy
M06A
Uterine, Adnexa Proc for Ovarian or Adnexal Malignancy W/O CC
Circumcision
M05Z
1,839
N02A
Testes Procedures W/O CC
M04B
Seps
N02B
AR-DRG Title
AR-DRG
V5.0 No.
0.03
0.03
0.04
0.13
0.04
0.09
0.04
0.03
0.03
0.05
0.07
0.05
0.08
0.06
0.09
0.13
0.12
0.15
0.21
0.03
0.02
0.02
0.04
0.02
0.06
0.05
0.08
0.03
0.06
0.08
0.08
0.04
Standard
error
0.60
0.53
1.00
1.75
0.59
2.96
0.61
0.63
0.94
1.20
1.44
1.57
2.75
1.87
2.06
3.05
2.06
3.49
4.04
0.33
0.52
0.48
1.08
0.50
1.45
0.70
1.38
0.48
1.09
1.35
0.68
0.80
Cost
Weight w/o
Emerg &
ICU
0.61
0.53
1.01
1.83
0.59
3.21
0.62
0.63
0.94
1.20
1.44
1.57
2.87
1.87
2.06
3.13
2.06
3.54
4.09
0.33
0.52
0.48
1.09
0.50
1.47
0.70
1.39
0.48
1.10
1.36
0.68
0.80
Cost
Weight w/o
Emerg
0.70
0.64
1.06
1.83
0.60
2.98
0.62
0.67
0.96
1.23
1.44
1.58
2.78
1.87
2.06
3.06
2.07
3.50
4.05
0.42
0.53
0.56
1.18
0.53
1.54
0.74
1.46
0.48
1.11
1.37
0.68
0.82
Cost
Weight w/o
ICU
0.70
0.64
1.06
1.91
0.60
3.24
0.62
0.67
0.96
1.24
1.45
1.59
2.90
1.88
2.07
3.14
2.08
3.56
4.10
0.42
0.53
0.56
1.19
0.53
1.56
0.75
1.47
0.48
1.11
1.37
0.68
0.83
Cost
weight w
all cost
groups
0.20
0.31
0.29
0.39
0.47
0.32
0.12
0.73
0.12
0.89
0.64
0.17
0.82
0.15
1.39
0.78
0.96
0.85
0.23
0.12
0.32
0.39
0.17
0.14
0.21
0.19
0.26
0.30
0.21
0.08
0.27
0.08
0.10
0.43
0.11
0.48
0.10
0.13
0.48
0.48
0.48
0.16
0.08
0.21
0.26
0.11
0.11
0.18
0.17
0.18
0.22
0.06
0.21
0.14
0.08
0.14
Outlier per
diem as a
weight
0.26
0.62
0.34
0.10
0.32
0.20
0.12
0.21
Transfer
cost weight
450
650
600
800
950
650
250
850
250
300
1,350
350
8
7
9
21
9
20
5
5
5
6
7
8
7
14
300
11
16
10
18
28
4
3
7
12
9
24
11
23
6
8
6
3
3
High trim
point (days)
1,500
400
1,500
1,500
1,500
500
250
650
800
350
550
350
550
700
200
650
450
250
450
Outlier
per diem
amount ($)
Appendix 1A: Acute Care Cost Weights (Rebased)
Part 1: General Cost weights
72
Vaginal Delivery W O.R. Procedure W/O Catastrophic or Severe
Ectopic Pregnancy
Postpartum and Post Abortion W O.R. Procedure
Abortion W OR Procedure
Vaginal Delivery W Catastrophic or Severe CC
Vaginal Delivery W/O Catastrophic or Severe CC
Single Uncomplicated Vaginal Delivery W/O Other Condition
Postpartum and Post Abortion W/O O.R. Procedure
Abortion W/O O.R. Procedure
False Labour Before 37 Weeks or W Catastrophic CC
False Labour After 37 Weeks W/O Catastrophic CC
Antenatal & Other Obstetric Admission
Antenatal & Other Obstetric Admission, Sameday
Neonate, Died or Transf <5 Days of Admission W Significant O.
Cardiothoracic/Vascular Procedures for Neonates
Neonate, AdmWt 1000-1499 g W Significant O.R. Procedure
Neonate, AdmWt 1500-1999 g W Significant O.R. Procedure
Neonate, AdmWt 2000-2499 g W Significant O.R. Procedure
Neonate, AdmWt > 2499 g W Significant O.R. Procedure W Multi
Neonate, Adm Wt > 2499 g W Significant O.R. Proc W/O Multi Ma
Neonate Died or Transf <5 Days of Adm, W/O Significant O.R. P
Neonate Died/Transf <5 Days of Adm, W/O Significant O.R. Proc
Neonate, AdmWt < 750 g
Neonate, AdmWt 750-999 g
Neonate, AdmWt 1000-1249 g W/O Significant O.R. Procedure
Neonate, AdmWt 1250-1499 g W/O Significant O.R. Procedure
Neonate, AdmWt 1500-1999 g W/O Significant O.R. Proc W Multi
O02B
O03Z
O04Z
O05Z
O60A
O60B
O60C
O61Z
O63Z
O64A
O64B
O66A
O66B
P01Z
P02Z
P03Z
P04Z
P05Z
P06A
P06B
P60A
P60B
P61Z
P62Z
P63Z
P64Z
P65A
13,716
Caesarean Delivery W/O Catastrophic or Severe CC
Vaginal Delivery W O.R. Procedure W Catastrophic or Severe CC
O01C
O02A
3,118
Caesarean Delivery W Catastrophic CC
Caesarean Delivery W Severe CC
O01A
O01B
67
337
253
148
4
238
480
3
125
52
37
60
53
95
8,530
10,851
1,603
1,872
1,308
3,839
9,649
34,299
4,403
7,293
487
781
1,016
669
1,025
2,630
Menstrual and Other Female Reproductive System Disorders W/O
N62B
Seps
AR-DRG Title
AR-DRG
V5.0 No.
0.73
0.69
1.04
3.38
26.35
0.05
0.07
0.63
1.78
1.56
1.46
3.92
1.28
0.14
0.02
0.08
0.01
0.03
0.01
0.02
0.02
0.04
0.04
0.02
0.04
0.05
0.05
0.05
0.06
0.14
0.10
0.01
Standard
error
6.87
9.76
11.55
27.37
143.28
0.30
0.44
5.13
14.49
14.28
17.28
27.34
15.51
1.26
0.11
0.52
0.23
0.47
0.32
0.59
0.79
0.99
1.33
0.68
0.89
1.03
1.17
1.47
1.78
2.03
2.49
0.28
Cost
Weight w/o
Emerg &
ICU
6.94
9.76
11.55
27.37
143.28
0.30
0.44
5.13
16.61
15.95
17.28
27.34
20.22
1.26
0.11
0.52
0.23
0.48
0.32
0.60
0.79
0.99
1.34
0.68
0.90
1.04
1.17
1.50
1.79
2.05
2.58
0.28
Cost
Weight w/o
Emerg
6.88
9.76
11.55
27.37
143.28
0.37
0.44
5.13
14.50
14.30
17.28
27.34
15.52
1.26
0.13
0.55
0.24
0.48
0.41
0.61
0.79
0.99
1.34
0.75
0.95
1.11
1.17
1.47
1.78
2.03
2.50
0.35
Cost
Weight w/o
ICU
6.95
9.76
11.55
27.37
143.28
0.37
0.44
5.13
16.62
15.97
17.28
27.34
20.23
1.26
0.13
0.55
0.24
0.48
0.41
0.62
0.80
0.99
1.35
0.75
0.97
1.11
1.17
1.50
1.79
2.06
2.59
0.35
Cost
weight w
all cost
groups
0.16
0.60
0.84
1.44
0.62
0.30
0.44
0.86
0.16
0.76
0.86
1.14
0.90
0.43
0.11
0.30
0.23
0.52
0.26
0.28
0.12
0.49
0.11
0.40
0.48
0.48
0.42
0.38
0.34
0.48
0.11
0.48
0.48
0.48
0.48
0.29
0.19
0.21
0.19
0.34
0.18
0.19
0.08
0.34
0.19
0.19
0.28
0.22
0.33
0.48
0.48
0.24
0.08
0.14
0.24
0.16
Outlier per
diem as a
weight
0.29
0.81
0.75
0.35
0.12
0.22
0.36
0.24
Transfer
cost weight
350
1,250
1,500
1,500
1,300
1,200
1,050
1,500
350
1,500
1,500
1,500
57
60
60
60
60
6
6
28
60
60
60
60
6
50
900
3
5
3
6
3
6
5
7
10
3
7
5
7
9
8
12
20
4
High trim
point (days)
1,500
600
650
600
1,050
550
600
250
1,050
600
600
700
1,500
1,500
750
250
450
750
500
Outlier
per diem
amount ($)
Appendix 1A: Acute Care Cost Weights (Rebased)
Part 1: General Cost weights
73
923
Red Blood Cell Disorders W/O Catastrophic or Severe CC
Coagulation Disorders
Lymphoma and Leukaemia W Major O.R. Procedures W
Catastrophic
Lymphoma and Leukaemia W Major O.R. Procedures W/O
Catastroph
Other Neoplastic Disorders W Major O.R. Procedures W Catastr
Other Neoplastic Disorders W Major O.R. Procedures W/O Catast
Q61C
Q62Z
R01A
R01B
R02A
R02B
362
152
127
114
1,167
2,468
628
720
397
Red Blood Cell Disorders W Catastrophic CC
Reticuloendothelial and Immunity Disorders W/O Cat or Sev CC
Q60C
Red Blood Cell Disorders W Severe CC
Reticuloendothelial and Immunity Disorders W/O Cat or Sev CC
Q60B
444
1,050
Q61B
Reticuloendothelial and Immunity Disorders W Catastrophic or
Q60A
136
94
62,068
3,977
2,963
700
967
372
73
442
349
Q61A
Other O.R. Procedure of Blood & Blood Forming Organs W/O Cata
Q02B
Neonate, AdmWt > 2499 g W/O Significant O.R. Procedure W
Othe
P67C
Other O.R. Procedure of Blood & Blood Forming Organs W Catast
Neonate, AdmWt > 2499 g W/O Significant O.R. Procedure W
Majo
P67B
Splenectomy
Neonate, AdmWt > 2499 g W/O Significant O.R. Procedure W
Mult
P67A
Q02A
Neonate, AdmWt 2000-2499 g W/O Significant O.R. Procedure
W/O
P66D
Q01Z
Neonate, AdmWt 2000-2499 g W/O Significant O.R. Procedure
WO
P66C
Neonate, AdmWt > 2499 g W/O Significant O.R. Procedure W/O Pr
Neonate, AdmWt 2000-2499 g W/O Significant O.R. Procedure W
M
P66B
Unqualified Neonates
Neonate, AdmWt 2000-2499 g W/O Significant O.R. Proc W Multi
P66A
P67D
1,389
Neonate, AdmWt 1500-1999 g W/O Significant O.R. Procedure
W/O
P65D
P67Z
255
Neonate, AdmWt 1500-1999 g W/O Significant O.R. Procedure W
O
P65C
360
Neonate, AdmWt 1500-1999 g W/O Significant O.R. Procedure W
M
P65B
Seps
AR-DRG Title
AR-DRG
V5.0 No.
0.12
0.38
0.21
0.65
0.04
0.02
0.04
0.07
0.04
0.04
0.14
0.05
0.44
0.15
0.04
0.02
0.05
0.11
0.26
0.07
0.15
0.31
0.56
0.28
0.38
0.47
Standard
error
2.48
6.05
3.30
11.60
0.93
0.54
1.04
1.83
0.88
1.31
2.99
1.13
6.60
3.54
0.45
0.64
0.97
1.74
3.56
1.04
2.41
3.55
5.03
4.35
4.88
5.39
Cost
Weight w/o
Emerg &
ICU
2.53
6.30
3.39
12.18
0.96
0.54
1.05
1.89
0.90
1.31
3.06
1.14
7.03
3.91
0.46
0.67
1.01
1.87
3.70
1.19
2.57
3.75
5.09
4.63
4.98
5.49
Cost
Weight w/o
Emerg
2.49
6.08
3.33
11.68
1.04
0.63
1.13
1.95
0.99
1.40
3.10
1.15
6.70
3.59
0.46
0.66
0.98
1.77
3.57
1.05
2.41
3.55
5.03
4.36
4.88
5.40
Cost
Weight w/o
ICU
2.54
6.33
3.42
12.26
1.08
0.63
1.14
2.01
1.02
1.41
3.16
1.16
7.12
3.96
0.46
0.69
1.03
1.90
3.72
1.20
2.58
3.76
5.09
4.63
4.98
5.49
Cost
weight w
all cost
groups
0.72
0.60
0.91
0.94
0.37
0.49
0.86
0.84
0.33
0.93
0.53
0.38
0.92
0.39
0.26
0.31
0.71
0.56
0.17
0.72
0.88
0.47
0.35
1.32
1.44
0.70
Transfer
cost weight
0.48
0.40
0.48
0.48
0.19
0.45
0.48
0.42
0.21
0.48
0.35
0.26
0.48
0.26
0.18
0.21
0.46
0.38
0.11
0.48
0.48
0.32
0.24
0.48
0.48
0.46
Outlier per
diem as a
weight
1,500
1,250
1,500
1,500
600
1,400
1,500
1,300
650
1,500
1,100
800
1,500
800
550
650
1,450
1,200
350
1,500
1,500
1,000
750
1,500
1,500
1,450
Outlier
per diem
amount ($)
14
33
24
56
13
8
14
22
10
12
19
10
43
14
7
8
11
18
27
15
29
36
45
38
44
50
High trim
point (days)
Appendix 1A: Acute Care Cost Weights (Rebased)
Part 1: General Cost weights
74
O.R. Procedures for Infectious and Parasitic Diseases W Catas
O.R. Procedures for Infectious and Parasitic Diseases W Sever
O.R. Procedures for Infectious and Parasitic Diseases W/O CC
Septicaemia W Catastrophic or Severe CC
Septicaemia W/O Catastrophic or Severe CC
Postoperative & Post-Traumatic Infect W Cat/Sev CC or (Age>54
Postoperative & Post-Traumatic Infections Age <55 W/O Catastr
Fever of Unknown Origin W CC
Fever of Unknown Origin W/O CC
T01A
T01B
T01C
T60A
T60B
T61A
T61B
T62A
T62B
Other Infectious and Parasitic Diseases W/O Catastrophic or S
HIV-Related Diseases W/O Catastophic or Severe CC
S65C
Other Infectious and Parasitic Diseases W Catastrophic or Sev
HIV-Related Diseases W Severe CC
S65B
T64B
HIV-Related Diseases W Catastrophic CC
S65A
T64A
HIV, Sameday
S60Z
Viral Illness Age >59 or W CC
Radiotherapy
R64Z
Viral Illness Age<60 W/O CC
Chemotherapy
R63Z
T63A
Other Neoplastic Disorders W/O CC
T63B
Other Neoplastic Disorders W CC
R62B
Acute Leukaemia W/O Catastrophic or Severe CC
Lymphoma and Non-Acute Leukaemia W Catastrophic CC
R60C
R61A
R62A
2,717
Acute Leukaemia W Severe CC
R60B
Lymphoma and Non-Acute Leukaemia W/O Catastrophic CC
Acute Leukaemia W Catastrophic CC
R60A
Lymphoma and Non-Acute Leukaemia, Sameday
Other Neoplastic Disorders W Other O.R. Procedures W/O Catast
R04B
R61B
Other Neoplastic Disorders W Other O.R. Procedures W Catastr
R04A
R61C
628
Lymphoma and Leukaemia W Other O.R. Procedures W/O
Catastroph
R03B
517
239
3,873
1,017
1,565
1,036
993
1,446
1,003
2,989
443
352
419
163
93
94
219
195
3,404
292
350
3,786
755
335
389
161
128
354
187
Lymphoma and Leukaemia W Other O.R. Procedures W
Catastrophic
R03A
Seps
AR-DRG Title
AR-DRG
V5.0 No.
0.04
0.20
0.01
0.04
0.02
0.04
0.03
0.05
0.06
0.07
0.07
0.21
0.40
0.17
0.31
0.62
0.08
0.06
0.02
0.04
0.11
0.01
0.07
0.21
0.12
0.25
0.71
0.07
0.25
0.08
0.44
Standard
error
0.87
3.38
0.49
0.84
0.50
1.35
0.92
1.36
1.19
2.69
2.17
4.46
10.90
3.19
4.42
9.26
0.65
0.84
0.18
0.79
2.20
0.21
1.57
5.60
2.40
3.70
10.77
1.26
3.63
1.75
8.38
Cost
Weight w/o
Emerg &
ICU
0.88
3.50
0.49
0.85
0.50
1.35
0.93
1.39
1.25
2.97
2.20
4.57
11.77
3.21
4.43
10.15
0.65
0.84
0.18
0.79
2.22
0.21
1.58
5.75
2.41
3.72
10.99
1.28
3.68
1.76
8.58
Cost
Weight w/o
Emerg
1.62
2.26
0.98
3.51
0.61
0.96
0.63
1.48
1.02
1.46
1.34
2.85
2.23
4.53
11.03
3.29
4.53
9.42
0.65
0.84
0.18
0.81
0.98
3.63
0.61
0.96
0.63
1.48
1.03
1.49
1.40
3.14
2.26
4.64
11.90
3.31
4.54
10.31
0.65
0.84
0.18
0.81
2.28
0.22
1.61
0.22
5.86
2.46
3.80
11.08
1.29
3.73
1.79
8.69
Cost
weight w
all cost
groups
5.71
2.45
3.77
10.87
1.27
3.68
1.78
8.49
Cost
Weight w/o
ICU
0.55
0.59
0.78
0.49
0.59
0.39
0.48
0.21
0.37
0.43
0.34
0.48
0.48
0.40
0.26
0.32
0.14
0.26
0.29
0.37
0.14
0.19
0.70
0.48
2.01
0.34
0.24
0.48
0.22
0.16
0.08
0.16
0.24
0.22
0.48
0.46
0.22
0.48
0.48
0.19
0.08
0.30
0.48
Outlier per
diem as a
weight
0.94
0.49
0.35
0.73
0.34
0.24
0.12
0.25
0.35
0.21
0.85
0.70
0.61
1.44
3.58
0.29
0.12
0.46
1.09
Transfer
cost weight
31
10
1,050
5
9
6
13
10
17
14
26
21
33
60
17
26
48
3
6
3
13
28
3
14
44
12
30
60
14
34
23
60
High trim
point (days)
1,500
1,500
1,250
800
1,000
450
800
900
1150
450
600
1,500
1,050
750
1,500
700
500
250
500
750
700
1,500
1,450
700
1,500
1,500
600
250
950
1,500
Outlier
per diem
amount ($)
Appendix 1A: Acute Care Cost Weights (Rebased)
Part 1: General Cost weights
75
Other Procedures for Injuries to Lower Limb Age<60 W/O CC
Other Procedures for Injuries to Hand
Other Procedures for Other Injuries W Catastrophic or Severe
X04B
X05Z
X06A
Opioid Use Disorder and Dependence, Left Against Medical Advi
V63B
Other Procedures for Injuries to Lower Limb Age>59 or W CC
Opioid Use Disorder and Dependence
V63A
X04A
Alcohol Use Disorder and Dependence, Sameday
V62B
Microvascular Tissue Transfer or Skin Grafts for Injuries to
Alcohol Use Disorder and Dependence
V62A
Multiple Trauma Without Significant Procedures
Drug Intoxication and Withdrawal
V61Z
X02Z
Alcohol Intoxication and Withdrawal W/O CC
V60B
W61Z
Alcohol Intoxication and Withdrawal W CC
V60A
Multiple Trauma, Died or Transf to Another Acute Care Facilit
Childhood Mental Disorders
U68Z
Other O.R. Procedures for Multiple Significant Trauma
Personality Disorders and Acute Reactions
U67Z
W60Z
Eating and Obsessive-Compulsive Disorders
U66Z
W04Z
Anxiety Disorders
U65Z
Abdominal Procedures for Multiple Significant Trauma
Other Affective and Somatoform Disorders
U64Z
Hip, Femur and Limb Procs for Multiple Significant Trauma, in
Major Affective Disorders Age<70 W/O Catastrophic or Severe C
U63B
W03Z
Major Affective Disorders W Cat or Sev CC or (Age>69 W/O Cat
U63A
W02Z
735
Paranoia & Acute Psych Disorder W/O Cat/Sev CC W/O Mental Hea
U62B
Other Drug Use Disorder and Dependence
Paranoia & Acute Psych Disorder W Cat/Sev CC or W Mental Heal
U62A
Ventilation or Craniotomy Procs for Multiple Significant Trau
Schizophrenia Disorders W/O Mental Health Legal Status
U61B
V64Z
Schizophrenia Disorders W Mental Health Legal Status
U61A
W01Z
118
Mental Health Treatment, Sameday, W/O ECT
U60Z
498
1,193
545
183
578
295
265
124
74
188
291
333
80
1,817
409
1,529
821
87
662
268
917
963
566
295
276
64
404
69
5,122
494
Mental Health Treatment, Sameday, W ECT
U40Z
Seps
AR-DRG Title
AR-DRG
V5.0 No.
0.12
0.03
0.03
0.15
0.05
0.12
0.09
0.38
0.23
0.34
0.56
0.04
0.10
0.11
0.03
0.09
0.02
0.01
0.04
0.10
0.02
0.43
0.04
0.04
0.02
0.19
0.01
0.14
0.03
0.06
0.01
0.03
Standard
error
3.31
0.94
1.02
2.34
1.34
2.83
1.27
7.38
3.66
7.92
14.16
0.65
0.75
1.17
0.21
1.25
0.52
0.26
0.71
1.28
0.46
5.88
0.93
0.85
0.39
2.24
0.24
1.17
0.47
0.59
0.12
0.16
Cost
Weight w/o
Emerg &
ICU
3.68
0.94
1.03
2.48
1.35
3.19
1.41
8.20
4.34
8.26
20.47
0.66
0.75
1.17
0.21
1.25
0.52
0.27
0.77
1.29
0.48
5.92
0.95
0.86
0.39
2.26
0.24
1.19
0.47
0.60
0.12
0.16
Cost
Weight w/o
Emerg
3.41
1.02
1.11
2.44
1.42
2.95
1.55
7.53
3.79
8.05
14.30
1.19
0.76
1.23
0.32
1.28
0.75
0.39
0.85
1.46
0.60
5.98
1.04
0.96
0.54
2.41
0.51
1.27
0.61
0.70
0.27
0.16
Cost
Weight w/o
ICU
3.78
1.02
1.12
2.58
1.43
3.31
1.68
8.35
4.46
8.40
20.61
1.20
0.76
1.23
0.32
1.29
0.76
0.39
0.91
1.46
0.62
6.01
1.05
0.96
0.54
2.43
0.51
1.28
0.62
0.71
0.27
0.16
Cost
weight w
all cost
groups
0.47
0.84
0.51
0.40
0.22
0.44
0.41
1.04
0.59
0.72
0.43
0.41
0.11
0.20
0.21
0.39
0.24
0.26
0.29
0.70
0.21
1.44
0.72
0.30
0.24
0.34
0.27
0.14
0.30
0.27
0.48
0.38
0.48
0.29
0.27
0.08
0.13
0.24
0.26
0.16
0.19
0.19
0.46
0.14
0.48
0.48
0.37
0.22
0.39
0.10
0.43
0.18
0.08
0.13
0.18
0.16
Outlier per
diem as a
weight
0.33
0.13
0.24
0.25
0.12
0.20
0.12
0.16
Transfer
cost weight
950
750
1,050
850
450
950
850
1,500
1,200
1,500
900
850
26
4
5
19
4
26
3
48
18
43
60
14
14
14
250
3
13
8
7
12
9
5
60
12
14
7
41
9
18
5
3
3
3
High trim
point (days)
400
750
800
500
600
600
1,450
450
1,500
1,500
700
1,150
300
1,350
550
250
400
550
500
Outlier
per diem
amount ($)
Appendix 1A: Acute Care Cost Weights (Rebased)
Part 1: General Cost weights
76
Poisoning/Toxic Effects of Drugs & Other Substances Age>59 or
Poisoning/Toxic Effects of Drugs & Other Substances Age<60 W/
Sequelae of Treatment W Catastrophic or Severe CC
Sequelae of Treatment W/O Catastrophic or Severe CC
Other Injury, Poisoning and Toxic Effect Diagnosis Age>59 or
Other Injury, Poisoning and Toxic Effect Diagnosis Age<60 W/O
Severe Full Thickness Burns
Other Burns W Skin Graft Age>64 or W Cat/Sev CC or W
Complicg
Other Burns W Skin Graft Age<65 W/O Cat or Sev CC W/O
Complic
Other O.R. Procedures for Other Burns
Burns, Transferred to Another Acute Care Facility < 5 Days
Severe Burns
Other Burns Age>64 or W Catastr or Severe CC or W Complicatin
Other Burns Age<65 W/O Catastr or Severe CC W/O Complicating
O.R. Procedures W Diagnoses of Other Contacts W Health Servic
O.R. Procedures W Diagnoses Other Contacts W Health Services
Follow Up After Completed Treatment W Endoscopy
Signs and Symptoms
Follow Up After Completed Treatment W/O Endoscopy
Other Aftercare W Catastrophic or Severe CC
Other Aftercare W/O Catastrophic or Severe CC
Other Factors Influencing Health Status
Other Factors Influencing Health Status, Sameday
Multiple, Other and Unspecified Congenital Anomalies
X62B
X63A
X63B
X64A
X64B
Y01Z
Y02A
Y02B
Y03Z
Y60Z
Y61Z
Y62A
Y62B
Z01A
Z01B
Z40Z
Z61Z
Z62Z
Z63A
Z63B
Z64A
Z64B
Z65Z
Injuries Age >64 W/O CC
X60B
X62A
Injuries Age>64 W CC
X60A
Injuries Age<65
Skin Grafts for Injuries Excluding Hand W/O Cat or Sev CC
X07B
Allergic Reactions
Mic Tissue Transfer or (Skin Graft W Cat/Sev CC) for Injuries
X07A
X60C
Other Procedures for Other Injuries W/O Catastrophic or Sever
X06B
X61Z
AR-DRG Title
AR-DRG
V5.0 No.
79
6,255
1,674
883
1,216
206
1,118
7,392
444
288
729
87
124
380
72
333
107
34
649
279
2,586
754
3,561
2,600
859
4,727
1,397
2,006
208
132
1,780
Seps
0.16
0.02
0.05
0.02
0.04
0.04
0.03
0.02
0.04
0.12
0.02
0.17
0.14
0.01
0.14
0.21
0.42
3.22
0.01
0.05
0.02
0.05
0.01
0.03
0.01
0.02
0.02
0.04
0.15
0.40
0.03
Standard
error
1.12
0.33
0.92
0.55
1.53
0.55
0.72
0.38
0.93
1.70
0.48
2.16
1.30
0.17
1.75
2.76
6.51
26.71
0.27
0.83
0.62
1.49
0.29
0.67
0.24
0.36
0.47
1.26
2.62
5.92
1.03
Cost
Weight w/o
Emerg &
ICU
1.14
0.33
0.93
0.56
1.57
0.55
0.72
0.38
0.94
1.79
0.49
2.32
1.43
0.20
1.81
2.79
6.67
34.19
0.30
0.90
0.63
1.58
0.33
0.81
0.28
0.37
0.48
1.27
2.62
6.10
1.05
Cost
Weight w/o
Emerg
1.14
0.34
0.98
0.55
1.54
0.55
0.81
0.38
0.93
1.71
0.57
2.23
1.38
0.39
1.84
2.77
6.58
26.72
0.34
1.04
0.73
1.59
0.43
0.83
0.37
0.48
0.62
1.43
2.71
6.03
1.11
Cost
Weight w/o
ICU
1.15
0.34
0.98
0.57
1.58
0.56
0.82
0.38
0.94
1.80
0.58
2.40
1.51
0.43
1.89
2.80
6.75
34.21
0.37
1.11
0.74
1.69
0.46
0.97
0.41
0.49
0.62
1.44
2.72
6.21
1.13
Cost
weight w
all cost
groups
1.21
0.26
0.33
0.38
0.38
0.39
0.32
0.71
0.33
0.85
0.18
0.22
0.26
0.13
0.26
0.08
0.37
0.22
0.29
0.24
0.45
0.24
0.48
0.48
0.74
0.24
0.22
0.48
0.48
0.24
0.11
0.11
0.11
0.18
0.37
0.17
0.34
0.78
1.44
0.36
0.18
0.16
0.16
0.27
0.18
0.16
0.27
0.27
0.16
0.16
0.37
0.45
0.46
0.29
Outlier per
diem as a
weight
0.24
0.24
0.40
0.29
0.49
0.68
0.69
0.98
Transfer
cost weight
3
10
550
16
9
23
5
13
3
4
11
5
22
16
3
17
28
41
60
3
14
7
16
3
9
3
4
10
23
27
45
6
High trim
point (days)
700
800
400
800
250
1,150
700
900
750
1,400
750
1,500
750
700
1,500
1,500
750
350
350
350
550
500
550
850
500
500
1,150
1,400
1,450
900
Outlier
per diem
amount ($)
Appendix 1A: Acute Care Cost Weights (Rebased)
Part 1: General Cost weights
77
Appendix 1A: Acute Care Cost Weights
Rebased
ACUTE CARE COST WEIGHTS
PART 2: SAME DAY
Part 2: Same Day Cost Weights for
for selected DRGS (Rebased)
Appendix 1A: Acute Care Cost Weights
Part 2: Same Day Cost Weights
Descriptions of the abbreviations shown
in tables are as follows:
AR-DRG No.
AR-DRG V5.0 number
AR-DRG Title
AR-DRG V5.0 description
Same day seps (No.)
Total same day separations
Seps w/o same day ED cases (No)
Same day separations excluding same day
cases treated in ED
Standard error
Standard error of the cost weight
Cost Weight w/o ED & ICU
Cost weight excluding ED and ICU cost groups
Cost Weight w all cost groups
Cost weight including all cost groups
Cost Weight w/o ED
Cost weight excluding ED cost group
Cost Weight w/o ICU
Cost weight excluding ICU cost group
79
440
1,464
Spinal Procedures W/O Catastrophic or Severe CC Day Case
Procs for Cerebral Palsy, Muscular Dystrophy, Neuropathy W/O Day Case
Established Paraplegia/Quadriplegia W or W/O O.R. Procs W/O C Day Case
Cerebral Palsy Day Case
Nervous System Neoplasm W/O Catastrophic or Severe CC Day Case
Degenerative Nervous System Disorders Age >59 W/O Catastr or Day Case
Degenerative Nervous System Disorders Age <60 W/O Catastrophi Day Case
Multiple Sclerosis and Cerebellar Ataxia W/O CC Day Case
B03B
B06B
B60B
B65Z
B66B
B67B
B67C
B68B
Respiratory Neoplasms W/O CC Day Case
Interstitial Lung Disease W/O Catastrophic or Severe CC Day Case
Other Respiratory System Diagnosis (Age<65 W CC) or (Age>64 W Day Case
E74C
E75B
Other Ear, Nose, Mouth and Throat Diagnoses W/O CC Day Case
D66B
E71C
Epistaxis Day Case
D62Z
Respiratory Neoplasms W Severe or Moderate CC Day Case
Dysequilibrium Day Case
D61Z
E71B
Ear, Nose, Mouth and Throat Malignancy W/O Catastrophic or Se Day Case
D60B
Cystic Fibrosis W/O Catastrophic or Severe CC Day Case
Dental Extractions and Restorations Day Case
D40Z
Pulmonary Embolism W/O Catastrophic or Severe CC Day Case
Mouth & Salivary Gland Procedures Day Case
D14Z
E60B
Maxillo Surgery W/O CC Day Case
D04B
E61B
Other Disorders of the Eye W/O CC Day Case
C63B
Dacryocystorhinostomy Day Case
Other Corneal, Scleral and Conjunctival Procedures Day Case
Enucleations and Orbital Procedures Day Case
C02Z
C05Z
Neurological & Vascular Disorders of the Eye Day Case
Other Disorders of the Nervous System W/O Catastrophic or Sev Day Case
B81B
C12Z
39
Other Head Injury Day Case
B80Z
C61Z
589
Headache Day Case
B77Z
191
112
385
253
112
50
1,331
216
314
258
5,151
623
105
725
149
571
148
517
657
1,062
Cranial and Peripheral Nerve Disorders W/O CC Day Case
Seizure W/O Catastrophic or Severe CC Day Case
B71B
B76B
799
240
186
371
236
409
29
119
Extensive O.R. Procedure Unrelated to Principal Diagnosis Day Case
901Z
Same day seps
AR-DRG Title
AR-DRG
V5.0 No.
0.06
0.07
0.06
0.07
0.04
0.23
0.02
0.01
0.02
0.05
0.05
0.04
0.21
0.02
0.02
0.06
0.08
0.17
0.05
0.02
0.02
0.03
0.02
0.03
0.03
0.03
0.05
0.10
0.10
0.07
0.69
0.20
Standard
error
0.65
0.55
0.71
0.71
0.32
0.91
0.36
0.23
0.18
0.77
0.58
0.79
1.49
0.34
0.31
0.92
0.89
1.02
0.51
0.23
0.25
0.33
0.27
0.29
0.22
0.22
0.57
0.91
0.79
1.15
1.84
2.25
Cost
Weight
w/o Emerg &
ICU*
0.69
0.55
0.71
0.71
0.32
0.91
0.36
0.23
0.18
0.77
0.58
0.79
1.49
0.34
0.31
0.92
0.89
1.02
0.51
0.23
0.25
0.33
0.27
0.29
0.22
0.22
0.57
0.91
0.79
1.15
1.84
2.25
Cost
Weight
w/o
Emerg
0.74
0.57
0.73
0.73
0.42
0.94
0.39
0.35
0.36
0.78
0.59
0.80
1.55
0.37
0.32
0.93
0.89
1.02
0.61
0.37
0.42
0.48
0.28
0.30
0.24
0.24
0.59
0.92
0.88
1.15
1.84
2.33
Cost
Weight
w/o ICU
0.79
0.57
0.73
0.73
0.42
0.94
0.39
0.35
0.36
0.78
0.59
0.80
1.55
0.37
0.32
0.93
0.89
1.02
0.61
0.37
0.42
0.48
0.28
0.30
0.24
0.24
0.60
0.92
0.88
1.16
1.85
2.33
Cost
weight w
all cost
groups
Appendix 1A: Acute Care Cost Weights (Rebased)
Part 2: Same Day Cost weights
80
329
204
Vascular Procs Except Major Reconstruction W/O CPB Pump W/O C Day Case
Other Circulatory System O.R. Procedures W/O Catastrophic CC Day Case
Circulatory Disorders W/O AMI W Invasive Cardiac Inves Proc W Day Case
Circulatory Disorders W/O AMI W Invasive Cardiac Inves Proc W Day Case
Venous Thrombosis W/O Catastrophic or Severe CC Day Case
Peripheral Vascular Disorders W/O Catastrophic or Severe CC Day Case
Coronary Atherosclerosis W/O CC Day Case
Hypertension W/O CC Day Case
Valvular Disorders W/O Catastrophic or Severe CC Day Case
Non-Major Arrhythmia and Conduction Disorders W/O Catastrophi Day Case
Syncope and Collapse W/O Catastrophic or Severe CC Day Case
Chest Pain Day Case
Other Circulatory System Diagnoses W/O Catastrophic or Severe Day Case
Abdominal and Other Hernia Procedures Age >59 or W Catastroph Day Case
Abdominal and Other Hernia Procedures Age 1 to 59 W/O Cat or Day Case
F14C
F21B
F42A
F42B
F63B
F65B
F66B
F67B
F69B
F71B
F73B
F74Z
F75C
G08A
G08B
489
Abdominal Pain or Mesenteric Adenitis W/O CC Day Case
Oesophagitis, Gastroent & Misc Digestive Systm Disorders Age> Day Case
Oesophagitis and Misc Digestive System Disorders Age<10 Day Case
Other Digestive System Diagnoses W CC Day Case
Other Digestive System Diagnoses W/O CC Day Case
Laparoscopic Cholecystectomy W/O Closed CDE W/O Catastrophic/ Day Case
ERCP Complex Therapeutic Procedure W/O Catastrophic or Severe Day Case
ERCP Other Therapeutic Procedure W/O CC Day Case
Cirrhosis and Alcoholic Hepatitis W Severe CC Day Case
Cirrhosis and Alcoholic Hepatitis W/O Catastrophic or Severe Day Case
G66B
G67B
G69Z
G70A
G70B
H08B
H41B
H42C
H60B
H60C
Inflammatory Bowel Disease Day Case
Abdominal Pain or Mesenteric Adenitis W CC Day Case
G64Z
G66A
276
Digestive Malignancy W Catastrophic or Severe CC Day Case
Digestive Malignancy W/O Catastrophic or Severe CC Day Case
G60A
G60B
222
121
419
261
220
1,163
237
175
1,865
1,021
160
143
4,772
1,482
Inguinal and Femoral Hernia Procedures Age>0 Day Case
Anal and Stomal Procedures W/O Catastrophic or Severe CC Day Case
G09Z
G11B
918
2,727
493
1,313
276
100
251
677
109
1,892
345
69
212
150
Cardiac Pacemaker Implantation Day Case
F12Z
Same day seps
AR-DRG Title
AR-DRG
V5.0 No.
0.03
0.06
0.07
0.16
0.13
0.02
0.04
0.03
0.02
0.02
0.02
0.07
0.05
0.06
0.03
0.06
0.05
0.07
0.05
0.01
0.02
0.03
0.02
0.03
0.02
0.03
0.02
0.08
0.09
0.15
0.06
0.30
Standard
error
0.40
0.40
0.72
1.11
1.43
0.32
0.32
0.33
0.24
0.28
0.28
0.84
0.53
0.53
0.69
1.02
0.98
0.98
0.54
0.23
0.21
0.39
0.29
0.23
0.32
0.38
0.20
0.56
0.56
1.19
1.03
1.88
Cost
Weight
w/o Emerg &
ICU*
0.40
0.40
0.72
1.11
1.44
0.32
0.32
0.33
0.24
0.28
0.28
0.84
0.53
0.53
0.69
1.02
0.98
0.98
0.54
0.23
0.21
0.42
0.29
0.23
0.32
0.39
0.20
0.56
0.56
1.19
1.03
1.88
Cost
Weight
w/o
Emerg
0.40
0.40
0.73
1.11
1.45
0.39
0.39
0.48
0.40
0.45
0.45
0.86
0.55
0.55
0.70
1.03
0.99
0.99
0.67
0.39
0.35
0.48
0.41
0.29
0.38
0.44
0.29
0.56
0.56
1.20
1.03
1.88
Cost
Weight
w/o ICU
0.40
0.40
0.73
1.11
1.45
0.39
0.39
0.48
0.40
0.45
0.45
0.86
0.55
0.55
0.70
1.03
0.99
0.99
0.67
0.39
0.35
0.51
0.41
0.29
0.39
0.44
0.29
0.56
0.56
1.20
1.03
1.88
Cost
weight w
all cost
groups
Appendix 1A: Acute Care Cost Weights (Rebased)
Part 2: Same Day Cost weights
81
67
135
Disorders of Liver Excep Malig, Cirrhosis, Alcoholic Hepatiti Day Case
Disorders of the Biliary Tract W/O CC Day Case
Other Knee Procedures Day Case
Other Elbow or Forearm Procedures Day Case
Soft Tissue Procedures W/O Catastrophic or Severe CC Day Case
Other Connective Tissue Procedures W/O CC Day Case
Osteomyelitis W/O CC Day Case
H63B
H64B
I18Z
I19Z
I27B
I28B
I64B
349
99
320
794
1,701
6,815
214
76
Bone Diseases&Spec Arthropathies(A<75 W Cat/Sev CC) or (A>74 Day Case
Bone Diseases & Spec Arthropathies Age<75 W/O Catastr or Seve Day Case
Musculotendinous Disorders Age <70 W/O CC Day Case
Tendonitis, Myositis and Bursitis Age<80 W/O Catastrophic or Day Case
Aftercare Conn Tiss Disorder (Age<60 W Cat/Sev CC) or (Age>59 Day Case
Aftercare of Connective Tissue Disorders Age<60 W/O Catastrop Day Case
Other Musculoskeletal Disorders Age<70 W/O CC Day Case
Other Skin Graft and/or Debridement Procedures W/O Catastroph Day Case
Other Skin, Subcutaneous Tissue and Breast Procedures Day Case
Lower Limb Procs W/O Ulcer/Cellulitis W/O (Skin Graft & Catas Day Case
I69B
I69C
I71C
I72B
I73B
I73C
I76C
J08B
J11Z
J13B
Minor Bladder Procedures W/O Catastrophic or Severe CC Day Case
Transurethral Procedures Except Prostatectomy W/O Catastrophi Day Case
Renal Failure W/O Catastrophic or Severe CC Day Case
L06B
L60C
Kidney, Ureter & Major Bladder Procedures for Non-Neoplasm W Day Case
L04B
L07B
Endocrine Disorders W/O Catastrophic or Severe CC Day Case
K64B
357
Inborn Errors of Metabolism Day Case
Endocrine Disorders W Catastrophic or Severe CC Day Case
Miscellaneous Metabolic Disorders W/O Catastrophic or Severe Day Case
K62C
K63Z
Miscellaneous Metabolic Disorders W Severe CC or (Age>74 W/O Day Case
K62B
K64A
651
Diabetes W/O Catastrophic or Severe CC Day Case
K60B
547
1,945
177
131
566
34
209
313
32
Malignant Breast Disorders W Catastrophic or Severe CC or (Ag Day Case
Other Endocrine, Nutritional and Metabolic O.R. Procedures Day Case
J62A
K09Z
336
911
526
1,583
Connective Tissue Malignancy, including Pathological Fx W/O C Day Case
Inflammatory Musculoskeletal Disorders W/O Cat or Sev CC Day Case
I65B
I66B
293
730
407
3,663
438
419
154
Malig Hepatobilry Sys, Pancreas (A<70 W/O Cat CC) or (A>69 W/ Day Case
H61B
Same day seps
AR-DRG Title
AR-DRG
V5.0 No.
0.03
0.05
0.08
0.26
0.03
0.10
0.07
0.03
0.03
0.03
0.21
0.07
0.05
0.02
0.04
0.03
0.03
0.03
0.03
0.02
0.03
0.03
0.03
0.05
0.04
0.06
0.04
0.08
0.04
0.03
0.06
0.07
Standard
error
0.28
0.85
0.85
1.95
0.48
0.48
0.37
0.32
0.32
0.32
1.17
0.37
1.05
0.56
0.98
0.42
0.39
0.39
0.37
0.26
0.29
0.29
0.33
0.59
0.29
1.12
0.87
1.28
0.93
0.38
0.66
0.60
Cost
Weight
w/o Emerg &
ICU*
0.28
0.85
0.85
1.95
0.48
0.48
0.37
0.32
0.32
0.35
1.17
0.37
1.05
0.56
0.98
0.42
0.39
0.39
0.37
0.27
0.29
0.29
0.33
0.59
0.29
1.12
0.87
1.28
0.93
0.38
0.66
0.60
Cost
Weight
w/o
Emerg
0.30
0.86
0.86
1.99
0.52
0.52
0.38
0.39
0.39
0.47
1.17
0.42
1.07
0.57
1.00
0.44
0.40
0.40
0.41
0.32
0.30
0.30
0.33
0.65
0.33
1.14
0.89
1.34
0.93
0.52
0.68
0.67
Cost
Weight
w/o ICU
0.30
0.86
0.86
1.99
0.52
0.52
0.38
0.39
0.39
0.50
1.17
0.42
1.07
0.57
1.00
0.44
0.40
0.40
0.41
0.32
0.30
0.30
0.33
0.65
0.33
1.14
0.89
1.34
0.93
0.52
0.68
0.67
Cost
weight w
all cost
groups
Appendix 1A: Acute Care Cost Weights (Rebased)
Part 2: Same Day Cost weights
82
Other Procedures for Injuries to Hand Day Case
Other Procedures for Other Injuries W/O Catastrophic or Sever Day Case
Injuries Age>64 W CC Day Case
Injuries Age >64 W/O CC Day Case
Injuries Age<65 Day Case
O.R. Procedures W Diagnoses of Other Contacts W Health Servic Day Case
O.R. Procedures W Diagnoses Other Contacts W Health Services Day Case
Signs and Symptoms Day Case
Follow Up After Completed Treatment W/O Endoscopy Day Case
Other Aftercare W/O Catastrophic or Severe CC Day Case
X60A
X60B
X60C
Z01A
Z01B
Z61Z
Z62Z
Z63B
Acute Leukaemia W Severe CC Day Case
Acute Leukaemia W/O Catastrophic or Severe CC Day Case
R60B
R60C
X06B
Acute Leukaemia W Catastrophic CC Day Case
R60A
X05Z
63
Coagulation Disorders Day Case
Q62Z
Other Infectious and Parasitic Diseases W/O Catastrophic or S Day Case
169
935
Red Blood Cell Disorders W/O Catastrophic or Severe CC Day Case
Other Drug Use Disorder and Dependence Day Case
51
Red Blood Cell Disorders W Severe CC Day Case
Q61B
Q61C
T64B
207
Red Blood Cell Disorders W Catastrophic CC Day Case
V64Z
67
Reticuloendothelial and Immunity Disorders W/O Cat or Sev CC Day Case
Q61A
172
2,022
780
856
271
1,582
206
150
504
663
59
726
6,638
3,580
69
538
4,619
3,622
30
Q60C
Uterine, Adnexa Procedure for Non-Ovarian or Adnexal Malignan Day Case
N03B
328
295
Reticuloendothelial and Immunity Disorders W/O Cat or Sev CC Day Case
Malignancy, Male Reproductive System W/O Catastrophic or Seve Day Case
M60B
False Labour Before 37 Weeks or W Catastrophic CC Day Case
Penis Procedures W/O CC Day Case
M03B
217
2,495
Q60B
Other Kidney and Urinary Tract Diagnoses W/O Catastrophic or Day Case
L67C
O64A
Other Kidney and Urinary Tract Diagnoses W Severe CC Day Case
L67B
427
934
Other Uterine and Adnexa Procedures for Non-Malignancy Day Case
Kidney and Urinary Tract Signs and Symptoms W/O Catastrophic Day Case
L65B
Conisation, Vagina, Cervix and Vulva Procedures Day Case
Urinary Stones and Obstruction Day Case
L64Z
195
N07Z
Kidney and Urinary Tract Neoplasms W/O Catastrophic or Severe Day Case
L62B
Same day seps
N09Z
AR-DRG Title
AR-DRG
V5.0 No.
0.02
0.01
0.04
0.03
0.07
0.03
0.03
0.05
0.06
0.07
0.04
0.06
0.07
0.08
0.07
0.03
0.02
0.02
0.03
0.02
0.05
0.03
0.02
0.03
0.22
0.05
0.06
0.03
0.06
0.03
0.02
0.04
Standard
error
0.32
0.29
0.53
0.72
0.72
0.33
0.33
0.33
0.86
0.73
0.28
0.43
0.51
0.51
0.51
0.28
0.28
0.28
0.28
0.23
0.23
0.36
0.60
0.87
1.36
0.54
0.90
0.33
0.33
0.31
0.28
0.36
Cost
Weight
w/o Emerg &
ICU*
0.32
0.29
0.53
0.72
0.72
0.33
0.33
0.33
0.86
0.73
0.28
0.43
0.51
0.51
0.51
0.28
0.28
0.28
0.28
0.23
0.23
0.36
0.60
0.87
1.36
0.54
0.90
0.33
0.33
0.32
0.28
0.36
Cost
Weight
w/o
Emerg
0.33
0.29
0.58
0.72
0.72
0.50
0.50
0.50
0.97
0.85
0.41
0.45
0.53
0.53
0.53
0.33
0.28
0.28
0.28
0.24
0.24
0.37
0.61
0.88
1.39
0.55
0.92
0.34
0.34
0.41
0.44
0.39
Cost
Weight
w/o ICU
0.33
0.29
0.58
0.72
0.72
0.50
0.50
0.50
0.97
0.85
0.41
0.45
0.53
0.53
0.53
0.33
0.28
0.28
0.28
0.24
0.24
0.37
0.61
0.88
1.39
0.55
0.93
0.34
0.34
0.41
0.44
0.39
Cost
weight w
all cost
groups
Appendix 1A: Acute Care Cost Weights (Rebased)
Part 2: Same Day Cost weights
83
Appendix 2: Average Acute Cost by Cost
Group and DRG
Part 1: Overnight
AVERAGE ACUTE COST
PART 1: OVERNIGHT
App 2: Average Acute Cost by Cost Group & DRG NSW
Part 1: General Acute Cost Averages
The costs shown in the following table have been
inflated to reflect 2009/10 prices.
The total per separation is not necessarily the sum of
the cost groups due to the effect of averaging.
85
17
63
Non-Extensive O.R. Procedure Unrelated to Principal Diagnosis
Prostatic O.R. Procedure Unrelated to Principal Diagnosis
902Z
903Z
3,115
132
Heart Transplant
Tracheostomy Any Age, Any Condition
A05Z
A06Z
Peripheral and Cranial Nerve & Other Nervous System Procedure
Plasmapheresis W Neurological Disease
Telemetric EEG Monitoring
Established Paraplegia/Quadriplegia W or W/O O.R. Procs W Cat
Established Paraplegia/Quadriplegia W or W/O O.R. Procs W/O C
B40Z
B41Z
B60A
B60B
Procs for Cerebral Palsy, Muscular Dystrophy, Neuropathy W/O
B06B
Peripheral and Cranial Nerve & Other Nervous System Procedure
Procs for Cerebral Palsy, Muscular Dystrophy, Neuropathy W C
B06A
B07A
Carpal Tunnel Release
B05Z
B07B
Extracranial Vascular Procedures W Catastrophic or Severe CC
Extracranial Vascular Procedures W/O Catastrophic or Severe C
B04A
B04B
Spinal Procedures W/O Catastrophic or Severe CC
Craniotomy W Catastrophic CC
B02A
Spinal Procedures W Catastrophic or Severe CC
Ventricular Shunt Revision
B01Z
B03B
Intubation Age<16 W/O CC
B03A
793
Intubation Age<16 W CC
A41A
A41B
Craniotomy W Severe or Moderate CC
ECMO W/O Cardiac Surgery
A40Z
Craniotomy W/O CC
639
Renal Transplant W/O Pancreas Transplant W/O Catastrophic CC
A09B
B02B
161
Renal Transplant W Pancreas Transplant or Catastrophic CC
A09A
B02C
24
Autologous Bone Marrow Transplant W/O Catastrophic CC
A08B
1,116
414
279
97
1,058
169
323
82
3,165
469
252
360
90
1,139
103
170
121
86
135
154
Allogeneic Bone Marrow Transplant
Autologous Bone Marrow Transplant W Catastrophic CC
A07Z
A08A
20
40
Liver Transplant
Lung or Heart/Lung Transplant
A01Z
A03Z
297
989
Extensive O.R. Procedure Unrelated to Principal Diagnosis
901Z
Total
Seps
AR-DRG Title
ARDRG
V5.0 No.
2,129
6,193
1,790
955
443
1,518
1,398
4,447
323
628
1,615
1,427
6,052
1,642
2,607
5,120
1,520
570
3,339
14,299
5,657
9,946
1,641
4,883
9,718
9,285
17,507
15,133
13,860
4,009
1,446
3,154
Clin
dept
($)
388
1,962
609
276
74
298
433
2,007
22
78
301
271
989
285
663
1,771
329
1,076
2,062
3,364
1,096
2,115
830
2,118
3,740
4,215
5,502
3,383
4,754
1,057
219
629
Allied
Health
($)
5,213
12,017
3,327
2,275
740
2,977
2,815
10,504
196
1,508
4,679
2,974
9,513
3,597
5,772
10,778
4,072
940
6,138
6,263
7,531
13,506
10,293
20,020
37,697
11,701
16,515
26,365
22,715
14,484
4,221
8,276
($)
Wards
388
799
113
134
315
568
27
317
20
51
102
67
235
176
205
291
332
963
684
83
90
95
9
114
12
418
442
441
242
767
232
325
Emerg
Dept
($)
725
1,118
434
95
2,032
2,374
2,874
2,608
1,142
230
2,638
90
522
25
660
84
731
1
571
1,548
3,570
3,174
276
804
1,580
2,458
5,822
353
3,607
5,057
43,479
443
3,404
14
2,502
8,806
60,215
49,687
23,786
14,643
1,856
500
1,119
($)
ICU
3,509
3,837
4,226
4,530
5,055
2,312
398
2,146
22,650
4,519
6,540
442
1,128
2,084
5,586
9,899
9,086
31,488
2,914
1,486
2,071
($)
Procs
264
931
308
214
49
252
97
988
8
202
534
205
1,134
557
876
1,615
459
364
670
3,506
971
2,071
283
832
898
3,262
2,868
1,456
2,994
928
316
885
($)
Imag
235
1,026
105
235
42
217
144
1,109
15
140
368
122
875
430
712
1,445
256
505
1,336
8,385
1,600
2,889
1,429
3,944
7,071
4,905
12,910
7,356
7,422
1,391
501
694
($)
Path
339
1,861
171
305
172
705
224
1,738
82
332
690
465
1,311
750
1,042
2,384
377
359
1,051
5,647
14,921
21,541
7,637
18,079
37,009
9,880
19,198
199
298
9
4
133
249
341
330
52
432
530
1,385
1,025
684
846
990
724
209
369
851
119
308
36
43
32
1,030
258
19
236
28,119
244
139
554
($)
Prosth
10,072
1,160
395
1,185
($)
Pharm
712
1,848
415
1,101
291
440
555
172
403
364
846
86
316
568
429
1,010
614
852
1,484
458
427
1,123
4,354
1,271
2,249
705
1,588
2,867
4,161
2,048
1,308
5,290
983
357
697
($)
Deprec
384
316
704
530
1,676
118
464
912
650
1,614
906
1,307
2,347
719
749
1,518
6,751
1,868
3,102
1,273
2,784
4,962
7,163
8,117
5,877
7,548
2,160
655
1,267
($)
Super
11,217
31,435
7,929
5,662
4,512
10,875
9,320
27,236
2,063
7,869
15,306
11,781
28,344
15,348
21,675
38,581
11,879
9,562
24,661
109,858
40,005
67,332
24,702
57,484
112,841
116,722
134,373
101,454
137,269
31,883
10,421
20,741
Total
per Sep
($)*
Appendix 2: Results of the NSW 2006/07
HCDC inflated to 2009/10 prices
Part 1: General (Overnight) cost averages by cost group
(day case costs excluded for selected AR-DRGs)
86
Intracranial Injury W/O Catastrophic or Severe CC
B78B
Skull Fractures
Intracranial Injury W Catastrophic or Severe CC
B78A
B79Z
Headache
Nontraumatic Stupor and Coma
B74Z
Seizure W/O Catastrophic or Severe CC
Viral Meningitis
B73Z
B77Z
Nervous System Infection Except Viral Meningitis W/O Cat or S
B72B
B76B
Nervous System Infection Except Viral Meningitis W Cat or Sev
B72A
Febrile Convulsions
Cranial and Peripheral Nerve Disorders W/O CC
B71B
Seizure or W Catastrophic or Severe CC
Cranial and Peripheral Nerve Disorders W CC
B71A
B76A
Stroke, Died or Transferred < 5 days
B75Z
Stroke W/O Catastrophic or Severe CC
B70D
Multiple Sclerosis and Cerebellar Ataxia W CC
B68A
B70C
Degenerative Nervous System Disorders Age <60 W/O Catastrophi
B67C
Stroke W Severe CC
Degenerative Nervous System Disorders Age >59 W/O Catastr or
B67B
Stroke W Catastrophic CC
Degenerative Nervous System Disorders W Catastrophic or Sever
B67A
B70B
Nervous System Neoplasm W/O Catastrophic or Severe CC
B66B
B70A
Nervous System Neoplasm W Catastrophic or Severe CC
B66A
TIA and Precerebral Occlusion W/O Catastrophic or Severe CC
Cerebral Palsy
B65Z
B69B
374
Delirium W/O Catastrophic CC
B64B
Multiple Sclerosis and Cerebellar Ataxia W/O CC
Delirium W Catastrophic CC
TIA and Precerebral Occlusion W Catastrophic or Severe CC
205
Dementia and Other Chronic Disturbances of Cerebral Function
B63Z
B64A
B68B
2,150
Admit for Apheresis
B62Z
B69A
521
Spinal Cord Conditions W or W/O O.R. Procedures W/O Catastrop
B61B
806
1,138
476
2,791
5,022
1,409
1,214
312
582
597
190
826
619
2,141
2,721
2,932
2,461
2,828
1,153
480
713
689
717
854
103
1,649
505
285
128
Spinal Cord Conditions W or W/O O.R. Procedures W Catastrophi
B61A
Total
Seps
AR-DRG Title
ARDRG
V5.0 No.
723
716
1,879
468
630
1,037
424
562
637
1,466
2,645
787
1,833
199
892
1,348
2,794
425
858
685
2,064
985
1,064
2,257
811
1,833
2,055
745
1,787
1,332
161
1,067
5,849
Clin
dept
($)
311
259
978
47
79
309
21
127
54
194
710
125
512
115
452
1,339
2,870
122
451
126
768
244
368
1,289
209
640
960
290
894
679
15
513
2,363
Allied
Health
($)
1,528
2,099
5,864
908
1,205
3,142
714
1,570
1,484
3,242
5,976
1,690
3,935
460
3,078
4,885
9,205
1,389
2,958
1,982
5,435
2,173
2,907
6,687
2,168
4,398
2,415
2,661
5,324
5,422
213
3,214
11,156
($)
Wards
731
941
729
447
399
610
370
547
557
477
474
377
558
862
400
468
495
446
501
279
394
321
413
462
440
384
56
677
546
540
1
391
630
Emerg
Dept
($)
76
61
108
43
25
73
22
44
29
121
303
354
1,238
19
99
499
21
174
39
381
773
44
258
176
91
149
147
173
412
7
45
4
279
66
46
503
74
74
77
61
150
12
0
158
1,756
($)
ICU
145
49
63
89
173
72
51
16
124
77
58
151
157
160
241
34
36
66
8
747
1,985
($)
Procs
396
573
616
186
140
377
39
229
158
294
706
153
342
405
452
485
747
259
328
151
312
164
206
366
236
351
123
259
406
237
7
378
1,029
($)
Imag
129
160
424
104
115
321
79
251
223
278
983
105
280
136
175
248
469
99
182
105
247
128
127
312
155
205
91
211
396
207
78
179
894
($)
Path
100
135
457
66
95
301
41
136
164
406
1,337
86
376
60
186
315
664
73
161
132
416
176
180
497
366
624
307
8
35
9
6
4
4
0
21
1
6
7
5
18
4
12
11
35
11
7
5
7
6
14
15
18
8
10
4
7
184
13
274
0
539
2,461
($)
Prosth
471
158
253
1,624
($)
Pharm
322
393
865
194
219
461
115
100
175
255
69
144
129
273
549
161
340
97
243
365
661
130
220
137
389
211
227
478
205
370
388
185
383
307
70
291
1,250
($)
Deprec
220
488
142
264
255
507
949
280
592
184
442
703
1,286
226
417
279
758
355
414
938
353
630
504
386
771
659
49
524
1,873
($)
Super
4,788
5,892
13,493
2,559
3,102
7,360
1,935
4,045
3,724
7,584
15,275
3,896
9,081
2,677
6,517
10,405
19,772
3,246
6,163
3,892
11,162
4,897
6,014
13,894
5,178
9,682
7,233
5,672
11,142
9,730
760
8,233
32,687
Total
per Sep
($)*
Appendix 2: Results of the NSW 2006/07
HCDC inflated to 2009/10 prices
Part 1: General (Overnight) cost averages by cost group
(day case costs excluded for selected AR-DRGs)
87
796
302
Procedures for Penetrating Eye Injury
Enucleations and Orbital Procedures
Retinal Procedures
Major Corneal, Scleral and Conjunctival Procedures
Dacryocystorhinostomy
Strabismus Procedures
Eyelid Procedures
Other Corneal, Scleral and Conjunctival Procedures
Lacrimal Procedures
Other Eye Procedures
C01Z
C02Z
C03Z
C04Z
C05Z
C10Z
C11Z
C12Z
C13Z
C14Z
1,170
Head and Neck Procedures W/O CC W/O Malignancy
Maxillo Surgery W CC
Maxillo Surgery W/O CC
D04A
D04B
Head and Neck Procedures W Moderate CC or Malignancy
D02B
Surgical Repair for Cleft Lip or Palate Diagnosis
Head and Neck Procedures W Catastrophic or Severe CC
D02A
D03Z
Cochlear Implant
D01Z
D02C
Other Disorders of the Eye W/O CC
C63B
888
Neurological & Vascular Disorders of the Eye
C61Z
Hyphema and Medically Managed Trauma to the Eye
Acute and Major Eye Infections Age <55 W/O Catastrophic or Se
C60B
Other Disorders of the Eye W CC
Acute and Major Eye Infections Age >54 or W Catastrophic or S
C60A
C62Z
Lens Procedures, Sameday
C16B
C63A
324
Lens Procedures
C16A
778
317
215
123
106
94
113
514
304
219
206
19,423
640
448
Glaucoma And Complex Cataract Procedures
Glaucoma And Complex Cataract Procedures, Sameday
C15A
C15B
221
105
1,266
549
116
303
1,946
159
188
1,969
Other Disorders of the Nervous System W Catastrophic or Sever
Other Disorders of the Nervous System W/O Catastrophic or Sev
2,052
B81A
Other Head Injury
B80Z
Total
Seps
B81B
AR-DRG Title
ARDRG
V5.0 No.
896
1,426
390
855
2,153
3,812
562
730
1,008
533
1,011
1,325
4,103
649
1,009
508
1,077
482
530
892
675
515
742
625
413
1,456
2,955
718
1,177
352
Clin
dept
($)
106
157
72
61
475
711
28
62
139
67
96
94
180
28
56
24
56
35
22
97
36
55
42
60
47
81
124
162
753
53
Allied
Health
($)
1,288
1,739
2,026
1,760
3,478
5,209
1,226
900
1,620
841
1,595
2,553
5,067
172
755
159
1,945
382
424
2,319
376
303
886
1,841
681
1,870
1,814
1,731
4,072
561
($)
Wards
145
212
3
70
25
83
11
351
310
481
344
294
453
17
11
11
33
19
33
55
69
4
31
16
13
51
208
499
550
375
Emerg
Dept
($)
2,472
2,950
2,201
2,438
4,203
5,317
3,612
56
374
48
138
499
885
3
3
7
138
51
115
13
5
44
1
9
1
10
1
1
24
4
3
7
1
2
99
26
26
104
122
($)
ICU
181
115
37
70
1,294
1,199
1,496
1,463
868
713
1,314
1,461
1,488
1,769
1,974
1,576
1,854
2,063
67
66
24
($)
Procs
90
215
3
100
141
240
26
49
117
126
257
62
68
7
10
5
36
8
5
24
27
4
13
23
14
57
74
244
339
237
($)
Imag
30
75
14
96
361
523
14
61
137
55
176
103
151
9
19
10
37
68
24
45
67
4
23
90
19
164
76
129
304
61
($)
Path
235
351
105
216
577
1,094
194
63
185
69
119
208
490
116
131
121
204
79
58
205
108
70
171
266
167
889
1,149
28
242
244
256
16,551
11
12
3
19
4
7
419
378
255
203
42
31
33
64
31
114
223
197
183
441
263
13
9
2
($)
Prosth
282
108
320
40
($)
Pharm
328
251
376
279
285
486
664
469
123
201
102
194
183
424
107
151
109
210
91
98
201
125
162
184
174
137
238
330
169
283
86
($)
Deprec
524
333
417
799
1,214
562
193
340
181
299
618
760
148
238
176
640
148
132
607
200
190
289
521
316
494
542
292
586
145
($)
Super
6,830
9,459
5,500
6,725
13,346
19,980
23,260
2,681
4,252
2,607
4,240
5,484
11,803
2,965
3,965
2,875
5,915
2,225
2,073
5,817
3,210
2,829
4,270
5,812
3,582
7,094
8,654
4,147
8,538
2,045
Total
per Sep
($)*
Appendix 2: Results of the NSW 2006/07
HCDC inflated to 2009/10 prices
Part 1: General (Overnight) cost averages by cost group
(day case costs excluded for selected AR-DRGs)
88
Pulmonary Embolism W/O Catastrophic or Severe CC
E61B
Respiratory Infections/Inflammations W Catastrophic CC
Pulmonary Embolism W Catastrophic or Severe CC
E61A
E62A
Cystic Fibrosis W/O Catastrophic or Severe CC
Other Respiratory System O.R. Procedures W/O Catastrophic or
E02C
Cystic Fibrosis W Catastrophic or Severe CC
Other Respiratory System O.R. Procedures W Severe CC
E02B
E60B
Other Respiratory System O.R. Procedures W Catastrophic CC
E02A
E60A
Major Chest Procedures W/O Catastrophic CC
E01B
Respiratory System Diagnosis W Ventilator Support
Major Chest Procedures W Catastrophic CC
E01A
Respiratory System Diagnosis W Non-invasive Ventilation
Oral and Dental Disorders Except Extractions and Restorations
D67B
E40Z
Oral and Dental Disorders Except Extractions and Restorations
D67A
E41Z
Other Ear, Nose, Mouth and Throat Diagnoses W/O CC
D66B
1,128
Nasal Trauma and Deformity
Other Ear, Nose, Mouth and Throat Diagnoses W CC
Laryngotracheitis and Epiglottitis
D64Z
D65Z
1,564
Otitis Media and URI W/O CC
D63B
D66A
1,772
Otitis Media and URI W CC
D63A
4,626
1,668
1,032
524
166
974
401
991
112
175
1,002
499
1,490
1,823
1,155
475
6,915
850
2,731
401
267
Dysequilibrium
Ear, Nose, Mouth and Throat Malignancy W Catastrophic or Seve
Ear, Nose, Mouth and Throat Malignancy W/O Catastrophic or Se
D60A
D60B
474
590
Epistaxis
Dental Extractions and Restorations
D40Z
D61Z
Mouth & Salivary Gland Procedures
D14Z
1,652
655
4,889
1,838
1,879
1,492
219
Total
Seps
D62Z
Other Ear, Nose, Mouth & Throat Procedures
Myringotomy W Tube Insertion
D12Z
D13Z
Nasal Procedures
Miscellaneous Ear, Nose, Mouth & Throat Procedures
D09Z
Tonsillectomy or Adenoidectomy
Sinus, Mastoid and Complex Middle Ear Procedures
D06Z
D10Z
Parotid Gland Procedures
D05Z
D11Z
AR-DRG Title
ARDRG
V5.0 No.
1,365
632
1,199
2,631
3,135
1,991
1,729
687
1,457
3,099
2,257
4,967
158
657
544
646
289
342
475
662
440
381
669
2,005
810
920
338
536
512
579
487
773
785
Clin
dept
($)
517
70
273
1,740
3,309
961
821
51
226
746
239
695
16
70
33
70
33
24
26
76
30
75
256
778
58
66
22
80
28
26
42
36
55
Allied
Health
($)
4,875
1,922
4,284
6,099
8,614
6,565
3,266
1,386
3,384
7,170
4,088
7,853
129
1,196
754
1,233
409
510
764
1,453
752
1,048
1,927
5,431
826
1,125
316
811
901
661
610
785
1,255
($)
Wards
530
382
500
125
182
496
244
30
229
455
144
253
253
366
284
400
182
415
349
399
435
457
54
238
171
106
20
188
41
9
25
16
9
Emerg
Dept
($)
95
32
93
319
522
133
297
1,353
1,504
1,703
2,788
369
73
330
69
124
4,758
7,437
230
767
1,164
693
0
2,529
359
66
25
202
11
70
8
11
41
5
14
184
156
312
1
54
11
7
27
40
24
($)
ICU
3,771
187
286
423
503
19
36
45
79
19
342
414
1,042
1,590
904
1,671
1,248
1,786
1,924
2,738
3,310
($)
Procs
372
384
568
168
402
501
880
65
512
1,447
863
1,375
33
142
63
113
110
22
41
112
29
145
113
345
49
67
8
69
25
12
18
35
31
($)
Imag
448
203
375
308
540
837
1,571
92
450
1,261
538
1,233
18
99
53
130
40
35
81
150
83
90
166
321
59
148
15
76
27
17
48
60
224
($)
Path
598
220
517
2,640
3,391
1,035
1,294
131
418
1,210
584
1,518
35
147
83
237
49
42
54
147
72
63
483
973
142
182
59
156
10
4
15
19
21
9
20
122
303
537
356
411
11
9
14
10
21
0
2
2
4
3
18
15
44
89
189
91
73
63
87
121
96
196
($)
Prosth
131
146
229
290
($)
Pharm
673
304
343
170
317
571
614
752
947
660
663
166
363
732
532
950
46
121
97
133
72
56
71
119
78
99
181
453
159
192
88
154
121
134
151
202
249
($)
Deprec
1,396
1,216
1,213
275
613
1,206
831
1,548
76
217
179
246
122
123
143
237
146
182
288
740
235
304
112
247
203
233
229
317
411
($)
Super
10,144
4,380
9,040
15,634
22,402
18,840
18,576
4,560
10,115
20,606
13,879
26,886
1,128
3,265
2,410
3,816
1,837
1,638
2,041
3,408
2,174
2,552
4,534
11,877
3,738
5,078
2,073
4,124
3,265
3,668
3,828
5,328
6,858
Total
per Sep
($)*
Appendix 2: Results of the NSW 2006/07
HCDC inflated to 2009/10 prices
Part 1: General (Overnight) cost averages by cost group
(day case costs excluded for selected AR-DRGs)
89
7,316
7,648
414
632
Respiratory Infections/Inflammations W/O CC
Sleep Apnoea
Pulmonary Oedema and Respiratory Failure
Chronic Obstructive Airways Disease W Catastrophic or Severe
Chronic Obstructive Airways Disease W/O Catastrophic or Sever
Major Chest Trauma Age>69 W CC
E62C
E63Z
E64Z
E65A
E65B
E66A
2,624
1,127
Respiratory Signs and Symptoms W Catastrophic or Severe CC
Respiratory Signs and Symptoms W/O Catastrophic or Severe CC
E67A
E67B
Pleural Effusion W Catastrophic CC
Pleural Effusion W Severe CC
Pleural Effusion W/O Catastrophic or Severe CC
Interstitial Lung Disease W Catastrophic CC
Interstitial Lung Disease W Severe CC
Interstitial Lung Disease W/O Catastrophic or Severe CC
Other Respiratory System Diagnosis Age>64 W CC
E73A
E73B
E73C
E74A
E74B
E74C
E75A
F02Z
AICD Component Implantation/Replacement
Implantation or Replacement of AICD, Total System W/O Catastr
Respiratory Problems Arising from Neonatal Period
E72Z
Implantation or Replacement of AICD, Total System W Catastr o
Respiratory Neoplasms W/O CC
E71C
F01B
Respiratory Neoplasms W Severe or Moderate CC
E71B
F01A
Respiratory Neoplasms W Catastrophic CC
E71A
Other Respiratory System Diagnosis (Age<65 W CC) or (Age>64 W
Whooping Cough and Acute Bronchiolitis W/O CC
E70B
Other Respiratory System Diagnosis Age<65 W/O CC
Whooping Cough and Acute Bronchiolitis W CC
E70A
E75C
Bronchitis and Asthma Age<50 W/O CC
E69C
E75B
2,030
Bronchitis and Asthma (Age<50 W CC) or (Age>49 W/O CC)
E69B
99
338
393
1,879
1,916
2,337
241
196
133
646
423
315
72
473
1,724
1,023
4,633
470
9,121
962
Pneumothorax
Bronchitis and Asthma Age>49 W CC
E68Z
E69A
641
420
Major Chest Trauma (Age<70 W CC) or (Age>69 W/O CC)
Major Chest Trauma Age<70 W/O CC
E66B
E66C
831
970
7,784
6,835
Respiratory Infections/Inflammations W Severe or Moderate CC
E62B
Total
Seps
AR-DRG Title
ARDRG
V5.0 No.
2,030
784
2,566
428
623
764
721
855
1,589
589
1,148
1,561
1,110
513
829
1,481
778
1,432
426
560
654
649
289
571
412
819
1,290
608
1,001
747
302
588
856
Clin
dept
($)
230
35
264
46
153
290
110
231
525
105
171
390
118
116
191
518
36
120
28
86
160
86
33
126
121
191
606
165
297
205
28
79
261
Allied
Health
($)
4,043
1,085
6,049
964
1,816
2,801
2,018
3,023
4,275
1,277
2,866
4,860
1,926
1,623
2,879
4,776
1,582
3,077
879
1,454
2,064
1,932
529
1,643
757
1,723
4,448
1,941
3,439
2,591
486
1,570
2,825
($)
Wards
216
45
180
291
410
463
262
327
399
331
358
360
154
260
348
467
358
425
457
417
385
440
315
499
510
518
537
398
462
573
34
429
495
Emerg
Dept
($)
2,922
2,478
4,620
119
93
62
149
403
100
242
267
1,291
26
1,679
29
52
63
33
183
228
6
15
51
114
50
8
33
134
49
112
42
188
73
130
10
50
29
271
306
54
161
668
41
27
101
($)
ICU
317
257
171
190
12
34
14
70
60
191
335
237
17
113
57
45
52
55
412
36
57
($)
Procs
331
156
519
111
166
222
194
285
458
323
468
491
80
217
351
555
41
72
42
105
130
431
157
249
318
424
429
131
204
167
18
118
213
($)
Imag
623
137
777
103
185
227
222
345
430
264
285
518
97
173
220
392
99
166
51
142
212
109
174
260
49
122
218
165
280
303
23
158
257
($)
Path
539
281
1,194
74
187
244
156
276
528
121
292
577
140
215
374
667
60
145
63
143
210
138
61
201
59
140
326
7,312
17,800
22,131
6
6
9
5
12
9
16
15
36
1
43
29
17
0
0
1
3
2
56
26
14
2
8
8
2
3
206
6
357
4
2
5
($)
Prosth
371
22
118
300
($)
Pharm
852
678
690
699
1,449
89
1,518
146
286
203
178
234
334
145
249
379
170
148
228
382
111
204
79
122
153
182
92
174
118
186
332
143
239
218
64
123
206
($)
Deprec
168
392
303
454
626
243
451
667
254
257
401
656
240
421
163
240
302
307
146
290
183
325
633
276
465
440
122
241
402
($)
Super
20,977
24,200
42,836
2,421
4,105
5,719
4,347
6,612
9,479
3,651
6,577
10,259
4,148
3,822
6,039
10,215
3,358
6,193
2,231
3,501
4,388
4,629
2,159
4,289
2,562
4,804
9,160
4,118
6,948
6,261
1,549
3,477
5,955
Total
per Sep
($)*
Appendix 2: Results of the NSW 2006/07
HCDC inflated to 2009/10 prices
Part 1: General (Overnight) cost averages by cost group
(day case costs excluded for selected AR-DRGs)
90
Other Cardiothoracic Procedures W/O CPB Pump W Catastrophic C
F09A
Circulatory Disorders W AMI W Invasive Cardiac Inves Proc W/O
F41B
276
Circulatory System Diagnosis W Ventilator Support
Circulatory Disorders W AMI W Invasive Cardiac Inves Proc W C
F40Z
F41A
361
Other Circulatory System O.R. Procedures W/O Catastrophic CC
F21B
1,556
1,017
180
1,830
Vein Ligation and Stripping
152
134
Other Circulatory System O.R. Procedures W Catastrophic CC
Other Trans-Vascular Percutaneous Cardiac Intervention
F19Z
F20Z
Cardiac Pacemaker Revision Except Device Replacement
F18Z
633
221
3,159
1,110
726
546
163
1,645
91
154
3,366
180
127
1,191
650
273
151
558
979
416
387
293
412
153
Total
Seps
F21A
Percutaneous Coronary Intervention W/O AMI W/O Stent Implanta
Cardiac Pacemaker Replacement
Percutaneous Coronary Intervention W/O AMI W Stent Implantati
F15Z
F16Z
Vascular Procs Except Major Reconstruction W/O CPB Pump W/O C
F14C
F17Z
Vascular Procs Except Major Reconstruction W/O CPB Pump W Cat
Vascular Procs Except Major Reconstruction W/O CPB Pump W Sev
F14A
F14B
Upper Limb and Toe Amputation for Circulatory System Disorder
Major Reconstruct Vascular Procedures W/O CPB Pump W/O
Catast
F08B
Cardiac Pacemaker Implantation
Major Reconstruct Vascular Procedures W/O CPB Pump W Catastro
F08A
F13Z
Other Cardiothoracic/Vascular Procedures W CPB Pump W/O Catas
F07B
F12Z
Other Cardiothoracic/Vascular Procedures W CPB Pump W Catastr
F07A
Amputation for Circ System Except Upper Limb and Toe W/O Cata
Coronary Bypass W/O Invasive Cardiac Inves W/O Catastr or Sev
F06B
Amputation for Circ System Except Upper Limb and Toe W Catast
Coronary Bypass W/O Invasive Cardiac Inves W Catastr or Sever
F06A
F11B
Coronary Bypass W Invasive Cardiac Inves W/O Catastrophic CC
F05B
F11A
Coronary Bypass W Invasive Cardiac Inves W Catastrophic CC
F05A
Other Cardiothoracic Procedures W/O CPB Pump W/O Catastrophic
Cardiac Valve Proc W CPB Pump W/O Invasive Cardiac Inves W/O
Percutaneous Coronary Intervention W AMI
Cardiac Valve Proc W CPB Pump W/O Invasive Cardiac Inves W Ca
F04A
F04B
F09B
Cardiac Valve Proc W CPB Pump W Invasive Cardiac Inves
F03Z
F10Z
AR-DRG Title
ARDRG
V5.0 No.
612
1,300
1,412
1,302
3,527
424
1,400
965
618
491
493
510
1,047
2,985
2,476
1,127
2,829
5,542
736
2,233
3,024
1,805
5,208
4,124
7,096
2,631
4,644
3,928
6,843
3,695
7,245
8,844
Clin
dept
($)
58
166
694
152
579
30
70
41
36
55
73
62
124
397
342
94
675
1,245
119
321
530
210
758
731
1,148
366
474
564
820
393
747
976
Allied
Health
($)
2,037
4,393
3,248
3,410
8,725
647
1,743
2,546
1,277
1,839
1,637
1,264
2,112
6,441
7,198
3,129
9,514
16,409
2,668
3,856
5,176
3,972
10,259
5,147
8,282
3,491
4,684
6,015
8,568
4,290
6,425
11,122
($)
Wards
218
332
252
94
355
15
19
79
65
134
1,040
946
376
1,706
2,764
1,772
4,526
1,228
1,193
1,893
1,475
2,218
47
1,914
2,701
1,599
1,555
2,343
3,817
1,956
3,052
3,071
4,447
7,031
6,007
8,741
7,296
7,614
8,692
8,455
6,137
7,650
9,670
($)
Procs
118
103
240
166
206
292
297
200
156
216
93
275
23
136
30
54
201
227
25
106
249
Emerg
Dept
($)
141
421
11,179
39
1,258
21
216
112
13
9
37
161
223
1,828
220
181
428
1,958
172
1,894
6,708
1,198
6,261
3,823
8,314
3,100
4,654
5,379
10,584
2,942
9,537
10,308
($)
ICU
218
388
778
244
715
68
159
127
106
248
143
663
583
1,100
368
245
553
1,304
201
230
731
407
1,391
404
918
456
714
629
1,107
495
870
1,179
($)
Imag
138
360
1,422
215
1,068
27
135
169
115
120
139
108
215
744
481
265
714
1,124
257
453
1,227
386
1,284
949
1,797
1,169
1,495
1,640
2,204
1,230
1,910
2,630
($)
Path
266
556
1,198
546
3,008
139
146
292
88
287
369
207
446
1,575
1,044
286
985
2,948
732
490
1,544
751
2,610
477
1,630
982
1,364
67
332
631
1,496
38
101
518
1,366
203
403
379
288
335
330
308
457
1,161
951
602
1,284
2,294
468
876
1,581
924
2,297
1,527
2,620
1,169
1,530
1,757
2,608
1,358
2,392
3,117
($)
Super
242
317
100
657
467
2,373
254
1,364
558
599
579
170
4,188
225
401
1,117
741
904
2,345
2,390
1,033
2,252
818
1,041
1,172
1,007
2,803
3,671
4,914
6,052
($)
Prosth
1,701
792
2,410
3,906
($)
Pharm
233
389
827
314
771
144
276
223
207
281
282
242
316
713
508
417
666
1,305
362
600
1,004
580
1,323
1,098
1,690
878
1,100
1,278
1,705
973
1,618
2,149
($)
Deprec
5,345
9,938
21,856
8,778
24,303
3,593
9,829
6,619
6,379
5,942
7,197
5,596
8,108
20,308
15,498
12,280
20,362
38,495
8,971
14,776
25,256
17,023
40,530
25,162
43,600
21,950
28,817
32,240
46,080
25,689
44,982
59,175
Total
per Sep
($)*
Appendix 2: Results of the NSW 2006/07
HCDC inflated to 2009/10 prices
Part 1: General (Overnight) cost averages by cost group
(day case costs excluded for selected AR-DRGs)
91
Valvular Disorders W Catastrophic or Severe CC
Valvular Disorders W/O Catastrophic or Severe CC
Major Arrhythmia and Cardiac Arrest W Catastrophic or Severe
Major Arrhythmia and Cardiac Arrest W/O Catastrophic or Sever
F69A
F69B
F70A
F70B
Other Circulatory System Diagnoses W Severe CC
Other Circulatory System Diagnoses W/O Catastrophic or Severe
F75B
F75C
16,503
Chest Pain
Other Circulatory System Diagnoses W Catastrophic CC
F74Z
Syncope and Collapse W/O Catastrophic or Severe CC
F73B
F75A
4,520
Syncope and Collapse W Catastrophic or Severe CC
F73A
1,269
2,232
1,191
606
2,056
5,496
Unstable Angina W Catastrophic or Severe CC
Unstable Angina W/O Catastrophic or Severe CC
F72A
7,711
2,934
1,523
559
1,136
456
189
662
511
F72B
Non-Major Arrhythmia and Conduction Disorders W Catastrophic
Congenital Heart Disease
F68Z
Non-Major Arrhythmia and Conduction Disorders W/O Catastrophi
Hypertension W/O CC
F67B
F71A
Hypertension W CC
F67A
F71B
1,818
Coronary Atherosclerosis W/O CC
1,842
Coronary Atherosclerosis W CC
F66A
F66B
877
1,487
164
1,182
Peripheral Vascular Disorders W Catastrophic or Severe CC
Skin Ulcers for Circulatory Disorders
F64Z
Peripheral Vascular Disorders W/O Catastrophic or Severe CC
Venous Thrombosis W/O Catastrophic or Severe CC
F63B
439
7,967
3,246
5,092
F65A
Venous Thrombosis W Catastrophic or Severe CC
F63A
4,291
2,890
F65B
Heart Failure and Shock W/O Catastrophic CC
F62B
319
Infective Endocarditis
Circulatory Disorders W AMI W/O Invasive Cardiac Inves Proced
F60C
Heart Failure and Shock W Catastrophic CC
Circulatory Disorders W AMI W/O Invasive Cardiac Inves Proc W
F60B
F61Z
Circulatory Disorders W AMI W/O Invasive Cardiac Inves Proc W
F60A
F62A
888
Circulatory Disorders W/O AMI W Invasive Cardiac Inves Proc W
F42B
2,908
Circulatory Disorders W/O AMI W Invasive Cardiac Inves Proc W
F42A
Total
Seps
AR-DRG Title
ARDRG
V5.0 No.
602
858
1,780
272
320
634
325
679
364
790
285
611
334
926
929
394
549
255
494
484
1,269
1,268
469
1,014
699
1,483
2,938
471
403
923
453
842
Clin
dept
($)
61
153
405
25
56
211
29
90
32
151
61
214
27
155
65
29
109
21
69
53
208
102
64
284
122
389
288
164
51
238
53
91
Allied
Health
($)
1,494
2,616
5,717
606
912
2,293
882
1,983
1,012
2,688
751
1,971
758
2,741
1,482
899
1,798
646
1,346
1,090
3,470
4,658
1,358
3,418
2,372
5,249
8,628
1,657
1,172
3,693
1,388
2,678
($)
Wards
397
440
434
403
499
540
385
415
324
428
603
676
375
414
148
321
395
312
334
306
434
394
447
429
437
495
277
929
407
501
219
269
Emerg
Dept
($)
163
140
219
15
19
43
30
52
46
69
276
1,195
26
26
51
103
170
85
223
187
119
668
90
46
261
95
20
167
53
69
25
256
8
4
43
77
358
911
308
201
601
20
91
($)
ICU
44
36
95
270
10
39
40
80
125
202
79
39
106
34
91
334
48
23
76
969
1,242
($)
Procs
149
227
463
158
140
201
105
152
67
163
68
198
73
198
123
137
210
75
130
280
368
110
169
352
152
295
590
211
78
238
220
271
($)
Imag
163
296
591
102
104
196
106
179
110
246
115
264
87
250
131
128
248
92
148
116
328
214
169
364
203
463
658
277
133
334
111
195
($)
Path
161
511
1,171
58
60
159
81
186
84
222
80
202
52
205
63
58
185
50
117
110
461
339
158
502
183
494
9
32
16
7
6
7
3
14
8
11
37
39
19
4
6
1
9
1
20
13
14
8
4
14
3
6
22
4
973
1
129
4
142
195
($)
Prosth
187
357
118
252
($)
Pharm
241
396
134
218
83
438
832
95
170
89
163
96
204
91
204
84
205
172
83
149
70
124
123
292
271
121
259
174
358
601
164
109
265
213
304
($)
Deprec
129
170
332
152
296
170
388
176
382
147
387
271
151
271
116
210
199
512
551
216
478
331
691
1,114
316
193
505
251
430
($)
Super
3,626
6,133
13,155
1,870
2,393
4,819
2,273
4,360
2,383
5,610
2,464
5,459
2,026
5,808
3,788
2,220
4,098
1,720
3,129
2,914
7,783
7,990
3,204
7,243
4,768
10,336
17,278
4,678
2,873
7,686
4,151
6,853
Total
per Sep
($)*
Appendix 2: Results of the NSW 2006/07
HCDC inflated to 2009/10 prices
Part 1: General (Overnight) cost averages by cost group
(day case costs excluded for selected AR-DRGs)
92
346
84
Major Small and Large Bowel Procedures W/O Catastrophic CC
Stomach, Oesophageal and Duodenal Procedures W Malignancy
Stomach, Oesophageal and Duodenal Procedures W/O Malignancy
W
Stomach, Oesophageal and Duodenal Procedures W/O Malignancy
W
Peritoneal Adhesiolysis Age>49 W CC
Peritoneal Adhesiolysis (Age<50 W CC) or (Age>49 W/O CC)
Peritoneal Adhesiolysis Age<50 W/O CC
Minor Small and Large Bowel Procedures W CC
Minor Small and Large Bowel Procedures W/O CC
G02B
G03A
G03B
G03C
G04A
G04B
G04C
G05A
G05B
1,123
Complex Colonoscopy
Other Colonoscopy W Catastrophic or Severe CC
Other Colonoscopy W/O Catastrophic or Severe CC
Other Colonoscopy, Sameday
Other Gastroscopy for Non-Major Digestive Disease
Other Gastroscopy for Non-Major Digestive Disease, Sameday
G44A
G44B
G44C
G45A
G45B
Other Digestive System O.R. Procedures W Catastr or Severe CC
G12A
G43Z
Anal and Stomal Procedures W/O Catastrophic or Severe CC
G11B
Other Gastroscopy for Major Digestive Disease, Sameday
Anal and Stomal Procedures W Catastrophic or Severe CC
G11A
G42B
664
Hernia Procedures Age<1
G10Z
Other Digestive System O.R. Procedures W/O Catastr or Sev CC
Inguinal and Femoral Hernia Procedures Age>0
G09Z
Other Gastroscopy for Major Digestive Disease
Abdominal and Other Hernia Procedures Age 1 to 59W/O Cat or
G08B
G12B
Abdominal and Other Hernia Procedures Age >59 or W Catastroph
G08A
G42A
568
Appendicectomy W/O Catastrophic or Severe CC
G07B
9,929
2,797
16,494
2,129
640
154
1,627
2,417
2,945
439
459
4,234
1,351
1,618
6,755
537
Pyloromyotomy Procedure
Appendicectomy W Catastrophic or Severe CC
G06Z
G07A
223
557
669
526
438
362
281
2,380
1,687
Rectal Resection W/O Catastrophic CC
Major Small and Large Bowel Procedures W Catastrophic CC
G01B
G02A
629
Rectal Resection W Catastrophic CC
G01A
Total
Seps
AR-DRG Title
ARDRG
V5.0 No.
242
899
255
975
1,923
330
244
1,014
869
2,520
522
1,128
497
564
637
1,064
855
1,944
1,258
1,210
2,121
949
1,752
3,594
1,291
4,064
5,108
2,250
5,343
2,786
5,622
Clin
dept
($)
12
103
14
69
315
20
13
117
63
348
27
91
37
29
33
95
44
161
72
86
272
68
136
499
237
1,030
1,082
270
1,007
284
929
Allied
Health
($)
136
1,912
118
2,008
4,836
541
133
2,462
1,672
19
356
15
245
392
60
27
343
221
115
379
762
142
62
16
72
96
362
430
536
32
92
271
227
435
151
273
94
181
336
68
204
Emerg
Dept
($)
5,565
1,839
1,080
711
911
1,864
1,313
3,500
2,478
2,214
5,264
1,875
3,335
6,890
3,082
8,385
8,160
4,485
11,261
5,333
11,769
($)
Wards
614
651
748
779
869
821
573
576
1,511
2,054
1,184
1,488
1,251
1,632
1,495
1,804
1,811
2,237
1,314
1,993
2,426
2,057
2,334
3,597
3,060
4,017
6,344
3,466
4,675
4,886
5,955
($)
Procs
11
49
1
35
421
1
1
184
82
1,027
8
157
22
13
19
211
14
268
14
48
476
58
217
1,475
401
3,292
3,776
462
3,828
466
3,043
($)
ICU
10
208
7
179
382
32
12
195
214
718
37
159
12
26
45
122
89
338
99
38
294
165
279
618
156
826
674
250
1,073
198
1,007
($)
Imag
87
240
71
236
580
51
93
318
207
772
66
262
20
38
45
121
135
372
121
176
458
163
306
635
208
1,037
1,219
442
1,340
524
1,431
($)
Path
36
51
221
39
26
61
64
100
34
52
89
184
77
87
175
178
209
249
95
99
43
176
219
146
194
237
222
49
192
607
103
41
298
239
1,101
115
305
74
118
115
249
172
400
101
215
544
200
461
1,346
349
270
691
1,990
359
596
460
529
640
($)
Prosth
2,080
2,272
689
2,111
($)
Pharm
76
328
78
333
716
122
74
391
351
955
198
376
218
210
231
389
326
652
417
435
809
393
612
1,263
619
1,619
1,907
833
1,986
1,050
2,076
($)
Super
61
192
64
193
399
97
57
221
203
543
122
213
154
136
145
226
199
365
277
257
427
222
337
682
365
933
1,041
482
1,073
578
1,125
($)
Deprec
1,346
5,201
1,445
5,300
11,448
2,276
1,303
6,150
5,706
16,040
3,231
6,235
3,612
3,669
3,953
6,472
5,412
10,735
6,741
6,901
13,387
6,555
10,162
21,170
10,108
27,395
31,879
14,040
34,293
17,349
35,651
Total
per Sep
($)*
Appendix 2: Results of the NSW 2006/07
HCDC inflated to 2009/10 prices
Part 1: General (Overnight) cost averages by cost group
(day case costs excluded for selected AR-DRGs)
93
7,701
1,421
Gastroenteritis Age<10 W CC
Gastroenteritis Age<10 W/O CC
G68A
G68B
4,418
Open Cholecystectomy W Closed CDE or Catastrophic CC
Open Cholecystectomy W/O Closed CDE W/O Catastrophic CC
Laparoscopic Cholecystectomy W Closed CDE Or Catastrophic/Sev
H08A
Other Hepatobiliary and Pancreas O.R. Procedures
H06Z
H07A
Hepatobiliary Diagnostic Procedures W/O Catastrophic or Sever
H05B
H07B
Hepatobiliary Diagnostic Procedures W Catastrophic or Severe
H05A
169
Major Biliary Tract Procedures W/O Malignancy W Severe or Mod
Major Biliary Tract Procedures W/O Malignancy W/O CC
154
Pancreas, Liver and Shunt Procedures W/O Catastrophic CC
Major Biliary Tract ProceduresW Malignancy or Catastrophic
H01B
H02A
H02B
475
Pancreas, Liver and Shunt Procedures W Catastrophic CC
H01A
H02C
315
Other Digestive System Diagnoses W/O CC
G70B
1,183
544
151
163
130
149
254
2,697
1,633
Oesophagitis and Misc Digestive System Disorders Age<10
Other Digestive System Diagnoses W CC
G69Z
G70A
627
12,417
Oesophagitis, Gastroent & Misc Digestive System Disorders Age
Oesophagitis, Gastroent & Misc Digestive Systm Disorders Age>
6,993
1,750
2,432
1,746
87
1,011
2,424
841
1,194
G67A
Abdominal Pain or Mesenteric Adenitis W/O CC
G66B
1,917
9,546
G67B
Abdominal Pain or Mesenteric Adenitis W CC
G66A
Complicated Peptic Ulcer
Uncomplicated Peptic Ulcer
G62Z
G63Z
GI Obstruction W/O CC
GI Haemorrhage Age<65 W/O Catastrophic or Severe CC
G61B
G65B
850
GI Haemorrhage (Age<65 W Catastrophic or Severe CC) or
Age>64
G61A
Inflammatory Bowel Disease
Digestive Malignancy W/O Catastrophic or Severe CC
G60B
GI Obstruction W CC
Digestive Malignancy W Catastrophic or Severe CC
G60A
G64Z
Complex Gastroscopy, Sameday
G46C
G65A
106
Complex Gastroscopy W/O Catastrophic or Severe CC
G46B
1,151
Complex Gastroscopy W Catastrophic or Severe CC
G46A
Total
Seps
AR-DRG Title
ARDRG
V5.0 No.
1,511
1,769
3,980
1,929
917
3,057
976
2,107
4,673
2,306
5,255
442
976
644
516
838
423
845
419
630
566
1,054
1,003
256
657
309
574
508
1,037
245
932
1,902
Clin
dept
($)
120
121
527
294
98
316
49
170
605
262
949
27
124
64
19
68
39
190
22
76
35
139
144
13
73
21
72
87
240
12
98
337
Allied
Health
($)
2,948
2,904
7,941
3,708
2,209
7,062
1,569
3,728
7,402
4,301
9,933
588
2,173
1,308
856
1,539
834
2,641
539
1,330
1,071
2,731
1,952
393
1,293
514
1,380
1,287
3,542
141
2,209
4,545
($)
Wards
229
139
283
123
122
255
61
238
285
96
2,831
2,568
3,484
1,614
2,002
3,287
2,289
3,108
5,130
3,895
111
5,813
185
133
21
9
40
22
63
24
45
65
82
64
26
132
32
54
95
77
797
939
1,100
($)
Procs
429
409
318
382
440
392
533
381
444
400
458
406
317
410
352
505
146
293
10
232
396
Emerg
Dept
($)
432
256
2,649
407
27
1,297
61
225
2,342
1,181
3,301
5
124
6
4
79
8
69
4
19
20
95
16
128
90
23
92
18
34
0
62
445
($)
ICU
508
260
1,045
1,052
498
769
277
574
916
503
1,447
102
278
51
15
38
123
222
165
262
225
327
171
115
391
85
105
106
214
9
172
379
($)
Imag
412
306
1,183
676
343
1,069
151
519
1,194
750
1,967
67
236
70
77
188
111
257
84
145
95
212
203
98
259
112
178
112
222
121
297
574
($)
Path
410
366
1,395
952
225
1,114
307
901
1,972
889
4,166
46
259
86
37
113
66
287
41
112
73
275
772
65
150
57
130
174
629
575
1,481
368
156
668
455
1,149
388
770
1,475
974
2,055
136
339
201
155
254
153
378
126
229
188
391
339
104
230
112
232
193
447
84
365
713
($)
Super
194
154
283
147
243
387
339
498
9
16
2
0
1
3
10
2
4
3
9
3
0
9
1
4
13
15
267
61
130
181
($)
Prosth
517
51
241
681
($)
Pharm
375
357
869
437
291
696
263
467
873
588
1,208
75
186
94
72
117
83
197
71
129
105
210
192
58
143
62
119
107
240
66
213
399
($)
Deprec
10,544
9,756
24,986
12,061
7,339
20,195
6,544
13,027
26,956
15,959
36,364
2,026
5,230
2,855
2,135
3,687
2,246
5,674
1,871
3,415
2,835
5,963
5,272
1,559
3,825
1,672
3,422
2,937
6,874
1,598
5,885
11,621
Total
per Sep
($)*
Appendix 2: Results of the NSW 2006/07
HCDC inflated to 2009/10 prices
Part 1: General (Overnight) cost averages by cost group
(day case costs excluded for selected AR-DRGs)
94
2,130
Spinal Fusion W/O Catastrophic or Severe CC
Other Back and Neck Procedures W Catastrophic or Severe CC
I09B
I10A
2,486
Other Hip and Femur Procedures W/O Catastrophic or Severe CC
Spinal Fusion W Catastrophic or Severe CC
Other Hip and Femur Procedures W Catastrophic or Severe CC
I08A
I08B
Amputation
I07Z
I09A
2,583
Spinal Fusion W Deformity
I06Z
95
319
551
244
84
58
525
4,797
Knee Replacement and Reattachment
Other Major Joint Replacement and Limb Reattachment Procedure
2,702
I04Z
Hip Replacement W/O Catastrophic or Severe CC
I03C
174
I05Z
Hip Replacement W Cat or Severe CC or Hip Revision W/O Cat or
I03B
225
Skin Graft W/O Catastrophic or Severe CC, Excluding Hand
Hip Revision W Catastrophic or Severe CC
I02B
I03A
323
3,082
1,605
714
714
158
Disorders of Liver Excep Malig, Cirrhosis, Alcoholic Hepatiti
H63B
Microvascular Tissue Transfer or (Skin Graft W Cat or Sev CC)
Disorders of Liver Except Malig, Cirrhosis, Alcoholic Hepatit
H63A
759
3,051
Bilateral or Multiple Major Joint Procs of Lower Extremity
Disorders of Pancreas Except for Malignancy W/O Catastrophic
H62B
I02A
Disorders of Pancreas Except for Malignancy W Catastrophic or
H62A
939
I01Z
Malig Hepatobilry Sys, Pancreas (A<70 W/O Cat CC) or (A>69 W/
H61B
310
766
Disorders of the Biliary Tract W CC
Malignancy of Hepatobiliary Sys, Pancreas W Catastr CC or (Ag
H61A
Disorders of the Biliary Tract W/O CC
Cirrhosis and Alcoholic Hepatitis W/O Catastrophic or Severe
H60C
547
600
H64A
Cirrhosis and Alcoholic Hepatitis W Severe CC
H60B
1,016
545
H64B
Cirrhosis and Alcoholic Hepatitis W Catastrophic CC
H60A
422
ERCP Other Therapeutic Procedure W Moderate CC
ERCP Other Therapeutic Procedure W/O CC
H42B
ERCP Other Therapeutic Procedure W Catastrophic or Severe CC
H42A
H42C
467
ERCP Complex Therapeutic Procedure W/O Catastrophic or Severe
H41B
161
359
Endoscopic Procedures for Bleeding Oesophageal Varices
ERCP Complex Therapeutic Procedure W Catastrophic or Severe C
H40Z
H41A
6,993
Laparoscopic Cholecystectomy W/O Closed CDE W/O
Catastrophic/
H08B
Total
Seps
AR-DRG Title
ARDRG
V5.0 No.
3,132
1,386
3,681
1,636
3,056
4,644
3,314
1,185
1,636
1,518
2,696
4,764
1,881
9,491
3,431
570
1,063
707
1,750
820
1,684
835
1,301
1,021
1,417
2,595
718
1,042
1,987
828
2,097
1,905
726
Clin
dept
($)
512
462
1,096
463
955
1,643
1,211
332
486
434
794
897
341
1,597
1,030
29
113
62
308
50
230
116
361
141
208
565
42
47
229
48
281
163
40
Allied
Health
($)
5,307
3,767
7,765
3,844
7,454
10,230
6,777
2,825
3,555
3,177
6,106
11,333
4,580
16,245
6,247
976
2,325
1,372
3,614
1,436
3,796
1,900
4,149
1,599
2,506
5,142
1,339
1,642
4,128
1,839
4,037
3,374
953
($)
Wards
140
78
227
313
443
403
31
115
23
113
286
3,303
4,179
5,866
2,419
2,905
4,558
7,185
3,373
3,481
3,177
3,343
4,578
5,847
193
12,283
6,335
64
121
95
194
120
157
91
137
91
136
283
987
1,053
1,039
1,095
1,388
1,116
2,331
($)
Procs
202
333
84
367
410
395
510
438
445
214
444
287
363
474
172
182
344
214
333
325
57
Emerg
Dept
($)
441
288
2,118
60
487
395
1,004
47
85
35
379
558
180
1,645
123
7
113
35
501
47
870
6
84
31
145
859
35
64
536
15
560
1,213
15
($)
ICU
402
335
846
449
751
506
418
242
167
202
511
755
377
1,301
388
139
291
186
363
264
586
304
377
171
218
496
337
364
753
360
649
411
137
($)
Imag
329
222
709
182
511
803
292
162
190
172
460
896
147
1,224
513
106
297
291
628
180
485
181
382
322
427
840
125
206
664
469
1,409
397
756
1,766
424
356
317
303
643
1,098
705
3,650
951
68
248
111
604
119
466
501
561
113
322
997
136
252
165
641
595
900
1,227
171
($)
Pharm
209
614
590
104
($)
Path
689
800
6,379
959
883
1,757
1,147
8,519
1,168
1,650
1,302
698
718
673
1,051
1,777
895
3,075
1,268
165
350
253
581
247
596
312
563
288
408
817
271
327
695
336
718
664
295
($)
Super
1,295
383
8,228
5,855
6,456
5,144
3,997
8,278
758
1,592
11,387
5
8
5
15
7
9
13
13
18
10
18
107
55
68
504
531
39
179
($)
Prosth
589
617
1,226
412
650
950
1,058
540
572
495
629
1,077
569
1,735
934
90
196
154
311
141
335
197
304
153
199
416
191
221
414
225
440
380
203
($)
Deprec
16,529
19,049
35,046
12,002
20,383
27,899
31,244
15,722
17,680
15,437
20,857
37,408
15,208
53,953
32,680
2,573
5,519
3,683
9,324
3,855
9,597
4,666
8,654
4,235
6,341
13,420
4,459
5,448
11,370
5,829
12,502
11,338
5,209
Total
per Sep
($)*
Appendix 2: Results of the NSW 2006/07
HCDC inflated to 2009/10 prices
Part 1: General (Overnight) cost averages by cost group
(day case costs excluded for selected AR-DRGs)
14
118
1,758
373
999
3,873
Limb Lengthening Procedures
Infect/Inflam of Bone & Joint W Misc Musc Sys & Conn Tiss Pro
Infect/Inflam of Bone & Joint W Misc Musc Sys & Conn Tiss Pro
Infect/Inflam Bone & Joint W Misc Musc Sys & Conn Tiss Proc W
Humerus, Tibia, Fibula and Ankle Procedures W Catastrophic or
Humerus, Tibia, Fibula and Ankle Procedures Age>59 W/O Catast
Humerus, Tibia, Fibula and Ankle Procedures Age<60 W/O Catast
Stump Revision
Cranio-Facial Surgery
Other Shoulder Procedures
Maxillo-Facial Surgery
Other Knee Procedures
Other Elbow or Forearm Procedures
Foot Procedures
Local Excision & Removal of Internal Fixation Devices of Hip
Local Excision & Removal of Internal Fixation Dev Ex Hip & Fm
Arthroscopy
Bone and Joint Diagnostic Procedures including Biopsy
Soft Tissue Procedures W Catastrophic or Severe CC
Soft Tissue Procedures W/O Catastrophic or Severe CC
Other Connective Tissue Procedures W CC
I11Z
I12A
I12B
I12C
I13A
I13B
I13C
I14Z
I15Z
I16Z
I17Z
I18Z
I19Z
I20Z
I21Z
I23Z
I24Z
I25Z
I27A
I27B
I28A
229
Connective Tissue Malignancy, including Pathological Fx W/O C
I65B
Inflammatory Musculoskeletal Disorders W Cat or Sev CC
Connective Tissue Malignancy, including Pathological Fx W Cat
I65A
I66A
Osteomyelitis W CC
Osteomyelitis W/O CC
I64A
I64B
Other Femoral Fractures
Sprains, Strains and Dislocations of Hip, Pelvis and Thigh
I61Z
Femoral Shaft Fractures
I60Z
I63Z
280
Hand Procedures
I30Z
865
379
886
869
300
424
476
8,463
804
Other Connective Tissue Procedures W/O CC
Knee Reconstruction Or Revision
I28B
I29Z
369
1,359
236
193
761
4,168
257
2,360
4,515
989
521
960
227
273
28
1,456
Other Back and Neck Procedures W/O Catastrophic or Severe CC
I10B
Total
Seps
AR-DRG Title
ARDRG
V5.0 No.
2,344
911
1,682
1,408
1,981
467
1,049
3,388
401
676
721
2,246
722
2,997
1,701
474
317
830
673
620
625
1,503
650
1,521
1,129
793
1,166
2,786
1,566
3,630
7,681
1,712
1,147
Clin
dept
($)
441
198
479
101
255
114
339
583
50
196
103
661
118
648
323
58
63
150
166
90
100
156
115
162
83
194
364
934
231
480
1,162
829
217
Allied
Health
($)
5,155
3,207
5,238
2,906
4,950
1,118
2,800
7,117
629
930
1,352
6,284
1,573
7,928
4,831
416
371
1,410
1,287
1,151
1,359
2,208
1,015
2,527
2,396
1,548
2,570
6,812
3,630
7,473
13,243
3,691
2,260
($)
Wards
267
264
364
263
282
512
457
900
183
19
193
349
229
328
173
48
14
47
127
272
113
127
16
21
84
242
256
371
179
316
410
3
51
Emerg
Dept
($)
687
104
146
191
163
275
183
405
1,767
2,679
1,672
719
6
53
30
82
30
152
66
15
11
22
34
268
1,607
663
87
7
4
75
16
45
22
266
17
990
-
16
36
474
42
109
1,133
6
81
($)
ICU
1,834
2,284
1,129
1,377
1,264
1,754
1,893
2,087
1,640
2,543
2,302
4,175
1,785
2,308
2,564
3,569
2,060
2,395
3,132
3,220
3,075
($)
Procs
489
246
521
256
513
213
434
319
74
55
166
656
109
722
849
15
30
91
99
232
49
152
22
152
77
277
307
900
169
480
1,499
229
154
($)
Imag
903
167
338
118
331
66
191
93
28
29
57
349
98
738
538
32
24
48
42
44
55
105
29
293
218
46
97
379
199
453
1,852
56
84
($)
Path
868
704
845
255
743
80
165
210
140
179
151
844
155
933
666
93
88
170
152
182
126
256
167
349
605
199
289
114
5
79
17
15
17
9
43
357
670
544
672
107
180
166
191
144
159
378
935
152
1,260
293
611
41
773
996
2,020
275
817
189
392
290
475
653
($)
Prosth
1,166
3,500
226
311
($)
Pharm
811
419
541
254
428
259
693
382
643
117
233
469
153
226
199
557
202
689
485
118
105
196
198
223
182
352
203
486
213
254
328
697
354
584
1,185
509
326
($)
Deprec
443
218
424
972
261
337
321
928
345
1,205
731
167
152
309
307
353
292
551
287
693
473
398
536
1,197
612
1,123
2,034
712
528
($)
Super
13,289
6,487
10,850
6,256
10,330
3,211
6,427
14,557
4,052
6,005
5,496
15,623
5,293
19,245
11,739
2,993
2,578
5,235
5,334
6,227
4,708
9,446
5,115
11,911
7,101
7,044
9,499
20,915
9,710
18,370
36,960
11,668
8,886
Total
per Sep
($)*
Appendix 2: Results of the NSW 2006/07
HCDC inflated to 2009/10 prices
Part 1: General (Overnight) cost averages by cost group
(day case costs excluded for selected AR-DRGs)
96
2,754
539
846
Bone Diseases&Spec Arthropathies(A<75 W Cat/Sev CC) or (A>74
Bone Diseases & Spec Arthropathies Age<75 W/O Catastr or Seve
Non-Specific Arthropathies
Musculotendinous Disorders Age>69 W CC
I69B
I69C
I70Z
I71A
2,078
Aftercare of Connective Tissue Disorders Age<60 W/O Catastrop
Injury to Forearm, Wrist, Hand or Foot Age>74 W CC
Injury to Forearm, Wrist, Hand or Foot (Age<75 W CC) or (Age>
Injury to Forearm, Wrist, Hand or Foot Age<75 W/O CC
Injury to Shoulder, Arm, Elbow, Knee, Leg or Ankle Age>64 W C
I73C
I74A
I74B
I74C
I75A
Major Procedures for Malignant Breast Conditions
Microvascular Tissue Transfer for Skin, Subcutaneous Tissue &
J01Z
J06A
Fractures of Neck of Femur W/O Catastrophic or Severe CC
I78B
966
Fractures of Pelvis W/O Catastrophic or Severe CC
Fractures of Neck of Femur W Catastrophic or Severe CC
I77B
Fractures of Pelvis W Catastrophic or Severe CC
I77A
I78A
792
Other Musculoskeletal Disorders Age<70 W/O CC
I76C
2,243
107
1,172
451
681
573
246
Other Musculoskeletal Disorders Age>69 W CC
Other Musculoskeletal Disorders (Age<70 W CC) or (Age>69 W/O
I76A
4,264
8,200
948
428
358
792
542
I76B
Inj to Should, Arm, Elbow, Knee, Leg, Ankle (Age<65 W CC) or
Aftercare Conn Tiss Disorder (Age<60 W Cat/Sev CC) or (Age>59
I73B
Injury to Shoulder, Arm, Elbow, Knee, Leg or Ankle Age<65 W/O
Aftercare of Connective Tissue Disorders Age>59 W Catastrophi
I73A
I75B
1,380
Tendonitis, Myositis and Bursitis Age<80 W/O Catastrophic or
I72B
I75C
332
Tendonitis, Myositis and Bursitis (Age<80 W Catastr or Severe
I72A
862
746
Musculotendinous Disorders (Age<70 W CC) or (Age>69 W/O CC)
Musculotendinous Disorders Age <70 W/O CC
I71B
I71C
304
870
1,266
584
2,744
Non-surgical Neck & Back Conditions, Sameday
4,444
Bone Diseases & Spec Arthropathies Age>74 W Catastrophic or S
Non-surgical Neck & Back Cond W/O CC
I68B
I68C
Non-Surg Neck & Back Conditions W CC
I68A
341
77
1,005
Total
Seps
I69A
Septic Arthritis W Catastrophic or Severe CC
Septic Arthritis W/O Catastrophic or Severe CC
I67A
Inflammatory Musculoskeletal Disorders W/O Cat or Sev CC
I66B
I67B
AR-DRG Title
ARDRG
V5.0 No.
910
4,531
330
1,132
728
1,648
610
694
995
332
532
1,284
290
423
903
576
700
1,676
600
1,059
608
500
729
735
609
704
1,427
211
711
1,504
802
3,584
969
Clin
dept
($)
82
322
75
373
333
823
78
237
509
100
239
698
38
118
398
267
177
877
51
328
55
127
255
90
85
195
661
31
147
478
90
390
112
Allied
Health
($)
1,247
5,775
963
3,616
2,289
6,194
801
1,488
3,174
553
1,579
4,313
380
887
2,929
1,635
1,880
7,657
1,262
3,071
770
1,185
2,244
1,507
1,521
2,327
4,588
121
1,873
4,388
1,864
7,898
1,676
($)
Wards
23
17
781
585
567
606
290
425
469
431
569
542
359
517
601
161
204
92
291
460
322
480
517
361
263
401
501
378
413
502
295
585
207
Emerg
Dept
($)
2,257
9,995
27
131
34
86
176
171
105
226
92
29
1,272
4
56
10
131
13
168
138
3
23
3
47
513
16
47
8
53
48
36
169
5
12
49
8
9
41
54
0
23
71
11
275
11
($)
ICU
121
327
242
205
198
177
59
74
44
58
61
126
50
35
113
167
47
82
183
337
99
($)
Procs
200
158
212
501
376
601
128
231
342
217
271
462
195
241
414
73
164
312
114
297
165
196
286
265
133
200
407
101
265
491
144
827
142
($)
Imag
312
466
89
271
122
290
58
113
242
28
93
247
19
61
178
44
79
347
91
235
78
110
150
189
135
160
322
25
69
213
157
785
198
($)
Path
206
1,935
56
212
138
392
54
145
257
43
91
260
48
75
163
65
119
523
73
263
50
99
167
140
98
147
327
42
198
440
3
18
3
8
9
19
8
30
11
13
31
35
44
26
14
43
4
5
4
4
7
4
5
5
9
17
17
15
96
9
22
8
($)
Prosth
329
206
1,232
167
($)
Pharm
343
1,838
230
1,029
102
261
196
186
483
414
124
177
246
85
144
309
83
111
228
149
133
374
110
242
105
114
191
150
141
184
334
49
161
336
149
549
195
($)
Deprec
351
782
172
281
461
149
262
602
137
198
432
247
265
868
206
450
172
204
335
244
228
327
638
79
284
602
280
1,054
285
($)
Super
6,037
27,706
2,822
7,616
5,120
11,952
2,523
4,134
6,926
2,189
3,885
8,877
2,089
2,994
6,561
3,454
3,978
12,986
2,895
6,609
2,377
3,078
4,974
3,813
3,277
4,708
9,362
1,210
4,094
8,996
4,179
17,513
4,067
Total
per Sep
($)*
Appendix 2: Results of the NSW 2006/07
HCDC inflated to 2009/10 prices
Part 1: General (Overnight) cost averages by cost group
(day case costs excluded for selected AR-DRGs)
97
147
161
Other Skin Graft and/or Debridement Procedures W Catastrophic
Other Skin Graft and/or Debridement Procedures W/O Catastroph
Perianal and Pilonidal Procedures
Skin, Subcutaneous Tissue and Breast Plastic O.R. Procedures
Other Skin, Subcutaneous Tissue and Breast Procedures
Lower Limb Procs W Ulcer/Cellulitis W Catastr CC
J08A
J08B
J09Z
J10Z
J11Z
J12A
733
662
74
Lower Limb Procs W/O Ulcer/Cellulitis W Skin Graft W Catastr/
Lower Limb Procs W/O Ulcer/Cellulitis W/O (Skin Graft & Catas
J13A
J13B
162
573
Skin Ulcers, Sameday
Malignant Breast Disorders W Catastrophic or Severe CC or (Ag
Malignant Breast Disorders (A<70 W/O Catastr or Severe CC) or
J60B
J62A
J62B
Major Skin Disorders, Sameday
Diabetic Foot Procedures
Pituitary Procedures
Adrenal Procedures
Major Procedures for Obesity
Parathyroid Procedures
J68B
K01Z
K02Z
K03Z
K04Z
K05Z
Thyroid Procedures
Major Skin Disorders
J68A
K06Z
Minor Skin Disorders, Sameday
J67B
2,492
Trauma to the Skin, Subcutaneous Tissue and Breast Age<70
Minor Skin Disorders
J65B
Trauma to the Skin, Subcutaneous Tissue and Breast Age>69
J65A
J67A
1,521
Cellulitis (Age>59 W/O Catastrophic or Severe CC) or Age<60
J64B
1,553
315
7
76
136
813
344
1,428
2,083
1,384
11,283
1,843
Non-Malignant Breast Disorders
Cellulitis Age>59 W Catastrophic or Severe CC
J63Z
J64A
294
83
889
Major Breast Reconstructions
Skin Ulcers
J14Z
J60A
182
234
Lower Limb Procs W Ulcer/Cellulitis W/O Catastr CC W Skin Gra
Lower Limb Procs W Ulcer/Cellulitis W/O Catastr CC W/O Skin G
J12B
J12C
1,259
2,257
807
1,270
444
1,625
Minor Procedures for Malignant Breast Conditions
Minor Procedures for Non-Malignant Breast Conditions
561
J07A
Major Procedures for Non-Malignant Breast Conditions
J06B
Total
Seps
J07B
AR-DRG Title
ARDRG
V5.0 No.
658
668
966
1,829
1,467
5,402
132
1,192
189
686
313
470
719
1,301
571
456
836
152
1,328
2,135
1,602
3,165
1,813
4,545
7,823
655
449
530
877
2,375
359
542
792
Clin
dept
($)
40
53
238
166
176
647
8
136
14
81
50
239
63
387
31
55
159
25
353
76
95
324
201
413
1,392
42
31
22
68
234
17
30
34
Allied
Health
($)
1,232
1,432
1,742
3,713
3,158
12,191
106
2,785
125
1,374
505
1,842
1,499
4,127
623
787
3,206
106
4,606
3,353
2,932
4,971
4,361
9,391
14,896
954
396
558
1,606
4,557
209
491
1,218
($)
Wards
11
16
18
54
23
361
91
308
66
352
382
576
400
487
253
62
228
587
342
3
27
71
208
231
323
74
22
47
83
150
19
23
10
Emerg
Dept
($)
2,899
2,477
4,739
3,774
3,884
2,958
19
62
377
106
93
253
44
1,185
1,943
520
0
79
1
16
24
17
136
15
48
137
2
1
20
0
31
6
11
58
58
21
390
72
4
2
19
364
1
5
9
($)
ICU
179
96
382
371
58
81
61
5,172
1,343
1,854
1,264
2,101
2,264
1,068
1,599
1,247
1,662
2,706
1,213
1,430
2,567
($)
Procs
41
73
270
215
354
717
3
71
16
67
188
250
81
228
52
155
280
30
195
46
44
84
171
220
644
60
14
9
45
154
85
154
24
($)
Imag
265
422
366
774
751
758
33
225
47
122
59
115
114
335
86
100
155
26
280
288
175
350
327
450
1,115
111
94
63
130
381
146
216
119
($)
Path
248
289
304
709
989
2,328
76
402
30
131
45
97
147
454
78
242
351
25
405
464
208
563
716
1,048
2,482
112
111
256
236
2,963
266
362
291
0
3
14
4
5
3
8
6
18
6
6
3
5
452
53
53
77
279
174
57
62
53
112
95
114
740
52
72
317
($)
Prosth
184
71
95
169
($)
Pharm
370
380
225
231
492
514
688
534
892
905
17
255
39
129
80
148
126
271
84
97
247
37
279
451
250
409
347
621
1,024
146
122
110
189
419
94
130
198
($)
Deprec
843
1,626
35
411
57
228
135
283
244
552
143
156
428
80
570
810
441
755
610
1,200
1,984
233
176
170
335
769
134
187
328
($)
Super
6,331
6,515
12,828
13,991
14,457
28,646
520
5,923
977
3,294
1,915
4,074
3,584
8,354
2,317
2,489
5,962
1,133
8,441
13,254
7,178
12,657
10,137
20,510
34,475
3,579
3,081
2,905
5,304
12,933
2,400
3,374
5,785
Total
per Sep
($)*
Appendix 2: Results of the NSW 2006/07
HCDC inflated to 2009/10 prices
Part 1: General (Overnight) cost averages by cost group
(day case costs excluded for selected AR-DRGs)
98
845
435
Kidney, Ureter and Major Bladder Procedures for Neoplasm W Ca
Kidney, Ureter and Major Bladder Procedures for Neoplasm W/O
Kidney, Ureter and Major Bladder Procedures for Non-Neoplasm
L03A
L03B
L04A
Other Procedures for Kidney and Urinary Tract Disorders W/O C
Ureteroscopy
L09C
L40Z
Cystourethroscopy, Sameday
Other Procedures for Kidney and Urinary Tract Disorders W Sev
L09B
L41Z
Other Procedures for Kidney and Urinary Tract Disorders W Cat
L09A
Transurethral Procedures Except Prostatectomy W/O Catastrophi
Urethral Procedures W CC
Transurethral Procedures Except Prostatectomy W Catastrophic
L07A
L07B
Urethral Procedures W/O CC
Minor Bladder Procedures W/O Catastrophic or Severe CC
L06B
L08A
Minor Bladder Procedures W Catastrophic or Severe CC
L06A
L08B
Transurethral Prostatectomy W Catastrophic or Severe CC
Transurethral Prostatectomy W/O Catastrophic or Severe CC
L05A
L05B
Kidney, Ureter & Major Bladder Procedures for Non-Neoplasm W
Operative Insertion of Peritoneal Catheter for Dialysis W/O C
L02B
Kidney, Ureter & Major Bladder Procedures for Non-Neoplasm W/
Operative Insertion of Peritoneal Catheter for Dialysis W Cat
L02A
L04B
Endocrine Disorders W/O Catastrophic or Severe CC
K64B
L04C
262
Endocrine Disorders W Catastrophic or Severe CC
K64A
5,973
217
340
97
183
324
108
1,096
360
335
154
211
66
1,254
444
321
168
92
1,082
330
154
1,392
Miscellaneous Metabolic Disorders W/O Catastrophic or Severe
1,773
Inborn Errors of Metabolism
Miscellaneous Metabolic Disorders W Severe CC or (Age>74 W/O
K62B
K62C
Miscellaneous Metabolic Disorders W Catastrophic CC
K62A
123
4,577
1,688
91
K63Z
Diabetes W/O Catastrophic or Severe CC
Diabetes W Catastrophic or Severe CC
Severe Nutritional Disturbance
Endoscopic or Investigative Procedure for Metabolic Disorders
K40Z
K60A
K60B
425
Other Endocrine, Nutritional and Metabolic O.R. Procedures
K09Z
K61Z
209
Thyroglossal Procedures
K08Z
46
Obesity Procedures
K07Z
Total
Seps
AR-DRG Title
ARDRG
V5.0 No.
329
646
808
2,813
8,228
456
700
626
1,556
743
2,230
1,140
2,032
1,499
2,018
4,346
1,815
3,837
847
3,392
571
1,487
1,438
699
698
1,256
2,423
880
1,597
329
3,259
477
1,591
Clin
dept
($)
15
27
95
260
1,070
28
47
36
147
42
260
56
351
61
123
524
170
515
92
923
51
248
328
163
183
579
2,020
162
337
38
319
31
69
Allied
Health
($)
125
421
1,167
5,783
12,381
494
849
935
3,166
1,120
4,644
1,573
5,313
1,831
3,613
7,919
2,845
6,403
2,028
7,044
1,460
3,965
2,826
1,809
2,285
4,244
6,534
1,692
4,272
430
6,228
730
3,702
($)
Wards
17
68
43
289
332
25
88
77
143
60
209
45
188
60
156
445
22
106
72
142
126
357
394
292
424
433
373
351
433
62
166
4
2
Emerg
Dept
($)
895
1,333
1,828
2,091
3,358
1,326
1,626
1,277
1,477
1,227
0
44
15
39
1,080
5
47
15
205
18
488
35
1,556
255
1,414
61
261
1,765
450
2,541
6
304
41
268
140
64
96
368
324
199
526
6
813
2
375
($)
ICU
2,003
2,540
2,767
2,791
4,197
4,924
1,549
2,328
49
78
104
48
48
88
258
49
118
719
2,646
1,786
2,515
($)
Procs
87
496
168
491
1,380
66
39
121
423
42
313
91
209
433
745
1,919
201
715
152
561
423
462
179
78
153
290
361
82
263
24
949
3
35
($)
Imag
18
50
194
801
1,267
43
94
133
415
74
511
151
410
148
423
1,456
412
1,089
217
1,195
113
423
338
162
194
395
537
201
415
154
819
119
138
($)
Path
54
100
365
1,252
4,860
98
191
113
370
130
686
178
554
222
448
2,151
453
1,351
465
2,702
165
488
386
104
195
446
946
79
160
311
264
446
85
54
79
112
105
91
97
122
377
475
286
400
440
262
410
8
5
9
7
7
11
28
7
9
122
28
57
409
86
53
($)
Prosth
428
1,289
109
244
($)
Pharm
96
216
82
163
201
439
301
1,048
849
111
151
144
288
147
380
183
380
307
426
976
420
770
210
638
183
314
395
149
172
309
489
150
314
74
662
150
273
($)
Deprec
1,864
173
241
223
506
233
718
310
666
454
651
1,427
689
1,338
366
1,229
248
576
563
274
326
587
953
281
601
118
1,145
227
639
($)
Super
1,796
3,720
5,496
15,362
37,252
2,910
4,125
3,777
8,768
3,941
12,034
5,273
12,470
8,009
12,097
25,822
12,052
23,841
6,266
20,823
3,445
8,638
7,109
3,845
4,763
8,965
15,232
4,153
9,265
2,041
18,642
3,769
9,615
Total
per Sep
($)*
Appendix 2: Results of the NSW 2006/07
HCDC inflated to 2009/10 prices
Part 1: General (Overnight) cost averages by cost group
(day case costs excluded for selected AR-DRGs)
99
Urinary Stones and Obstruction
Kidney and Urinary Tract Signs and Symptoms W Catastrophic or
Kidney and Urinary Tract Signs and Symptoms W/O Catastrophic
L64Z
L65A
L65B
4,711
Penis Procedures W/O CC
Testes Procedures W CC
Testes Procedures W/O CC
Circumcision
Other Male Reproductive System O.R. Procedures for Malignancy
Other Male Reproductive System O.R. Procedures Except for Mal
Cystourethroscopy W/O CC
M03B
M04A
M04B
M05Z
M06A
M06B
M40Z
Benign Prostatic Hypertrophy W Catastrophic or Severe CC
Benign Prostatic Hypertrophy W/O Catastrophic or Severe CC
Inflammation of the Male Reproductive System W CC
M61A
M61B
M62A
Malignancy, Male Reproductive System W Catastrophic or Severe
Penis Procedures W CC
M03A
Malignancy, Male Reproductive System W/O Catastrophic or Seve
Transurethral Prostatectomy W/O Catastrophic or Severe CC
M02B
M60A
Transurethral Prostatectomy W Catastrophic or Severe CC
M02A
M60B
Other Kidney and Urinary Tract Diagnoses W/O Catastrophic or
Major Male Pelvic Procedures
L67C
M01Z
331
472
127
257
462
476
130
163
1,353
2,036
144
205
49
2,120
442
632
508
144
1,569
635
4,794
2,202
Kidney and Urinary Tract Infections Age<70 W/O Catastrophic o
L63C
1,357
5,780
928
Kidney and Urinary Tract Infections (Age<70 W Severe CC) or A
L63B
Other Kidney and Urinary Tract Diagnoses W Severe CC
Kidney and Urinary Tract Infections W Catastrophic CC
L63A
379
232
L67B
Kidney and Urinary Tract Neoplasms W/O Catastrophic or Severe
L62B
Urethral Stricture
Kidney and Urinary Tract Neoplasms W Catastrophic or Severe C
L62A
1,138
#####
Other Kidney and Urinary Tract Diagnoses W Catastrophic CC
Admit for Renal Dialysis
L61Z
L66Z
Renal Failure W/O Catastrophic or Severe CC
L60C
879
742
466
Total
Seps
L67A
Renal Failure W Catastrophic CC
Renal Failure W Severe CC
L60A
ESW Lithotripsy for Urinary Stones
L42Z
L60B
AR-DRG Title
ARDRG
V5.0 No.
832
436
1,126
553
874
511
667
709
351
382
942
576
1,077
980
2,055
2,080
673
1,035
2,037
424
475
901
460
564
623
1,541
675
1,334
165
780
1,234
2,454
156
Clin
dept
($)
89
25
120
96
211
17
44
49
23
27
65
31
61
47
118
137
62
142
654
24
32
140
24
38
173
539
69
254
8
144
329
899
19
Allied
Health
($)
1,868
476
2,522
1,287
2,535
146
858
1,202
351
477
1,576
1,260
1,285
1,361
3,347
3,371
1,764
2,924
6,249
560
889
2,516
565
1,313
2,352
4,948
1,913
3,758
220
2,333
3,390
6,717
53
($)
Wards
354
121
313
152
273
15
67
55
13
89
97
63
177
17
78
19
296
353
495
99
365
513
375
458
531
508
137
373
4
382
422
519
5
Emerg
Dept
($)
148
412
363
145
100
670
1,244
1,941
1,204
1,366
1,662
36
2
54
22
23
0
6
13
3
4
159
70
35
1,947
21
217
337
77
150
781
3
6
44
14
13
18
187
16
34
1
171
274
1,582
1
($)
ICU
1,825
1,715
2,038
4,662
132
138
212
694
94
148
313
47
44
96
151
216
18
67
104
170
1,727
($)
Procs
172
44
167
64
175
19
153
151
18
19
94
4
54
24
144
182
115
215
459
63
78
156
248
143
188
325
180
325
2
190
279
546
72
($)
Imag
191
93
277
104
164
41
273
142
36
70
208
27
101
141
400
486
164
282
643
77
120
260
75
134
188
412
129
268
14
239
410
933
11
($)
Path
259
53
195
229
533
45
107
164
80
77
225
93
242
170
367
480
109
306
1,090
87
74
299
66
93
178
509
297
4
22
13
15
9
51
323
164
55
80
78
54
221
116
138
414
17
12
15
13
5
12
41
3
5
14
24
10
1
420
11
53
45
19
229
($)
Prosth
226
442
1,089
47
($)
Pharm
266
109
143
72
202
124
359
195
358
64
129
214
97
120
190
188
224
180
319
439
135
209
480
79
83
180
94
110
164
336
141
280
23
177
257
514
384
($)
Deprec
186
89
207
306
142
170
328
258
317
294
565
727
256
399
878
137
158
364
149
215
323
660
262
500
31
340
490
1,013
107
($)
Super
4,353
1,862
5,696
2,969
5,438
1,668
4,084
5,109
2,380
2,889
5,603
4,540
5,649
5,066
9,772
13,294
3,790
6,148
13,910
2,258
2,370
5,517
2,413
3,124
4,770
10,036
3,995
7,755
540
5,040
7,637
16,299
2,810
Total
per Sep
($)*
Appendix 2: Results of the NSW 2006/07
HCDC inflated to 2009/10 prices
Part 1: General (Overnight) cost averages by cost group
(day case costs excluded for selected AR-DRGs)
100
Abortion W OR Procedure
Vaginal Delivery W Catastrophic or Severe CC
Vaginal Delivery W/O Catastrophic or Severe CC
O05Z
O60A
O60B
Caesarean Delivery W/O Catastrophic or Severe CC
O01C
Postpartum and Post Abortion W O.R. Procedure
Caesarean Delivery W Severe CC
O01B
Ectopic Pregnancy
Caesarean Delivery W Catastrophic CC
O01A
O04Z
Menstrual and Other Female Reproductive System Disorders W/O
N62B
O03Z
Menstrual and Other Female Reproductive System Disorders W CC
N62A
Vaginal Delivery W O.R. Procedure W Catastrophic or Severe CC
Infections, Female Reproductive System
N61Z
Vaginal Delivery W O.R. Procedure W/O Catastrophic or Severe
Malignancy, Female Reproductive System W/O Catastrophic or Se
N60B
O02A
Malignancy, Female Reproductive System W Catastrophic or Seve
N60A
O02B
Other Female Reproductive Sys O.R. Procs Age>64 or W Malignan
Other Female Reproductive System O.R. Procs Age<65 W/O Malign
N11A
N11B
Diagnostic Curettage or Diagnostic Hysteroscopy
N10Z
4,265
Endoscopic Procedures for Female Reproductive System
Conisation, Vagina, Cervix and Vulva Procedures
N08Z
Other Uterine and Adnexa Procedures for Non-Malignancy
N07Z
N09Z
1,726
Female Reproductive System Reconstructive Procedures
N06Z
37,969
4,874
8,073
539
865
1,125
741
15,184
3,452
1,135
2,911
475
559
338
351
624
53
5,262
917
2,195
973
120
4,048
242
213
143
Oophorectomies & Complex Fallopian Tube Procs for Non-Malig W
Uterine, Adnexa Procedure for Non-Ovarian or Adnexal Malignan
N03A
Oophorectomies and Complex Fallopian Tube Procs for Non-Malig
Uterine, Adnexa Proc for Ovarian or Adnexal Malignancy W/O CC
N02B
73
188
N05B
Uterine, Adnexa Proc for Ovarian or Adnexal Malignancy W CC
N02A
N05A
Pelvic Evisceration and Radical Vulvectomy
N01Z
658
1,231
Uterine, Adnexa Procedure for Non-Ovarian or Adnexal Malignan
Other Male Reproductive System Diagnoses
M64Z
Hysterectomy for Non-Malignancy
Sterilisation, Male
M63Z
807
N03B
Inflammation of the Male Reproductive System W/O CC
M62B
Total
Seps
N04Z
AR-DRG Title
ARDRG
V5.0 No.
832
1,093
247
544
483
909
1,110
1,166
1,415
2,036
256
440
464
647
1,263
190
1,793
165
398
322
642
884
784
1,953
991
1,004
1,520
1,164
1,692
1,776
283
348
465
Clin
dept
($)
33
61
27
30
34
47
68
47
81
137
14
61
37
106
216
4
252
17
29
31
29
50
64
191
62
94
280
138
359
354
19
22
19
Allied
Health
($)
1,813
2,320
367
950
765
1,965
2,435
2,032
2,722
3,862
326
1,044
832
1,567
3,170
138
3,558
215
730
418
891
1,473
1,304
2,804
1,937
2,319
4,342
2,183
5,256
6,235
349
138
694
($)
Wards
9
10
241
219
257
6
11
8
10
48
240
326
379
174
264
13
91
21
135
69
122
18
63
93
13
21
37
51
52
18
290
12
290
Emerg
Dept
($)
308
571
1,144
947
1,562
555
824
1,941
1,720
1,852
116
7
30
3
53
16
8
111
13
97
309
2
3
14
54
6
273
1
872
5
15
6
29
25
16
432
24
18
283
15
182
171
4
1
4
($)
ICU
146
326
214
659
2,138
1,237
979
1,807
1,821
1,806
2,237
2,706
2,352
2,037
2,267
2,125
2,558
2,428
236
965
106
($)
Procs
10
25
20
48
53
22
32
35
54
108
60
100
110
132
270
6
386
12
23
25
37
27
39
201
36
48
210
47
245
436
48
10
66
($)
Imag
41
134
134
175
156
58
159
71
182
354
68
143
131
122
239
200
556
80
94
65
104
47
165
365
151
463
902
445
895
738
56
60
90
($)
Path
66
125
88
105
135
97
167
201
264
443
28
87
73
473
522
338
538
79
87
121
145
172
208
497
221
296
534
324
11
20
89
49
98
33
46
96
106
128
5
11
3
12
15
332
190
123
65
145
90
216
116
143
137
128
197
123
275
198
774
10
30
3
($)
Prosth
1,006
46
62
82
($)
Pharm
255
342
117
171
114
128
151
148
232
144
194
223
269
388
44
101
84
146
263
80
409
94
153
142
166
199
209
378
254
319
499
282
576
549
59
78
71
($)
Deprec
211
293
370
387
462
622
79
174
147
234
449
110
675
118
184
183
253
312
317
618
385
437
692
444
811
771
98
100
129
($)
Super
3,501
4,901
2,618
3,448
3,931
4,137
5,522
6,220
7,378
10,274
1,235
2,637
2,308
3,940
7,101
2,072
11,385
2,164
2,892
3,334
4,325
5,226
5,520
10,351
6,564
7,181
11,749
7,339
13,836
14,522
1,497
1,826
2,011
Total
per Sep
($)*
Appendix 2: Results of the NSW 2006/07
HCDC inflated to 2009/10 prices
Part 1: General (Overnight) cost averages by cost group
(day case costs excluded for selected AR-DRGs)
101
59
66
Postpartum and Post Abortion W/O O.R. Procedure
Abortion W/O O.R. Procedure
False Labour Before 37 Weeks or W Catastrophic CC
False Labour After 37 Weeks W/O Catastrophic CC
Antenatal & Other Obstetric Admission
Antenatal & Other Obstetric Admission, Sameday
Neonate, Died or Transf <5 Days of Admission W Significant O.
Cardiothoracic/Vascular Procedures for Neonates
O61Z
O63Z
O64A
O64B
O66A
O66B
P01Z
P02Z
138
141
Neonate, AdmWt 2000-2499 g W Significant O.R. Procedure
Neonate, AdmWt > 2499 g W Significant O.R. Procedure W Multi
P05Z
P06A
280
Neonate, AdmWt 1500-1999 g W/O Significant O.R. Proc W Multi
Neonate, AdmWt 1500-1999 g W/O Significant O.R. Procedure W
M
Neonate, AdmWt 1500-1999 g W/O Significant O.R. Procedure W
O
Neonate, AdmWt 1500-1999 g W/O Significant O.R. Procedure
W/O
Neonate, AdmWt 2000-2499 g W/O Significant O.R. Proc W Multi
Neonate, AdmWt 2000-2499 g W/O Significant O.R. Procedure W
M
Neonate, AdmWt 2000-2499 g W/O Significant O.R. Procedure
WO
Neonate, AdmWt 2000-2499 g W/O Significant O.R. Procedure
W/O
Neonate, AdmWt > 2499 g W/O Significant O.R. Procedure W
Mult
P65A
P65B
P65C
P65D
P66A
P66B
P66C
P66D
P67A
Neonate, AdmWt 1000-1249 g W/O Significant O.R. Procedure
Neonate, AdmWt 1250-1499 g W/O Significant O.R. Procedure
Neonate, AdmWt 750-999 g
P62Z
P63Z
Neonate, AdmWt < 750 g
P61Z
P64Z
164
Neonate Died/Transf <5 Days of Adm, W/O Significant O.R. Proc
P60B
282
775
1,070
412
81
489
386
399
74
373
71
287
404
Neonate, Adm Wt > 2499 g W Significant O.R. Proc W/O Multi Ma
Neonate Died or Transf <5 Days of Adm, W/O Significant O.R. P
P06B
P60A
58
41
Neonate, AdmWt 1000-1499 g W Significant O.R. Procedure
Neonate, AdmWt 1500-1999 g W Significant O.R. Procedure
P03Z
P04Z
105
9,308
12,012
1,775
2,072
1,448
4,250
10,681
Single Uncomplicated Vaginal Delivery W/O Other Condition
O60C
Total
Seps
AR-DRG Title
ARDRG
V5.0 No.
2,420
1,267
2,446
2,688
2,846
4,652
5,101
3,778
5,955
5,932
7,968
15,978
27,355
334
350
2,219
6,169
5,597
8,167
12,984
9,183
155
76
564
242
566
242
616
715
Clin
dept
($)
290
140
128
258
581
159
199
282
543
717
575
2,189
4,815
143
7
626
1,508
2,161
1,624
1,674
2,601
57
19
31
6
24
49
23
25
Allied
Health
($)
7,242
2,038
4,555
7,285
10,797
8,484
8,507
11,192
12,402
20,919
25,956
81,334
183,880
924
537
8,664
29,223
34,169
40,913
68,727
30,429
196
151
954
341
906
453
998
1,492
($)
Wards
50
24
22
21
22
28
134
38
58
104
104
70
86
135
12
182
24
277
373
918
735
125
80
1,892
2,211
1,961
1,191
1,101
7,318
2,610
44
93
73
115
78
120
145
($)
Procs
36
14
67
35
63
173
2
51
42
73
25
74
20
-
15
96
38
12
290
87
12
Emerg
Dept
($)
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
0
18
1
7
4
26
6
($)
ICU
554
24
60
194
561
70
140
253
470
449
590
1,537
2,423
162
101
512
1,895
1,142
1,452
1,629
1,224
150
3
44
1
21
36
26
5
($)
Imag
510
62
156
258
592
152
243
362
660
512
601
2,457
4,159
158
68
730
2,111
1,388
1,742
3,036
3,047
276
33
102
22
81
122
43
23
($)
Path
387
66
248
480
689
349
877
690
977
1,325
1,899
4,529
9,707
83
31
631
2,294
1,927
3,133
3,851
1,568
133
28
10
3
2
3
4
2
5
2
2
12
15
51
39
14
0
114
195
139
98
47
191
58
1
3
0
54
1
47
3
3
4
($)
Prosth
30
40
47
39
($)
Pharm
877
324
606
917
1,224
1,094
1,106
1,356
1,706
2,429
3,115
9,045
19,798
165
81
1,197
4,032
4,098
5,128
8,365
4,835
209
29
153
63
143
99
170
210
($)
Super
506
176
343
508
758
556
658
755
1,004
1,369
1,737
5,683
13,002
108
54
790
2,584
2,359
3,184
4,640
3,099
204
15
80
28
75
52
84
93
($)
Deprec
13,487
4,657
9,182
13,409
18,362
16,542
17,264
19,140
24,155
34,519
43,012
123,936
265,974
2,578
1,311
18,310
58,646
60,493
68,955
106,293
77,475
4,351
413
2,191
843
1,997
1,458
2,237
2,769
Total
per Sep
($)*
Appendix 2: Results of the NSW 2006/07
HCDC inflated to 2009/10 prices
Part 1: General (Overnight) cost averages by cost group
(day case costs excluded for selected AR-DRGs)
102
439
168
401
Red Blood Cell Disorders W/O Catastrophic or Severe CC
Coagulation Disorders
Lymphoma and Leukaemia W Major O.R. Procedures W
Catastrophic
Lymphoma and Leukaemia W Major O.R. Procedures W/O
Catastroph
Other Neoplastic Disorders W Major O.R. Procedures W Catastr
Q61C
Q62Z
R01A
R01B
R02A
695
Lymphoma and Non-Acute Leukaemia W Catastrophic CC
R61A
Other Neoplastic Disorders W CC
Acute Leukaemia W/O Catastrophic or Severe CC
R60C
R62A
3,008
Acute Leukaemia W Severe CC
R60B
Lymphoma and Non-Acute Leukaemia W/O Catastrophic CC
Acute Leukaemia W Catastrophic CC
Lymphoma and Non-Acute Leukaemia, Sameday
695
Other Neoplastic Disorders W Other O.R. Procedures W/O Catast
R04B
R60A
R61B
178
Other Neoplastic Disorders W Other O.R. Procedures W Catastr
R04A
R61C
142
Lymphoma and Leukaemia W Other O.R. Procedures W/O
Catastroph
R03B
387
4,191
836
371
431
392
207
Other Neoplastic Disorders W Major O.R. Procedures W/O Catast
Lymphoma and Leukaemia W Other O.R. Procedures W
Catastrophic
R02B
R03A
141
126
1,292
2,732
1,022
Red Blood Cell Disorders W Catastrophic CC
Red Blood Cell Disorders W Severe CC
Q61A
797
Q61B
Reticuloendothelial and Immunity Disorders W/O Cat or Sev CC
Reticuloendothelial and Immunity Disorders W/O Cat or Sev CC
Q60B
Q60C
1,162
492
151
104
68,710
Reticuloendothelial and Immunity Disorders W Catastrophic or
Splenectomy
Q01Z
Q60A
Unqualified Neonates
P67Z
4,403
Other O.R. Procedure of Blood & Blood Forming Organs W Catast
Neonate, AdmWt > 2499 g W/O Significant O.R. Procedure W/O Pr
P67D
3,280
Other O.R. Procedure of Blood & Blood Forming Organs W/O Cata
Neonate, AdmWt > 2499 g W/O Significant O.R. Procedure W
Othe
P67C
1,538
Q02A
Neonate, AdmWt > 2499 g W/O Significant O.R. Procedure W
Majo
P67B
Total
Seps
Q02B
AR-DRG Title
ARDRG
V5.0 No.
1,298
130
648
2,183
943
1,549
4,037
602
2,046
647
3,392
1,368
3,516
1,523
6,023
648
448
703
1,260
795
610
1,354
580
3,775
2,125
454
658
1,103
1,793
Clin
dept
($)
373
12
210
706
224
326
1,352
55
364
109
1,191
113
555
248
1,345
75
45
108
286
69
151
368
45
769
240
30
45
62
226
Allied
Health
($)
4,159
208
2,560
8,082
4,350
6,746
15,074
999
5,316
1,765
11,372
2,552
8,096
3,660
13,921
1,773
1,007
2,039
3,679
1,369
2,320
5,145
913
8,758
3,737
832
1,248
2,020
3,739
($)
Wards
220
57
151
381
174
264
338
41
172
87
394
32
110
80
287
384
297
301
420
397
337
374
64
337
181
5
69
39
99
Emerg
Dept
($)
296
63
147
378
329
335
707
1,649
1,758
1,475
1,982
3,028
5,507
2,333
3,995
98
217
203
210
85
39
129
1,393
2,071
3,363
41
25
60
71
($)
Procs
69
1
36
510
19
76
756
63
157
41
707
165
847
312
2,020
115
10
38
206
75
17
222
50
1,471
1,288
-
-
-
-
($)
ICU
340
13
185
695
107
254
778
107
411
207
1,579
109
487
560
1,658
84
56
124
234
109
91
250
81
845
287
85
508
1,803
662
1,123
3,197
240
717
718
2,485
390
859
905
3,449
255
158
383
442
204
310
692
404
1,248
1
626
0
36
107
183
($)
Path
361
19
37
142
($)
Imag
637
131
1,610
4,643
1,532
2,062
10,994
198
689
549
4,946
428
1,547
562
6,651
194
145
258
569
172
632
2,267
143
3,278
614
31
37
74
164
($)
Pharm
39
2
21
31
13
17
33
122
166
126
493
132
269
732
678
6
38
20
10
3
6
4
81
227
189
0
0
2
4
($)
Prosth
569
49
383
1,164
580
818
2,047
278
819
373
1,746
583
1,580
740
2,267
287
179
299
521
254
332
723
238
1,498
836
113
180
280
529
($)
Super
344
27
218
666
349
433
1,232
186
483
244
1,124
342
888
448
1,422
148
100
161
268
168
170
402
153
850
537
61
92
146
270
($)
Deprec
8,621
777
6,669
21,177
9,396
13,985
40,513
4,527
13,086
6,332
31,369
9,236
24,213
12,069
43,626
4,051
2,693
4,622
8,070
3,686
4,999
11,972
4,143
25,358
14,019
1,623
2,506
4,121
7,662
Total
per Sep
($)*
Appendix 2: Results of the NSW 2006/07
HCDC inflated to 2009/10 prices
Part 1: General (Overnight) cost averages by cost group
(day case costs excluded for selected AR-DRGs)
103
O.R. Procedures for Infectious and Parasitic Diseases W Catas
O.R. Procedures for Infectious and Parasitic Diseases W Sever
O.R. Procedures for Infectious and Parasitic Diseases W/O CC
Septicaemia W Catastrophic or Severe CC
Septicaemia W/O Catastrophic or Severe CC
Postoperative & Post-Traumatic Infect W Cat/Sev CC or (Age>54
T01A
T01B
T01C
T60A
T60B
T61A
Major Affective Disorders Age<70 W/O Catastrophic or Severe C
Other Affective and Somatoform Disorders
Anxiety Disorders
U63B
U64Z
U65Z
Childhood Mental Disorders
Major Affective Disorders W Cat or Sev CC or (Age>69 W/O Cat
U63A
U68Z
Paranoia & Acute Psych Disorder W/O Cat/Sev CC W/O Mental Hea
U62B
Eating and Obsessive-Compulsive Disorders
Paranoia & Acute Psych Disorder W Cat/Sev CC or W Mental Heal
U62A
Personality Disorders and Acute Reactions
Schizophrenia Disorders W/O Mental Health Legal Status
U61B
U66Z
Schizophrenia Disorders W Mental Health Legal Status
U61A
U67Z
Mental Health Treatment, Sameday, W ECT
Mental Health Treatment, Sameday, W/O ECT
U40Z
U60Z
Other Infectious and Parasitic Diseases W Catastrophic or Sev
Other Infectious and Parasitic Diseases W/O Catastrophic or S
T64A
T64B
Viral Illness Age >59 or W CC
Viral Illness Age<60 W/O CC
T63A
T63B
Fever of Unknown OriginW/O CC
HIV-Related Diseases W/O Catastophic or Severe CC
S65C
T62B
1,099
HIV-Related Diseases W Severe CC
S65B
Postoperative & Post-Traumatic Infections Age <55 W/O Catastr
HIV-Related Diseases W Catastrophic CC
S65A
Fever of Unknown Origin W CC
HIV, Sameday
S60Z
T61B
Radiotherapy
R64Z
T62A
1,601
Chemotherapy
R63Z
96
733
297
1,015
1,066
627
327
306
71
447
76
5,670
547
572
265
4,287
1,126
1,732
1,147
1,110
3,309
490
390
464
180
103
104
242
216
3,768
323
Other Neoplastic Disorders W/O CC
R62B
Total
Seps
AR-DRG Title
ARDRG
V5.0 No.
1,295
480
4,174
841
712
766
1,101
542
950
559
813
51
94
829
1,881
478
686
424
794
1,011
1,136
735
1,557
1,600
3,447
7,885
3,003
4,826
8,403
208
2,224
78
446
Clin
dept
($)
209
57
1,158
217
113
76
289
82
196
62
106
16
8
65
365
22
78
35
127
44
107
118
398
119
326
1,261
492
474
2,117
2
23
16
58
Allied
Health
($)
2,509
1,023
13,994
2,226
1,985
1,382
4,747
1,285
3,045
1,034
583
96
92
1,684
6,154
860
1,509
909
2,643
1,538
2,660
2,311
4,949
2,851
6,309
14,888
3,564
5,005
8,769
175
332
168
919
($)
Wards
611
496
317
370
361
522
598
945
336
487
367
541
7
369
446
402
413
424
456
351
343
533
570
212
252
456
339
381
577
12
3
4
99
Emerg
Dept
($)
84
31
70
76
52
61
307
21
98
19
12
54
128
56
11
8
65
14
52
6
35
2
11
0
38
14
424
8
22
2
9
31
121
202
993
86
399
3,017
72
65
3,086
-
-
0
2
($)
ICU
281
42
294
15
53
15
54
108
139
79
137
1,452
2,100
3,583
348
446
810
1,362
6
65
437
($)
Procs
82
42
93
109
58
41
184
93
108
46
45
37
1
73
475
50
120
83
229
86
141
191
448
154
356
1,439
353
356
924
2
10
6
190
($)
Imag
101
76
360
109
114
116
233
102
162
119
138
58
9
245
770
107
238
135
354
105
215
252
583
280
489
1,658
966
1,181
2,602
124
10
38
125
($)
Path
93
83
433
122
125
143
432
148
267
205
265
21
20
197
2,434
55
237
71
429
152
387
240
1,071
382
1,186
6,436
1,819
1,898
4
10
19
2
1
1
23
1
7
1
0
1
0
2
21
1
22
3
2
6
9
8
16
171
177
481
10
29
55
65
92
0
0
28
($)
Prosth
8,297
33
198
292
($)
Pharm
373
175
1,601
223
83
1,041
122
160
262
95
288
115
170
92
75
30
20
138
448
82
132
81
208
132
197
185
383
273
549
1,306
329
397
1,038
93
123
22
114
($)
Deprec
321
219
637
236
400
187
171
64
38
269
849
159
246
163
381
249
380
346
740
492
977
2,318
747
1,076
2,183
142
140
32
176
($)
Super
5,605
2,597
23,443
4,600
3,906
3,415
8,882
3,568
5,772
2,802
2,591
944
569
3,913
14,491
2,237
3,753
2,329
5,695
3,805
5,820
5,170
11,749
8,068
16,534
44,318
12,026
16,117
38,121
2,266
2,906
631
2,896
Total
per Sep
($)*
Appendix 2: Results of the NSW 2006/07
HCDC inflated to 2009/10 prices
Part 1: General (Overnight) cost averages by cost group
(day case costs excluded for selected AR-DRGs)
104
814
Injuries Age>64 W CC
Injuries Age >64 W/O CC
Injuries Age<65
Allergic Reactions
Poisoning/Toxic Effects of Drugs & Other Substances Age>59 or
Poisoning/Toxic Effects of Drugs & Other Substances Age<60 W/
Sequelae of Treatment W Catastrophic or Severe CC
Sequelae of Treatment W/O Catastrophic or Severe CC
Other Injury, Poisoning and Toxic Effect Diagnosis Age>59 or
Other Injury, Poisoning and Toxic Effect Diagnosis Age<60 W/O
Severe Full Thickness Burns
X60B
X60C
X61Z
X62A
X62B
X63A
X63B
X64A
X64B
Y01Z
Other Procedures for Other Injuries W/O Catastrophic or Sever
X06B
X60A
Other Procedures for Other Injuries W Catastrophic or Severe
X06A
Mic Tissue Transfer or (Skin Graft W Cat/Sev CC) for Injuries
Other Procedures for Injuries to Hand
X05Z
Skin Grafts for Injuries Excluding Hand W/O Cat or Sev CC
Other Procedures for Injuries to Lower Limb Age<60 W/O CC
X04B
X07A
Other Procedures for Injuries to Lower Limb Age>59 or W CC
X04A
X07B
327
Microvascular Tissue Transfer or Skin Grafts for Injuries to
X02Z
38
718
309
2,863
835
3,942
2,878
951
5,233
1,546
2,221
230
146
1,970
551
1,321
603
203
640
Multiple Trauma Without Significant Procedures
W61Z
137
293
Other O.R. Procedures for Multiple Significant Trauma
Multiple Trauma, Died or Transf to Another Acute Care Facilit
W04Z
82
208
322
369
89
2,011
W60Z
Hip, Femur and Limb Procs for Multiple Significant Trauma, in
Abdominal Procedures for Multiple Significant Trauma
W02Z
W03Z
Other Drug Use Disorder and Dependence
Ventilation or Craniotomy Procs for Multiple Significant Trau
Opioid Use Disorder and Dependence
Opioid Use Disorder and Dependence, Left Against Medical Advi
V63A
V63B
V64Z
Alcohol Use Disorder and Dependence, Sameday
V62B
W01Z
131
Alcohol Use Disorder and Dependence
V62A
453
1,693
Alcohol Intoxication and Withdrawal W/O CC
Drug Intoxication and Withdrawal
909
V60B
Alcohol Intoxication and Withdrawal W CC
V60A
Total
Seps
V61Z
AR-DRG Title
ARDRG
V5.0 No.
14,046
246
413
542
1,138
249
450
235
309
308
686
2,066
4,854
641
2,217
412
553
1,601
545
1,900
721
3,741
2,512
4,165
8,910
872
1,179
1,530
346
1,279
433
204
539
Clin
dept
($)
7,795
35
141
45
203
26
99
25
34
95
340
250
629
59
299
53
81
526
92
775
206
1,365
579
1,793
4,383
56
15
87
21
146
51
48
116
Allied
Health
($)
30,096
406
1,452
1,001
2,626
435
1,168
404
427
782
2,594
3,963
7,957
1,129
4,725
695
890
2,771
978
5,158
233
7,917
3,776
9,286
12,338
817
1,012
1,815
164
2,634
937
440
1,341
($)
Wards
66
244
726
371
373
470
559
450
415
506
589
335
398
297
341
265
323
345
294
412
945
521
435
467
495
1,873
31
211
389
128
821
437
478
Emerg
Dept
($)
13,330
25
32
169
235
16
46
25
196
67
25,938
95
220
34
333
124
505
126
13
8
36
10
67
614
2,067
67
1,287
14
29
480
31
1,265
464
2,854
2,339
1,206
21,853
14
0
11
0
20
19
14
210
($)
ICU
4,649
1,314
2,093
1,549
1,499
2,008
2,273
239
776
5,411
3,354
5,727
8,130
5
0
17
11
16
14
13
28
($)
Procs
1,370
63
252
63
247
39
128
31
138
198
292
94
240
98
413
56
119
247
46
728
1,236
837
1,035
1,490
2,446
28
2
21
28
38
59
52
167
($)
Imag
5,926
48
230
92
285
112
240
76
42
70
175
104
401
67
450
30
37
224
32
212
300
288
622
475
1,885
68
74
87
65
131
121
95
200
($)
Path
13,077
33
171
98
316
55
148
55
42
57
166
412
1,013
137
1,003
132
131
404
229
395
193
1,364
763
1,477
5,145
55
38
151
1
4
23
35
1
3
1
11
4
15
76
279
101
292
93
107
250
151
35
272
2,957
254
2,490
3,065
4
-0
2
0
126
5
16
2
2
7
($)
Prosth
168
90
45
118
($)
Pharm
9,315
94
4,525
50
161
101
288
230
409
63
129
66
76
96
204
346
730
164
476
143
156
341
195
494
265
1,113
613
1,185
2,825
148
109
173
28
146
82
51
121
($)
Deprec
181
123
256
121
125
163
377
664
1,349
295
842
282
259
583
395
846
355
1,851
1,037
1,825
4,581
328
199
284
63
326
189
101
239
($)
Super
125,051
1,322
4,060
2,708
6,402
1,692
3,681
1,597
1,820
2,338
5,520
10,380
23,065
4,357
14,327
3,716
4,173
9,740
5,251
12,389
5,848
29,954
17,088
31,510
73,958
4,235
2,659
4,360
1,125
5,031
2,800
1,491
3,535
Total
per Sep
($)*
Appendix 2: Results of the NSW 2006/07
HCDC inflated to 2009/10 prices
Part 1: General (Overnight) cost averages by cost group
(day case costs excluded for selected AR-DRGs)
105
Other Factors Influencing Health Status
Other Factors Influencing Health Status, Sameday
Multiple, Other and Unspecified Congenital Anomalies
Z64A
Z64B
Z65Z
Follow Up After Completed Treatment W/O Endoscopy
Z62Z
Other Aftercare W Catastrophic or Severe CC
Signs and Symptoms
Z61Z
Other Aftercare W/O Catastrophic or Severe CC
Follow Up After Completed Treatment W Endoscopy
Z40Z
Z63A
O.R. Procedures W Diagnoses Other Contacts W Health Services
Z01B
Z63B
O.R. Procedures W Diagnoses of Other Contacts W Health Servic
Severe Burns
Y61Z
Z01A
Burns, Transferred to Another Acute Care Facility < 5 Days
Y60Z
Other Burns Age>64 or W Catastr or Severe CC or W Complicatin
Other O.R. Procedures for Other Burns
Y03Z
Other Burns Age<65 W/O Catastr or Severe CC W/O Complicating
Other Burns W Skin Graft Age<65 W/O Cat or Sev CC W/O
Complic
Y02B
Y62A
Other Burns W Skin Graft Age>64 or W Cat/Sev CC or W
Complicg
Y02A
Y62B
AR-DRG Title
ARDRG
V5.0 No.
87
6,924
1,853
977
1,346
228
1,238
8,183
492
319
807
96
137
421
80
369
118
Total
Seps
762
223
796
545
1,048
470
728
289
470
1,152
482
881
503
117
1,497
1,296
7,255
Clin
dept
($)
175
27
309
149
568
61
133
13
27
164
141
359
309
25
327
489
890
Allied
Health
($)
1,466
138
2,600
1,180
3,421
791
1,456
130
931
2,774
891
4,512
2,885
162
2,264
4,103
7,611
($)
Wards
61
38
192
17
53
20
329
11
9
23
303
252
255
786
296
55
266
Emerg
Dept
($)
206
449
102
48
55
182
46
627
1,291
1,797
41
175
135
26
1,171
2,048
2,859
($)
Procs
55
1
14
51
148
18
28
1
13
312
48
571
447
125
181
108
581
($)
ICU
319
38
81
37
91
264
129
8
43
221
11
110
147
43
112
63
149
75
206
39
63
251
34
251
56
68
29
147
107
652
($)
Path
40
40
12
144
($)
Imag
111
59
177
65
238
179
129
38
123
465
44
288
106
48
168
235
1,114
($)
Pharm
46
40
12
4
8
14
4
40
208
431
0
9
3
2
69
179
144
($)
Prosth
303
70
334
162
431
138
243
72
243
496
158
637
401
108
456
668
1,162
($)
Super
266
51
174
84
180
104
139
54
137
311
95
329
224
48
307
451
755
($)
Deprec
3,996
1,179
4,899
2,399
6,373
2,316
3,559
1,323
3,558
8,343
2,244
8,304
5,336
1,499
6,915
9,748
23,398
Total
per Sep
($)*
Appendix 2: Results of the NSW 2006/07
HCDC inflated to 2009/10 prices
Part 1: General (Overnight) cost averages by cost group
(day case costs excluded for selected AR-DRGs)
106
Appendix 2:Average Acute Cost by Cost Group and DRG
Part 2: Same Day
AVERAGE ACUTE COST
PART 2: SAME DAY
App 2: Average Acute Cost by Cost Group & DRG NSW
Part 2: Same Day Acute Averages for Selected AR-DRGs
The costs shown in the following table have been
inflated to reflect 2009/10 prices.
The total per separation is not necessarily the sum of
the cost groups due to the effect of averaging.
108
487
1,621
Spinal Procedures W/O Catastrophic or Severe CC
Procs for Cerebral Palsy, Muscular Dystrophy, Neuropathy W/O
Established Paraplegia/Quadriplegia W or W/O O.R. Procs W/O C
Cerebral Palsy
Nervous System Neoplasm W/O Catastrophic or Severe CC
Degenerative Nervous System Disorders Age >59 W/O Catastr or
Degenerative Nervous System Disorders Age <60 W/O Catastrophi
Multiple Sclerosis and Cerebellar Ataxia W/O CC
B03B
B06B
B60B
B65Z
B66B
B67B
B67C
B68B
572
652
Headache
Other Head Injury
B77Z
B80Z
165
803
Dacryocystorhinostomy
Other Corneal, Scleral and Conjunctival Procedures
Neurological & Vascular Disorders of the Eye
C05Z
C12Z
C61Z
348
239
Mouth & Salivary Gland Procedures
Dental Extractions and Restorations
Ear, Nose, Mouth and Throat Malignancy W/O Catastrophic or Se
Dysequilibrium
D14Z
D40Z
D60B
D61Z
Interstitial Lung Disease W/O Catastrophic or Severe CC
Other Respiratory System Diagnosis (Age<65 W CC) or (Age>64 W
E74C
E75B
280
Respiratory Neoplasms W Severe or Moderate CC
Respiratory Neoplasms W/O CC
E71B
Pulmonary Embolism W/O Catastrophic or Severe CC
E61B
E71C
124
Cystic Fibrosis W/O Catastrophic or Severe CC
E60B
211
124
426
55
1,473
Epistaxis
Other Ear, Nose, Mouth and Throat Diagnoses W/O CC
D62Z
D66B
286
5,702
690
116
Other Disorders of the Eye W/O CC
Maxillo Surgery W/O CC
C63B
D04B
632
164
43
Other Disorders of the Nervous System W/O Catastrophic or Sev
Enucleations and Orbital Procedures
B81B
C02Z
727
1,176
Cranial and Peripheral Nerve Disorders W/O CC
Seizure W/O Catastrophic or Severe CC
B71B
B76B
884
266
206
411
261
453
32
132
Extensive O.R. Procedure Unrelated to Principal Diagnosis
901Z
Total
Seps
AR-DRG Title
ARDRG
V5.0 No.
298
259
236
502
219
605
192
159
82
499
235
480
1,032
386
261
798
291
538
236
114
109
195
265
263
166
451
194
789
602
488
865
1,128
Clin
dept
($)
107
26
58
178
6
289
22
15
17
53
19
30
48
50
29
33
17
37
76
29
27
62
22
31
52
180
112
1,003
92
131
176
589
Allied
Health
($)
302
160
174
482
152
599
232
175
135
319
208
243
370
162
168
292
198
388
226
178
160
283
286
235
221
316
404
426
444
416
362
486
($)
Wards
324
55
98
376
332
77
93
406
620
36
18
23
202
102
38
34
9
0
331
478
561
482
60
34
46
110
75
22
325
32
10
249
Emerg
Dept
($)
683
778
888
431
37
802
498
182
13
1,100
148
1
1
4
0
2
0
0
0
0
1
1
1,176
0
1
2
1
0
-
1
6
0
5
0
1
1
2
1
3
2
2
2
8
($)
ICU
1,383
1,926
286
226
1,472
1,881
1,671
409
17
119
105
87
58
67
71
476
336
709
1,776
190
2,954
($)
Procs
131
55
294
207
459
45
42
18
103
38
7
15
76
38
102
14
9
20
382
220
129
160
21
49
54
31
266
79
120
18
19
313
($)
Imag
253
266
302
158
14
284
36
57
107
125
11
124
41
28
31
52
8
93
91
63
106
108
46
158
52
76
52
13
94
121
3
220
($)
Path
183
121
173
246
55
223
43
43
49
197
66
87
155
45
62
110
143
127
65
31
56
66
77
83
49
207
24
55
47
24
0
12
16
15
4
46
62
59
1,032
9
4
51
67
222
34
2
12
4
5
1
4
1
32
38
91
194
84
446
3,929
823
($)
Prosth
152
127
87
529
($)
Pharm
165
94
81
61
95
96
127
71
88
54
41
38
93
82
105
146
61
50
106
116
136
85
45
48
58
29
28
28
38
96
116
118
144
266
306
($)
Deprec
153
99
157
89
73
78
150
110
153
232
70
62
190
280
227
119
85
93
100
63
68
56
86
110
205
147
203
348
292
($)
Super
2,668
1,935
2,490
2,856
1,433
3,178
1,327
1,177
1,230
2,655
1,994
2,711
5,258
1,248
1,083
3,151
3,020
3,460
2,070
1,258
1,409
1,616
960
1,010
800
1,564
2,018
3,123
2,996
3,916
6,256
7,893
Total
per Sep
($)**
Appendix 2: Results of the NSW 2006/07
HCDC inflated to 2009/10 prices
Part 2: General (Same Day) cost averages by cost group
(day case costs excluded for selected AR-DRGs)
109
Coronary Atherosclerosis W/O CC
Hypertension W/O CC
Valvular Disorders W/O Catastrophic or Severe CC
Non-Major Arrhythmia and Conduction Disorders W/O Catastrophi
Syncope and Collapse W/O Catastrophic or Severe CC
Chest Pain
Other Circulatory System Diagnoses W/O Catastrophic or Severe
Abdominal and Other Hernia Procedures Age >59 or W Catastroph
Abdominal and Other Hernia Procedures Age 1 to 59 W/O Cat or
Inguinal and Femoral Hernia Procedures Age>0
Anal and Stomal Procedures W/O Catastrophic or Severe CC
Digestive Malignancy W Catastrophic or Severe CC
Digestive Malignancy W/O Catastrophic or Severe CC
Inflammatory Bowel Disease
Abdominal Pain or Mesenteric Adenitis W CC
Abdominal Pain or Mesenteric Adenitis W/O CC
Oesophagitis, Gastroent & Misc Digestive Systm Disorders Age>
Oesophagitis and Misc Digestive System Disorders Age<10
Other Digestive System Diagnoses W CC
Other Digestive System Diagnoses W/O CC
Laparoscopic Cholecystectomy W/O Closed CDE W/O
Catastrophic/
ERCP Complex Therapeutic Procedure W/O Catastrophic or Severe
ERCP Other Therapeutic Procedure W/O CC
Cirrhosis and Alcoholic Hepatitis W Severe CC
F66B
F67B
F69B
F71B
F73B
F74Z
F75C
G08A
G08B
G09Z
G11B
G60A
G60B
G64Z
G66A
G66B
G67B
G69Z
G70A
G70B
H08B
H41B
H42C
H60B
Cirrhosis and Alcoholic Hepatitis W/O Catastrophic or Severe
364
Peripheral Vascular Disorders W/O Catastrophic or Severe CC
F65B
H60C
3,019
Venous Thrombosis W/O Catastrophic or Severe CC
F63B
246
134
464
289
244
1,287
262
194
2,065
1,130
177
541
306
158
5,283
1,641
1,016
226
546
1,453
306
111
278
749
121
2,094
382
76
235
Circulatory Disorders W/O AMI W Invasive Cardiac Inves Proc W
Other Circulatory System O.R. Procedures W/O Catastrophic CC
F21B
Circulatory Disorders W/O AMI W Invasive Cardiac Inves Proc W
Vascular Procs Except Major Reconstruction W/O CPB Pump W/O C
F14C
166
F42A
Cardiac Pacemaker Implantation
F12Z
Total
Seps
F42B
AR-DRG Title
ARDRG
V5.0 No.
300
433
309
348
551
243
467
176
137
245
153
283
296
271
383
495
507
861
245
106
91
237
164
139
151
204
137
214
486
489
226
83
Clin
dept
($)
18
56
20
16
97
17
42
46
24
17
24
177
54
51
18
34
32
67
36
14
20
22
25
16
13
24
72
37
110
53
43
21
Allied
Health
($)
259
422
276
324
602
212
230
461
203
233
195
315
311
387
265
394
380
354
346
204
147
220
188
115
220
242
97
204
249
348
328
33
($)
Wards
11
47
16
12
40
228
319
535
550
560
566
63
93
169
26
34
28
86
456
544
480
309
395
204
232
172
307
23
62
28
0
7
Emerg
Dept
($)
368
321
1,157
1,328
2,666
309
393
88
47
57
1
2
1
1
2
1
48
1
0
0
1
1
80
2
1
1
1
1
2
4
2
1
105
0
0
4
6
0
1
3
1
4
0
($)
ICU
222
490
226
1,232
1,746
1,569
2,202
339
48
20
389
206
26
308
285
85
887
1,996
1,936
1,372
2,013
($)
Procs
47
129
186
76
88
46
123
52
80
121
193
42
156
174
10
11
17
39
150
112
95
86
130
234
88
213
54
96
362
285
513
135
($)
Imag
153
447
44
76
81
56
271
87
131
113
171
91
64
124
55
30
31
74
180
119
130
98
85
154
93
88
63
51
152
137
85
7
($)
Path
79
210
148
140
167
45
170
43
57
37
73
1,523
149
178
95
118
99
199
122
42
59
57
40
35
50
74
141
7
73
109
33
2
151
297
82
122
108
88
97
95
106
99
102
126
180
166
223
137
84
74
116
79
48
77
93
67
110
195
192
147
150
($)
Super
1,118
78
29
78
5
5
5
8
3
70
24
69
296
391
493
185
4
47
29
17
7
9
17
5
151
64
244
55
227
518
3,741
($)
Prosth
128
216
119
43
($)
Pharm
54
68
142
185
237
49
78
56
44
52
50
78
68
57
98
142
132
195
95
50
40
83
58
24
67
67
32
86
176
156
123
150
($)
Deprec
1,370
2,246
2,474
3,776
4,905
1,311
2,322
1,642
1,354
1,526
1,596
2,908
1,880
1,791
2,378
3,481
3,353
4,794
2,280
1,316
1,195
1,734
1,378
998
1,306
1,483
974
1,915
4,181
4,078
3,479
6,382
Total
per Sep
($)**
Appendix 2: Results of the NSW 2006/07
HCDC inflated to 2009/10 prices
Part 2: General (Same Day) cost averages by cost group
(day case costs excluded for selected AR-DRGs)
110
Diabetes W/O Catastrophic or Severe CC
Miscellaneous Metabolic Disorders W Severe CC or (Age>74 W/O
Miscellaneous Metabolic Disorders W/O Catastrophic or Severe
Inborn Errors of Metabolism
Endocrine Disorders W Catastrophic or Severe CC
Endocrine Disorders W/O Catastrophic or Severe CC
Kidney, Ureter & Major Bladder Procedures for Non-Neoplasm W
Minor Bladder Procedures W/O Catastrophic or Severe CC
Transurethral Procedures Except Prostatectomy W/O Catastrophi
Renal Failure W/O Catastrophic or Severe CC
K62C
K63Z
K64A
K64B
L04B
L06B
L07B
L60C
Aftercare of Connective Tissue Disorders Age<60 W/O Catastrop
I73C
K62B
Aftercare Conn Tiss Disorder (Age<60 W Cat/Sev CC) or (Age>59
K60B
Tendonitis, Myositis and Bursitis Age<80 W/O Catastrophic or
I72B
I73B
Other Endocrine, Nutritional and Metabolic O.R. Procedures
Musculotendinous Disorders Age <70 W/O CC
I71C
Malignant Breast Disorders W Catastrophic or Severe CC or (Ag
Bone Diseases & Spec Arthropathies Age<75 W/O Catastr or Seve
I69C
K09Z
Bone Diseases&Spec Arthropathies(A<75 W Cat/Sev CC) or (A>74
I69B
J62A
Inflammatory Musculoskeletal Disorders W/O Cat or Sev CC
I66B
Lower Limb Procs W/O Ulcer/Cellulitis W/O (Skin Graft & Catas
Connective Tissue Malignancy, including Pathological Fx W/O C
I65B
Other Skin, Subcutaneous Tissue and Breast Procedures
Osteomyelitis W/O CC
I64B
J13B
Other Connective Tissue Procedures W/O CC
I28B
J11Z
879
Soft Tissue Procedures W/O Catastrophic or Severe CC
I27B
Other Musculoskeletal Disorders Age<70 W/O CC
Other Elbow or Forearm Procedures
I19Z
Other Skin Graft and/or Debridement Procedures W/O Catastroph
354
Other Knee Procedures
I18Z
I76C
386
Disorders of the Biliary Tract W/O CC
H64B
J08B
372
Disorders of Liver Excep Malig, Cirrhosis, Alcoholic Hepatiti
H63B
606
2,153
196
145
627
38
395
721
231
346
35
84
237
7,544
1,883
110
1,008
582
1,752
149
74
324
808
451
4,055
485
464
170
Malig Hepatobilry Sys, Pancreas (A<70 W/O Cat CC) or (A>69 W/
H61B
Total
Seps
AR-DRG Title
ARDRG
V5.0 No.
269
552
442
1,055
282
321
337
244
303
232
563
357
668
281
496
237
186
446
340
258
250
332
249
560
220
398
407
397
453
303
459
258
Clin
dept
($)
31
30
27
105
37
113
47
47
102
64
71
50
44
23
49
120
112
196
99
37
22
69
49
75
33
87
53
68
92
21
19
128
Allied
Health
($)
266
217
323
206
208
368
273
254
248
253
187
370
296
162
302
295
236
237
244
189
204
188
202
395
157
331
402
443
298
294
327
306
($)
Wards
82
37
43
147
121
118
31
227
314
524
0
175
62
19
58
57
42
480
136
177
31
81
18
193
150
62
92
206
26
470
37
219
Emerg
Dept
($)
25
1,290
1,450
2,415
228
263
120
95
335
42
0
1
1
6
4
6
1
1
2
89
1
-
28
1
1
1
1
0
2
3
2
0
1
1
1
2
1
1
1
1
2
1
2
($)
ICU
1,627
1,748
1,026
1,786
393
496
330
262
146
153
148
163
242
201
1,493
1,416
1,989
1,632
158
636
341
($)
Procs
50
147
38
780
93
311
40
56
84
52
166
90
46
9
15
102
69
138
55
85
27
35
13
217
38
117
44
146
21
128
120
318
($)
Imag
105
156
79
454
243
237
234
163
121
171
478
64
178
87
115
36
18
78
52
45
76
58
75
82
57
55
96
24
22
160
332
177
($)
Path
82
95
138
228
165
143
63
59
153
102
305
154
192
69
146
46
37
94
51
33
77
111
255
197
131
173
11
111
112
798
94
54
4
30
8
25
175
0
62
53
95
21
13
19
16
7
68
3
3
10
27
799
110
719
108
225
140
3
25
21
($)
Prosth
104
57
99
218
($)
Pharm
55
152
61
120
261
109
161
113
113
46
53
63
54
157
41
156
80
138
64
58
73
51
40
39
44
34
83
46
155
117
180
127
67
93
113
($)
Deprec
305
89
98
84
82
102
102
226
89
172
107
178
91
85
136
86
65
66
77
62
116
62
183
176
236
168
113
140
149
($)
Super
1,032
2,907
2,923
6,758
1,764
2,172
1,295
1,323
1,830
1,699
3,973
1,416
3,623
1,919
3,378
1,486
1,357
2,205
1,393
1,078
1,015
1,141
1,122
2,196
1,123
3,853
3,026
4,542
3,169
1,765
2,291
2,266
Total
per Sep
($)**
Appendix 2: Results of the NSW 2006/07
HCDC inflated to 2009/10 prices
Part 2: General (Same Day) cost averages by cost group
(day case costs excluded for selected AR-DRGs)
111
76
56
187
Coagulation Disorders
Acute Leukaemia W Catastrophic CC
Q62Z
R60A
O.R. Procedures W Diagnoses Other Contacts W Health Services
Follow Up After Completed Treatment W/O Endoscopy
Other Aftercare W/O Catastrophic or Severe CC
Z62Z
Z63B
O.R. Procedures W Diagnoses of Other Contacts W Health Servic
Z01A
Signs and Symptoms
Injuries Age<65
X60C
Z61Z
Injuries Age >64 W/O CC
X60B
Z01B
Injuries Age>64 W CC
X60A
734
Other Procedures for Injuries to Hand
Other Procedures for Other Injuries W/O Catastrophic or Sever
X05Z
Other Drug Use Disorder and Dependence
V64Z
X06B
65
Other Infectious and Parasitic Diseases W/O Catastrophic or S
T64B
190
2,238
863
948
300
1,751
228
166
558
70
1,035
Acute Leukaemia W Severe CC
Acute Leukaemia W/O Catastrophic or Severe CC
R60B
R60C
804
7,348
229
74
3,963
Red Blood Cell Disorders W/O Catastrophic or Severe CC
Reticuloendothelial and Immunity Disorders W/O Cat or Sev CC
Q60C
Q61C
Reticuloendothelial and Immunity Disorders W/O Cat or Sev CC
Q60B
596
5,113
Red Blood Cell Disorders W Catastrophic CC
False Labour Before 37 Weeks or W Catastrophic CC
O64A
Red Blood Cell Disorders W Severe CC
Conisation, Vagina, Cervix and Vulva Procedures
N09Z
33
4,010
Q61A
Other Uterine and Adnexa Procedures for Non-Malignancy
N07Z
363
240
473
1,034
Q61B
Uterine, Adnexa Procedure for Non-Ovarian or Adnexal Malignan
N03B
327
Penis Procedures W/O CC
Other Kidney and Urinary Tract Diagnoses W/O Catastrophic or
L67C
Malignancy, Male Reproductive System W/O Catastrophic or Seve
Other Kidney and Urinary Tract Diagnoses W Severe CC
L67B
M03B
Kidney and Urinary Tract Signs and Symptoms W/O Catastrophic
L65B
M60B
2,762
Urinary Stones and Obstruction
L64Z
216
Kidney and Urinary Tract Neoplasms W/O Catastrophic or Severe
L62B
Total
Seps
AR-DRG Title
ARDRG
V5.0 No.
285
218
595
334
613
169
99
80
402
200
342
208
255
676
2,092
199
167
363
551
199
218
316
170
250
421
341
288
275
256
172
125
296
Clin
dept
($)
37
28
49
30
62
26
46
262
46
27
11
53
74
74
122
34
17
203
48
25
65
16
18
24
90
19
24
25
41
18
14
35
Allied
Health
($)
191
136
222
253
223
226
91
115
468
382
225
159
545
850
681
232
199
368
254
228
474
519
204
238
271
152
450
293
343
188
157
185
($)
Wards
33
12
177
16
54
584
474
620
372
404
460
53
77
159
991
185
25
234
177
32
50
21
41
35
125
47
89
58
150
313
547
85
Emerg
Dept
($)
297
197
213
1,163
1,649
293
97
19
1,358
1
1
3
0
1
0
0
-
1
0
0
1,312
33
0
3
54
0
1
2
3
1
1
0
1
1
-
1
1
1
1
1
0
4
($)
ICU
371
134
82
172
43
276
322
342
67
44
129
1,185
1,824
2,670
655
1,659
122
51
261
146
284
($)
Procs
25
95
66
42
95
127
170
218
48
35
10
20
21
202
2,602
17
8
142
271
8
45
5
8
10
16
56
18
50
59
51
221
134
($)
Imag
58
62
257
71
165
35
63
111
63
20
106
127
237
948
1,713
197
75
257
92
65
652
80
103
91
333
161
50
149
89
152
76
56
($)
Path
57
119
152
84
194
49
55
110
113
113
68
390
227
804
2,671
124
88
183
423
92
573
41
85
134
213
206
75
43
15
55
222
464
13
3
4
93
91
21
8
9
6
6
2
10
6
0
6
3
1
64
83
150
60
163
9
14
70
15
23
12
($)
Prosth
138
63
43
98
($)
Pharm
60
41
43
76
55
96
119
141
65
45
49
121
110
50
46
59
133
393
33
36
79
98
28
47
39
91
130
202
82
131
43
60
64
69
45
($)
Deprec
131
187
117
76
100
200
204
76
83
115
231
299
73
59
134
125
55
163
79
112
159
236
93
177
68
65
89
90
66
($)
Super
1,124
983
1,980
2,444
3,848
1,691
1,205
1,671
3,273
2,885
1,392
1,522
1,809
4,169
11,794
1,134
962
2,286
2,382
807
2,335
1,245
2,081
2,977
4,725
1,873
3,137
1,166
1,266
1,381
1,499
1,322
Total
per Sep
($)**
Appendix 2: Results of the NSW 2006/07
HCDC inflated to 2009/10 prices
Part 2: General (Same Day) cost averages by cost group
(day case costs excluded for selected AR-DRGs)
112
Appendix 3: Sub- and Non-Acute Care
Classification and Weights
Appendix 3: Sub- and Non-Acute Care
Classification and Weights
Class
Description
Low
Trim
High
Trim
Episode
weight
Inlier
per diem
weight
Outlier
per diem
weight
0
4
0.1298
0.0424
0.0221
Palliative Care, overnight admitted
2101
Admit for assessment only
2102
Stable, RUG-ADL 4
1
16
0.1405
0.0424
0.0592
2103
Stable, RUG-ADL 5-17
3
18
0.2636
0.0424
0.0684
2104
Stable, RUG-ADL 18
2
17
0.3533
0.0424
0.0807
2105
Unstable, RUG-ADL 4-17
1
16
0.2275
0.0424
0.0708
2106
Unstable, RUG-ADL 18
0
12
0.2430
0.0424
0.0984
2107
Deteriorating, RUG-ADL 4-14
0
15
0.2215
0.0424
0.0715
2108
Deteriorating, RUG-ADL 15-18, age <=52
0
15
0.3095
0.0424
0.0865
2109
Deteriorating, RUG-ADL 15-18, age >=53
0
12
0.2499
0.0424
0.1008
2110
Terminal, RUG-ADL 4-16
0
11
0.2060
0.0424
0.1049
2111
Terminal, RUG-ADL 17-18
0
9
0.1744
0.0424
0.1341
Bereavement
0
2
0.0904
0.0424
0.0000
2112
Rehabilitation, overnight admitted
2201
Admit for assessment only
0
4
0.1298
0.0424
0.0221
2202
Brain,Neuro,Spine & MMT,FIM 13
43
70
3.2749
0.0424
0.1002
2203
All other impairments, FIM 13
12
39
0.8909
0.0424
0.0780
2204
Stroke ,Mot 63-91,Cog 20-35
7
31
0.3176
0.0424
0.0609
2205
Stroke ,Mot 63-91,Cog 5-19
8
35
0.5526
0.0424
0.0686
2206
Stroke, motor 47-62, cog 16-35
13
40
0.4060
0.0424
0.0577
2207
Stroke, motor 47-62, cog 5-15
13
40
0.5625
0.0424
0.0633
2208
Stroke, Mot 14-46, Age>=75
16
43
0.6221
0.0424
0.0638
2209
Stroke, Mot 14-46, Age<=74
28
55
0.9351
0.0424
0.0651
2210
Brain Dysfunction, motor 56-91, cog 32-35
7
27
0.3309
0.0424
0.0670
2211
Brain Dysfunction, motor 56-91, cog 24-31
7
30
0.4683
0.0424
0.0713
2212
Brain Dysfunction, motor 56-91, cog 20-23
7
33
0.5248
0.0424
0.0688
2213
Brain Dysfunction, motor 56-91, cog 5-19
12
39
0.4413
0.0424
0.0596
2214
Brain Dysfnc, Motor 24-55
19
46
0.8032
0.0424
0.0668
2215
Brain Dysfunction, motor 14-23
48
75
1.8177
0.0424
0.0721
2216
Neurological, motor 63-91
7
30
0.1801
0.0424
0.0535
2217
Neurological, motor 49-62
7
34
0.3996
0.0424
0.0623
2218
Neurological, motor 18-48
12
39
0.6048
0.0424
0.0660
2219
Neurological, motor 14-17
9
36
1.0338
0.0424
0.0894
2220
Spnl Cord Dysfnc,Mot 81-91
7
26
0.1421
0.0424
0.0538
2221
Spnl Cord Dysfnc,Mot 47-80
12
39
0.5533
0.0424
0.0639
2222
Spnl Cord Dysfnc,Mot 14-46, Age>=33
31
58
1.6405
0.0424
0.0791
2223
Spnl Cord Dysfnc,Mot 14-46, Age<=32
39
66
1.8977
0.0424
0.0789
2224
Amp of limb,Mot 72-91
9
36
0.1421
0.0424
0.0486
2225
Amp of limb,Mot 14-71
17
44
0.5197
0.0424
0.0594
2226
Pain Syndromes
7
28
0.1573
0.0424
0.0532
2227
Orthpaed Conds, Fractures, Mot 58-91
7
31
0.1583
0.0424
0.0515
2228
Orthpaed Conds, Fractures, Mot 48-57
10
37
0.3453
0.0424
0.0570
2229
Orthpaed Conds, Fractures, Mot 14-47, Cog19-35
14
41
0.4724
0.0424
0.0597
2230
Orthpaed Conds, Fractures, Mot 14-47, Cog 5-18
8
35
0.4079
0.0424
0.0612
2231
Orthpaed Conds, Replcmnt, Mot 72-91
7
26
0.1037
0.0424
0.0504
2232
Orthpaed Conds, Replcmnt, Mot 49-71
7
32
0.2382
0.0424
0.0556
114
Appendix 3: Sub- and Non-Acute Care
Classification and Weights
Class
Description
Low
Trim
High
Trim
Episode
weight
Inlier
per diem
weight
Outlier
per diem
weight
37
0.4677
0.0424
0.0620
Rehabilitation, overnight admitted (cont)
2233
Orthpaed Conds, Replcmnt, Mot 14-48
10
2234
Orthpaed Conds, Other, Mot 68-91
7
29
0.1128
0.0424
0.0499
2235
Orthpaed Conds, Other, Mot 53-67
7
34
0.1799
0.0424
0.0513
2236
Orthpaed Conds, Other, Mot 14-52
13
40
0.4492
0.0424
0.0594
2237
Cardiac
7
32
0.2769
0.0424
0.0574
2238
Major Multiple Trauma, FIMtotal 101-126
7
27
0.4581
0.0424
0.0777
2239
Major Multiple Trauma, FIMtotal 74-100; or Burns
9
36
0.6513
0.0424
0.0714
2240
Major Multiple Trauma, FIMtotal 44-73
12
39
0.5752
0.0424
0.0651
2241
Major Multiple Trauma, FIMtotal 19-43
52
79
1.9915
0.0424
0.0728
2242
Oth Impairs,Mot 67-91
7
29
0.1390
0.0424
0.0516
2243
Oth Impairs,Mot 53-66
7
31
0.2683
0.0424
0.0578
2244
Oth Impairs,Mot 25-52
7
34
0.3883
0.0424
0.0616
2245
Oth Impairs,Mot 14-24
14
41
0.4982
0.0424
0.0606
2241
Major Multiple Trauma, FIMtotal 19-43
52
79
1.9915
0.0424
0.0728
2242
Oth Impairs,Mot 67-91
7
29
0.1390
0.0424
0.0516
2243
Oth Impairs,Mot 53-66
7
31
0.2683
0.0424
0.0578
2244
Oth Impairs,Mot 25-52
7
34
0.3883
0.0424
0.0616
2245
Oth Impairs,Mot 14-24
14
41
0.4982
0.0424
0.0606
Psychogeriatric, overnight admitted
2301
Admit for assessment only
0
4
0.1298
0.0424
0.0221
2302
HoNOS Overactive behaviour 3,4
0
0
0.0000
0.0000
0.0728
2303
HoNOS Overactive behaviour 1,2, ADL 4
0
0
0.0000
0.0000
0.0751
2304
HoNOS Overactive behaviour 1,2, ADL 0-3
0
0
0.0000
0.0000
0.0633
2305
HoNOS Overactive behaviour 0, HoNOS total>=18
0
0
0.0000
0.0000
0.0658
2306
HoNOS Overactive behaviour 0, HoNOS total<=17
0
0
0.0000
0.0000
0.0560
2307
Long term care
0
0
0.0000
0.0000
0.0354
Geriatric evaluation and management (GEM), overnight admitted
2401
Admit for assessment only
0
4
0.1298
0.0424
0.0221
2402
Cognition<=15, motor 13-43
0
0
0.0000
0.0000
0.0600
2403
Cognition<=15, motor 44-91, age>=84
0
0
0.0000
0.0000
0.0508
2404
Cognition<=15, motor 44-91, age<=83
0
0
0.0000
0.0000
0.0487
2405
Cognition 16-35, motor 13-50
0
0
0.0000
0.0000
0.0565
2406
Cognition 16-35, motor 51-77
0
0
0.0000
0.0000
0.0483
2407
Cognition 16-35, motor 78-91
0
0
0.0000
0.0000
0.0435
0.0221
Maintenance, overnight admitted
2501
Admit for assessment only
0
4
0.1298
0.0424
2502
Respite, RUG 15-18
0
0
0.0000
0.0000
0.0565
2503
Respite, RUG 5-14
0
0
0.0000
0.0000
0.0485
2504
Respite, RUG 4
0
0
0.0000
0.0000
0.0388
2505
Nursing Home Type, RUG 11-18
0
0
0.0000
0.0000
0.0510
2506
Nursing Home Type, RUG 4-10
0
0
0.0000
0.0000
0.0451
2507
Convalescent care
0
0
0.0000
0.0000
0.0489
2508
Other Maintenance, RUG 14-18
0
0
0.0000
0.0000
0.0559
2509
Other Maintenance, RUG 4-13
0
0
0.0000
0.0000
0.0518
2510
Long term care, RUG 17-18
0
0
0.0000
0.0000
0.0331
2511
Long term care, RUG 10-16
0
0
0.0000
0.0000
0.0302
2512
Long term care, RUG 4-9
0
0
0.0000
0.0000
0.0221
115
Appendix 4: Cost Group Inclusions
and Exclusions
Source: NSW Health Department. (2008b2008b). NSW Program and Product
Data Collection Standards 2007-2008. Sydney: Casemix Policy Unit, NSW
Health Department.
Appendix 4:
Cost Group Inclusions and Exclusions
CLINICAL DEPARTMENT COST GROUP
Exclusions
The cost group includes expenditure directly related
to the operation of medical and surgical clinical
departments with the exception of the Anaesthetics
Department, ED and ICU. This includes medical
salaries and wages, VMO payments, secretarial
and other administrative support related to the
functioning of clinical departments.
• Non-medical costs associated with Specialised
Procedure Suites or Operating Room services.
Inclusions
• Medical salary costs and VMO payments of all
clinical department services including:
•
Respiratory function testing
•
Cardiology laboratories
•
Neurology laboratory
•
Services closely aligned with individual clinical departments
•
Medical salary and VMO costs associated with the clinical department activities of Haematology and Clinical Immunology
• Medical salary and VMO costs reported in ward
cost centres.
• All other costs of cost centres which directly
relate to the activities of clinical departments. This
may include nursing and other salaries, goods &
services, administration support etc if these relate
to clinical departments and cannot sensibly be
associated with one of the other cost groups (e.g.
specialty based Clinical Nurse Consultants).
• All medical salaries and VMO payment costs of
the Anaesthetics Department that relate to the
Operating Room and Specialised Procedure Suite
Cost Groups.
• All costs associated with the Anaesthetics
Department that relate to Operating Room and
Specialised Procedure Suite Cost Group.
• Any medical salary and VMO payments that are
included in the following cost groups: Imaging,
Pathology, ICU and Emergency Departments.
• Any nursing salaries expenditure that relates
directly to ward activities (include in Ward cost
group).
• Any Allied Health staff costs.
• Prostheses, depreciation, employee related
oncosts, pathology, imaging and drugs (include in
their respective cost group).
• Haematology and Clinical Immunology
laboratories. Costs associated with these services
should be included in the pathology cost group
with the exception of specific clinical department
functions of these departments which should be
included in this cost group.
• Pain Management or other non-theatre activities
of Anaesthetics Department
117
Appendix 4:
Cost Group Inclusions and Exclusions
INVASIVE PROCEDURE COST GROUPS
OTHER INVASIVE PROCEDURE SUITES
The cost group comprises two sub-groups:
‘operating suites’ and ‘other invasive procedure
suites’. Ideally, costs for each of these sub-groups
will be reported in separate cost groups. However,
it is recognised that some sites will not be able to
identify activity separately and the costs associated
with other invasive procedure suites.
This sub-group includes all costs centres associated
with the following invasive procedure suites only
where the costs and activity associated with
these services can be separated from operating
suite services: Cardiac Catheter Suite, Endoscopy,
Bronchoscopy and Vascular Angiography. Note that
all other Angiography services should be reported
under the Imaging cost group.
The protocol for this data collection is that other
invasive procedure suites should be reported in a
separate cost group only where data are routinely
available. The cost group definitions, inclusions and
exclusions provided below refer to each sub-group
for sites that are able to report separately.
Sites not able to report each sub-group separately
should report all invasive procedure costs as a single
group using the definitions, inclusions and exclusions
provided under operating suites.
Operating Suite
This sub-group includes all expenses related to the
running of the operating room, recovery, day surgery
and surgical delivery suite.
Inclusions
• Nursing and other non-medical salaries, goods
and services (including medical surgical supplies)
and RMR associated with the operating suite.
• Anaesthetics Department costs associated with
operating suite.
Inclusions
• Nursing and other non-medical salaries, goods
and services (including medical and surgical
supplies) and RMR associated with the Specialised
Procedure Suites.
• Anaesthetic costs associated with Specialised
Procedure Suites.
Exclusions
• Pain Management or other non Specialised
Procedure Suite activities of Anaesthetics
Department.
• Non-Anaesthetics Department medical salary
and VMO costs (include in the Clinical
Departments cost group).
• Peri-operative wards (include in the Wards
cost group).
• Prostheses, depreciation, employee related
oncosts, imaging, pathology, drugs, and allied
health (include in their respective cost groups).
Exclusions
• Pain Management or other non-operating room
activities of Anaesthetics Department (e.g.
Anaesthetists attending patients in the Delivery
Suite or for imaging procedures.
• Non-Anaesthetics Department medical salary and
VMO costs (include in the Clinical Departments
cost group).
• Peri-operative wards (include in the Wards
cost group).
• Prostheses, Depreciation, Employee related
on-costs, imaging, pathology, drugs, and allied
health (include in their respective cost groups).
118
Appendix 4:
Cost Group Inclusions and Exclusions
PATHOLOGY COST GROUP
Pathology Costs are to be reported in three
separate cost groups:
Pathology ICU
Pathology ED
Pathology DRG
This is to facilitate the development and
implementation of the Episode Funding. Sites not
able to report each subgroup separately should
report all pathology costs under the Pathology DRG
Cost Group using the definitions of the inclusions
and exclusions of that group.
These cost groups comprises costs associated with
pathology laboratory services including but not
limited to:
• Biochemistry (or Clinical Chemistry)
• Haematology
• Anatomical Pathology (or Histopathology)
• Microbiology
• Immunology
• Cytology
• Blood Bank (including associated cost centres
such as Blood Collections)
Costs associated with the administration of
pathology laboratory services should also be included
in this cost group.
Note: All direct patient care services such as
Clinical Haematology and Clinical Immunology
should be separated and reported in the relevant
clinical department cost group.
In some cases, such as where an external pathology
service is provided, expenditure may recorded as a
charge to individual clinical areas. These costs should
be included in a separate pathology cost component,
or rolled up into a ‘pathology’ cost centre to allow
costs to be reported in these groups.
Pathology ICU
Inclusions
• All salaries and wages, VMO payments and
goods and services costs in Pathology cost
centres (where in house services exist) or charges
relating to pathology tests ordered for patients in
Level 5 or 6 ICU and larger level 4 Rural ICUs in
scope for ICU Funding Model from 2003/4.
Exclusions
• Prostheses, depreciation, Employee related oncosts, imaging, drugs and allied health (include in
their respective cost group)
Pathology ED
Inclusions
• All salaries and wages, VMO payments and
goods and services costs in Pathology cost
centres (where in house services exist) or charges
relating to pathology tests ordered for patients
admitted and discharged from Level 4 and above
Emergency Departments and larger level 3 EDs in
scope for the ED Funding Model.
Exclusions
• Prostheses, depreciation, Employee related oncosts, imaging, drugs and allied health (include in
their respective cost group)
Pathology DRG
Inclusions
• All salaries and wages, VMO payments and
goods and services costs in Pathology cost
centres (where in house services exist) or charges
relating to pathology tests ordered for all patients
not included in pathology ED or Pathology ICU
• Where ED and ICU pathology costs are unable to
be identified, all pathology expenses should be
reported in this cost group.
Exclusions
• Prostheses, depreciation, Employee related oncosts, imaging, drugs and allied health (include in
their respective cost group)
119
Appendix 4:
Cost Group Inclusions and Exclusions
IMAGING COST GROUP
Imaging costs are to be reported in three
separate cost groups.
Imaging ICU
Imaging ED
Imaging DRG
This is to facilitate the development and
implementation of the Episode Funding. Sites not
able to report each subgroup separately should
report all imaging costs under the Imaging DRG Cost
Groups using the definitions of the inclusions and
exclusions of that group.
These cost groups comprises costs associated with
diagnostic imaging including but not limited to:
• General Radiology
Imaging ICU
Inclusions
• All salaries and wages, VMO payments and
goods and services costs in Imaging cost centres
(where in house services exist) or charges relating
to imaging tests ordered for patients in Level 5 or
6 ICUs and larger level 4 Rural ICUs in scope for
ICU Funding Model from 2003/4.
Exclusions
• Prostheses, depreciation, Employee related oncosts, pathology, drugs and allied health (include
in their respective cost group).
Imaging ED
Inclusions
• MRI services
• All salaries and wages, VMO payments and
goods and services costs in Imaging cost centres
(where in house services exist) or charges
relating to imaging tests ordered for patients
admitted and discharged from Level 4 and above
Emergency Departments and larger level 3 EDs in
scope for the ED Funding Model.
• PET services
Exclusions
Costs associated with the administration of
diagnostic imaging services should also be included
in this cost group.
• Prostheses, depreciation, Employee related oncosts, pathology, drugs and allied health (include
in their respective cost group).
In some cases, such as where an external imaging
service is provided, expenditure may be recorded as a
charge to individual clinical areas. These costs should
be included in a separate imaging cost component or
rolled up into an ‘imaging’ cost centre, to allow the
costs to be reported in these cost groups.
Imaging DRG
Inclusions
• CT Scanning
• Angiography
• Nuclear Medicine
• Ultrasound
• All salaries and wages, VMO payments and
goods and services costs in imaging cost centres
(where in house services exist) or charges relating
to imaging tests ordered for all patients not
included in Imaging ED or Imaging ICU.
• Where ED and ICU imaging costs are unable to
be identified, all imaging expenses should be
reported in this cost group.
Exclusions
• Prostheses, depreciation, Employee related oncosts, pathology, drugs and allied health (include
in their respective cost group).
• Invasive Imaging procedures performed in a
specialised procedure suite (include in Specialised
Procedure Suite cost group).
120
Appendix 4:
Cost Group Inclusions and Exclusions
WARD COST GROUP
EMERGENCY DEPARTMENT COST GROUP
This cost group can be defined as areas to which a
hospital’s patient administration system can admit
patients to beds. It includes high dependency
units, step down wards, dialysis units, radiotherapy
and chemotherapy wards, day stay and perioperative wards, level three and below emergency
departments, level four and below ICU and CCUs
(except larger level 3 EDs and level 4 rural ICUs to be
included in scope for the ED and ICU Funding Model
and treated like level 4 and above EDs and level 5/6
ICUs for costing purposes).
This cost group includes all costs associated
with designated Level 4 and above Emergency
Departments (plus larger level 3 EDs in scope for
the ED Funding Model).
Inclusions
• Salary and wages of nursing and other nonmedical staff.
• An appropriate share of medical costs estimated
as belonging to the Emergency Department
where medical salary and/or VMO payments are
held in centralised cost centers.
• Goods and services costs associated with ward
cost centres including medical supplies.
• Costs for goods and services associated with
emergency departments.
• Costs from level three and below Emergency
Departments (except larger level 3 EDs in scope
for the ED Funding Model).
Exclusions
• Costs from level four and below ICUs (except
larger rural ICUs in scope for the ICU Funding
Model in 2003/4).
• Costs associated with high dependency units
Exclusions
• Day surgery areas that are part of an operating
suite (should be included in Operating Room or
Specialised Procedure cost groups)
• Imaging day stay procedure areas, Bronchoscopy
and Endoscopy day stay areas and other areas
that undertake invasive procedures (should be
included in the Specialised Procedure Suite cost
group)
• Medical and VMO payment costs (include in
Clinical Department cost groups)
Other Emergency Departments are considered
wards for the purposes of this study.
Inclusions
• All costs recorded in Emergency Department cost
centres including medical salaries and wages,
VMO payments, nursing and other salary and
wage costs.
• Level 3 and below Emergency Departments
unless they have been included in the ED
Funding Model; medical costs for level 3 and
below emergency departments will be included
in the Clinical Departments cost group. Other
costs related to level 2 and below emergency
departments will be included in the Ward cost
group.
• Imaging expenses charged to Intensive Care
(include in ICU).
• Imaging expenses charged to Emergency
Departments where patients is Admitted and
Discharged from ED or Not Admitted.
(Include in ED).
• Prostheses, Depreciation, Employee related
oncosts, drugs and allied health (include in their
respective cost group).
• Salary and wage costs of Allied Health staff
(include in Allied Health cost groups)
• Prostheses, Depreciation, Employee related oncosts, diagnostics, drugs and allied health (include
in their respective cost group)
121
Appendix 4:
Cost Group Inclusions and Exclusions
INTENSIVE CARE COST GROUP
ALLIED HEALTH COST GROUP
This cost group includes all costs associated with
designated level five and six Intensive Care Units plus
larger level 4 Rural ICUs in scope for ICU Funding
Model from 2003/4. Lower Level Intensive Care Units
are considered wards for the purposes of this study.
Allied Health Costs are to be reported in three
separate cost groups.
Where the hospital has established virtual wards
to split ICU activity into Intensive Care (IC) and
High Dependency (HD) patients and can assign
costs to these virtual wards this cost bucket should
only relate to the IC ward. The virtual HD ward
should be considered a ward for the purposes of
the NSW PPDC.
Allied Health DRG
Inclusions
These cost groups include all costs associated with
providing allied health services where these services
can be separately identified.
• All costs recorded in Intensive Care cost centres
(for units at level five or above). Including medical
salaries and wages, VMO payments, nursing and
other salary and wage costs.
• All costs for goods and services associated
with ICU.
• Include Pathology and Drugs used in ICU.
Exclusions
• ICUs with a role delineation of Level four and
below (except larger level 4 Rural ICUs in scope
for ICU Funding Model from 2003/4), High
dependency units, Coronary Care units (include in
Ward cost group).
• Prostheses, Depreciation, Employee related
on-costs, drugs and allied health (include in their
respective cost group).
Allied Health ICU
Allied Health ED
This is to facilitate the development and
implementation of the Episode Funding. Sites not
able to report each subgroups separately should
report all allied health costs under the Allied Health
DRG Cost Groups using the definitions of the
inclusions and exclusions of that group.
Allied Health ICU
Inclusions
• All salaries and wages and goods and services
costs in Allied Health Cost Centres relating to
services provided to patients in Level 5 or 6 ICU
and larger level 4 Rural ICUs in scope for ICU
Funding Model from 2003/4.
• Allied Health salaries and wages held within an
ICU cost centre.
Exclusions
• Prostheses, depreciation, employee related
oncosts, imaging, pathology and drugs.
Allied Health ED
Inclusions
• All salaries and wages and goods and services
costs in Allied Health Cost Centres relating to
services provided to patients admitted and
discharged from Level 4 and above Emergency
Departments and larger level 3 EDs in scope for
the ED Funding Model.
• Allied Health salaries and wages held within an
ED cost centre. (This includes services where
patients are admitted and discharged from ED, or
admitted and transferred to a general ward.).
Exclusions
• Prostheses, depreciation, employee related
oncosts, imaging, pathology and drugs.
122
Appendix 4:
Cost Group Inclusions and Exclusions
Allied Health DRG
Inclusions
• All salaries and wages and goods and services
costs in allied health cost centres not included in
columns 16 and 17.
• Allied health salaries and wages held within cost
centres other than ED and ICU.
Exclusions
• Prostheses, Depreciation, Employee related oncosts, imaging, pathology and drugs (include in
the respective cost group).
PHARMACY/DRUGS COST GROUP
Pharmacy/Drug Costs are to be reported in three
separate cost groups.
Drugs ICU
Drugs ED
Pharmacy/Drugs DRG
This is to facilitate the development and
implementation of the Episode Funding. Sites not
able to report each subgroups separately should
report all pharmacy/drugs costs under the Pharmacy/
Drugs DRG Cost Groups using the definitions of the
inclusions and exclusions of that group.
These groups will include all costs associated with
drugs and pharmacy services.
Drugs ICU
Inclusions
• All imprest and dispensed drug costs ordered
for patients in Level 5 or 6 ICU and larger level 4
Rural ICUs in scope for ICU Funding Model from
2003/4.
Drugs ED
Inclusions
• All imprest drug costs for patients treated within
Level 4 and above Emergency Departments
Departments and larger level 3 EDs in scope for
the ED Funding Model.
• All dispensed drug costs for patients admitted
and discharged from Level 4 and above
Emergency Departments.
Pharmacy/Drugs DRG
Includes all costs not included in Drugs ED or
ICU that is:
• All salaries and wages of pharmacy department
staff
• Costs of goods and services within Pharmacy
departments
• All imprest and dispensed drug costs for general
inpatient wards.
• All dispensed drug costs for patients admitted to
ED and transferred to a general inpatient ward.
Exclusions
• Prostheses, Depreciation, Employee related oncosts, imaging, and pathology (include in the
respective cost group)
123
Appendix 4:
Cost Group Inclusions and Exclusions
PROSTHESES COST GROUP
This cost group includes all costs associated with
inpatient prostheses recorded in study cost centres.
The term study cost centre includes cost component
level expenditure.
DEPRECIATION COST GROUP
This cost group includes all costs associated with
depreciation recorded in study cost centres.
EMPLOYEE RELATED ON COSTS COST GROUP
This cost group includes all superannuation and
workers compensation expenditure.
124
Appendix 5: Methodology to Determine
Transfer Cost Weights
Appendix 5:
Methodology to Determine Transfer Cost Weights
The methodology introduced in 2003/04 to
determine the transfer cost weights is as follows:
Step One
If the DRG is defined by its length of stay it has
a transfer weight equal to its standard weight
excluding ED and ICU. This includes the 14 DRGs
which are defined as being same day or <5 days (see
G42B in table A1 below).
If the DRG is a surgical DRG and it has a separate same
day cost weight, then set the transfer weight equal to
the same day cost weight (excluding ED and ICU) plus
0.5 x the outlier per diem (see E02A in table A1).
If the DRG is not a surgical DRG and it has a separate
same day cost weight, then set the transfer weight
equal to the same day cost weight (excluding ED
and ICU) plus 0.5 x the outlier per diem (see E60B in
table A1).
If the DRG is not a surgical DRG and it does not have
a separate same day weight, then set the transfer
weight equal to the smaller of:
a) 1.5 x the outlier per diem (see E60A in table A1),
and
b) the standard cost weight excluding ED and ICU
(see L66Z in table A1).
If the DRG is a surgical DRG and it does not have a
separate same day cost weight, then set the transfer
weight equal to the smaller of:
a) the weight needed to cover the operating
room and prostheses components + 1.5 x the
outlier per diem (see E01B in table A1). (The
weight needed to cover the operating room
and prostheses components = cost of these two
components divided by the cost base), and
b) the standard cost weight excluding ED and ICU
(see C10Z in table A1).
Table A1 Example of Step 1 of Transfer weight calculation
DRG
Cost Weight
w/o Emerg & ICU
Same Day
weight
Procedures +
prostheses weight
Outlier per diem
weight
New transfer
weight
C10Z
0.59
#N/A
0.32
0.25
0.59
E01B
3.05
#N/A
0.65
0.21
0.96
E02A
4.58
0.77
0.24
0.25
0.89
E60A
4.09
#N/A
0.06
0.25
0.38
E60B
3.02
0.62
0.04
0.25
0.74
G42B
0.30
#N/A
0.13
0.21
0.30
L66Z
0.39
#N/A
0.13
0.29
0.39
126
Appendix 5:
Methodology to Determine Transfer Cost Weights
Step Two
Check to see if there are any DRGs at a lower level in
the adjacent DRG which have a higher cost weight.
If so, set the cost weight to this weight except where
this would take the transfer weight higher than the
standard weight excluding ED and ICU.
Table A2
Example of Step 2 of Transfer weight
calculation
DRG
Step 1
Weight
Final
Weight
B70A
0.31
0.69
B70B
0.53
0.69
B70C
0.53
0.69
B70D
0.69
0.69
E60A
0.38
0.74
E60B
0.74
0.74
I76A
0.22
0.31
I76B
0.31
0.31
I76C
0.28
0.28
L09A
1.14
1.14
L09B
0.93
1.01
L09C
1.01
1.01
127
Appendix 6: Methodology to Determine
AR-DRGs to have separate
Same Day Cost weights
Appendix 6: Methodology to Determine
AR-DRGs to have separate same day cost weights
NSW ISC 2000/01*
NO
MATERNITY OR NEONATE AR-DRG?
YES
One cost weight (set at average for
same day and longer stay episodes)
(44 AR-DRGs)
NO
AR-DRG WITH SAME DAY EPISODES
>=50%?
YES
One cost weight (set at average for
same day and longer stay episodes)
(83 AR-DRGs)
NO
TOTAL SEPARATIONS <100 OR
TOTAL SAME DAY SEPARATIONS <25?
YES
One cost weight (set at average for
same day and longer stay episodes)
(292 AR-DRGs)
NO
RATIO OF SAME DAY COSTS TO
TOTAL COSTS >=0.5?
YES
One cost weight (set at average for
same day and longer stay episodes)
(26 AR-DRGs)
NO
SD < 10% OF EPISODES
YES
One cost weight (set at average for
same day and longer stay episodes)
(60 AR-DRGs)
NO
OVERNIGHT LOS < 2 DAYS
YES
One cost weight (set at average for
same day and longer stay episodes)
(109 AR-DRGs)
NO
NO SIGNIFICANT DIFFERENCES
IN THE PROPORTION OF SAME DAY
SEPARATIONS BETWEEN HOSPITALS
YES
One cost weight (set at average for
same day and longer stay episodes)
(9 AR-DRGs)
NO
1
* Excludes ‘error’ and ‘rehabilitation” AR-DRGs and SD transfers
out and deaths. Includes only episodes in the scope of the NSW
2000/01 HCDC
(131 AR-DRGs)
129
Appendix 6: Methodology to Determine
AR-DRGs to have separate same day cost weights
1
IS THE AR-DRG STANDALONE
(ie NO ADJACENT AR-DRG)?
YES
SPLIT. SEPARATE COST WEIGHTS FOR
SAME DAY & LONG STAY CASES
YES
SPLIT. SEPARATE COST WEIGHTS FOR
SAME DAY & LONG STAY CASES
YES
SPLIT. SEPARATE COST WEIGHTS FOR
SAME DAY & LONG STAY CASES.
COST WEIGHT OF THE HIGHER LEVEL
SAME DAYS IS BASED ON THE AVERAGE
OF THE SAME DAY CASES IN THE
LOWEST LEVEL AR-DRG.
YES
SPLIT. COST WEIGHT OF SAME DAY
CASES IS BASED ON THE AVERAGE
OF ALL CASES (ie INCLUDING SAME
DAY AND OVERNIGHT) OF THE LOWER
LEVEL ADJACENT AR-DRG.
NO
IS THE AR-DRG AT THE LOWEST
LEVEL ADJACENT AR-DRG HIERARCHY?
NO
HAS THE LOWER LEVEL ADJACENT
AR-DRG BEEN SPLIT?
NO
IS THE AR-DRG A SURGICAL/
PROCEDURAL AR-DRG?
NO
NO
SPLIT. SPLIT ADJACENT AR-DRGS
ALSO. SEPARATE COST WEIGHTS FOR
SAME DAY AND LONGER STAY CASES
FOR ALL ADJACENT AR-DRGS. SAME
DAY COST WEIGHTS ARE BASED ON THE
AVERAGE OF THE SAME DAY CASES IN
THE LOWEST LEVEL AR-DRG.
After this analysis there was a consultation process
with clinicians to confirm which AR-DRGs should
have separate cost weights where some were added
to the list and others removed from it.
130
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131
132