ࡱ> f h S T U V W X Y Z [ \ ] ^ _ ` a b c d e M ebjbj== eWWZ= l@*0ZZZ4h@ V V V V h,#$ 6.Z,&V V ,&,&MZZV V ҡMMM,&ZV ZV M,&MMvRZZZ\V z 7ݔR$'%\ ]D0\4dMd ]MZZZZ Ministry of Health WIES8A Methodology and Casemix Purchase Unit Allocation for the 2001/2002 Financial Year Frozen Specification for implementation on NMDS 9 May 2001 with minor modifications on 3 August and 10 October 2001 Authors: Michael Rains James Hogan Marty de Boer Table of Contents  TOC \o "1-3" 1 Introduction  PAGEREF _Toc521471115 \h 4 1.1 Background  PAGEREF _Toc521471116 \h 4 1.2 Changes from the WIES5A version for the 2000/2001 FY  PAGEREF _Toc521471117 \h 5 1.2.1 Propagation of the current exclusion framework  PAGEREF _Toc521471118 \h 5 1.3 Areas for change in the future  PAGEREF _Toc521471119 \h 5 1.3.1 Exclusion rule Post Natal Early Intervention  PAGEREF _Toc521471120 \h 5 1.3.2 Neonatal CPAP  PAGEREF _Toc521471121 \h 5 1.3.3 Other possible exclusions  PAGEREF _Toc521471122 \h 6 2 WIES8A calculation  PAGEREF _Toc521471123 \h 7 2.1 Derived variables required in calculation  PAGEREF _Toc521471124 \h 7 2.1.1 Length of Stay  PAGEREF _Toc521471125 \h 7 2.1.2 Reallocated DRG  PAGEREF _Toc521471126 \h 7 2.2 DRG Reallocations  PAGEREF _Toc521471127 \h 7 2.2.1 AR-DRG A04, Bone Marrow Transplants  PAGEREF _Toc521471128 \h 8 2.2.2 Adjustment for Peritoneal Dialysis  PAGEREF _Toc521471129 \h 8 2.2.3 Adjustment of medical AR-DRGs with radiotherapy  PAGEREF _Toc521471130 \h 8 2.2.4 All other AR-DRGs  PAGEREF _Toc521471131 \h 8 2.3 Adjusted Mechanical Ventilation Days  PAGEREF _Toc521471132 \h 8 2.3.1 DRGs excluded from mechanical ventilation days  PAGEREF _Toc521471133 \h 9 2.3.2 Calculation of mechanical ventilation days from hours  PAGEREF _Toc521471134 \h 9 2.3.3 Calculation of mechanical ventilation days without hours  PAGEREF _Toc521471135 \h 9 2.4 General Calculation  PAGEREF _Toc521471136 \h 9 2.4.1 Calculating WIES8A  PAGEREF _Toc521471137 \h 11 2.4.2 Copayment for Mechanical Ventilation  PAGEREF _Toc521471138 \h 12 2.4.3 Base WIES  PAGEREF _Toc521471139 \h 13 2.4.4 Final WIES weight  PAGEREF _Toc521471140 \h 15 3 HFA Purchase Unit allocation  PAGEREF _Toc521471141 \h 15 3.1 Derived variables required in allocation  PAGEREF _Toc521471142 \h 15 3.1.1 Patients Age  PAGEREF _Toc521471143 \h 15 3.1.2 Length of Stay  PAGEREF _Toc521471144 \h 15 3.2 Exclusions from casemix purchasing  PAGEREF _Toc521471145 \h 15 3.2.1 Neonatal Inpatient Casemix Purchasing  PAGEREF _Toc521471146 \h 15 3.2.2 Non- Medical/Surgical Purchasing  PAGEREF _Toc521471147 \h 15 3.2.3 Non Base Funding Purchases  PAGEREF _Toc521471148 \h 15 3.2.4 Designated Hospital Purchasing  PAGEREF _Toc521471149 \h 15 3.2.5 Non-Treated Patients  PAGEREF _Toc521471150 \h 15 3.2.6 Error DRGs  PAGEREF _Toc521471151 \h 15 3.2.7 Some Transplants  PAGEREF _Toc521471152 \h 15 3.2.8 Some Spinal Injuries  PAGEREF _Toc521471153 \h 15 3.2.9 Surgical Termination of Pregnancy  PAGEREF _Toc521471154 \h 15 3.2.10 Renal and Peritoneal Dialysis  PAGEREF _Toc521471155 \h 15 3.2.11 Sameday Chemotherapy & Radiotherapy  PAGEREF _Toc521471156 \h 15 3.2.12 Sleep Apnoea  PAGEREF _Toc521471157 \h 15 3.2.13 Lithotripsy  PAGEREF _Toc521471158 \h 15 3.2.14 Colposcopies  PAGEREF _Toc521471159 \h 15 3.2.15 Cystoscopies  PAGEREF _Toc521471160 \h 15 3.2.16 ERCPs  PAGEREF _Toc521471161 \h 15 3.2.17 Colonoscopies  PAGEREF _Toc521471162 \h 15 3.2.18 Gastroscopies  PAGEREF _Toc521471163 \h 15 3.2.19 Bronchoscopies  PAGEREF _Toc521471164 \h 15 3.2.20 Day Case Blood Transfusions  PAGEREF _Toc521471165 \h 15 3.3 Mapping of Health Service Speciality codes to MoH casemix PUs  PAGEREF _Toc521471166 \h 15 4 Appendices  PAGEREF _Toc521471167 \h 15 4.1 Spreadsheet containing 01/02 FY DRG weights and associated variables for calculating WIES8A  PAGEREF _Toc521471168 \h 15 4.2 SAS Code for Derivation of WIES8A  PAGEREF _Toc521471169 \h 15  Introduction This report specifies the final version of the 2001/2002 Financial Year (01/02 FY) WIES8A methodology for casemix purchasing employed by the Ministry of Health. It is the same as the document for the 00/01 FY with adaptation to the new costweights, WIES8A, to be used in New Zealand from 1 July 2001. The original intent for this document was to specify the casemix methodology used by the Ministry so that case weighted discharges can be calculated for all National Minimum Dataset (NMDS) events by the New Zealand Health Information Service (NZHIS). Further variables are also required to identify casemix purchased Purchase Units (PUs), case complexity (for future costing work) and the costweight version used. A secondary purpose of this document is to provide a definitive explanation of Ministry casemix purchasing for use throughout the health sector. As such, additional information beyond that required by NZHIS for implementation on the NMDS is provided both as a background and to identify areas which may be subject to revision for future contracting. As requested by NZHIS, the specification is described as much as possible in plain english. There are, however, also references to lists of International Classifications of Diseases (ICD-9-CM-A & ICD10-AM version 1), Diagnostic Related Groupings (DRGs) and other lists of coded variables from the Data Dictionary for the NMDS. Such lists, including logical conjunctions of different sets of variables, are provided to exactly identify what is included (or excluded) in the english definition. Background Inheriting the Health Funding Authority purchasing processes, the Ministry currently purchases a range of inpatient events (principally Medical/Surgical events) from publicly funded hospitals via a casemix methodology know as the Weighted Inlier Equivalent Separations, Version 5 with Amendments for New Zealand (WIES5A). Casemix events are contracted for via Purchase Units (PUs) which are derived from a mapping of Health Service Speciality codes. The introduction of ICD10-AM version 1 coding by Health and Hospital Services (HHS) required HHSs to backmap their ICD10 coded data to ICD-9-CM-A in order to calculate DRG3.1s for use in the WIES5A costweight calculation. In addition, the costweights themselves were beginning to date resulting in the funding of hospital services potentially diverging from their cost of production. In order for casemix funding to remain relevant for service remuneration as well as reflecting the change in clinical coding which had occurred within the sector, the Health Funding Authority (HFA) and the Crown Health Association (CHA) established a Costweights Group dedicated to the generation of a new costweights schedule based on ICD-10-AM v2, AR-DRG 4.1, and Victoria's WIES8 costweights schedule. This paper builds on the work of the Costweights Group. Changes from the WIES5A version for the 2000/2001 FY The main change from the 00/01 FY WIES5A methodology, which allows for blood and pre-admits, is the revision of costweights based on Victorias WIES8 system adapted to New Zealand circumstances. This revision involves updated costs from Victorias cost study used to generate WIES8, use of the New Zealand LOS profile, and allowance for blood and pre-admits. (see appendix attachment). Propagation of the current exclusion framework This document continues the framework developed last year, but updates that documentation for the introduction of WIES8A. Hence all existing exclusions from casemix remain. It has been recommended that anaesthetic codes be captured on the NMDS and directly coded after the procedure code they relate to. The Coding Standards Advisory Committee and NCCH agreed to use as default anaesthetic codes GA -92502-02 or sedation 92503-00. This has implications for the exclusions defined in 3.2.13-3.2.20 which depend on either the second or third procedure code being blank. As a consequence, these tests have been augmented to test whether the second or third code is either blank or an anaesthetic code. Areas for change in the future A joint sector Costweights Project may continue to investigate casemix methodologies for the 2002/2003 FY, it is also possible that some minor changes will be required to the 01/02 WIES8A methodology, partly as additional variable and codes may be added to the NMDS. Exclusion rule Post Natal Early Intervention A new Health Speciality code to identify Post Natal Early Intervention cases has been approved by the National Data Policy Group (NDPG). The new health speciality code, P50, are excluded from casemix Purchase Unit allocation. Neonatal CPAP A field recording this variable has been introduced to the NMDS and HHSs are required to submit CPAP hours for neonates from 1 July 2001. For the 01/02 FY this field will not be used for calculations that make adjustments to the costweight for an event. It will, however, form the basis of a future study of CPAP utilisation and whether or not any supplementary payment is required for the use of CPAP for neonates. If yes, a decision will be made as to how this could best be applied, either by a modification to the WIES8A calculation or some other method. This work is in progress as part of the Maternity Casemix Review. Other possible exclusions Subject to changes on the NMDS, it may be possible to identify additional cases that require exclusion from casemix Purchase Unit allocation, e.g. CAPD & MUDS. WIES8A calculation The following section describes the derived variables required, the DRG reallocation tests applied (AR-DRG => WIES DRG), the Mechanical Ventilation calculation, the matching of events with appropriate costweights and the WIES8A case weight calculation. In what follows the phrases case weight and costweight may be used interchangeably. Derived variables required in calculation The following derived variables are used in the WIES8A calculation. Length of Stay The Length of Stay (LOS) calculation used in the methodology is specific for use within the WIES8A calculation. This is because it has a maximum and minimum applied to it, as well as having any Event Leave Days subtracted. A maximum of 365 days applies as the methodology is used for calculating the costweight associated with a particular year. A minimum of 1 day is applied to deal with the few cases where Event Leave Days are equal to the difference between the admission and discharge dates (Note: this does not affect the LOS comparison with low boundary points as the WIES DRG boundary points are integer and the tests for whether an event is same or one day use date tests rather than the LOS). Hence, the calculated LOS equals the difference in integer days between the discharge and admission dates, minus any Event Leave Days. Further, this is set to 365 if the LOS is greater 365 or is set to 1 if the LOS=0. Reallocated DRG As in previous years a number of adjustments are to be made to the original AR-DRG 4.1 grouping by utilising the WIES DRG field, prior to the calculation of WIES8A. Some of the AN-DRG3 adjustments applied in earlier versions of WIES, namely Cerebral Infarction, Neonates, Transvascular Percutaneous Cardiac Intervention (Stents) and Chemotherapy, are no longer required as the modification has been included within AR-DRG 4.1. WIES DRGs are still required for Peritoneal Dialysis (an exclusion in New Zealand), Radiotherapy (in Victoria) and Bone Marrow Transplants. Details of the DRG splits prior to the case weight calculation are given below. These events, however, should not have the original AR-DRG overwritten (Note: the MoH SAS code creates a new variable, DRG_NZ, to hold the WIES DRG appropriate for the case weight calculation). The WIES DRGs contain all the AR-DRGs as well as additional DRG codes (not used in AR-DRG) for the purpose of applying the appropriate costweights to NMDS events. DRG Reallocations The following are the tests for the allocation of AR-DRGs to WIES DRGs for the purposes of the WIES8A case weight calculation. Note that with the introduction of AR-DRG 4.1 and improvements in the coding system, Victoria now only uses two DRG splits. AR-DRG A04, Bone Marrow Transplants Bone Marrow Transplants have their AR-DRG 4.1 reallocated from A04Z to WIES DRG A04A if certain procedures were performed or to WIES DRG A04B if they were not. These are tested for by checking: IF AR-DRG is equal to A04Z AND Any recorded procedure codes fall in the range: ICD-10-AM 2nd Edition Bone Marrow, any procedure in the range (13706-00, 13706-06,13706-09,13706-10). THEN DRG is reallocated to WIES DRG A04A. ELSE IF AR-DRG is equal to A04Z AND No recorded procedure falls in the above range THEN DRG is reallocated to WIES DRG A04B. NB: 13706-00 and 13706-09 map to the ICD-10-AM 1st edition procedure code 13706-00 and 13706-06 and 13706-10 map to the ICD-10-AM 1st edition procedure code 13706-06. Adjustment for Peritoneal Dialysis In recognition of cost differences between peritoneal and haemodialysis, episodes with a principal diagnosis of peritoneal dialysis (ICD-10-AM code Z49.2) are to be assigned a WIES DRG of L61Y. Note, however, that both dialysis DRGs are casemix exclusions in New Zealand; see 3.2.10 below. Adjustment of medical AR-DRGs with radiotherapy Records with medical DRGs where radiotherapy (Z51.0) has been provided are mapped to AR-DRG R64Z (Radiotherapy). Medical DRGs are those where the number part of the DRG is greater than 60 (the format of a DRG is AnnA). 2.2.4 All other AR-DRGs All other AR-DRGs not reallocated in the above tests are given the same DRG number, i.e. the WIES DRG is set to the same value as the AR-DRG. Adjusted Mechanical Days The WIES8A calculation includes a component for Adjusted Mechanical Ventilation Days used to calculate the MV copayment. However, not all events are eligible for this component and a range of DRGs have their days set to zero. Also, as the variable recording hours of mechanical ventilation was only introduced onto the NMDS from 1 July 1999, prior to this time procedures codes are tested as a proxy for calculating this component. DRGs excluded from mechanical ventilation days The following range of AR-DRGs have their events Adjusted Mechanical Ventilation Days set to zero and are ineligible for a MV copayment. (A01Z, A02Z, A03Z, A04A, A04B, A05Z, A40Z, F02Z, F40Z, L61Y, P01Z, P02Z, P03Z, P04Z, P05Z, P60A, P60B, P61Z, P62Z, P63Z, P64Z, P65A, P65B, P65C, P65D, P66A, P66B, P66C, P66D, P67A, P67B, P67C, P67D, W01Z, 960Z, 961Z). Calculation of mechanical ventilation days from hours For other AR-DRGs than above, Adjusted Mechanical Ventilation Days is calculated in the following way: If hours of ventilation are less than 6 then Adjusted Mechanical Ventilation Days is set to zero. If hours of ventilation are 6 or more then Adjusted Mechanical Ventilation Days are calculated by adding 12 hours to the hours reported, dividing the result by 24 and rounding (i.e. gives integer days, effectively rounded up). Calculation of mechanical ventilation days without hours Prior to 1 July 1999 NMDS events did not have hours of mechanical ventilation reported (as this variable was only introduced from that date) and procedure tests are used to calculate Adjusted Mechanical Ventilation Days. These tests will still be required to calculate ventilation days for events prior to the 99/00 FY (but reported hours will be used, as above, for later events). For included AR-DRGs (see 2.3.1), if any reported procedure falls in the range ICD9 (9672, 9671 or 9670) then the Adjusted Mechanical Ventilation Days is calculated to be, respectively, (5, 2 or 1). The days are set to zero if none of the above procedures is found. The ICD10 code equivalents are (1388202) => 5 days, (1388201 or 1385700 or 1387900) => 2 days and (1388200) => 1 day. General Calculation For the WIES8A calculation, each NMDS event is initially matched by its allocated WIES DRG to the file containing the WIES DRG costweights and other associated variables. WIES DRGs are flagged as either Sameday, Oneday or other DRGs in this file by the SOflag (Same Day/One Day WIES DRG Flag) and each has some slightly different tests. The methodology is slightly different from what has been used in the last three years. While the development of the weight schedule has followed the same pattern as before, the calculation has now been presented in an easier format, using per diem rates for both high and low outliers, inlier weight, a one day weight, and a same day weight which is usually equal to half the one day weight. The base WIES score for sameday episodes (inlier and low outlier), one day episodes (inlier and low outliers), and multiday inliers can be read directly from the WIES8 weights table using the appropriate column and row (WIES DRG4). The base WIES score for multiday low outliers can be calculated by multiplying the per diem weight given in the WIES8 weights table by the patients length of stay. The base WIES score for high outliers is obtained by multiplying the number of high outlier days by the high outlier per diem weight (from the WIES8 weights table and adding the multiday inlier weight (from table)). Technical details are provided in the following sections. An events LOS is generally compared with the WIES DRGs low and high LOS boundary points to determine an intermediate variable (IES) and which particular costweight should be applied to it. In the following sections, shortened variable names from the WIES DRG weights file are used (see also Appendix 4.1). Note that in the following table VIC-DRG4 is synonymous with DRG_NZ and WIES DRG. Variable (Column Heading)LabelDescriptionVictorian DRGVIC-DRG4Victorian modification to AR-DRG4.1. Same day medical targetSdmtVIC-DRG4s marked with a Y are classed as same day medical target VIC-DRG4s. VIC-DRG4s marked with N are not classed as same day medical target VIC-DRG4s. WIES for same day patients allocated to same day medical target VIC-DRG4s are calculated normally but the total WIES associated with same day patients in these VIC-DRG4s cannot exceed specified levels (usually 6.5% of total WIES). Excess same day medical target WIES are not funded.Mechanical ventilation Mv_eligThis describes the way mechanical ventilation severity co-payments are made for the VIC-DRG4. Options are :- D: funded provided at least six hours of ventilation is provided. Patients attract a daily rate of 0.7729 WIES E: patients with a reported ICD-10-AM procedure code of 13382-02 are funded an additional 3.1323 WIES 4: funded for each day of mechanical ventilation after 4 days. Patients attract a daily rate of 0.7729 WIES. I: ineligible for mechanical ventilation co-paymentsOther co-payments (Only in Victoria, not in New Zealand)CopaySome groups of patients attract additional funds in recognition of their higher costs. Options are:- Thal: a co-payment of 0.2648 WIES is made to patients with a reported ICD-10-AM thalessaemia diagnosis code of D56.x or D57.2 (Note: These do not have to be principal diagnoses) Low inlier boundaryLbThe low length of stay boundary for inliers. Patients with a length of stay of less than the low boundary are classed as low outliers. For most VIC-DRG4s the low boundary has been set at a third of the estimated average length of stay for the VIC-DRG4. Boundaries are truncated to the whole number.High inlier boundaryHbThe high length of stay boundary for inliers. Patients with a length of stay greater than the high boundary are classed as high outliers. For most VIC-DRG4s the high boundary has been set at three times the estimated average length of stay for the VIC-DRG4. Boundaries are rounded to the nearest whole number. Inlier average length of stayi_alosThe average length of stay (days) for inliers.VIC-DRG4 designationSd_odFlag for designated sameday (S) or one day (O) VIC-DRG4s Same day weight SdThe same day weight is used to allocate WIES to episodes where patients are admitted and separated on the same day. Depending upon the VIC-DRG4, same day patients may be either low outliers or inliers:- Designated Same day VIC-DRG4s The same day weight is based on the costs of same day patients. Non-Same Day VIC-DRG4s with a low boundary of zero days The same day weight is set at the multiday inlier weight. Non-Same Day VIC-DRG4s with a low boundary of 1 day The same day weight is set at half the multiday inlier weight Non-Same Day VIC-DRG4s with a low boundary of 2 days or more (low outliers) The same day weight is set at half of the multiday inlier weight divided by the low boundary (0.5symbol 180 \f "Symbol" \s 9md_in symbol 184 \f "Symbol" \s 9 lb)One day weightOdThe one day weight is used to allocate WIES to episodes where patients have a length of stay of one but who were not separated on the same day as they were admitted. Depending upon the VIC-DRG4, one day patients may be either low outliers or inliers:- Designated Same day VIC-DRG4s The one day weight is based on the costs of all inliers excluding same day patients. If the patient is an inlier they attract the full multiday inlier weight. If the patient is a low outlier they attract the low outlier per diem weight. Designated One day VIC-DRG4s The one day weight is based on the costs of patients with a length of stay of one day. Non-Same/One Day VIC-DRG4s with a low boundary of 1 day or less The one day weight is set at the multiday inlier weight. Non-Same/One Day VIC-DRG4s with a low boundary of 2 day or more (low outliers) The one day weight is set at the low outlier per diem weight.Low outlier multiday per diem weight Lo_pdThe low outlier multiday per diem weight is used to allocate WIES to low outliers who have a length of stay of at least two days. Not all VIC-DRG4s have low outliers. No weight is reported in these cases. For most VIC-DRG4s the weight is derived as: md_in symbol 184 \f "Symbol" \s 9 lb The WIES value is calculated by multiplying the low outlier multiday per diem weight by the patients length of stay.Inlier multiday weightmd_inThe inlier multiday weight is used to allocate WIES to inliers who have a length of stay of at least two days. For designated VIC-DRG4s, same day/one day patients are excluded when deriving the inlier multiday weight. Calculating WIES8A To calculate the WIES weight allocated to a patient you need to:- Calculate the WIES co-payment for MV(see box 1) Calculate the base WIES allocation using the WIES DRG4 and the patients length of stay adjusted for mechanical ventilation per diem. This can be done using the appropriate weights from the WIES8A weights table. Add the base WIES payment and co-payment (see box 3). The steps are described in detail below with technical specifications provided in the boxes. Copayment for Mechanical Ventilation For 01/02 there is one co-payment, namely for mechanical ventilation. Technical specifications for mechanical ventilation co-payments are given in box 1. To be eligible for a mechanical ventilation co-payment the patient must have had at least six hours of continuous mechanical ventilation and have been allocated to a WIES DRG4 that is eligible for a mechanical ventilation co-payment. WIES DRG4s are classed as either: Eligible for daily co-payments of 0.7729 WIES (mv_elig =D in the WIES8A weights table); Eligible for an episode WIES co-payment 3.1323 when the ICD-10-AM procedure code 13882-02 is present (mv_elig = E in the WIES8A weights table); Eligible for daily co-payments at 0.7729 WIES for ventilated days in excess of four days (96 hours) mechanical ventilation (mv_elig = 4 in the WIES8A weights table); or Ineligible for co-payments (mv_elig = I in the WIES8A weights table). Box 1: Calculating Mechanical Ventilation Co-payments Select mv_elig case D then if (hours on mechanical ventilation is greater than or equal to 6 ) then Adjmvday = round((hours mechanical ventilation +12)/24) else adjmvday = 0 mv_copay = adjmvday symbol 180 \f "Symbol" \s 12 0.7729 go to box 2b case E then adjmvday = 0 If any procedure of 13882-02 mv_copay = 3.1323 else mv_copay = 0 go to box 2b case 4 then if (hours on mechanical ventilation > 96) then adjmvday = round((hours mechanical ventilation +12)/24) - 4 else adjmvday = 0 mv_copay = adjmvday symbol 180 \f "Symbol" \s 12 0.7729 go to box 2b otherwise do adjmvday = 0 mv_copay = 0 go to box 2b Base WIES payments for high outliers are reduced when a patient receives daily mechanical ventilation co-payments. To make this reduction you will need to remember the number of days receiving mechanical ventilation co-payments (adjmvday in the technical specifications). In 99/00 Victoria provided a hip revision copayment, however, this is no longer required as these are separately identified in AR-DRG 4.1 (I03A, I03B). Base WIES To calculate a patient's base WIES you need to determine: The patients WIES DRG4. The patients length of stay (LOS). The patients length of stay category (LOS_cat: S= same day, O= one day, M= multiday). The number of mechanical ventilation co-payment days (adjmvday see box 2a). The patients inlier status (I= inlier, L= low outlier, H= high outlier). The patients length of stay and length of stay category are derived from the admission date, separation date and leave days. A maximum length of stay of one years (365 days) is used. This ensures that WIES are not allocated to extreme stays that are likely to represent non-acute care. Technical specifications are given in Box 2a. Box 2a: Determining Length of Stay Category and Maximum Length of Stay Sameday='Y' if admission date = separation date Else sameday='N' If (sameday = Y) then LOS_cat = S go to step/box 2b else if (sameday = N) and (LOS less than or equal to 1) then LOS_cat = O go to step/box 2b else LOS = min(LOS,365) LOS_cat = M go to step/box 2b The patients inlier status is determined by comparing the patients length of stay with the inlier boundaries for the WIES DRG4 to which the patient is allocated. The low inlier and the high inlier boundaries are given in the WIES8A weights table. A patient is classified as an inlier when their length of stay is greater than or equal to the low inlier boundary and less than or equal to the sum of the high inlier boundary plus any mechanical ventilation co-payment days. Patients with a length of stay less than the low inlier boundary are classified as low outliers. Patients with a length of stay greater than the sum of the high inlier boundary and mechanical ventilation co-payment days are classified as high outliers. Technical specifications are given in box 2b. Box 2b: Calculate Inlier Status If LOS < LB then Inlier = L go to box 2c else if LOS > (HB + adjmvday) then Inlier = H go to box 2c else Inlier = I go to box 2c Separate columns occur in the WIES8A weights table for episodes which are same day one day multiday low outliers multiday inliers high outliers. The base WIES score for sameday episodes (inlier and low outlier), one day episodes (inlier and low outliers), and multiday inliers can be read directly from the WIES8A weights table using the appropriate column and row (WIES DRG4). The base WIES score for multiday low outliers can be calculated by multiplying the per diem weight given in the WIES8A weights table by the patients length of stay. The base WIES score for high outliers is obtained by multiplying the number of high outlier days by the high outlier per diem weight (from the WIES8A weights table and adding the multiday inlier weight (from table)). Technical details are provided in box 2c. Box 2c: Calculate Base WIES Select Inlier case L do select LOS_cat case S do base_WIES = sd IES = base_WIES symbol 184 \f "Symbol" \s 12 md_in go to box 3 case O do base_WIES = od IES = base_WIES symbol 184 \f "Symbol" \s 12 md_in go to box 3 case M do base_WIES = LOS symbol 180 \f "Symbol" \s 12 lo_pd IES = base_WIES symbol 184 \f "Symbol" \s 12 md_in go to box 3 case I do IES=1 select LOS_cat case S do base_WIES = sd go to box 3 case O do base_WIES = od go to box 3 case M do base_WIES = md_in go to box 3 case H do high_days = max(0, LOS - hb - adjmvday) base_WIES = Md_in + high_days symbol 180 \f "Symbol" \s 12 ho_pd IES = base_WIES symbol 184 \f "Symbol" \s 12 Md_in go to box 3 High outlier days are days stayed in excess of the high outlier boundary plus any mechanical co-payment ventilation days (adjmvdays - see boxes 1 and 2b). Inlier Equivalent Separations (IES) can be calculated by dividing the base WIES by the multiday inlier weight. Final WIES weight The WIES score is calculated by adding the base WIES and the co-payment WIES. Details are provided in box 3. Box 3: Calculating WIES Score WIES8A = base_WIES + mv_copay HFA Purchase Unit allocation The following section describes the derived variables required, the exclusion tests applied and the mappings used to allocate MoH/DHB casemix Purchase Units to NMDS events. Derived variables required in allocation The following derived variables are required for casemix exclusion testing. Patients Age The patients age is calculated in integer years as at the date of discharge. Length of Stay (Note: same as section 2.1.1) The Length of Stay (LOS) calculation used in the methodology is specific for use within the WIES8A calculation. This is because it has a maximum and minimum applied to it, as well as having any Event Leave Days subtracted. A maximum of 365 days applies as the methodology is used for calculating the costweight associated with a particular year. A minimum of 1 day is applied to deal with the few cases where Event Leave Days are equal to the difference between the admission and discharge dates. (Note: this does not affect the LOS comparison with low boundary points as the DRG boundary points are integer and the tests for whether an event is same or one day use date tests rather than the LOS). Hence, the calculated LOS equals the difference in integer days between the discharge and admission dates, minus any Event Leave Days. Further, this is set to 365 if the LOS is greater 365 or is set to 1 if the LOS=0. Exclusions from casemix purchasing The following section lists the tests that identify whether or not a particular event is purchased through the MoH casemix methodology. It should be noted that some of the tests are order sensitive, e.g. the Medical/Surgical test assumes that the Neonatal test has already been applied. Also, an event may be excluded for more than one reason (note - the MoH SAS methodology uses individual exclusion flag fields to generate an overall exclusion flag {Yes/No} for each event). Neonatal Inpatient Casemix Purchasing This test takes the form of an inclusion rule (as this is easier to specify than the converse exclusion rule). To be potentially included in neonatal casemix purchasing an event requires a Pregnancy & Childbirth Health Speciality code and to meet one of a variety of tests (originally agreed by the 98/99 joint HFA/HHS Maternity & Neonates project) which attempt to distinguish between well new-borns and those who required additional health services: The Health Service Speciality code is in the Pregnancy & Childbirth range (i.e. where the first character is P) AND (The Health Service Speciality code is in the range (P40, P41, P42, P43) OR (The AR-DRG is in the range (P02Z, P61Z, P62Z, P03Z, P63Z, P64Z, P04Z, P65A, P65B, P65C, P65D, P05Z, P66A, P66B, P66C, P06A, P06B, P67B, P67A, P67C)) OR (The AR-DRG is in the range (P60A, P01Z, P60B, P66D, P67D) AND (the third ICD diagnosis is NOT blank OR the first ICD procedure is NOT blank))) Non- Medical/Surgical Purchasing Events which have a DSS or Mental Health Service Speciality code, i.e. first character is D or Y, are excluded. In addition, Pregnancy & Childbirth events (where the first character is P) are excluded if they do not meet the criteria above in the Neonatal casemix inclusion rule. Non Base Funding Purchases Events which are not part of an HHSs base contract purchasing are excluded. HFA base contract events, now base DHB service agreements, should have a Purchaser code in the range (01, 02, 03, 04, 13). Events with any other Purchaser code should be excluded, e.g. privates, ACC direct and Insurers, Elective, i.e. the former Waiting Times Fund (WTF), events, other MoH/DHB specific non-base purchasing, etc. In addition, any Admission Types of ZW (indicating an ACC elective purchase) are excluded. Designated Hospital Purchasing A combination of a range of Agencies and Facilities have been identified as the providers through which the MoH/DHBs will monitor base casemix contracts. All other facilities (historically designated as rural) are excluded. Note with HHS sub-contracting the list of included Facilities may require updating periodically (this assumes that the Agency will reflect the organisation who have the original contract with the HFA). A list of included Agencies and Facilities is given below. Any combination of Agency & Facility which does not fall in the below lists are excluded from MoH/DHB casemix purchasing. Health Agency codeAgency Name1022Auckland Healthcare3091Capital Coast Health4121Canterbury Health4111Coast Health Care3082Good Health Wanganui3061Hawkes Bay Health4131Healthcare Otago4122Healthlink South4123South Canterbury Health3092Hutt Valley Health2031Health Waikato2042Lakeland3081Midcentral Health1011Northland Health3101Nelson-Marlborough Health2047Pacific Health2041East Bay Health (kept for historical analysis)2043Western Bay Health (kept for historical analysis)1023South Auckland Health4141Southern Health2071Taranaki Healthcare2051Tairawhiti Health3093Wairarapa Health1021Waitemata Health0223Heart Surgery South Island Facility codeFacility name4111Whangarei Area Hospital4112Kaitaia3211Auckland3212Greenlane3213National Womens3214Middlemore3215North Shore3216Waitakere3239Starship Hospital5011Thames3311Whakatane4911Tauranga3411Gisborne5311Waikato5312Rotorua5313Te Kuiti5320Queen Elizabeth5323Tokoroa4811Taumarunui5329Taupo General4711Taranaki Base4712Hawera3611Napier3612Hastings Memorial5711Wanganui4311Palmerston North5511Masterton5812Hutt5816Kenepuru5811Wellington3811Wairau3911Nelson4011Christchurch4013Burwood4014Christchurch Womens3111Ashburton5911Grey Base Hospital4411Timaru4211Dunedin4511Southland3250Manukau SuperClinic3220Pukekohe3221Papakura Obstetric3240Botany Downs Maternity Hospital4113Dargaville4114Bay of Islands8270Southern Cross, Hamilton8331Bowen8432Wakefield8595Ascot Hospital8233Mercy, Auckland8422Our Ladys Home of Compassion8366St Georges8377Southern Cross Trust, Christchurch8580Oxford Day Clinic3313Murupara3314Opotiki4212Wakari8507Manor Park Hospital8462Boulcott Clinic8471Southern Cross, Wellington5818Paraparaumu5819Puketiro5820Te Whare O Rangituhi5814Porirua8313Aorangi, (was Mercy) 8314Southern Cross, Palmerston North Non-Treated Patients Events where no treatment is provided are excluded. These include Boarders who may be admitted or in the case of Cancelled Operations. Boarders are tested for by checking the primary diagnosis code (only) for a set of codes: ICD10 Boarders, primary diagnosis in the range: Z763, Z764. Cancelled Operations are tested for by checking that: The primary operation/procedure code is blank AND That the event is non-acute (i.e. Admission Type not in AC,ZC) AND Length of Stay is less than 2 days AND The one (or more) of the first six diagnosis codes contain the following codes: ICD10 Canc Ops, one (or more) of diagnosis 1-6 in the range: Z530, Z531, Z532, Z538, Z539. Error DRGs Events coded to an Error AR-DRG are excluded. Error AR-DRGs are in the range (960Z, 961Z, 962Z, 963Z). Some Transplants Some organ Transplants are excluded as they are not purchased via casemix, e.g. liver, heart and lung transplants. Excluded Transplants are in the AR-DRG range (A01Z, A02Z, A03Z, A05Z). Simultaneous pancreas/kidney transplants will be coded so as to fall under A02Z, Multiple Organ Transplants, thus excluded from casemix purchasing. Some Spinal Injuries Some Spinal services are excluded as they are not purchased via casemix. Excluded Spinal services are in the Health Services Speciality code range (S50, S53). Surgical Termination of Pregnancy Surgical Termination of Pregnancy (ToP) events are excluded. These are tested for by checking: The AR-DRG is equal to O40Z AND That the primary procedure/procedure codes fall in the range: ICD10 Surg ToP, primary procedure in the range: (3564300, 3564301) AND primary diagnosis in the range (O040-O049 {O04*}). Renal and Peritoneal Dialysis The WIES DRGs for Renal Dialysis, L61Z, and Peritoneal Dialysis, L61Y, are excluded from casemix purchasing. Unless the associated events were previously coded to DRG3.1 572, this represents a new exclusion from casemix. Sameday Chemotherapy & Radiotherapy Some sameday cases for Chemotherapy and Radiotherapy are excluded from casemix purchasing. These events are tested for by checking: That the Admission date is the same as the Discharge date AND That either of the first two diagnosis codes fall in the range: ICD10 Chem/Radio, either of the first two diagnosis in the range: (Z510, Z511, Z512). Sleep Apnoea Some Sleep Apnoea events where they stay overnight for tests are excluded from casemix purchasing. These events are tested for by checking: That the integer difference in days between the Discharge and Admission dates is less than 2 AND That the AR-DRG equals E63Z. Lithotripsy Some sameday Lithotripsy events are excluded from casemix purchasing. These events are tested for by checking: That the Admission and Discharge dates are the same AND That the event is non-acute (i.e. Admission Type not in AC,ZC) AND That the primary procedure code falls in the following range: ICD10 Lithotripsy, first procedure in the range: (3654600). AND That the second procedure code falls in the following range: ICD10 Lithotripsy, second procedure in the range: (3654600,9250202,9250300, blank). AND That the third procedure code is in the range: (3654600,9250202,9250300, 9250202,9250300, blank). Colposcopies Some sameday Colposcopy events are excluded from casemix purchasing. These events are tested for by checking: That the Admission and Discharge dates are the same AND That the event is non-acute (i.e. Admission Type not in AC,ZC) AND The patients age is greater than 15 years old AND That the primary procedure code falls in the following range: ICD10 Colposcopy, first procedure in the range: (3560800, 3564600, 3564700, 3560801, 3553902, 3561100, 3553904, 3563705, 3553903, 3560802, 3561400). AND That the second procedure code falls in the following range: ICD10 Colposcopy, second procedure in the range: (3560800, 3564600, 3564700, 3560801, 3553902, 3561100, 3553904, 3563705, 3553903, 3560802, 3561400,9250202,9250300, blank). AND That the third procedure code is in (9250202,9250300,blank). Cystoscopies Some sameday Cystoscopies events are excluded from casemix purchasing. These events are tested for by checking: That the Admission and Discharge dates are the same AND That the event is non-acute (i.e. Admission Type not in AC,ZC) AND The patients age is greater than 15 years old AND That the primary procedure code falls in the following range: ICD10 Cystoscopies, first procedure in the range: (3681201, 3681200, 3683600, 3683904, 3684503, 3683902, 3684501, 3684500, 3683900, 3684505, 3684504, 3684502, 3731801, 3731500, 3681501, 3682700). AND That the second procedure code falls in the following range: ICD10 Cystoscopies, second procedure in the range: (3681201, 3681200, 3683600, 3683904, 3684503, 3683902, 3684501, 3684500, 3683900, 3684505, 3684504, 3684502, 3731801, 3731500, 3681501, 3682700, 9250202,9250300, blank). AND That the third procedure code is in (9250202,9250300,blank). ERCPs Some sameday ERCP (endoscopic retrograde cholangiopancreatography) events are excluded from casemix purchasing. These events are tested for by checking: That the Admission and Discharge dates are the same AND That the event is non-acute (i.e. Admission Type not in AC,ZC) AND The patients age is greater than 15 years old AND That the primary procedure code falls in the following range: ICD10 ERCP, first procedure in the range: (3048400, 3048401, 3048402, 3045200, 3048500, 3049100, 3045202, 3048501, 3049101, 3049400, 3045100, 3045201, 3044200). AND That the second procedure code falls in the following range: ICD10 second procedure in the range: (3048400, 3048401, 3048402, 3045200, 3048500, 3049100, 3045202, 3048501, 3049101, 3049400, 3045100, 3045201, 3044200, 3047801, 3047802, 3209000, 3208400, 3209001, 3208401, 3209300, 3208700, 9030800, 3209400, 3207500, 3207200, 3207201, 3207501, 9031200, 9031201, 3207800, 3208100, 3209900, 3210800, 9034100, 3210500, 4181600, 3047303, 3047810, 4182500, 4182200, 3047304, 3047600, 3047601, 3047806, 3047809, 3047811, 3047812, 3047602, 3047813, 3047900, 3047807, 3047603, 3047300, 3047301, 3047500, 3047501, 3047803, 3209500, 3047804, 9250202,9250300, blank). AND That the third procedure code is in (9250202,9250300,blank). Colonoscopies Some sameday Colonoscopies events are excluded from casemix purchasing. These events are tested for by checking: That the Admission and Discharge dates are the same AND That the event is non-acute (i.e. Admission Type not in AC,ZC) AND The patients age is greater than 15 years old AND That the primary procedure code falls in the following range: ICD10 Colonoscopies, first procedure in the range: (3209000, 3208400, 3209001, 3208401, 3209300, 3208700, 9030800, 3209400, 3207500, 3207200, 3207201, 3207501, 9031200, 9031201, 3207800, 3208100, 3209900, 3210800, 9034100, 3210500). AND That the second procedure code falls in the following range: ICD10 second procedure in the range: (3048400, 3048401, 3048402, 3045200, 3048500, 3049100, 3045202, 3048501, 3049101, 3049400, 3045100, 3045201, 3044200, 3047801, 3047802, 3209000, 3208400, 3209001, 3208401, 3209300, 3208700, 9030800, 3209400, 3207500, 3207200, 3207201, 3207501, 9031200, 9031201, 3207800, 3208100, 3209900, 3210800, 9034100, 3210500, 4181600, 3047303, 3047810, 4182500, 4182200, 3047304, 3047600, 3047601, 3047806, 3047809, 3047811, 3047812, 3047602, 3047813, 3047900, 3047807, 3047603, 3047300, 3047301, 3047500, 3047501, 3047803, 3209500, 3047804, 9250202,9250300, blank). AND That the third procedure code is in (9250202,9250300,blank). Gastroscopies Some sameday Gastroscopies events are excluded from casemix purchasing. These events are tested for by checking: That the Admission and Discharge dates are the same AND That the event is non-acute (i.e. Admission Type not in AC,ZC) AND The patients age is greater than 15 years old AND That the primary procedure code falls in the following range: ICD10 Gastroscopies, first procedure in the range: (4181600, 3047303, 3047810, 4182500, 4182200, 3047304, 3047600, 3047601, 3047806, 3047809, 3047811, 3047812, 3047602, 3047813, 3047900, 3047807, 3047603, 3047300, 3047301, 3047500, 3047501, 3047803, 3209500, 3047804, 3047801, 3047802). AND That the second procedure code falls in the following range: ICD10 second procedure in the range: (3048400, 3048401, 3048402, 3045200, 3048500, 3049100, 3045202, 3048501, 3049101, 3049400, 3045100, 3045201, 3044200, 3047801, 3047802, 3209000, 3208400, 3209001, 3208401, 3209300, 3208700, 9030800, 3209400, 3207500, 3207200, 3207201, 3207501, 9031200, 9031201, 3207800, 3208100, 3209900, 3210800, 9034100, 3210500, 4181600, 3047303, 3047810, 4182500, 4182200, 3047304, 3047600, 3047601, 3047806, 3047809, 3047811, 3047812, 3047602, 3047813, 3047900, 3047807, 3047603, 3047300, 3047301, 3047500, 3047501, 3047803, 3209500, 3047804, 9250202,9250300, blank). AND That the third procedure code is in (9250202,9250300,blank). Bronchoscopies Some sameday Bronchoscopies events are excluded from casemix purchasing. These events are tested for by checking: That the Admission and Discharge dates are the same AND That the event is non-acute (i.e. Admission Type not in AC,ZC) AND The patients age is greater than 15 years old AND That the primary procedure code falls in the following range: ICD10 Bronchoscopies, first procedure in the range: (4188901, 4189800, 4188900, 4189200, 4189801, 4176404, 4176403, 4184600, 4184900, 4185500, 4189500). AND That the second procedure code falls in the following range: ICD10 Bronchoscopies, second procedure in the range:. (4188901, 4189800, 4188900, 4189200, 4189801, 4176404, 4176403, 4184600, 4184900, 4185500, 4189500, 9250202, 9250300, blank). AND That the third procedure code is in (9250202,9250300,blank). Day Case Blood Transfusions Some sameday Blood Transfusion events are excluded from casemix purchasing. These events are tested for by checking: That the Admission and Discharge dates are the same AND That the event is non-acute (i.e. Admission Type not in AC,ZC) AND That the primary diagnosis OR the first three procedure codes fall in the range: ICD10 Blood, primary diagnosis in the range (Z513) OR {primary procedure in the range (9206000, 1370601, 1370602, 1370603) AND second procedure in the range (9206000, 1370601, 1370602, 1370603, blank) AND third procedure blank}. Mapping of Health Service Speciality codes to MoH casemix PUs MoH/DHB casemix Purchase Units are derived from a mapping of Health Service Speciality codes. This mapping only applies for included events, i.e. any events excluded from casemix purchasing should not be given a casemix PU code. (Note: the MoH SAS code gives excluded events a PU code of EXCLU rather than blank). The following health service speciality codes are initially remapped to other health service speciality codes: 'M01' , 'M02' , 'M03' = 'M00' 'M06' , 'M07' = 'M05' 'M11' , 'M12' , 'M13' = 'M10' 'M16' , 'M17' , 'M18' , 'M19' = 'M15' 'M21' , 'M22' , 'M23' = 'M20' 'M26' , 'M27' , 'M28' = 'M25' 'M31' , 'M32' , 'M33' = 'M30' 'M36' , 'M37' , 'M38' = 'M35' 'M41' , 'M42' , 'M43' = 'M40' 'M46' , 'M47' , 'M48' = 'M45' 'M51' , 'M52' , 'M53' = 'M50' 'M56' , 'M57' , 'M58' = 'M55' 'M61' , 'M62' , 'M63' = 'M60' 'M66' , 'M67' , 'M68' = 'M65' 'M71' , 'M72' , 'M73' = 'M70' 'M76' , 'M77' , 'M78' = 'M75' 'M81' , 'M82' , 'M83' = 'M80' 'M87' , 'M88' = 'M85' 'M91' , 'M92' , 'M93' = 'M90' 'S01' , 'S02' , 'S03' = 'S00' 'S06' , 'S07' , 'S08' = 'S05' 'S11' , 'S12' , 'S13' = 'S10' 'S16' , 'S17' , 'S18' = 'S15' 'S21' , 'S22' , 'S23' = 'S20' 'S26' , 'S27' , 'S28' = 'S25' 'S31' , 'S32' , 'S33' = 'S30' 'S36' , 'S37' , 'S38' = 'S35' 'S41' , 'S42' , 'S43' = 'S40' 'S46' , 'S47' , 'S48' = 'S45' 'S51' , 'S52' , 'S53' = 'S50' 'S55' , 'S56' , 'S57' = 'S59' 'S61' , 'S62' , 'S63' = 'S60' 'S66' , 'S67' , 'S68' = 'S65' 'S71' , 'S72' , 'S73' = 'S70' 'S76' , 'S77' , 'S78' = 'S75' And from there mapped to the following casemix purchased purchase units: 'S20' = 'D01.01' 'S50' = 'EXCLU' 'M00' , 'M05' , 'M08' , 'M85' , 'M86' , 'M89' = 'M00.01' 'M10' = 'M10.01' 'M14' = 'M10.05' 'M15' = 'M15.01' 'M20' = 'M20.01' 'M25' = 'M25.01' 'M30' = 'M30.01' 'M34' = 'M34.01' 'M40' , 'M75' = 'M40.01' 'M45' = 'M45.01' 'M49' = 'M49.01' 'M50' , 'M90' = 'M50.01' 'M54' , 'M94' = 'M54.01' 'M24' , 'M29' , 'M39' , 'M44' , 'M55' , 'M59' , 'M64' , 'M69' , 'M74' , 'M79' , 'M84' = 'M55.01' 'M60' = 'M60.01' 'M65' = 'M65.01' 'M35' , 'M70' = 'M70.01' 'M80' = 'M80.01' 'S00' , 'S05' , 'S10' = 'S00.01' 'S15' , 'S19' = 'S15.01' 'S25' = 'S25.01' 'S30' = 'S30.01' 'S35' = 'S35.01' 'S40' = 'S40.01' 'S45' = 'S45.01' 'S58' , 'S59' = 'S55.01' 'S24', 'S60' , 'S65' = 'S60.01' 'S70' = 'S70.01' 'S75' = 'S75.01' 'P40' , 'P41' , 'P42' , 'P43' = 'W06.03' other = 'EXCLU'; Each PU code is then described: 'D01.01'='Inpatient Dental treatment (DRGs)' 'M00.01'='General Internal Medical Services - Inpatient Services (DRGs)' 'M10.01'='Cardiology - Inpatient Services (DRGs)' 'M10.05'='Specialist Paediatric Cardiac - Inpatient Services (DRGs)' 'M15.01'='Dermatology - Inpatient Services (DRGs)' 'M20.01'='Endocrinology & Diabetic - Inpatient Services (DRGs)' 'M25.01'='Gastroenterology - Inpatient Services (DRGs)' 'M30.01'='Haematology - Inpatient Services (DRGs)' 'M34.01'='Specialist Paediatric Haematology - Inpatient Services (DRGs)' 'M40.01'='Infectious Diseases (incl Venereology) - Inpatient Services (DRGs)' 'M45.01'='Neurology - Inpatient Services (DRGs)' 'M49.01'='Specialist Paediatric Neurology Inpatient Services (DRGs)' 'M50.01'='Oncology - Inpatient Services (DRGs)' 'M54.01'='Specialist Paediatric Oncology - Inpatient Services (DRGs)' 'M55.01'='Paediatric Medical - Inpatient Services (DRGs)' 'M60.01'='Renal Medicine - Inpatient Services (DRGs)' 'M65.01'='Respiratory - Inpatient Services (DRGs)' 'M70.01'='Rheumatology (incl Immunology) - Inpatient Services (DRGs)' 'M80.01'='Palliative Care - Inpatient Services (DRGs)' 'S00.01'='General Surgery - Inpatient Services (DRGs)' 'S15.01'='Cardiothoracic - Inpatient Services (DRGs)' 'S25.01'='Ear, Nose and Throat - Inpatient Services (DRGs)' 'S30.01'='Gynaecology - Inpatient Services (DRGs)' 'S35.01'='Neurosurgery - Inpatient Services (DRGs)' 'S40.01'='Ophthalmology - Inpatient Services (DRGs)' 'S45.01'='Orthopaedics - Inpatient Services (DRGs)' 'S55.01'='Paediatric Surgical Services (DRGs)' 'S60.01'='Plastic & Burns - Inpatient Services (DRGs)' 'S70.01'='Urology - Inpatient Services (DRGs)' 'S75.01'='Vascular Surgery - Inpatient Services (DRGs)' 'W06.03'='Neonatal Inpatient (DRGs)' other ='Not a DRG casemix Purchase Unit' Appendices Spreadsheet containing 01/02 FY DRG weights and associated variables for calculating WIES8A Variables names translation 8 character to name: SOflag {Same Day/One Day DRG Flag} Sd {Same Day Costweight} Od {One Day Costweight} Md_in {Multi day inlier weight} Ho_pd {High Outlier per diem} Lb {Low Boundary Point for LOS} Hb {High Boundary Point for LOS} I_alos {Average Inlier LOS} NZ WIES 8 ScheduleVictorian DRG 4.1New Zealand Schedule CostweightsWeightsMech.Vent.Same DayInlier BoundaryAverageOutlier Per DiemsCodeDRG DescriptionCopaymentOne DayLowHighInlier LOSInlierHighLowSame DayOne DayDRG41mv_eliglbHBi_alosmd_inho_pdlo_pdsdodA01ZLiver TransplantI5 53 25.05000022.0722470.3376104.4144492.2072254.414449A02ZMultiple Organs TransplantI3 35 10.50000016.2043780.3376105.4014592.7007305.401459A03ZLung TransplantI6 62 23.20588217.3546530.3376102.8924421.4462212.892442A04AAllogenic Bone Marrow TransplantI23 53 35.07272718.9256060.3376100.8228520.4114260.822852A04BNon-allogenic Bone Marrow TransplantI13 29 20.7311838.6569780.2923080.6659210.3329610.665921A05ZHeart TransplantI4 44 17.63636411.0479440.3376102.7619861.3809932.761986A06ZTracheostomy Any Age, Any Condition415 35 22.92809412.5394700.3376100.8359650.4179820.835965A40ZECMO W/O Cardiac SurgeryI6 16 8.62500013.1386870.3376102.1897811.0948912.189781A41ZIntubation Age<16D2 19 7.6574074.2897380.3376102.1448691.0724342.144869B01ZVentricular Shunt Revis No Other OR ProcD1 14 4.0645161.8424080.3173040.0000000.9212041.842408B02ACraniotomy W Catastrophic CCD5 45 16.5777137.8346410.3308211.5669280.7834641.566928B02BCraniotomy W Severe or Moderate CCD2 27 9.0437644.5074330.3376102.2537171.1268582.253717B02CCraniotomy W/O CCD2 20 6.9902233.0570310.3061311.5285160.7642581.528516B03ASpinal Procedures W Catastroph/Severe CCD4 36 11.3513513.6710110.2263790.9177530.4588760.917753B03BSpinal Procs W/O Catastrophic/Severe CCD2 18 5.7172412.5663820.3142191.2831910.6415961.283191B04AExtracranial Vascular Procs W Cat/Sev CCD1 16 6.4884792.5667680.2769120.0000001.2833842.566768B04BExtracranial Vascular Proc no Cat/Sev CCD1 11 3.9684811.8930320.3339120.0000000.9465161.893032B05ZCarpal Tunnel ReleaseD0 3 1.0226240.4562850.3123330.0000000.4562850.456285B06APrs CPalsy,Musc Dys,Neuropathy W C/S CCD3 33 7.9444443.2186060.2835971.0728690.5364341.072869B06BPrs CPalsy,Musc Dys,Neuropathy No C/S CCD0 5 1.4411760.8122510.3376100.0000000.8122510.812251B07APeriph+Cranial Nerve & Nerv Sys Procs+CCD1 16 3.2417581.5718750.3376100.0000000.7859381.571875B07BPeriph,Cranial & Oth Nerve Procs No CCD0 4 1.4342110.8675070.3376100.0000000.8675070.867507B40ZPlasmapheresis W Neurological DiseaseDSame day3 28 9.4857141.6221240.1368060.5407080.2780950.540708B41ZProlonged Monitoring - Complex EpilepsyD3 7 4.7419351.2323830.2079120.4107940.2053970.410794B60ANon-Ac Para/Quadriplegia WWO ORPs+Cat CCD9 22 13.9347833.1583170.1813200.3509240.1754620.350924B60BN-Ac Para/Quadriplegia WWO ORP No Cat CCD3 9 5.0445861.5221990.2413990.5074000.2537000.507400B61ASpinal Cord Cond W/W/O ORPs W Cat/Sev CCD16 37 22.5000006.1513790.2187160.3844610.1922310.384461B61BSpinal Cord Cond W/W/O ORPs W/O C/Sev CCD4 10 5.9565222.0854270.2800870.5213570.2606780.521357B62ZAdmit for ApheresisD0 3 1.0015760.3297980.2634230.0000000.3297980.329798B63ZDementia+Oth Chr Disturb - Cerebral FuncD34 312 40.82978712.7998860.2507950.3764670.1882340.376467B64ZDeliriumD2 19 7.7984961.2676930.1300450.6338460.3169230.633846B65ZCerebral PalsyD1 10 1.3750000.4833500.2812220.0000000.2416750.483350B66ANervous System Neoplasm Age>64D2 24 8.0482761.7811570.1770470.8905780.4452890.890578B66BNervous System Neoplasm Age<65D1 13 3.0264321.0744010.2840050.0000000.5372001.074401NZ WIES 8 ScheduleVictorian DRG 4.1New Zealand Schedule CostweightsWeightsMech.Vent.Same DayInlier BoundaryAverageOutlier Per DiemsCodeDRG DescriptionCopaymentOne DayLowHighInlier LOSInlierHighLowSame DayOne DayDRG41mv_eliglbHBi_alosmd_inho_pdlo_pdsdodB67ADegen Nervous System Disord W Cat/Sev CCD11 99 19.8783783.6425980.1465950.3311450.1655730.331145B67BDegen Nervous Sys Disords W/O Cat/Sev CCD8 74 14.5531913.0376760.1669830.3797090.1898550.379709B68AMult Sclerosis & Cerebellar Ataxia W CCD2 18 6.6419751.5064040.1814400.7532020.3766010.753202B68BMult Sclerosis & Cerebellar Ataxia no CCD0 6 2.1002130.4186390.1594650.0000000.4186390.418639B69ATIA & Precerebral Occlusion W Catast CCD1 17 6.3235291.0678610.1350970.0000000.5339301.067861B69BTIA & Precerebral Occlusion W Severe CCD1 11 3.7314810.7553080.1619320.0000000.3776540.755308B69CTIA+Precerebral Occlusion W/O Cat/Sev CCD0 7 2.2347830.5262260.1883770.0000000.5262260.526226B70AStroke W Severe/Complicating Diag/ProcD3 30 13.2354462.2450580.1357000.7483530.3741760.748353B70BStroke W Other CCD2 19 8.1195451.5188010.1496440.7594010.3797000.759401B70CStroke W/O Other CCDSame day2 20 6.1100481.2994500.1701390.6497250.4600080.649725B70DStroke, Died or Transferred < 5 daysD0 5 1.6918600.6063310.2867050.0000000.6063310.606331B71ACranial & Peripheral Nerve Disorder W CCD1 16 4.7060931.1992170.2038580.0000000.5996081.199217B71BCranial & Peripheral Nerve Disords no CCDSame day1 11 3.5322581.1115550.2517500.0000000.5034661.111555B72ZNervous Sys Infect Exc Viral MeningitisD1 16 5.9916321.5526810.2073130.0000000.7763411.552681B73ZViral MeningitisD0 7 2.4142010.5613760.1860240.0000000.5613760.561376B74ZNontraumatic Stupor and ComaD0 8 1.7421880.4832850.2219210.0000000.4832850.483285B75ZFebrile ConvulsionsD0 4 1.3239800.3457100.2088920.0000000.3457100.345710B76ASeizure <3 or W Catastrophic/Severe CCD1 9 2.7327000.7217250.2112860.0000000.3608630.721725B76BSeizure Age>2 W/O Catastrophic/Severe CCDSame day0 7 2.1538460.5575350.2070850.0000000.1948900.557535B77ZHeadacheDSame day0 6 1.9089990.4613290.1933280.0000000.1923480.461329B78ZIntracranial InjuryD1 12 3.5238101.0262620.2329890.0000000.5131311.026262B79ZSkull FracturesD0 7 2.1693550.6557130.2418090.0000000.6557130.655713B80ZOther Head InjuryDSame day0 4 1.3251630.3651640.2204490.0000000.1750180.365164B81AOth Disord - Nervous Sys W Cat/Sev CCD2 19 7.1288661.4357920.1611240.7178960.3589480.717896B81BOth Disords - Nervous Sys W/O Cat/Sev CCD0 8 1.9052890.5210900.2187970.0000000.5210900.521090C01ZProcedures for Pentetrating Eye InjuryD0 7 2.8524591.1520520.2827160.0000001.1520521.152052C02ZEnucleations and Orbital ProceduresD0 6 2.0084030.8969620.3126230.0000000.8969620.896962C03ZRetinal ProceduresD0 5 1.5926560.8438470.3376100.0000000.8438470.843847C04ZMaj Corneal,Scleral & Conjunctival ProcsD0 4 1.2342340.7835840.3376100.0000000.7835840.783584C05ZDacryocrystorhinostomyD0 3 1.0871210.7642650.3376100.0000000.7642650.764265C06ZComplex Glaucoma ProceduresD0 5 1.3790320.6145650.3119550.0000000.6145650.614565C07ZOther Glaucoma ProceduresD0 3 1.1935480.6728030.3376100.0000000.6728030.672803C08ZMajor Lens ProceduresD0 3 1.0365760.5465940.3376100.0000000.5465940.546594C09ZOther Lens ProceduresD0 3 1.0851250.6528780.3376100.0000000.6528780.652878NZ WIES 8 ScheduleVictorian DRG 4.1New Zealand Schedule CostweightsWeightsMech.Vent.Same DayInlier BoundaryAverageOutlier Per DiemsCodeDRG DescriptionCopaymentOne DayLowHighInlier LOSInlierHighLowSame DayOne DayDRG41mv_eliglbHBi_alosmd_inho_pdlo_pdsdodC10ZStrabismus ProceduresDSame day0 3 1.0347220.6393710.3376100.0000000.4718590.639371C11ZEyelid ProceduresDSame day0 5 1.4247310.7653830.3376100.0000000.4421830.765383C12ZOth Corneal,Scleral & Conjunctival ProcsD0 3 1.0357140.3540000.2392550.0000000.3540000.354000C13ZLacrimal ProceduresD0 3 1.0359710.4123680.2786350.0000000.4123680.412368C14ZOther Eye ProceduresD0 3 1.0404490.3779740.2542960.0000000.3779740.377974C60AAcute and Major Eye Infections Age>54D1 14 4.6170210.7462310.1293010.0000000.3731150.746231C60BAcute and Major Eye Infections Age<55D0 9 3.5636360.7668110.1721410.0000000.7668110.766811C61ZNeurological & Vascular Disorders of EyeD0 7 2.3223140.5383850.1854650.0000000.5383850.538385C62ZHyphema & Medically Mand Trauma to EyeDSame day0 6 2.1976050.3465790.1261660.0000000.1907580.346579C63AOther Disorders of the Eye W CCD0 8 2.5840710.6648570.2058330.0000000.6648570.664857C63BOther Disorders of the Eye W/O CCDSame day0 7 2.4931510.5795270.1859580.0000000.2796890.579527D01ZCochlear ImplantD0 6 2.1228076.6112380.3376100.0000006.6112386.611238D02AHead and Neck Procedures W CCD3 27 10.6400003.9340500.2588191.3113500.6556751.311350D02BHead and Neck Procedures W/O CCD0 8 2.1792451.0617480.3376100.0000001.0617481.061748D03ZSurgical Repair - Cleft Lip/Palate DiagD1 10 2.3589741.4009480.3376100.0000000.7004741.400948D04AMaxillo Surgery W CCD1 11 3.0793651.5044020.3376100.0000000.7522011.504402D04BMaxillo Surgery W/O CCD0 7 1.7650491.0793560.3376100.0000001.0793561.079356D05ZSialoadenectomyD0 6 2.4402521.2590490.3376100.0000001.2590491.259049D06ZSinus,Mastoid & Complex Middle Ear ProcsD0 4 1.2481040.9181060.3376100.0000000.9181060.918106D07ZSalivary Gland Procs Exc SialoadenectomyD0 5 1.4000000.7431260.3376100.0000000.7431260.743126D08ZMouth ProceduresD0 4 1.2601630.5815010.3230150.0000000.5815010.581501D09ZMisc Ear, Nose, Mouth & Throat ProcsDSame day0 4 1.2077350.8432710.3376100.0000000.4074580.843271D10ZRhinoplasty (W or W/O Turbinectomy)D0 3 1.1866800.7853760.3376100.0000000.7853760.785376D11ZTonsillectomy or AdenoidectomyDSame day0 3 1.1449230.5232120.3198890.0000000.3134000.523212D12ZOther Ear,Nose,Mouth & Throat ProceduresD0 6 1.6825000.7173820.2984650.0000000.7173820.717382D13ZMyringotomy W Tube InsertionD0 3 1.0060330.2901730.2019030.0000000.2901730.290173D40ZDental Extractions and RestorationsD0 3 1.0388480.4268910.3287410.0000000.4268910.426891D60AEar,Nose,Mouth,Throat Malig W Cat/Sev CCD2 18 6.4153851.9267240.2402630.9633620.4816810.963362D60BEar,Nose,Mouth,Throat Malig No Cat/SevCCD0 8 2.2848300.8127140.2845600.0000000.8127140.812714D61ZDysequilibriumD0 7 1.7730670.3697150.1668140.0000000.3697150.369715D62ZEpistaxisD0 5 1.6852250.3543960.1682370.0000000.3543960.354396D63AOtitis Media and URI W CCD0 6 2.2521740.6050880.2149350.0000000.6050880.605088D63BOtitis Media and URI W/O CCDSame day0 5 1.9240280.4385510.1823470.0000000.1656880.438551D64ZLaryngotracheitis and EpiglottitisDSame day0 4 1.4003380.3873800.2213060.0000000.1917910.387380NZ WIES 8 ScheduleVictorian DRG 4.1New Zealand Schedule CostweightsWeightsMech.Vent.Same DayInlier BoundaryAverageOutlier Per DiemsCodeDRG DescriptionCopaymentOne DayLowHighInlier LOSInlierHighLowSame DayOne DayDRG41mv_eliglbHBi_alosmd_inho_pdlo_pdsdodD65ZNasal Trauma and DeformityDSame day0 4 1.1505380.3905060.2715290.0000000.2981510.390506D66AOther Ear,Nose,Mouth & Throat Diags W CCD0 7 2.2869200.6231260.2179790.0000000.6231260.623126D66BOther Ear,Nose,Mouth & Throat Diag no CCDSame day0 5 1.7354260.4492840.2071120.0000000.2899170.449284D67ZDental+Oral Dis Exc Extract/RestorationsDSame day0 6 1.9497210.6195860.2542260.0000000.2462060.619586E01AMajor Chest Procedures W Catastrophic CCD4 39 14.7659575.3437150.2533261.3359290.6679641.335929E01BMajor Chest Procs W/O Catastrophic CCD2 23 8.0693283.0857820.2676861.5428910.7714451.542891E02AOth Respiratory Sys OR Procs W Catast CCD2 25 10.7272732.8253300.1843651.4126650.7063331.412665E02BOth Respiratory Sys OR Procs W Severe CCDSame day1 18 5.7324561.7512620.2138500.0000000.3528001.751262E02COth Resp System OR Procs W/O Cat/Sev CCDSame day1 11 2.7164461.0903210.2809640.0000000.3590551.090321E40ZRespiratory Sys Diag+Ventilator SupportD2 23 8.6739134.5765290.3376102.2882641.1441322.288264E60ACystic Fibrosis W Catastrophic/Severe CCD3 32 12.8338113.3696000.2100451.1232000.5616001.123200E60BCystic Fibrosis W/O Catastroph/Severe CCD2 22 9.0000002.1747330.1933101.0873660.5436831.087366E61APulmonary Embolism W Catast/Severe CCD2 22 8.8391961.8234010.1650290.9117010.4558500.911701E61BPulmonary Embolism W/O Catast/Severe CCD1 15 5.6702131.1616540.1638960.0000000.5808271.161654E62AResp Infections/Inflammations W Cat CCD2 23 8.6215521.7288860.1604250.8644430.4322220.864443E62BResp Infect/Inflammations W Sev/Mod CCD1 15 5.0780171.0703770.1686290.0000000.5351891.070377E62CRespiratory Infect/Inflammations W/O CCD0 8 3.0326410.6287710.1658680.0000000.6287710.628771E63ZSleep ApnoeaDOne Day1 11 3.4333330.8980970.2092650.0000000.2278110.227811E64ZPulmonary Oedema and Respiratory FailureD1 14 4.4986071.2200580.2169660.0000000.6100291.220058E65AChr Obstruct Airway Disease W Cat/Sev CCDSame day2 19 7.0523141.2978950.1472310.6489480.1956880.648948E65BChr Obstruct Airway Dis No Cat/Sev CCDSame day1 14 4.3120810.8877020.1646910.0000000.1981450.887702E66AMajor Chest Trauma Age>69 W CCD2 20 7.2203391.7068970.1891210.8534490.4267240.853449E66BMaj Chest Trauma <70+CC or >69 W/O CCD1 13 4.3333331.1191580.2066140.0000000.5595791.119158E66CMajor Chest Trauma Age<70 W/O CCD0 6 1.9296880.4940180.2048080.0000000.4940180.494018E67ARespiratory Signs+Symptoms W Cat/Sev CCD1 9 2.1890550.5808510.2122750.0000000.2904260.580851E67BResp Signs & Symptoms<3 No Cat/Sev CCD0 5 1.4888890.3855080.2071390.0000000.3855080.385508E67CResp Signs+Symptoms>2 No Cat/Sev CCD0 5 1.2996580.3788690.2332120.0000000.3788690.378869E68ZPneumothoraxD1 12 3.8184080.8800910.1843890.0000000.4400450.880091E69ABronchitis and Asthma Age>49 W CCD1 13 4.3439150.9499170.1749420.0000000.4749590.949917E69BBronchitis & Asthma <50+CC or >49 W/O CCDSame day1 9 3.1760560.7977240.2009340.0000000.2017940.797724E69CBronchitis and Asthma Age<50 W/O CCDSame day0 5 1.8105600.4697380.2075550.0000000.1747700.469738E70AWhoop Cough+Ac Bronchiolitis+Cat/Sev CCD1 13 4.7913041.2367370.2064970.0000000.6183681.236737E70BWhoop Cough+Ac Bronch'tis No Cat/Sev CCD0 7 2.3898780.5812410.1945680.0000000.5812410.581241E71ARespiratory Neoplasms W CCD1 15 3.7356430.9683730.2073800.0000000.4841870.968373NZ WIES 8 ScheduleVictorian DRG 4.1New Zealand Schedule CostweightsWeightsMech.Vent.Same DayInlier BoundaryAverageOutlier Per DiemsCodeDRG DescriptionCopaymentOne DayLowHighInlier LOSInlierHighLowSame DayOne DayDRG41mv_eliglbHBi_alosmd_inho_pdlo_pdsdodE71BRespiratory Neoplasms W/O CCDSame day1 13 2.4950170.8511360.2729070.0000000.2475180.851136E72ZRespiratory Problem from Neonatal PeriodDOne Day4 38 14.2500002.9909770.1679140.7477440.2432410.243241E73APleural Effusion W Catastrophic CCD2 23 8.6363641.6655950.1542870.8327970.4163990.832797E73BPleural Effusion W Severe CCD1 14 3.6862750.9404820.2041050.0000000.4702410.940482E73CPleural Effusion W/O Catast/Severe CCD0 8 2.3129250.6081260.2103400.0000000.6081260.608126E74AInterstitial Lung Disease >64+Cat/Sev CCD2 20 8.6379311.7642220.1633930.8821110.4410560.882111E74BI-st Lung Dis<65+C/S CC or >64 No C/S CCD1 14 5.3214291.2744540.1915960.0000000.6372271.274454E74CInterstitial Lung Dis <65 W/O Cat/Sev CCD0 6 2.1086960.6351610.2409680.0000000.6351610.635161E75AOther Respiratory System Diag >64 W CCD1 14 4.3396230.9662220.1781210.0000000.4831110.966222E75BOth Resp System Diag <65+CC or >64 No CCD1 10 3.0576210.8164200.2136090.0000000.4082100.816420E75COther Respiratory System Diag <65 W/O CCD0 5 1.5961120.4139480.2074780.0000000.4139480.413948F01ZImplant or Replace of AICD, Total SystemD2 25 5.89473716.3195270.3376108.1597634.0798828.159763F02ZAICD Component Implantation/ReplacementI1 9 6.00000014.2371960.3376100.0000007.11859814.237196F03ZCardiac Valve Proc+Pump+Inv Card Inv PrD6 62 18.96825412.6530930.3376102.1088491.0544242.108849F04ACard Valve Pr+Pump No Inv Inv Pr+C/S CCD3 36 9.6375008.5893990.3376102.8631331.4315672.863133F04BCard Val Pr+Pump No Inv Inv Pr No C/S CCD2 26 7.1458336.5519200.3376103.2759601.6379803.275960F05ACoronary Bypass+Inv Card Inv Proc+Cat CCD5 53 15.48859910.2859990.3376102.0572001.0286002.057200F05BCoron Bypass+Inv Card Inv Proc No Cat CCD5 45 12.8928578.3235010.3376101.6647000.8323501.664700F06ACoron Bypass No Inv Card Inv Pr W C/S CCD3 32 8.9973517.1123850.3376102.3707951.1853972.370795F06BCor Bypass No Inv Card Inv Pr W/O C/S CCD2 26 7.2803746.1583730.3376103.0791871.5395933.079187F07ZOth Cardiothoracic/Vascular Procs W PumpD3 32 8.2664097.3575970.3376102.4525321.2262662.452532F08AMaj Recon Vasc Procs W/O Pump W Cat CCD4 42 15.3956046.3933780.2906911.5983450.7991721.598345F08BMaj Recon Vasc Procs W/O Pump W/O Cat CCD2 22 7.4980083.5495710.3313811.7747860.8873931.774786F09ZOther Cardiothoracic Procedures W/O PumpD2 21 7.4296884.6441870.3376102.3220941.1610472.322094F10ZPercutaneous Coronary Angioplasty W AMID1 16 4.8615022.9201740.3376100.0000001.4600872.920174F11AAmput-Circ Sys Exc Up Limb+Toe W Cat CCD6 61 22.5764715.3789980.1667800.8965000.4482500.896500F11BAmput-Circ Sys Exc Up Limb+Toe No Cat CCD5 47 16.6315793.7804000.1591120.7560800.3780400.756080F12ZCardiac Pacemaker ImplantationD1 10 2.8627454.0300350.3376100.0000002.0150174.030035F13ZUp Limb+Toe Amputation for Circ Sys DisD3 32 13.4672902.8658730.1489620.9552910.4776460.955291F14AVasc Procs Exc Maj Recon No Pump+Cat CCD2 23 7.6367522.9982620.2748271.4991310.7495651.499131F14BVasc Procs Exc Maj Recon No Pump+Sev CCD1 9 2.6909091.4559130.3376100.0000000.7279571.455913F14CVasc Prs Exc Maj Rec W/O Pump W/O C/S CCD0 5 1.6615041.1130650.3376100.0000001.1130651.113065F15ZPercut Coron Angioplasty W/O AMI W StentD0 9 1.8867922.2383490.3376100.0000002.2383492.238349F16ZPercut Coron Angioplasty No AMI No StentD1 9 1.8186271.9811270.3376100.0000000.9905631.981127NZ WIES 8 ScheduleVictorian DRG 4.1New Zealand Schedule CostweightsWeightsMech.Vent.Same DayInlier BoundaryAverageOutlier Per DiemsCodeDRG DescriptionCopaymentOne DayLowHighInlier LOSInlierHighLowSame DayOne DayDRG41mv_eliglbHBi_alosmd_inho_pdlo_pdsdodF17ZCardiac Pacemaker ReplacementD0 8 1.5721152.0760870.3376100.0000002.0760872.076087F18ZCardiac Pacemaker Rev Exc Device ReplaceD0 8 2.3555561.7744510.3376100.0000001.7744511.774451F19ZOth Trans-Vasc Percut Cardiac InterventD0 6 1.7232141.5253140.3376100.0000001.5253141.525314F20ZVein Ligation and StrippingD0 5 1.1972290.7640140.3376100.0000000.7640140.764014F21AOth Circ Sys ORP+Cat CC or >64 No Cat CCD3 35 13.3012053.4851830.1834141.1617280.5808641.161728F21BOth Circ System OR Procs <65 W/O Cat CCD1 18 3.3200001.5152750.3194860.0000000.7576371.515275F40ZCirculatory Sys Diag+Ventilator SupportI2 22 7.5161294.3876160.3376102.1938081.0969042.193808F41ACirc Dis W AMI W Inv Card Inv Pr+C/S CCD3 28 8.8212292.7965500.2536200.9321830.4660920.932183F41BCirc Dis W AMI W Inv Car Inv Pr NoC/S CCDSame day2 19 6.1377052.0441380.2664371.0220690.4690921.022069F42ACirc Dis No AMI+Inv Card Inv Pr+Cx Dx/PrD1 11 3.2769541.1986310.2926210.0000000.5993161.198631F42BCirc Dis No AMI W Card Inv No Comp Dx/PrDSame day1 9 1.8804731.0970720.3376100.0000000.5124701.097072F60ACirc Dis W AMI No Inv Card Inv Pr+C/S CCD2 21 7.2817261.9973180.2194330.9986590.4993300.998659F60BCirc Dis+AMI W/O Card Inv W/O Cat/Sev CCD1 14 4.5383511.4176820.2499030.0000000.7088411.417682F60CCirc Dis W AMI No Inv Card Inv Proc,DiedD1 10 2.4708330.8285700.2682720.0000000.4142850.828570F61ZInfective EndocarditisD5 51 24.3653854.5411640.1491020.9082330.4541160.908233F62AHeart Failure & Shock W Catastrophic CCDSame day2 26 8.9368421.7535560.1569730.8767780.2947380.876778F62BHeart Failure & Shock no Catastrophic CCDSame day1 16 4.9237221.0798910.1754590.0000000.2180371.079891F63AVenous Thrombosis W Catastroph/Severe CCD1 18 7.1446811.3016940.1457530.0000000.6508471.301694F63BVenous Thrombosis W/O Catast/Severe CCD1 9 4.5486440.6116240.1075700.0000000.3058120.611624F64ZSkin Ulcers for Circulatory DisordersD2 22 11.1034481.9362840.1395090.9681420.4840710.968142F65APeripheral Vascular Disords W Cat/Sev CCDSame day1 16 4.9338841.2400480.2010660.0000000.4089761.240048F65BPeriph Vascular Disorders W/O Cat/Sev CCDSame day0 7 2.2490040.7267660.2585200.0000000.4655610.726766F66ACoronary Atherosclerosis W CCD1 10 2.3030850.6260560.2174670.0000000.3130280.626056F66BCoronary Atherosclerosis W/O CCDSame day0 7 1.9703870.5716010.2320760.0000000.2557040.571601F67AHypertension W CCD1 11 3.4523810.7661410.1775330.0000000.3830710.766141F67BHypertension W/O CCD0 7 1.6263350.4152980.2042870.0000000.4152980.415298F68ZCongenital Heart DiseaseD0 4 1.1295340.4115660.2914950.0000000.4115660.411566F69AValvular Disorder W Catastroph/Severe CCD1 13 3.7368420.9696190.2075800.0000000.4848090.969619F69BValvular Disorders W/O Catast/Severe CCD0 6 1.2975000.3418350.2107660.0000000.3418350.341835F70AMaj Arrhythmia+Cardiac Arrest+Cat/Sev CCD1 15 4.2639591.3510670.2534860.0000000.6755341.351067F70BMaj Arrhythmia+Cardiac Arr No Cat/Sev CCD0 8 2.2056070.7253170.2630810.0000000.7253170.725317F71ANon-Maj Arrhythmia+Conduct Dis W C/S CCDSame day1 13 4.7622501.2216170.2052170.0000000.2025021.221617F71BNon-Maj Arrhythmia+Conduct Dis No C/S CCDSame day0 7 2.4048820.7161180.2382220.0000000.2376070.716118F72AUnstable Angina W Catastrophic/Severe CCD1 14 4.1579431.1170200.2149180.0000000.5585101.117020NZ WIES 8 ScheduleVictorian DRG 4.1New Zealand Schedule CostweightsWeightsMech.Vent.Same DayInlier BoundaryAverageOutlier Per DiemsCodeDRG DescriptionCopaymentOne DayLowHighInlier LOSInlierHighLowSame DayOne DayDRG41mv_eliglbHBi_alosmd_inho_pdlo_pdsdodF72BUnstable Angina W/O Catastroph/Severe CCD1 10 2.5968120.7594160.2339530.0000000.3797080.759416F73ASyncope & Collapse W Catast/Severe CCD1 11 3.2494670.6957010.1712780.0000000.3478510.695701F73BSyncope & Collapse W/O Catast/Severe CCDSame day0 7 2.2401370.5415070.1933840.0000000.1872630.541507F74ZChest PainDSame day0 6 1.7543480.5417450.2470410.0000000.2213730.541745F75AOther Circulatory Sys Diags W Catast CCD2 21 8.0087722.0158990.2013691.0079500.5039751.007950F75BOth Circulatory System Diags W Severe CCD1 13 4.0289391.1590230.2301400.0000000.5795111.159023F75COth Circulatory Sys Diags W/O Cat/Sev CCD0 9 1.9409500.7118110.2933870.0000000.7118110.711811G01ARectal Resection W Catastrophic CCD5 47 15.5976105.4860830.2462081.0972170.5486081.097217G01BRectal Resection W/O Catastrophic CCD3 33 10.4524713.6085350.2416631.2028450.6014231.202845G02AMaj Small & Large Bowel Proc W Catast CCD4 45 15.3825944.9961910.2273571.2490480.6245241.249048G02BMaj Small+Large Bowel Proc no Catast CCD3 29 9.3157142.9912740.2247700.9970910.4985460.997091G03AStomach,Oesophal,Duodenal Procs W MaligD4 41 15.9148945.8171120.2558601.4542780.7271391.454278G03BStom,Oesophal,Duodenal Pr No Mal +C/S CCD4 38 11.7486034.4107770.2628011.1026940.5513471.102694G03CStom,Oesoph,Duodenal Pr No Mal NoC/S CCD1 14 4.5900001.9219990.2931150.0000000.9609991.921999G04APeritoneal Adhesiolysis Age>49 W CCD3 36 11.4320003.2091270.1965001.0697090.5348541.069709G04BPeriton Adhesiolysis <50+CC or >49 no CCD2 22 7.7280002.1938780.1987211.0969390.5484701.096939G04CPeritoneal Adhesiolysis Age<50 W/O CCD1 13 3.3235291.1511350.2424510.0000000.5755671.151135G05AMinor Small & Large Bowel Procedures +CCD2 26 8.2405062.3400410.1987781.1700200.5850101.170020G05BMinor Small & Large Bowel Procs W/O CCD1 15 4.1588241.2966600.2182500.0000000.6483301.296660G06ZPyloromyotomy ProcedureD1 12 3.9019611.2786080.2293780.0000000.6393041.278608G07AAppendicectomy W Catastrophic/Severe CCD1 18 5.7851851.7123810.2071960.0000000.8561901.712381G07BAppendicectomy no Catastrophic/Severe CCD0 8 2.9557651.0449510.2474710.0000001.0449511.044951G08ZAbdominal,Umbilical & Oth Hernia Procs>0D0 7 2.1128470.8681420.2876210.0000000.8681420.868142G09ZInguinal & Femoral Hernia Procedures >0D0 4 1.3519740.7315340.3376100.0000000.7315340.731534G10ZHernia Procedures Age<1DSame day0 5 1.3441860.7083350.3376100.0000000.3982120.708335G11AAnal & Stomal Procs W Catast/Severe CCD1 10 3.0080970.9735420.2265480.0000000.4867710.973542G11BAnal & Stomal Procs W/O Catast/Severe CCDSame day0 6 1.9622290.7168920.2557420.0000000.4020040.716892G12AOth Dig Sys ORPs W C/S CC or W MaligD2 25 9.0059172.8245870.2195461.4122930.7061471.412293G12BOth Dig Sys ORP No C/S CC No MalignancyD0 9 2.2745100.8877470.2732120.0000000.8877470.887747G40ACplx Ther G'scopy-Maj Dig+C/S CC/Comp PrD2 24 7.2241382.0263360.2243961.0131680.5065841.013168G40BCx Th Gas'py-Mj Dig Dis No C/S CC/Cmp PrD1 12 3.3529411.1081900.2644100.0000000.5540951.108190G41ACmplx Ther Gastroscopy - Non-Maj Dig DisD1 15 4.3801651.3731990.2508030.0000000.6866001.373199G41BCplx Ther Gastroscopy Non-Maj Dig Dis,SDD0 3 1.0000000.3042140.2433710.0000000.3042140.304214G42AOth Gastroscopy - Maj Digestive DiseaseD1 14 4.3674101.1794330.2160430.0000000.5897161.179433NZ WIES 8 ScheduleVictorian DRG 4.1New Zealand Schedule CostweightsWeightsMech.Vent.Same DayInlier BoundaryAverageOutlier Per DiemsCodeDRG DescriptionCopaymentOne DayLowHighInlier LOSInlierHighLowSame DayOne DayDRG41mv_eliglbHBi_alosmd_inho_pdlo_pdsdodG42BOth Gastroscopy for Maj Dig Dis,SamedayD0 3 1.0000000.2747560.2198050.0000000.2747560.274756G43ZComplex Therapeutic ColonoscopyD0 7 1.3913040.4286440.2464700.0000000.4286440.428644G44AOth Colonoscopy W Cat/Sev CC or Comp PrD2 20 6.8129251.5732870.1847410.7866440.3933220.786644G44BOth Colonosc W/O Cat/Sev CC or Comp ProcD1 11 3.3282760.8564800.2058670.0000000.4282400.856480G44COther Colonoscopy, SamedayD0 3 1.0000000.2524720.2019780.0000000.2524720.252472G45AOth Gastroscopy - Non-Maj Digest DiseaseD1 10 2.9172480.8645090.2370750.0000000.4322540.864509G45BOth Gas'py - Non-Maj Dig Disease,SamedayD0 3 1.0000000.2185060.1748050.0000000.2185060.218506G60ADigestive Malignancy W Catast/Severe CCDSame day1 18 5.3140791.2029700.1810990.0000000.1581741.202970G60BDigestive Malignancy no Catast/Severe CCDSame day1 14 2.9658390.9115110.2458690.0000000.2379410.911511G61AGI Haemorrh <65+Catast/Severe CC or >64D1 9 2.4444440.6445770.2109530.0000000.3222890.644577G61BGI Haemorrhage <65 W/O Catast/Severe CCD0 5 1.4545450.3188120.1753470.0000000.3188120.318812G62ZComplicated Peptic UlcerD1 12 3.2647060.8770500.2149170.0000000.4385250.877050G63ZUncomplicated Peptic UlcerD0 6 1.2777780.2843100.1780030.0000000.2843100.284310G64ZInflammatory Bowel DiseaseD1 12 3.8269230.8038070.1680320.0000000.4019030.803807G65AGI Obstruction W CCD1 16 4.6148150.9469160.1641520.0000000.4734580.946916G65BGI Obstruction W/O CCD1 9 2.8592590.5970480.1670500.0000000.2985240.597048G66AAbdominal Pain/Mesenteric Adenitis W CCDSame day0 9 2.7075310.6490190.1917670.0000000.1837150.649019G66BAbdominal Pain/Mesenteric Adenitis no CCDSame day0 5 1.6682220.3907450.1873830.0000000.1690020.390745G67AOesophagitis,GE,Misc Dig Sys >9 W C/S CCDSame day1 13 4.2317070.9352890.1768150.0000000.2200790.935289G67BOesophagitis,GE,Misc Dig Sys >9 NoC/S CCDSame day0 7 2.2175860.5020240.1811060.0000000.1514940.502024G68AGastroenteritis Age<10 W CCD0 7 2.3291930.7455220.2560620.0000000.7455220.745522G68BGastroenteritis Age<10 W/O CCD0 4 1.6339780.4422170.2165110.0000000.4422170.442217G69ZOesophagitis & Misc Dig Sys Disords <10D0 5 1.6966970.4289650.2022590.0000000.4289650.428965G70AOther Digestive System Diagnoses W CCD1 11 3.0136190.7862150.2087100.0000000.3931070.786215G70BOther Digestive System Diagnoses W/O CCDSame day0 7 2.1723160.5141880.1893600.0000000.2201100.514188H01APancreas,Liver & Shunt Procs W Catast CCD6 61 20.0476196.8395960.2388171.1399330.5699661.139933H01BPancreas,Liver,Shunt Procs W Sev/Mod CCD3 28 11.0163933.8254590.2430761.2751530.6375761.275153H01CPancreas,Liver & Shunt Procedures W/O CCD2 22 7.9642863.1096480.2733141.5548240.7774121.554824H02AMajor Biliary Tract Procs W MalignancyD5 46 14.5312504.3880240.2113800.8776050.4388020.877605H02BMaj Biliary Tr Proc W/O Malig W C/Sev CCD4 39 13.1290323.8999440.2079330.9749860.4874930.974986H02CMaj Biliary Tr Procs No Malig No C/S CCD2 21 8.3333332.6609190.2235171.3304600.6652301.330460H03ACholecystectomy+Closed CDE W Cat/Sev CCD3 35 12.7049183.8286180.2109441.2762060.6381031.276206H03BCholecystectomy+Closed CDE no Cat/Sev CCD2 23 7.5873022.4964680.2303231.2482340.6241171.248234H04ACholecystectomy no Closed CDE+Cat/Sev CCD1 18 5.8614072.0884540.2494140.0000001.0442272.088454NZ WIES 8 ScheduleVictorian DRG 4.1New Zealand Schedule CostweightsWeightsMech.Vent.Same DayInlier BoundaryAverageOutlier Per DiemsCodeDRG DescriptionCopaymentOne DayLowHighInlier LOSInlierHighLowSame DayOne DayDRG41mv_eliglbHBi_alosmd_inho_pdlo_pdsdodH04BCholecyst'my No Closed CDE No Cat/Sev CCD0 7 2.2243351.1885970.3376100.0000001.1885971.188597H05AHepatobiliary Diagnost Procs+Cat/Sev CCD3 31 11.2941183.4380100.2130851.1460030.5730021.146003H05BHepatobiliary Diag Procs W/O Cat/Sev CCD1 11 2.6883120.8730220.2273230.0000000.4365110.873022H06ZOther Hepatobiliary & Pancreas OR ProcsD4 39 15.9130434.6870330.2061781.1717580.5858791.171758H40ZEndoscop Procs-Bleeding Oesophal VaricesD1 14 4.5084751.5550190.2759280.0000000.7775091.555019H41AERCP Compx Therapeutic Proc W Cat/Sev CCD2 23 8.8372092.2224310.2011891.1112160.5556081.111216H41BERCP Compx Therapeut Proc W/O Cat/Sev CCD1 11 3.4482761.0338210.2398460.0000000.5169101.033821H42AERCP Other Therapeutic Proc W Cat/Sev CCD2 24 7.9398151.9588320.1973680.9794160.4897080.979416H42BERCP Oth Therapeutic Proc W/O Cat/Sev CCD0 8 2.1487510.6140700.2286240.0000000.6140700.614070H60ACirrhosis & Alcoholic Hepatitis W Cat CCD3 28 10.7962962.7645840.2048540.9215280.4607640.921528H60BCirrhosis+Alcoholic Hepatitis+Cat/Sev CCD1 15 3.5000000.9982780.2281780.0000000.4991390.998278H60CCirrhosis+Alcoh Hepatitis W/O Cat/Sev CCD0 8 1.6563470.4957780.2394560.0000000.4957780.495778H61AMal Hepatobiliary Sys,Pancreas>69+C/S CCD2 23 7.7950821.5961290.1638090.7980640.3990320.798064H61BMal Hepat,Panc<70+C/S CC or >69 NoC/S CCD1 14 3.3682090.8753990.2079200.0000000.4377000.875399H61CMalig Hepato Sys,Pancreas <70 W/O C/S CCD1 10 2.1346150.7207210.2701080.0000000.3603600.720721H62ADis Pancreas Exc for Malig W Cat/Sev CCD2 23 7.5388601.7241970.1829660.8620980.4310490.862098H62BDisorder of Pancreas Exc Malig No C/S CCD1 12 4.0070420.8514690.1699940.0000000.4257340.851469H63ADis Liver Exc Mal,Cirrhos,Al Hep+C/S CCD2 19 7.2094021.8656000.2070190.9328000.4664000.932800H63BDis Liver Exc Mal,Cirr,Al Hep No C/S CCDSame day1 11 2.9798490.9496430.2549510.0000000.3139560.949643H64ADisorders of the Biliary Tract W CCD1 14 4.0692120.9539140.1875380.0000000.4769570.953914H64BDisorders of the Biliary Tract W/O CCDSame day0 8 2.6986900.6190470.1835100.0000000.1792550.619047I01ZBilateral/Mult Maj Jt Procs - Low ExtremD4 44 14.1111115.4250650.2691171.3562660.6781331.356266I02AM-vasc Tiss Tr/Skin Grt+C/S CC Exc HandD8 80 27.2783518.4561160.2169961.0570150.5285071.057015I02BSkin Graft W/O Cat/Sev CC,Excluding HandD3 30 12.1267613.7405120.2159161.2468370.6234191.246837I03AHip Revision W Catastrophic or Severe CCD4 44 16.3820226.0733970.2595151.5183490.7591751.518349I03BHip Replac W C/S CC or Hip Rev No C/S CCD3 30 11.6164874.1646510.2509581.3882170.6941091.388217I03CHip Replacement W/O Catastroph/Severe CCD2 22 8.8169234.0085690.3182512.0042851.0021422.004285I04AKnee Replacement & Reattach W Catast CCD4 40 14.3950624.6618740.2266971.1654680.5827341.165468I04BKnee Replace & Reattach W/O Catast CCD2 24 9.5082213.9427040.2902641.9713520.9856761.971352I05ZOth Maj Joint Repl & Limb Reattach ProcsD2 18 6.6056342.9723960.3149851.4861980.7430991.486198I06ZSpinal Fusion W DeformityD3 32 12.3846155.5093840.3114001.8364610.9182311.836461I07ZAmputationD5 53 16.5142864.5300410.1920170.9060080.4530040.906008I08AOth Hip & Femur Procs W Catast/Severe CCD3 34 11.4449153.3749060.2064181.1249690.5624841.124969I08BOth Hip & Femur Procs >54 W/O Cat/Sev CCD2 24 9.0316032.7351990.2119931.3675990.6838001.367599NZ WIES 8 ScheduleVictorian DRG 4.1New Zealand Schedule CostweightsWeightsMech.Vent.Same DayInlier BoundaryAverageOutlier Per DiemsCodeDRG DescriptionCopaymentOne DayLowHighInlier LOSInlierHighLowSame DayOne DayDRG41mv_eliglbHBi_alosmd_inho_pdlo_pdsdodI08COth Hip & Femur Procs <55 W/O Cat/Sev CCD1 17 5.1002642.1344270.2929450.0000001.0672142.134427I09ASpinal Fusion W Catastrophic/Severe CCD4 40 11.6266675.2586270.3166031.3146570.6573281.314657I09BSpinal Fusion W/O Catastrophic/Severe CCD2 23 7.4000003.7113240.3376101.8556620.9278311.855662I10AOth Back & Neck Procs W Catast/Severe CCD3 36 10.7908163.5453350.2299861.1817780.5908891.181778I10BOther Back & Neck Procs no Catast/Sev CCD2 19 6.0530552.2138910.2560231.1069450.5534731.106945I11ZLimb Lengthening ProceduresD3 30 6.3333332.2340110.2469170.7446700.3723350.744670I12AInfect/Inflam Bone,Joint+Misc Pr+Cat CCD6 56 24.0454554.8834890.1421660.8139150.4069570.813915I12BInfect/Inflam Bone,Joint+Misc Pr+Sev CCD2 27 9.7888892.3583200.1686431.1791600.5895801.179160I12CInfect/Inflam Bone,Jnt+Misc Pr No C/S CCD1 13 3.0607901.1659650.2666550.0000000.5829831.165965I13AHumerus,Tibia, etc Procs W Cat/Sev CCD3 31 9.9862392.9254800.2050660.9751600.4875800.975160I13BHumerus,Tibia etc Procs >59 No C/Sev CCD2 19 6.4198901.9644300.2141940.9822150.4911080.982215I13CHumerus,Tibia etc Procs <60 No C/Sev CCD1 11 3.4716391.5658850.3157350.0000000.7829421.565885I14ZStump RevisionD1 18 4.1875001.1095700.1854800.0000000.5547851.109570I15ZCranio-Facial SurgeryD1 12 4.4459461.9154450.3015810.0000000.9577221.915445I16ZOther Shoulder ProceduresD0 6 2.1236671.1556720.3376100.0000001.1556721.155672I17ZMaxillo-Facial SurgeryD1 9 2.3232321.2630840.3376100.0000000.6315421.263084I18ZKnee ProceduresDSame day1 10 2.1974471.0726970.3376100.0000000.5254991.072697I19ZOther Elbow or Forearm ProceduresD0 7 2.1714641.0698740.3376100.0000001.0698741.069874I20ZFoot ProceduresD0 8 2.2294120.9425480.2959450.0000000.9425480.942548I21ZLoc Excis & Remov Int Fix Dev Hip+FemurD0 5 2.5000000.8172740.2288370.0000000.8172740.817274I22ZMajor Wrist, Hand and Thumb ProceduresD0 5 1.4534880.7570210.3376100.0000000.7570210.757021I23ZLoc Exc+Removl Int Fix Dev Exc Hip,FemurDSame day0 6 1.5984000.8706800.3376100.0000000.4194270.870680I24ZArthroscopyD0 4 1.0736200.5785020.3376100.0000000.5785020.578502I25ZBone & Joint Diagnostic Proc incl BiopsyD1 14 3.3846151.0857440.2245510.0000000.5428721.085744I26ZOther Wrist and Hand ProceduresDSame day0 5 1.4608920.8418120.3376100.0000000.4939190.841812I27ZSoft Tissue ProceduresDSame day1 9 2.4692741.0153020.2878220.0000000.4426661.015302I28AOther Connective Tissue Procedures W CCD2 24 7.7661292.2054230.1987861.1027120.5513561.102712I28BOther Connective Tissue Procedures NO CCD0 7 1.7620040.7769780.3086740.0000000.7769780.776978I60ZFemoral Shaft,Open Fem Condyle FracturesD4 37 8.0714292.5996120.2576610.6499030.3249510.649903I61ZOther Femoral FracturesD2 20 8.8000001.6828770.1529890.8414380.4207190.841438I62AFracture- Pelvis+Femoral Neck+Catast CCD3 30 13.6326532.2212550.1303490.7404180.3702090.740418I62BFracture - Pelvis,Femoral Neck+Severe CCD2 21 9.3493981.4820360.1268130.7410180.3705090.741018I62CFractures-Pelvis+Fem Neck No Cat/Sev CCD1 13 3.5419350.7642530.1726180.0000000.3821260.764253I63ZSprain,Strain & Disloc- Hip,Pelvis,ThighD0 6 2.2500000.5575060.1982240.0000000.5575060.557506NZ WIES 8 ScheduleVictorian DRG 4.1New Zealand Schedule CostweightsWeightsMech.Vent.Same DayInlier BoundaryAverageOutlier Per DiemsCodeDRG DescriptionCopaymentOne DayLowHighInlier LOSInlierHighLowSame DayOne DayDRG41mv_eliglbHBi_alosmd_inho_pdlo_pdsdodI64AOsteomyelitis (< 65 W Cat/Sev CC) or >64D3 30 10.5316462.2126420.1680760.7375470.3687740.737547I64BOsteomyelitis <65 W/O Catast/Severe CCDSame day1 18 4.8644071.2065930.1984360.0000000.3652261.206593I65AConn Tiss Malig W Pathological Frac >64D2 19 7.1869161.8269380.2033630.9134690.4567340.913469I65BConn Tiss Malig W Pathological Frac <65D1 12 2.2772640.8897710.3125750.0000000.4448850.889771I66AOth Conn Tiss Dis <65+C/S CC or >64D1 16 5.2672411.3258920.2013790.0000000.6629461.325892I66BConnective Tissue Dis <65 W/O Cat/Sev CCD0 9 2.1501150.6748830.2511060.0000000.6748830.674883I67ASeptic Arthritis+Catastrophic/Severe CCD3 31 12.1428572.5053070.1650560.8351020.4175510.835102I67BSeptic Arthritis W/O Catast/Severe CCD1 12 4.7291670.8624480.1458940.0000000.4312240.862448I68AN-Sg Neck,Back No Pain Pr/Myel<75+CC/>74D1 15 4.0174500.7715980.1536490.0000000.3857990.771598I68BN-Surg Neck,Back No Pain Pr/Myel<75 NoCCD0 8 1.8269700.3966140.1736710.0000000.3966140.396614I68CNsurg Neck,Back W Pain Man Pr/MyelogramD0 5 1.1374210.3462200.2435130.0000000.3462200.346220I69ABone Dis & Spec Arthropath >74 W C/S CCD2 19 7.7058821.6798350.1506710.7256560.3628280.725656I69BBone Dis & Spec Arthropath >74 No C/S CCDSame day6 61 10.6212121.6798350.1337870.2960380.2464550.296038I69CBone Diseases & Spec Arthropathies <75DSame day1 12 4.0735290.9036480.1774670.0000000.2991290.903648I70ZNon-Specific ArthropathiesD1 10 2.4090910.5957350.1978290.0000000.2978680.595735I71AMusculotendinous Disorders Age>69 W CCD1 13 3.4701990.6560650.1512450.0000000.3280320.656065I71BMusculotendinous Dis <70+CC or >69 No CCD0 7 1.7694610.4620700.2089090.0000000.4620700.462070I71CMusculotendinous Disorders <70 W/O CCD0 5 1.2747440.3068020.1925420.0000000.3068020.306802I72ATendonitis,Myositis,etc<80+C/S CC or >79D1 13 4.4303800.8144170.1470600.0000000.4072090.814417I72BTendonitis,Myositis etc<80 No Cat/Sev CCD0 6 1.6957610.4303740.2030350.0000000.4303740.430374I73AA-care - Conn Tissue Dis >59 W C/Sev CCD2 24 9.0800001.4548280.1281790.7274140.3637070.727414I73BA-care CT Dis<60+C/S CC or >59 No C/S CCD1 10 2.8423910.7151160.2012720.0000000.3575580.715116I73CA'care of Conn Tissue Dis <60 W/O C/S CCD0 5 1.2244900.4427470.2892610.0000000.4427470.442747I74AInjury- Forearm,Wrist,Hand,Foot >74 W CCD1 14 2.5882350.7429510.2296390.0000000.3714760.742951I74BInj Forearm,Foot,etc <75+CC or >74 No CCD0 6 1.3345590.4262590.2555200.0000000.4262590.426259I74CInjury- Forearm,Wrist,Hand,Foot<75 no CCD0 3 1.0912660.4143490.3037560.0000000.4143490.414349I75AInjury-Shoulder,Arm,Leg,Ankle etc >64+CCD2 19 8.3232321.3735690.1320230.6867840.3433920.686784I75BInj Shldr,Arm,Leg,etc <65+CC or >64 NoCCDSame day1 12 3.5205050.7884420.1791660.0000000.1760480.788442I75CInj to Shoulder,Arm,Leg,etc<65 No CCDSame day0 5 1.7535610.5631530.2569190.0000000.1895900.563153I76AOth Connective Tissue Disorders >69 W CCD12 110 20.6666673.8769650.1500760.3230800.1615400.323080I76BOth Conn Tissue Dis <70+CC or >69 No CCD1 14 2.2350230.6110130.2187050.0000000.3055060.611013I76COth Connective Tissue Disorder <70 no CCDSame day0 6 1.7598250.6723500.3056440.0000000.2744560.672350J01ZM-vasc Tiss Tr Skin,Subc Tiss,Breast DisD2 24 11.8181824.4825200.2655032.2412601.1206302.241260J02ALLimb+Skin Gr/Flap Rpr W Ulc/Cell+Cat CCD8 78 34.8245615.5751060.1120640.6968880.3484440.696888NZ WIES 8 ScheduleVictorian DRG 4.1New Zealand Schedule CostweightsWeightsMech.Vent.Same DayInlier BoundaryAverageOutlier Per DiemsCodeDRG DescriptionCopaymentOne DayLowHighInlier LOSInlierHighLowSame DayOne DayDRG41mv_eliglbHBi_alosmd_inho_pdlo_pdsdodJ02BLLimb+Skin Gr/Flap Rpr+Ul/Cell No Cat CCD4 37 17.2500003.1409970.1274610.7852490.3926250.785249J03ALLimb+Skin Gr/Flap No Ulc/Cell W C/S CCD3 28 12.6909092.2900500.1263140.7633500.3816750.763350J03BLLimb+Skin Gr/Flap No Ulc/Cell No C/S CCD1 13 5.7666671.2152400.1475150.0000000.6076201.215240J04ALLimb No Skin Gr/Flap W Ul/Cell W C/S CCD3 35 14.7640453.0339490.1438471.0113160.5056581.011316J04BLLimb No Skin Gr/Flap W Ul/Cell NoC/S CCD2 20 7.1515151.7686450.1731170.8843230.4421610.884323J05ZLLimb W ORP Not Skin Gr/Flap No Ulc/CellD0 7 2.2000000.7125880.2267330.0000000.7125880.712588J06AMajor Procs- Malignant Breast ConditionsD1 12 4.6570301.3831470.2079010.0000000.6915741.383147J06BMaj Procs for Non-Malignant Breast CondD0 7 1.6495100.8150460.3376100.0000000.8150460.815046J07AMinor Procs- Malignant Breast ConditionsD0 5 1.4823940.6671420.3150310.0000000.6671420.667142J07BMin Procs for Non-Malignant Breast CondD0 3 1.0216000.4048200.2773820.0000000.4048200.404820J08AOth Skin Graft +/ Debride Procs W C/S CCDSame day2 20 7.0236221.8819230.1875590.9409620.6432940.940962J08BOth Skin Graft +/ Debride Proc No C/S CCDSame day1 9 2.3941021.0184830.2977890.0000000.5661181.018483J09ZPerianal and Pilonidal ProceduresD0 4 1.5097400.6055370.2807610.0000000.6055370.605537J10ZSkin,Subcut Tissue & Breast Plastic ORPsDSame day0 7 1.7830510.9280750.3376100.0000000.4960340.928075J11ZOther Skin, Subcut Tissue & Breast ProcsD0 3 1.0691030.4760120.3116710.0000000.4760120.476012J60ASkin Ulcers Age>64DSame day3 28 10.6331361.7596400.1323890.5865470.4318650.586547J60BSkin Ulcers Age<65DSame day2 22 7.6463411.4071830.1472270.7035910.5843400.703591J61ZSevere Skin DisordersD1 14 5.2230221.3933560.2134180.0000000.6966781.393356J62AMalignant Breast Disorders Age>69 W CCD3 27 8.0000001.7116700.1711670.5705570.2852780.570557J62BMalig Breast Dis <70+CC or >69 No CCD1 14 1.7409090.5478850.2517700.0000000.2739430.547885J62CMalignant Breast Disorders Age<70 W/O CCD0 8 1.0800000.3330080.2466720.0000000.3330080.333008J63ZNon-Malignant Breast DisordersD0 5 1.3654820.4320540.2531290.0000000.4320540.432054J64ACellulitis >59 W Catastrophic/Severe CCD2 20 7.8115501.2566760.1286990.6283380.3141690.628338J64BCellulitis >59 W/O Catast/Sev CC or <60D0 8 3.3725910.5721830.1357250.0000000.5721830.572183J65ASkin Trauma, Subcut Tissue & Breast >69D1 11 1.8059070.3766560.1668550.0000000.1883280.376656J65BSkin Trauma, Subcut Tissue & Breast <70DSame day0 5 1.5078130.4001450.2123050.0000000.2080430.400145J66AModerate Skin Disord W Catast/Severe CCD1 14 3.9411760.9738770.1976820.0000000.4869380.973877J66BModerate Skin Disord no Catast/Severe CCDSame day1 11 3.5693070.9253830.2074090.0000000.2500530.925383J67AMinor Skin Disorders W CCDSame day1 11 3.4114290.9903340.2322390.0000000.2729090.990334J67BMinor Skin Disorders W/O CCDSame day0 6 2.0126050.5942850.2362250.0000000.3061800.594285K01ZDiabetic FootD6 55 20.6065574.5944570.1560730.7657430.3828710.765743K02ZPituitary ProceduresD2 22 8.8358213.2375860.2564911.6187930.8093971.618793K03ZAdrenal ProceduresD2 27 7.6470593.6317460.3324441.8158730.9079361.815873K04ZMajor Procedures for ObesityD3 29 5.2978723.0971990.3376101.0324000.5162001.032400NZ WIES 8 ScheduleVictorian DRG 4.1New Zealand Schedule CostweightsWeightsMech.Vent.Same DayInlier BoundaryAverageOutlier Per DiemsCodeDRG DescriptionCopaymentOne DayLowHighInlier LOSInlierHighLowSame DayOne DayDRG41mv_eliglbHBi_alosmd_inho_pdlo_pdsdodK05ZParathyroid ProceduresD1 12 4.1470591.7198330.2902980.0000000.8599171.719833K06ZThyroid ProceduresD0 8 2.9871091.3887540.3254410.0000001.3887541.388754K07ZObesity ProceduresD2 22 5.3181821.4937290.1966100.7468640.3734320.746864K08ZThyroglossal ProceduresD0 4 1.1509430.6800720.3376100.0000000.6800720.680072K09ZOth Endocrine,Nutritional,Metabolic ORPsD1 15 3.0684931.2991210.2963620.0000000.6495601.299121K40ZEndoscopic/Inv Proc for Metab Dis W/O CCD0 6 1.4931510.4740190.2222240.0000000.4740190.474019K60ADiabetes W Catastrophic or Severe CCD1 18 6.2027031.3726490.1770390.0000000.6863241.372649K60BDiabetes W/O Catastrophic or Severe CCD1 10 3.0538150.6980810.1828750.0000000.3490410.698081K61ZSevere Nutritional DisturbanceD3 35 12.5952382.5024860.1589480.8341620.4170810.834162K62AMisc Metabolic Disorders W Catast CCD2 19 8.0901291.5701220.1552630.7850610.3925300.785061K62BMisc Metabolic Dis +Sev CC or >74-Sev CCD1 12 2.9887280.7712020.2064300.0000000.3856010.771202K62CMisc Metabolic Dis W/O Cat/Sev CC < 75D0 8 1.6305970.4222520.2071650.0000000.4222520.422252K63ZInborn Errors of MetabolismD0 8 1.8659790.7064770.3028870.0000000.7064770.706477K64AEndocrine Disorders W Catast/Severe CCD2 21 7.4851491.8445220.1971390.9222610.4611310.922261K64BEndocrine Disorders W/O Catast/Severe CCD0 7 1.9087050.5757140.2413000.0000000.5757140.575714L01AKidney Transplant W Catastroph/Severe CCD3 36 12.8750005.9094350.3212901.9698120.9849061.969812L01BKidney Transplant W/O Catast/Severe CCD2 23 8.0000004.3317800.3376102.1658901.0829452.165890L02ZOp'tive Insert Periton Catheter-DialysisD2 18 7.0612242.2530050.2233471.1265020.5632511.126502L03AKidney,Ureter,Maj Blad Procs- Neo+C/S CCD4 37 12.9685044.6598220.2515231.1649560.5824781.164956L03BKidney,Ureter,Maj Blad Prs Neo No C/S CCD2 24 8.3939392.9148650.2430811.4574330.7287161.457433L04AKidny,Uret,Maj Blad Prs Non-Neo W C/S CCD2 27 9.2311323.0678960.2326401.5339480.7669741.533948L04BKidn,Uret,Maj Blad Prs Non-Neo No C/S CCD1 12 4.5081971.6226570.2519540.0000000.8113281.622657L05ATransurethral Prostatectomy W Cat/Sev CCD2 20 7.4492751.8469710.1735580.9234850.4617430.923485L05BTransureth Prostatectomy W/O Cat/Sev CCD1 9 3.3361341.0234830.2147510.0000000.5117421.023483L06AMinor Bladder Procs W Catast/Severe CCD1 15 4.5500001.4205750.2185500.0000000.7102881.420575L06BMin Bladder Procs W/O Catast/Severe CCD0 7 2.0974360.7779280.2596260.0000000.7779280.777928L07ATransur Procs Exc Prostatectomy+C/Sev CCD1 11 3.0348840.9575270.2208550.0000000.4787640.957527L07BTransur Proc Exc Prostatectomy No C/S CCDSame day0 6 1.7932100.7838520.3059850.0000000.3776860.783852L08AUrethral Procedures W CCD0 8 2.7741940.8030990.2026430.0000000.8030990.803099L08BUrethral Procedures W/O CCD0 5 1.6540880.6022120.2548520.0000000.6022120.602212L09AOth Proc- Kidney+Urinary Tr Dis W Cat CCD3 28 10.9843753.4744260.2214141.1581420.5790711.158142L09BOth Proc- Kidney+Urinary Tr Dis W Sev CCD1 12 3.5641031.5682630.3080110.0000000.7841321.568263L09COth Procs- Kidney+Urin Tr Dis No C/S CCD0 8 2.2018351.1825660.3376100.0000001.1825661.182566L40ZUreteroscopyDSame day0 7 2.4444440.9585380.3137030.0000000.5886810.958538NZ WIES 8 ScheduleVictorian DRG 4.1New Zealand Schedule CostweightsWeightsMech.Vent.Same DayInlier BoundaryAverageOutlier Per DiemsCodeDRG DescriptionCopaymentOne DayLowHighInlier LOSInlierHighLowSame DayOne DayDRG41mv_eliglbHBi_alosmd_inho_pdlo_pdsdodL41ZCystourethroscopy W/O CCDSame day0 6 1.9630680.8080010.3292810.0000000.2561190.808001L42ZESW Lithotripsy for Urinary StonesD0 3 1.7500000.7581190.3376100.0000000.7581190.758119L60ARenal Failure W Catastrophic CCD2 27 10.0219782.1701450.1732311.0850730.5425361.085073L60BRenal Failure W Sev CC or >69 W/O Sev CCD1 16 5.1926781.2276420.1891340.0000000.6138211.227642L60CRenal Failure <70 W/O Catast/Severe CCD1 9 2.1192660.6964480.2629020.0000000.3482240.696448L61YAdmit for peritoneal DialysisI0 3 1.0055430.2696620.2145400.0000000.2696620.269662L61ZAdmit for Renal DialysisD0 3 1.0001360.1265100.1011940.0000000.1265100.126510L62AKidney+Urinary Tract Neoplasm+Cat/Sev CCD2 19 6.0263161.4210190.1886420.7105090.3552550.710509L62BKidney+Urinary Tr Neoplasm No Cat/Sev CCD0 8 1.6000000.5339000.2669500.0000000.5339000.533900L63AKidney+Urinary Tr Infects >69 W Cat CCD2 19 7.7081551.2616870.1309460.6308440.3154220.630844L63BKidney+Urinary Tr Infect >69 W/O Cat CCD1 12 3.0753010.6559910.1706480.0000000.3279950.655991L63CKidney & Urinary Tract Infections < 70D0 7 2.5252320.5622300.1781160.0000000.5622300.562230L64ZUrinary Stones and ObstructionDSame day0 6 1.7602910.4998570.2271700.0000000.1948920.499857L65AKidney+Urinary Tr Sign+Syms W Cat/Sev CCD1 11 3.1483050.6998300.1778300.0000000.3499150.699830L65BKidney+Urinary Tr Sign+Syms W/O Cat/S CCDSame day0 7 2.1290320.5322310.1999900.0000000.1882280.532231L66ZUrethral StrictureD0 4 1.2190480.3412160.2239230.0000000.3412160.341216L67AOth Kidney+Urinary Tract Diags W Cat CCD1 17 5.7672961.3810050.1915640.0000000.6905021.381005L67BOth Kidney+Urinary Tract Diags W Sev CCD1 10 2.6805560.7147160.2133040.0000000.3573580.714716L67COth Kidney+Urinary Tr Diag No Cat/Sev CCDSame day0 8 2.1760840.6860990.2522330.0000000.2233910.686099M01ZMajor Male Pelvic ProceduresD1 17 8.3750002.6567770.2220590.0000001.3283892.656777M02ATransurethral Prostatectomy W Cat/Sev CCD1 12 5.1638231.4324970.1941870.0000000.7162481.432497M02BTransureth Prostatectomy W/O Cat/Sev CCD0 8 2.9711231.0630000.2504440.0000001.0630001.063000M03APenis Procedures W CCD1 12 3.1000001.0815250.2442150.0000000.5407631.081525M03BPenis Procedures W/O CCD0 6 1.5161290.6412520.2960680.0000000.6412520.641252M04ATestes Procedures W CCD0 6 2.0537630.7675950.2616250.0000000.7675950.767595M04BTestes Procedures W/O CCDSame day0 4 1.2973620.6356660.3376100.0000000.3694950.635666M05ZCircumcisionD0 3 1.0135420.3425160.2365580.0000000.3425160.342516M06AOth Male Repro System OR Procs for MaligD1 10 2.9541282.3656010.3376100.0000001.1828002.365601M06BOth Male Repro System ORPs Exc for MaligD0 8 2.4102560.8307060.2412580.0000000.8307060.830706M40ZCystourethroscopy W/O CCD0 3 1.0352940.2882370.2227280.0000000.2882370.288237M60AMalignancy, Male Reprod Sys W Cat/Sev CCD1 16 4.3125000.9894910.1835580.0000000.4947450.989491M60BMalig Male Repro System W/O Cat/Sev CCDSame day2 21 4.4255321.3418690.2425690.6709350.2998740.670935M61ABen Prostatic Hypertrophy W Cat/Sev CCD1 11 3.4193550.7670090.1794510.0000000.3835040.767009M61BBen Prostatic Hypertrophy W/O Cat/Sev CCD0 4 1.2600900.3190200.2025380.0000000.3190200.319020NZ WIES 8 ScheduleVictorian DRG 4.1New Zealand Schedule CostweightsWeightsMech.Vent.Same DayInlier BoundaryAverageOutlier Per DiemsCodeDRG DescriptionCopaymentOne DayLowHighInlier LOSInlierHighLowSame DayOne DayDRG41mv_eliglbHBi_alosmd_inho_pdlo_pdsdodM62AInflammation of the Male Repro Sys W CCD1 9 3.5666670.7132300.1599770.0000000.3566150.713230M62BInflammation Male Repro Sys W/O CCD0 5 1.8169640.3705920.1631700.0000000.3705920.370592M63ZSterilisation, MaleD0 3 1.0000000.3681310.2945050.0000000.3681310.368131M64ZOther Male Reproductive System DiagnosesD0 3 1.0797870.2790200.2067220.0000000.2790200.279020N01ZPelvic Evisceration & Radical VulvectomyD3 29 9.1052633.0315330.2330601.0105110.5052551.010511N02AUterine,Adnexa Proc-Ovarian/Adn Malig+CCD3 28 9.8870973.6888800.2611701.2296270.6148131.229627N02BUterine,Adnexa Proc-Ovar/Adn Malig No CCD1 16 4.9130431.9721260.2809840.0000000.9860631.972126N03AUterine,Adnexa Pr- Non-Ovar/Adn Malig+CCD2 22 7.5555562.5966570.2405731.2983290.6491641.298329N03BUterine,Adnexa Pr-Non-Ovar/Adn Mal No CCD1 15 6.4576272.0996550.2276000.0000001.0498282.099655N04ZHysterectomy for Non-MalignancyD1 13 4.1826371.5179500.2540420.0000000.7589751.517950N05AOophs,Cx Fall Tube Prs- Non-Mal W C/S CCD2 20 6.0181822.2087350.2569071.1043670.5521841.104367N05BOophs,Cx Fall Tube Prs-Non-Mal No C/S CCDSame day1 11 3.2887541.3984550.2976560.0000000.7676451.398455N06ZFemale Repro System Reconstructive ProcsD1 11 3.6404961.2970060.2493900.0000000.6485031.297006N07ZOth Uterine & Adnexa Procs for Non-MaligDSame day0 8 1.9668971.0071620.3376100.0000000.5113411.007162N08ZEndoscopic Procs for Female Repro SystemDSame day0 6 1.5296050.7999540.3376100.0000000.4370570.799954N09ZConistation,Vagina,Cervix & Vulva ProcsD0 3 1.0506520.3467350.2310130.0000000.3467350.346735N10ZDiagnostic Curettage or HysteroscopyD0 3 1.0176090.3342920.2299550.0000000.3342920.334292N11AOth Fem Repro Sys ORP >64 or Malig or CCD2 24 6.4722222.0562810.2223961.0281410.5140701.028141N11BOth Fem Repro Sys ORP <65 No Malig No CCD0 6 1.3852140.6452920.3260900.0000000.6452920.645292N60AMalig - Female Repro System W Cat/Sev CCD1 15 3.2743361.2224930.2986850.0000000.6112471.222493N60BMalig Female Repro System W/O Cat/Sev CCD0 8 1.7792210.6723040.3022910.0000000.6723040.672304N61ZInfections, Female Reproductive SystemD0 6 2.1148650.4696310.1776490.0000000.4696310.469631N62AMenstrual+Oth Female Repro Sys Dis W CCD0 6 1.5032680.4072780.2167430.0000000.4072780.407278N62BMenstrual+Oth Fem Repro Sys Disord No CCDSame day0 5 1.5483870.4083790.2109960.0000000.1779190.408379O01ACaesarean Del W Mult Comp Diags 1+ SevD2 23 7.2991801.7666910.1694280.8833450.4416730.883345O01BCaesarean Delivery W Severe Complic DiagD1 16 5.8556811.2582920.1504190.0000000.6291461.258292O01CCaesarean Delivery W Moderate Comp DiagD1 13 5.2582421.1842130.1576480.0000000.5921071.184213O01DCaesarean Delivery W/O Complicating DiagD1 12 4.9023721.0295500.1470070.0000000.5147751.029550O02ZVaginal Delivery W Complicating OR ProcD1 10 2.7894740.7442710.1867700.0000000.3721350.744271O03ZEctopic PregnancyD0 7 1.8771080.9050200.3376100.0000000.9050200.905020O04ZPostpartum & Post Abortion W O.R. ProcDSame day0 6 1.7549020.7243240.2889200.0000000.3284220.724324O40ZAbortion W D&C,Asp Curettage/HysterotomyDSame day0 4 1.1898550.5161290.3036420.0000000.1969810.516129O60AVaginal Delivery W Mult Comp Diag,1+ SevD1 14 5.0288460.9123230.1451340.0000000.4561610.912323O60BVaginal Delivery W Severe Complic DiagD0 9 3.8492420.5036700.1046790.0000000.5036700.503670NZ WIES 8 ScheduleVictorian DRG 4.1New Zealand Schedule CostweightsWeightsMech.Vent.Same DayInlier BoundaryAverageOutlier Per DiemsCodeDRG DescriptionCopaymentOne DayLowHighInlier LOSInlierHighLowSame DayOne DayDRG41mv_eliglbHBi_alosmd_inho_pdlo_pdsdodO60CVaginal Delivery W Moderate Complic DiagD0 8 3.5764710.4957090.1108820.0000000.4957090.495709O60DVaginal Delivery no Complicating DiagD0 6 3.0359730.3244620.0875280.0000000.3244620.324462O61ZPostpartum & Post Abortion W/O O.R. ProcD0 8 2.4114500.4222020.1400660.0000000.4222020.422202O62ZThreatened AbortionDSame day0 4 1.4375000.2800070.1558300.0000000.1507130.280007O63ZAbortion no D&C,Asp Curette/HysterotomyDSame day0 4 1.2929290.5129740.3174030.0000000.2608390.512974O64ZFalse LabourD0 4 1.2025910.2087680.1388790.0000000.2087680.208768O65AOth Antenatal Admission W Sev Comp DiagDSame day0 8 2.8019560.4966640.1418050.0000000.1001150.496664O65BOth Antenatal W Moderate/No Comp DiagDSame day0 6 2.0143690.4219450.1675740.0000000.1358950.421945P01ZNeonate Died/Trans<5 Days W Sign OR ProcI0 6 2.0000001.9266860.3376100.0000001.9266861.926686P02ZCardiothoracic/Vascular Procs - NeonatesI12 27 16.57575813.8125930.3376101.1510490.5755251.151049P03ZNeonate, AdmWt 1000-1499G W Sign OR ProcI29 66 48.26315817.0552980.2473670.5881140.2940570.588114P04ZNeonate, AdmWt 1500-1999G W Sign OR ProcI19 45 29.0000009.2233320.2226320.4854390.2427190.485439P05ZNeonate, AdmWt 2000-2499G W Sign OR ProcI14 33 20.5000008.5484020.3376100.6106000.3053000.610600P06ANeonate>2499G W Sign ORP W Mult Maj ProbE6 59 20.93846210.7850020.3376101.7975000.8987501.797500P06BNeonate>2499 W Sign ORP No Mult Maj ProbE5 12 7.5744683.4699270.3206760.6939850.3469930.693985P60ANeonate Died/Tr<5 W/O Sign ORP,Born HereI0 4 1.4814810.3608050.2435430.0000000.3608050.360805P60BNeo Died/Tr<5 No Sign ORP, Not Born HereI0 5 2.1155380.9671200.3376100.0000000.9671200.967120P61ZNeonate, AdmWt < 750 GI38 87 68.27272732.5327860.3376100.8561260.4280630.856126P62ZNeonate, AdmWt 750-999 GI36 82 58.40000019.7608760.3376100.5489130.2744570.548913P63ZNeonate 1000-1249G W/O Sign OR ProcI26 60 40.0232568.5541840.2137300.3290070.1645040.329007P64ZNeonate 1250-1499G No Significant ORPI22 51 31.3000006.2081980.1983450.2821910.1410950.282191P65ANeo 1500-1999G No Sign ORP W Mlt Maj PrbI18 41 25.4117655.8910000.2318220.3272780.1636390.327278P65BNeo 1500-1999G No Sign ORP W Maj ProblemI16 37 26.0847465.3747510.2060500.3359220.1679610.335922P65CNeo 1500-1999G No Sign ORP W Oth ProblemI12 28 19.0549454.2269080.2218270.3522420.1761210.352242P65DNeo 1500-1999G No Sign ORP No ProblemI9 21 14.5333332.2081730.1519390.2453530.1226760.245353P66ANeo 2000-2499G No Sign ORP W Mlt Maj PrbI10 24 16.5000005.0139630.2431010.5013960.2506980.501396P66BNeo 2000-2499G W/O Sign ORP W Major ProbI9 21 13.1944443.0365560.2531530.3373950.1686980.337395P66CNeo 2000-2499G W/O Sign ORP W Other ProbI6 15 9.4448531.7450770.1847650.2908460.1454230.290846P66DNeo 2000-2499G W/O Sign ORP W/O ProblemI1 15 4.0831460.5817760.1424820.0000000.2908880.581776P67ANeonate>2499 No Sign ORP W Mult Maj ProbI2 22 7.9636362.6375590.3312001.3187790.6593901.318779P67BNeonate>2499G W/O Sign ORP W Maj ProbI1 16 5.6479691.5021330.3191520.0000000.7510661.502133P67CNeonate>2499G W/O Sign ORP W Oth ProbI1 13 4.6523020.7419830.1275900.0000000.3709910.741983P67DNeonate>2499G W/O Sign ORP W/O ProblemI0 7 2.9261040.2478080.0875280.0000000.2478080.247808Q01ZSplenectomyD1 17 6.9733332.4903640.2499890.0000001.2451822.490364NZ WIES 8 ScheduleVictorian DRG 4.1New Zealand Schedule CostweightsWeightsMech.Vent.Same DayInlier BoundaryAverageOutlier Per DiemsCodeDRG DescriptionCopaymentOne DayLowHighInlier LOSInlierHighLowSame DayOne DayDRG41mv_eliglbHBi_alosmd_inho_pdlo_pdsdodQ02AOth ORP- Blood & Forming Organs W C/S CCDSame day2 25 8.8333333.0374700.2407051.5187350.4724821.518735Q02BOth ORP- Blood+Forming Organs W/O C/S CCDSame day0 8 2.5565221.2374510.3376100.0000000.5794941.237451Q60AReticuloendothelial+Immun Dis+Cat/Sev CCDSame day1 18 6.0038102.3305280.3105400.0000000.3795752.330528Q60BReticuloendothelial+Imm Dis No C/S CCDSame day1 10 3.9417721.3009800.2640400.0000000.3813021.300980Q61ARed Blood Cell Disords W Catastrophic CCDSame day1 13 4.5202951.0449140.1849280.0000000.3347031.044914Q61BRed Blood Cell Disorders W Severe CCDSame day1 10 3.3466670.9117560.2179500.0000000.4903140.911756Q61CRed Blood Cell Disorder no Catast/Sev CCDSame day0 7 2.2624630.7004860.2476900.0000000.4736140.700486Q62ACoagulation Disorders Age>69DSame day1 15 4.0396041.1496930.2276840.0000000.5253991.149693Q62BCoagulation Disorders Age<70DSame day0 8 2.7474751.0310790.3002260.0000000.7334621.031079R01ALymphoma+Leukaemia+Major ORP+Cat/Sev CCD5 53 16.5862075.6645230.2390641.1329050.5664521.132905R01BLymphoma+Leukaemia+Maj ORP No Cat/Sev CCD2 19 5.1428572.2693350.3088821.1346670.5673341.134667R02AOth Neoplastic Dis W Maj ORPs W C/S CCD3 31 11.7462693.7355570.2226141.2451860.6225931.245186R02BOth Neoplastic Dis W Maj ORPs No C/S CCD1 15 4.8421051.7947760.2594620.0000000.8973881.794776R03ALymphoma+Leukaemia+Oth ORP+Cat/Sev CCDSame day5 46 17.4500006.0742040.2436641.2148410.3751941.214841R03BLymphoma+Leukaemia+Oth ORP No Cat/Sev CCDSame day1 11 3.2521011.4236570.3064360.0000000.4766491.423657R04AOth Neoplastic Dis W Oth ORPs W C/S CCDSame day2 21 7.4130432.1049370.1987651.0524690.3300611.052469R04BOth Neoplastic Dis W Oth ORPs No C/S CCDSame day1 11 3.0857141.3047940.2959950.0000000.4172791.304794R60AAcute Leukaemia W Catastrophic CCD12 29 22.3492066.9500210.2487790.5791680.2895840.579168R60BAcute Leukaemia W Severe CCDSame day2 23 7.3246752.9305430.3200731.4652710.3498621.465271R60CAcute Leukaemia no Catastroph/Severe CCDSame day1 12 3.5840001.8960980.3376100.0000000.4342671.896098R61ALymphoma & Non-Ac Leukaemia W Catast CCD3 31 10.5428573.0819200.2338581.0273070.5136531.027307R61BLymphoma & Non-Ac Leukaemia no Catast CCD1 12 3.3310911.3032020.3129790.0000000.6516011.303202R61CLymphoma & Non-Acute Leukaemia, SamedayDSame day0 3 1.0000000.3410030.2728030.0000000.3410030.341003R62AOther Neoplastic Disorders W CCD1 17 3.3079851.2267360.2966730.0000000.6133681.226736R62BOther Neoplastic Disorders W/O CCD1 11 1.5890050.5993510.3017490.0000000.2996760.599351R63ZChemotherapyD0 3 1.0006740.1960140.1567060.0000000.1960140.196014R64ZRadiotherapyDSame day2 24 8.7966282.6341160.2395571.3170580.2965141.317058S60ZHIV, SamedayD0 3 1.0000000.5369850.3376100.0000000.5369850.536985S61ZHIV-Related CNS DiseaseD8 20 11.8333332.8271460.1911310.3533930.1766970.353393S62ZHIV-Related MalignancyD1 16 6.3181821.8971070.2402090.0000000.9485541.897107S63AHIV-Related Infection W Catastrophic CCD4 44 18.9259264.7502420.2007931.1875610.5937801.187561S63BHIV-Related Infection no Catastrophic CCD1 16 6.5752211.8381440.2236450.0000000.9190721.838144S64AOther HIV W Catastrophic CCD2 23 11.6000002.7850710.1920741.3925360.6962681.392536S64BOther HIV W/O Catastrophic CCD1 12 4.5822781.4766510.2578020.0000000.7383261.476651NZ WIES 8 ScheduleVictorian DRG 4.1New Zealand Schedule CostweightsWeightsMech.Vent.Same DayInlier BoundaryAverageOutlier Per DiemsCodeDRG DescriptionCopaymentOne DayLowHighInlier LOSInlierHighLowSame DayOne DayDRG41mv_eliglbHBi_alosmd_inho_pdlo_pdsdodT01AORPs - Infect+Parasitic Disease W Cat CCD5 47 19.5483874.8442940.1734670.9688590.4844290.968859T01BORPs Infect & Parasitic Dis W Sev/Mod CCD2 23 8.6474822.0465290.1656631.0232640.5116321.023264T01CORP - Infect+Parasitic Diseases W/O CCD1 14 2.9148940.9734040.2337590.0000000.4867020.973404T60ASepticaemia W Catastrophic or Severe CCD2 21 7.7843372.0196200.2075571.0098100.5049051.009810T60BSepticaemia W/O Catastrophic/Severe CCD1 11 4.1200001.0066710.1954700.0000000.5033351.006671T61APost-Op,Trauma Inf+C/S CC or >54NoC/S CCD1 13 4.4953450.9021670.1605510.0000000.4510840.902167T61BPostop & Post-Traum Infect <55 No C/S CCD0 8 2.8588710.5739070.1605970.0000000.5739070.573907T62AFever of Unknown Origin W CCD1 12 3.7050000.9679890.2090120.0000000.4839940.967989T62BFever of Unknown Origin W/O CCD0 5 1.8058690.4378730.1939780.0000000.4378730.437873T63AViral Illness Age>59D1 9 2.2857140.5330070.1865530.0000000.2665040.533007T63BViral Illness Age<60DSame day0 5 1.9022770.5032600.2116450.0000000.1812660.503260T64AOth Infect & Parasitic Dis W Cat/Sev CCD2 18 6.8378381.5886590.1858670.7943300.3971650.794330T64BOth Infect+Parasitic Dis W/O Cat/Sev CCD0 6 2.0310880.5229320.2059710.0000000.5229320.522932U40ZMental Health Treatment, Sameday, W ECTD0 3 1.0000000.0906750.0875280.0000000.0906750.090675U60ZMental Health Treatment,Sameday,W/O ECTD0 3 1.0000000.1641470.1313180.0000000.1641470.164147U61ASchizophrenia Disorders+MH Legal StatusD11 101 13.0000003.6866060.2268680.3351460.1675730.335146U61BSchizophrenia Disord W/O MH Legal StatusD11 101 13.0000003.6866060.2268680.3351460.1675730.335146U62AParanoia & Ac Psych Dis W C/S CC or MHLSD6 54 14.0000003.2057090.1831830.5342850.2671420.534285U62BParanoia,Ac Psych Dis No C/S CC No MHLSD2 19 5.1250000.8425780.1315240.4212890.2106440.421289U63AMaj Aff Dis W C/S CC or >69 W/O C/S CCD16 149 21.0000004.6536160.1772810.2908510.1454250.290851U63BMaj Affective Disords <70 W/O Cat/Sev CCD2 25 4.8888891.1287560.1847060.5643780.2821890.564378U64ZOther Affective and Somatoform DisordersD2 25 7.8358211.3262820.1354070.6631410.3315700.663141U65ZAnxiety DisordersD0 8 2.4401910.5798790.1901090.0000000.5798790.579879U66ZEating & Obsessive-Compulsive DisordersD3 29 13.2682932.5789700.1554970.8596570.4298280.859657U67ZPersonality Disorders & Acute ReactionsD1 9 1.7520000.4039290.1844420.0000000.2019640.403929U68ZChildhood Mental DisordersD0 6 2.4935060.6085440.1952410.0000000.6085440.608544V60ZAlcohol Intoxication and WithdrawalD0 5 1.1768230.2247030.1527520.0000000.2247030.224703V61ADrug Intoxication and Withdrawal W CCD1 17 4.0400000.8316810.1646890.0000000.4158400.831681V61BDrug Intoxication and Withdrawal WO CCD0 8 1.4600000.2835980.1553960.0000000.2835980.283598V62AAlcohol Use Disorder and DependanceD1 13 4.4472570.7329930.1318550.0000000.3664970.732993V62BAlcohol Use Disorder & Depend'ce,SamedayD0 3 1.0000000.1581950.1265560.0000000.1581950.158195V63ZOpioid Use Disorder and DependenceD1 9 3.4000000.5358260.1260770.0000000.2679130.535826V64ZOther Drug Use Disorder and DependanceD0 5 1.5000000.2747150.1465150.0000000.2747150.274715W01ZVentil/Craniotomy Procs-Mult Sign TraumaI16 38 26.00000018.0805240.3376101.1300330.5650161.130033NZ WIES 8 ScheduleVictorian DRG 4.1New Zealand Schedule CostweightsWeightsMech.Vent.Same DayInlier BoundaryAverageOutlier Per DiemsCodeDRG DescriptionCopaymentOne DayLowHighInlier LOSInlierHighLowSame DayOne DayDRG41mv_eliglbHBi_alosmd_inho_pdlo_pdsdodW02ZHip,Femur,Limb Prs Mult Sign Trauma+ImpD5 52 15.3750006.6451450.3025431.3290290.6645151.329029W03ZAbdominal Procs for Mult Signif TraumaD4 41 10.5000004.4520360.2968021.1130090.5565051.113009W04ZOther OR Procs for Mult Signif TraumaD5 52 14.8222226.5823820.3108621.3164760.6582381.316476W60ZMult Trauma, Died/Transferred LOS<5 DaysD0 4 1.7659571.8419390.3376100.0000001.8419391.841939W61ZMultiple Trauma W/O Significant ProcsD2 22 8.5647062.5149910.2349171.2574960.6287481.257496X01ZMicrovasc Tiss Transf/ Skin Gr Inj LLimbD3 28 12.3723402.2494050.1272660.7498020.3749010.749802X02ZMicrovasc Tiss Tran/Skin Graft- Inj HandD0 7 1.7724720.8189290.3234180.0000000.8189290.818929X03ZMicrovasc Tiss Transf/Skin Graft-Oth InjD2 25 9.5394742.7571040.2023141.3785520.6892761.378552X04AOth Procs - Injuries - Low Limb >59/W CCD2 21 8.1666672.1886970.1876031.0943490.5471741.094349X04BOth Procs-Injuries to Low Limb <60 No CCD0 7 2.7439020.9905550.2527010.0000000.9905550.990555X05ZOther Procedures for Injuries to HandDSame day0 5 1.4949490.7531350.3376100.0000000.4039710.753135X06AOth Procs for Oth Injuries W Cat/Sev CCD2 20 6.7525772.2417860.2323931.1208930.5604461.120893X06BOth Procs for Oth Injuries no Cat/Sev CCD0 6 1.6119120.6877830.2986820.0000000.6877830.687783X60AInjuries Age>64 W CCD1 15 2.9212830.5977370.1636920.0000000.2988690.597737X60BInjuries Age>64 W/O CCDSame day1 10 2.4187500.4615170.1526470.0000000.1812410.461517X60CInjuries Age < 65DSame day0 5 1.4628190.4087000.2235140.0000000.1868230.408700X61ZAllergic ReactionsD0 4 1.2181210.3638270.2389430.0000000.3638270.363827X62APoison/Tox Eff-Drugs,Oth Subs >59 or +CCDSame day0 7 2.2312990.7903430.2833660.0000000.2159910.790343X62BPoison/Tox Eff-Drugs,Oth Subs <60 No CCDSame day0 4 1.3104760.4015010.2451020.0000000.1822180.401501X63ASequelae of Treatment W Catast/Severe CCD1 13 3.7200001.0091770.2170270.0000000.5045891.009177X63BSequelae of Treat W/O Catast/Severe CCDSame day0 7 2.3046450.5622030.1951550.0000000.2216150.562203X64AOth Injury,Poison,Toxic Eff Dx>59 or +CCDSame day1 11 2.9019611.1397630.3142050.0000000.2289191.139763X64BOth Injury,Poison,Tox Eff Diag <60 No CCDSame day0 4 1.2083330.4052540.2683060.0000000.3206430.405254Y01ZSevere Full Thickness BurnsD23 53 28.22222215.0987000.3376100.6564650.3282330.656465Y02AO Burn+Skin Gr>64 or C/S CC or Cmp Dx/PrD4 43 19.3958334.8008100.1732621.2002020.6001011.200202Y02BOth Burn+Skin Gr<65 NoC/S CC NoCmp Dx/PrD2 21 8.8666672.4663250.1947101.2331630.6165811.233163Y03ZOther O.R. Procedures for Other BurnsD1 17 4.3055561.2187010.2830530.0000000.6093501.218701Y60ZBurns,Tran Oth Ac Care Facility< 5 DaysD0 4 1.1641790.6218870.3376100.0000000.6218870.621887Y61ZSevere BurnsD1 10 3.0000000.7660300.2553430.0000000.3830150.766030Y62AOth Burns>64 or +C/S CC or +Comp Dx/ProcD1 15 5.6086961.0169250.1813120.0000000.5084631.016925Y62BOth Burns<65 No C/S CC No Comp Diag/ProcD0 7 1.8503650.3869210.2091050.0000000.3869210.386921Z01AORPs W Diags Oth Contacts W Cat/Sev CCD1 13 2.2857140.8905260.2727240.0000000.4452630.890526Z01BORPs W Diags Oth Contacts W/O Cat/Sev CCD0 4 1.1146790.4588040.3376100.0000000.4588040.458804Z40ZF-Up After Completed Treat W EndoscopyD0 3 1.0083260.2384040.1891480.0000000.2384040.238404NZ WIES 8 ScheduleVictorian DRG 4.1New Zealand Schedule CostweightsWeightsMech.Vent.Same DayInlier BoundaryAverageOutlier Per DiemsCodeDRG DescriptionCopaymentOne DayLowHighInlier LOSInlierHighLowSame DayOne DayDRG41mv_eliglbHBi_alosmd_inho_pdlo_pdsdodZ60ARehabilitation W Catastrophic/Severe CCD6 16 10.6666672.2572400.1692930.3762070.1881030.376207Z60BRehabilitation no Catastrophic/Severe CCD6 14 9.5000002.2482470.1893260.3747080.1873540.374708Z60CRehabilitation, SamedayD0 3 1.0000000.1233190.0986550.0000000.1233190.123319Z61ZSigns and SymptomsD0 7 1.8236070.4586100.2011880.0000000.4586100.458610Z62ZF-Up After Completed Treat W/O EndoscopyD0 3 1.0160640.3407390.2682810.0000000.3407390.340739Z63AOther Aftercare W Catastrophic/Severe CCD2 22 7.6636361.2822460.1673160.6411230.3205620.641123Z63BOth Aftercare W/O Catastrophic/Severe CCD1 10 1.9096210.4589570.2403390.0000000.2294790.458957Z64AOther Factors Influenc Health Status >79DSame day2 25 10.1219511.4588490.1153020.7294240.3389320.729424Z64BOther Factors Influenc Health Status <80DSame day1 9 2.6568910.6426040.1934900.0000000.3254590.642604Z65ZMult Oth & Unspec Congenital AnomaliesD0 6 1.1111110.3912480.2816980.0000000.3912480.391248901ZExtensive OR Proc Unrelated to PDiagD 2 21 7.2037042.6417780.2567071.3208890.6604441.320889902ZNon-Extensive OR Proc Unrelated to PDiagD 2 18 6.3894741.7838680.1954320.8919340.3289510.891934903ZProstatic OR Proc Unrelated to PDiagD 4 38 21.8076924.1311580.1326051.0327900.5163951.032790960ZUngroupableI 0 3 1.0000000.0000000.0000000.0000000.0000000.000000961ZUnacceptable Principal DiagnosisI 0 6 1.0000000.0000000.0000000.0000000.0000000.000000962ZUnacceptable Obstetric Diag CombinationD 0 8 3.0000000.0000000.0000000.0000000.0000000.000000963ZNeonatal Diagnosis Inconsistent W/WeightD 5 47 18.0000000.0000000.0000000.0000000.0000000.000000 SAS Code for Derivation of WIES8A %macro w8ICD10(indset, outdset); options nomlogic nomrecall nodetails nomerror nomprint nosymbolgen; Proc format; value $newpu 'S20' = 'D01.01' 'S50' = 'EXCLU' 'M00' , 'M05' , 'M08' , 'M85' , 'M86' , 'M89' = 'M00.01' 'M10' = 'M10.01' 'M14' = 'M10.05' 'M15' = 'M15.01' 'M20' = 'M20.01' 'M25' = 'M25.01' 'M30' = 'M30.01' 'M34' = 'M34.01' 'M40' , 'M75' = 'M40.01' 'M45' = 'M45.01' 'M49' = 'M49.01' 'M50' , 'M90' = 'M50.01' 'M54' , 'M94' = 'M54.01' 'M24' , 'M29' , 'M39' , 'M44' , 'M55' , 'M59' , 'M64' , 'M69' , 'M74' , 'M79' , 'M84' = 'M55.01' 'M60' = 'M60.01' 'M65' = 'M65.01' 'M35' , 'M70' = 'M70.01' 'M80' = 'M80.01' 'S00' , 'S05' , 'S10' = 'S00.01' 'S15' , 'S19' = 'S15.01' 'S25' = 'S25.01' 'S30' = 'S30.01' 'S35' = 'S35.01' 'S40' = 'S40.01' 'S45' = 'S45.01' 'S58' , 'S59' = 'S55.01' 'S24', 'S60' , 'S65' = 'S60.01' 'S70' = 'S70.01' 'S75' = 'S75.01' 'P40' , 'P41' , 'P42' , 'P43' = 'W06.03' other = 'EXCLU'; value $remap 'M01' , 'M02' , 'M03' = 'M00' 'M06' , 'M07' = 'M05' 'M11' , 'M12' , 'M13' = 'M10' 'M16' , 'M17' , 'M18' , 'M19' = 'M15' 'M21' , 'M22' , 'M23' = 'M20' 'M26' , 'M27' , 'M28' = 'M25' 'M31' , 'M32' , 'M33' = 'M30' 'M36' , 'M37' , 'M38' = 'M35' 'M41' , 'M42' , 'M43' = 'M40' 'M46' , 'M47' , 'M48' = 'M45' 'M51' , 'M52' , 'M53' = 'M50' 'M56' , 'M57' , 'M58' = 'M55' 'M61' , 'M62' , 'M63' = 'M60' 'M66' , 'M67' , 'M68' = 'M65' 'M71' , 'M72' , 'M73' = 'M70' 'M76' , 'M77' , 'M78' = 'M75' 'M81' , 'M82' , 'M83' = 'M80' 'M87' , 'M88' = 'M85' 'M91' , 'M92' , 'M93' = 'M90' 'S01' , 'S02' , 'S03' = 'S00' 'S06' , 'S07' , 'S08' = 'S05' 'S11' , 'S12' , 'S13' = 'S10' 'S16' , 'S17' , 'S18' = 'S15' 'S21' , 'S22' , 'S23' = 'S20' 'S26' , 'S27' , 'S28' = 'S25' 'S31' , 'S32' , 'S33' = 'S30' 'S36' , 'S37' , 'S38' = 'S35' 'S41' , 'S42' , 'S43' = 'S40' 'S46' , 'S47' , 'S48' = 'S45' 'S51' , 'S52' , 'S53' = 'S50' 'S55' , 'S56' , 'S57' = 'S59' 'S61' , 'S62' , 'S63' = 'S60' 'S66' , 'S67' , 'S68' = 'S65' 'S71' , 'S72' , 'S73' = 'S70' 'S76' , 'S77' , 'S78' = 'S75' other = '???' ; value $PU_name 'D01.01' = 'Inpatient Dental treatment (DRGs)' 'M00.01' = 'General Internal Medical Services - Inpatient Services (DRGs)' 'M10.01' = 'Cardiology - Inpatient Services (DRGs)' 'M10.05' = 'Specialist Paediatric Cardiac - Inpatient Services (DRGs)' 'M15.01' = 'Dermatology - Inpatient Services (DRGs)' 'M20.01' = 'Endocrinology & Diabetic - Inpatient Services (DRGs)' 'M25.01' = 'Gastroenterology - Inpatient Services (DRGs)' 'M30.01' = 'Haematology - Inpatient Services (DRGs)' 'M34.01' = 'Specialist Paediatric Haematology - Inpatient Services (DRGs)' 'M40.01' = 'Infectious Diseases (incl Venereology) - Inpatient Services (DRGs)' 'M45.01' = 'Neurology - Inpatient Services (DRGs)' 'M49.01' = 'Specialist Paediatric Neurology Inpatient Services (DRGs)' 'M50.01' = 'Oncology - Inpatient Services (DRGs)' 'M54.01' = 'Specialist Paediatric Oncology - Inpatient Services (DRGs)' 'M55.01' = 'Paediatric Medical - Inpatient Services (DRGs)' 'M60.01' = 'Renal Medicine - Inpatient Services (DRGs)' 'M65.01' = 'Respiratory - Inpatient Services (DRGs)' 'M70.01' = 'Rheumatology (incl Immunology) - Inpatient Services (DRGs)' 'M80.01' = 'Palliative Care - Inpatient Services (DRGs)' 'S00.01' = 'General Surgery - Inpatient Services (DRGs)' 'S15.01' = 'Cardiothoracic - Inpatient Services (DRGs)' 'S25.01' = 'Ear, Nose and Throat - Inpatient Services (DRGs)' 'S30.01' = 'Gynaecology - Inpatient Services (DRGs)' 'S35.01' = 'Neurosurgery - Inpatient Services (DRGs)' 'S40.01' = 'Ophthalmology - Inpatient Services (DRGs)' 'S45.01' = 'Orthopaedics - Inpatient Services (DRGs)' 'S55.01' = 'Paediatric Surgical Services (DRGs)' 'S60.01' = 'Plastic & Burns - Inpatient Services (DRGs)' 'S70.01' = 'Urology - Inpatient Services (DRGs)' 'S75.01' = 'Vascular Surgery - Inpatient Services (DRGs)' 'W06.03' = 'Neonatal Inpatient (DRGs)' other = 'Not a DRG casemix Purchase Unit'; value $cystos '3681201','3681200','3681501','3683600', '3683904','3684503','3683902','3684501', '3684500','3683900','3684505','3684504', '3684502','3731801','3731500','3682700' = 1 other = 0; value $notret 'Z530','Z531','Z532','Z538','Z539' = 1 other = 0; value $error '960Z', '961Z', '962Z', '963Z' = 'Y' other = 'N'; value $transp 'A01Z', 'A02Z', 'A03Z', 'A05Z' = 'Y' other = 'N'; value $COLPO '3560800','3564600','3564700','3560801', '3553902','3561100','3553904','3563705', '3553903','3560802','3561400' = 1 other = 0; value $ERCPa '3048400','3048401','3048402','3049400', '3045200','3048500','3049100','3045202','3045201','3044200', '3048501','3049101','3045100' = 1 other = 0; value $COLONsa '3209000','3208400','3209001','3208401', '3209300','3208700','9030800','3209400', '3207500','3207200','3207201','3207501', '9031200','9031201','3207800','3208100', '3209900','3210800','9034100','3210500' = 1 other = 0; value $GASTRa '4181600','3047303','3047810','4182500', '4182200','3047304','3047600','3047601', '3047806','3047809','3047811','3047812', '3047602','3047813','3047900','3047807', '3047603','3047300','3047301','3047500', '3047501','3047803','3209500','3047804', '3047802','3047801' = 1 other = 0; value $op2test '3048400','3048401','3048402','3049400', '3045200','3048500','3049100','3045202','3045201','3044200', '3048501','3049101','3045100', '3209000','3208400','3209001','3208401', '3209300','3208700','9030800','3209400', '3207500','3207200','3207201','3207501', '9031200','9031201','3207800','3208100', '3209900','3210800','9034100','3210500', '4181600','3047303','3047810','4182500', '4182200','3047304','3047600','3047601', '3047806','3047809','3047811','3047812', '3047602','3047813','3047900','3047807', '3047603','3047300','3047301','3047500', '3047501','3047803','3209500','3047804', '3047802','3047801','9250202','9250300',' '= 1 other = 0; value $BRON '4188901','4189800','4188900','4189200', '4189801','4176404','4176403','4184600', '4184900','4185500','4189500' = 1 other = 0; value $bone '1370600','1370606' = 1 other = 0; value $mechven '1385700','1387900','1388201' = 1 other = 0; /* Formats desage and desfac were put in in order to identify the combination of a range of Agencies and Facilities that have been identified as the providers through which the MoH and DHBs will monitor its base casemix service agreements. All other facilities (historically designated as "rural") are excluded. */ value $desage '1022','3091','4121','4111','2041', '3082','3061','4131','4122','4123', '3092','2031','2042','3081','1011', '3101','2047','1023','4141','2071', '2051','2043','3093','1021','0223' = 1 other = 0; value $desfac '4111','4112','3211','3212','3213', '3214','3215','3216','3239','5011', '3311','4911','3411','5311','5312', '5313','5320','5323','4811','5329', '4711','4712','3611','3612','5711', '4311','5511','5812','5816','5811', '3811','3911','4011','4013','4014', '3111','5911','4411','4211','4511', '3250','3220','3221','3240','4113', '4114','8270','8331','8432','8595', '8233','8422','8366','8377','8580', '3313','3314','4212','8507','8462', '8471','5818','5819','5820','5814', '8313','8314' = 1 other = 0; run; options missing = 0; data test(index = (drg_nz)); length NONMEDSG deshosp BOARDER CANC_OP ERR_DRG XPLANT SPINAL TERMPREG RENAL CHEM_RAD SLEEP LITHO COLPO CYSTO ERCP COLON GASTRO BRONCHO TRANSFUS base $1; set &indset; array px {15} op01-op15; /* load up oper1-15 */ array dx {15} diag01-diag15; /* load up diag1-15 */ drg_nz = drg_41; *-- Require change in DRG for medical DRGs with code V580 --; radio='N'; drgnumb=input(substr(drg_nz,2),2.); do i = 1 to 15; tempx = dx{i} || ' '; if substr(tempx,1,4) = 'Z510' then radio='Y'; end; if (radio = 'Y') and (drgnumb ge 60) then drg_nz = 'R64Z'; if substr(diag01,1,4) = 'Z492' then drg_nz='L61Y'; age = intck('year', dob, evendate); LOS = max(1,min(sum(evendate, -evstdate, -(evntlvd/1)), 365)) ; *REMAP THE HEALTH SPECIALITY CODES; if not(put(hlthspec, $remap.) = '???') then hlthspec = put(hlthspec, $remap.); *BELOW IS INCLUSION RULE FOR NEONATAL INPATIENT (CASEMIX) SERVICES; if substr(hlthspec,1,1)='P' and ((hlthspec in ('P40','P41','P42','P43')) or (drg_nz in ('P02Z', 'P61Z', 'P62Z', 'P03Z', 'P63Z', 'P64Z', 'P04Z', 'P65A', 'P65B', 'P65C', 'P65D', 'P05Z', 'P66A', 'P66B', 'P66C', 'P06A', 'P06B', 'P67B', 'P67A', 'P67C')) or (drg_nz in ('P60A', 'P01Z', 'P60B', 'P66D', 'P67D') and (diag03 ne ' ' or op01 ne ' ') )) then NEONATE='Y'; else NEONATE='N'; if hlthspec = 'P50' then NEONATE = 'N'; * specifically exclude this code; *BELOW IS EXCLUSION RULE FOR NON MEDICAL/SURGICAL SERVICES; if ((substr(hlthspec,1,1) in ('D','Y')) or (substr(hlthspec,1,1)='P' and (neonate ='N'))) then NONMEDSG='Y'; else NONMEDSG='N'; *DEFINE BASE CONTRACT PAYMENTS; If compress(purchasr) in ('01','02','03','04','13') then base = 'Y'; else base = 'N'; if compress(adm_typ) = 'ZW' then base = 'N'; *BELOW IS EXCLUSION RULE FOR DESIGNATED HOSPITAL PURCHASING; If (put(agency, $desage.)*put(facility, $desfac.)) then Deshosp = 'Y'; else deshosp='N'; *BELOW ARE EXCLUSION RULES FOR NON-TREATED PATIENTS; if diag01 in ('Z763','Z764') then BOARDER='Y'; else BOARDER='N'; if (put(diag01, $notret.) + put(diag02, $notret.) + put(diag03, $notret.) + put(diag04, $notret.) + put(diag05, $notret.) + put(diag06, $notret.)) and (op01=' ') and (substr(adm_typ,2,1) ne 'C') and (LOS<2) then CANC_OP='Y'; else CANC_OP='N'; *BELOW IS EXCLUSION RULE FOR ERROR DRGS; err_drg = put(drg_nz, $error.); *BELOW IS EXCLUSION RULE FOR TRANSPLANTS (LIVER, HEART, LUNG); xplant = put(drg_nz, $transp.); *BELOW IS EXCLUSION RULE FOR SPINAL INJURIES; if HLTHSPEC in ('S50','S53') then SPINAL='Y'; else SPINAL='N'; *BELOW IS EXCLUSION RULE FOR SURGICAL TERMINATION OF PREGNANCY; if drg_nz='O40Z' and op01 in ('3564300','3564301') and substr(diag01,1,3) = 'O04' then TERMPREG='Y'; else TERMPREG='N'; * the above diag01 code collect o04, not 004. Its been capitalised above, so dont get confused; *BELOW IS EXCLUSION RULE FOR RENAL DIALYSIS; if drg_nz in ('L61Z','L61Y') then RENAL='Y'; else RENAL='N'; *BELOW IS EXCLUSION RULE FOR CHEMOTHERAPY/RADIOTHERAPY; if (diag01 in ('Z510', 'Z511', 'Z512') or diag02 in ('Z510', 'Z511', 'Z512')) and (evendate=evstdate) then CHEM_RAD='Y'; else CHEM_RAD='N'; *BELOW IS EXCLUSION RULE FOR SLEEP APNOEA; if drg_nz = ('E63Z') and (evendate-evstdate < 2) then SLEEP='Y'; else SLEEP='N'; *BELOW IS EXCLUSION RULE FOR LITHOTRIPSY; if op01='3654600' and op02 in (' ','3654600','9250202','9250300') and op03 in (' ','9250202','9250300') and evendate=evstdate and substr(adm_typ,2,1) ne 'C' then LITHO='Y'; else LITHO='N'; *BELOW IS EXCLUSION RULE FOR COLPOSCOPIES; if put(op01, $COLPO.)*(put(op02, $COLPO.) or op02 in (' ','9250202','9250300')) and op03 in (' ','9250202','9250300') and age>15 and substr(adm_typ,2,1) ne 'C' and evendate=evstdate then COLPO='Y'; else COLPO='N'; *BELOW IS EXCLUSION RULE FOR CYSTOSCOPIES; if put(op01, $CYSTOS.)*(put(op02, $CYSTOS.) or op02 in (' ','9250202','9250300')) and op03 in (' ','9250202','9250300') and (evendate=evstdate) and age>15 and substr(adm_typ,2,1) ne 'C' then CYSTO='Y'; else CYSTO='N'; *BELOW IS EXCLUSION RULE FOR ERCPs; if (put(op01, $ERCPa.)*put(op02, $op2test.)) and op03 in (' ','9250202','9250300') and evendate=evstdate and substr(adm_typ,2,1) ne 'C' and age>15 then ERCP='Y'; else ERCP='N'; *BELOW IS EXCLUSION RULE FOR COLONOSCOPIES; if (put(op01, $COLONsa.)*put(op02, $op2test.)) and op03 in (' ','9250202','9250300') and evendate=evstdate and substr(adm_typ,2,1) ne 'C' and age>15 then COLON='Y'; else COLON='N'; *BELOW IS EXCLUSION RULE FOR GASTROSCOPIES; if (put(op01, $GASTRa.)*put(op02, $op2test.)) and op03 in (' ','9250202','9250300') and evendate=evstdate and substr(adm_typ,2,1) ne 'C' and age>15 then GASTRO='Y'; else GASTRO='N'; *BELOW IS EXCLUSION RULE FOR BRONCHOSCOPIES; if (put(op01, $bron.)*((put(op02, $bron.) or op02 in (' ','9250202','9250300')))) and op03 in (' ','9250202','9250300') and evendate=evstdate and substr(adm_typ,2,1) ne 'C' and age>15 then BRONCHO='Y'; else BRONCHO='N'; *BELOW IS EXCLUSION RULE FOR DAY CASE BLOOD TRANSFUSIONS; if (diag01='Z513' or (op01 in ('9206000','1370601','1370602','1370603') and op02 in (' ','9206000','1370601','1370602','1370603') and op03 =' ')) and evendate=evstdate and substr(adm_typ,2,1) ne 'C' then TRANSFUS='Y'; else TRANSFUS='N'; *BELOW CREATES A MASTER EXCLUSION VARIABLE TO IDENTIFY ALL EXCLUDED EVENTS; if NONMEDSG='Y' or Deshosp='N' or BOARDER='Y' or CANC_OP='Y' or ERR_DRG='Y' or XPLANT='Y' or SPINAL='Y' or TERMPREG='Y' or RENAL='Y' or CHEM_RAD='Y' or SLEEP='Y' or LITHO='Y' or COLPO='Y' or CYSTO='Y' or ERCP='Y' or COLON='Y' or GASTRO='Y' or BRONCHO='Y' or TRANSFUS='Y' or base = 'N' then EXCLU='Y'; else EXCLU='N'; *BELOW MAPS EVENTS TO CASEMIX PURCHASED UNITS OR IDENTIFIES AS CASEMIX EXCLUSIONS; if EXCLU='N' then do; if NEONATE='Y' then PU='W06.03'; else pu = put(hlthspec, $newpu.); end; else PU='EXCLU'; PU_name=put(PU,$PU_name.); *BELOW REALLOCATES BONE MARROW TRANSPLANT AN-DRGs; if drg_nz='A04Z' then do; if (put(op01, $bone.) + put(op02, $bone.) + put(op03, $bone.) + put(op04, $bone.)+ put(op05, $bone.) + put(op06, $bone.) + put(op07, $bone.) + put(op08, $bone.)+ put(op09, $bone.) + put(op10, $bone.) + put(op11, $bone.) + put(op12, $bone.)+ put(op13, $bone.) + put(op14, $bone.) + put(op15, $bone.) ) then DRG_NZ='A04A'; else DRG_NZ='A04B'; end; proc sort data = cwd.wies8; by vicdrg4; data &outdset; merge test (in=wanted) cwd.wies8 (rename=(vicdrg4=drg_nz) drop =vicdesc sameday); by DRG_nz; if wanted; *------------------------------------------------------------------*; *---------- Mechanical ventilation copayments first -----------*; *------------------------------------------------------------------*; if evendate < mdy(07,01,1999) then do; if drg_nz in ('A01Z', 'A02Z', 'A03Z', 'A04A', 'A04B', 'A05Z', 'A40Z', 'F02Z', 'F40Z', 'L61Y', 'P01Z', 'P02Z', 'P03Z', 'P04Z', 'P05Z', 'P60A', 'P60B', 'P61Z', 'P62Z', 'P63Z', 'P64Z', 'P65A', 'P65B', 'P65C', 'P65D', 'P66A', 'P66B', 'P66C', 'P66D', 'P67A', 'P67B', 'P67C', 'P67D', 'W01Z', '960Z', '961Z') then adjmvday=0; else if op01='1388202' or op02='1388202' or op03='1388202' or op04='1388202' or op05='1388202' or op06='1388202' or op07='1388202' or op08='1388202' or op09='1388202' or op10='1388202' or op11='1388202' or op12='1388202' or op13='1388202' or op14='1388202' or op15='1388202' then adjmvday=5; else if (put(op01, $mechven.) + put(op02, $mechven.) + put(op03, $mechven.) + put(op04, $mechven.)+ put(op05, $mechven.) + put(op06, $mechven.) + put(op07, $mechven.) + put(op08, $mechven.)+ put(op09, $mechven.) + put(op10, $mechven.) + put(op11, $mechven.) + put(op12, $mechven.)+ put(op13, $mechven.) + put(op14, $mechven.) + put(op15, $mechven.) ) then adjmvday=2; else if op01='1388200' or op02='1388200' or op03='1388200' or op04='1388200' or op05='1388200' or op06='1388200' or op07='1388200' or op08='1388200' or op09='1388200' or op10='1388200' or op11='1388200' or op12='1388200' or op13='1388200' or op14='1388200' or op15='1388200' then adjmvday=1; else adjmvday=0; end; else do; if drg_nz in ('A01Z', 'A02Z', 'A03Z', 'A04A', 'A04B', 'A05Z', 'A40Z', 'F02Z', 'F40Z', 'L61Y', 'P01Z', 'P02Z', 'P03Z', 'P04Z', 'P05Z', 'P60A', 'P60B', 'P61Z', 'P62Z', 'P63Z', 'P64Z', 'P65A', 'P65B', 'P65C', 'P65D', 'P66A', 'P66B', 'P66C', 'P66D', 'P67A', 'P67B', 'P67C', 'P67D', 'W01Z', '960Z', '961Z') then adjmvday=0; else if (HMVHRS < 6) then adjmvday=0; else adjmvday=round((HMVHRS+12)/24); end; *------------------------------------------------------------------*; *---------- LOS category and Inlier category ---------*; *------------------------------------------------------------------*; if (sum(evendate, -evstdate, -(evntlvd/1)) lt lb) then inlier='L'; else if (sum(evendate, -evstdate, -(evntlvd/1)) gt sum(HB, adjmvday)) then inlier='H'; else inlier='I'; if evstdate=evendate then los_cat = 'S'; else if (sum(evendate, -evstdate, -(evntlvd/1)) less than or eq 1) then los_cat = 'O'; else los_cat = 'M'; array px(15) op01-op15; nmvsepn = 0; select (mv_elig); when ('D') do; if (adjmvday > 0) then mv_copay = adjmvday *0.7729; else mv_copay = 0; end; when ('E') do; *--- Check for neonate mechanical ventilation ---*; do i = 1 to 15; if (substr(px(i),1,7) = '1388202') then nmvsepn = 1; end; if (nmvsepn = 1) then do; adjmvday= 0; mv_copay = 3.1323; end; else do; adjmvday = 0; mv_copay = 0; end; end; when ('4') if (hmvhrs gt 96) then do; adjmvday= sum(adjmvday, -4); mv_copay = adjmvday *0.7729; end; else do; adjmvday = 0; mv_copay = 0; end; otherwise do; adjmvday = 0; mv_copay = 0; end; end; *------------------------------------------------------------------*; *---------- Box 3c: Calculate Base WIES -----*; *------------------------------------------------------------------*; select (Inlier); when ('L') do; *---- Same day cases --; select (los_cat); when ('S') wies8 = sd; when ('O') wies8 = od; when ('M') wies8 = los * lo_pd; otherwise wies8 = 0; end; if md_in gt 0 then ies= wies8 / md_in; else ies=0; high_day = 0; hiwies = 0; end; when ('I') do; *---- Inlier calculations --; select (los_cat); when ('S') wies8 = sd; when ('O') wies8 = od; when ('M') wies8 = md_in; otherwise wies8 = 0; end; ies= 1; high_day=0; hiwies = 0; end; when ('H') do; *---- high outlier calculations --; high_day = max(0,sum(los,-hb,-adjmvday)); hiwies = high_day * ho_pd ; wies8 = md_in + hiwies; if md_in gt 0 then ies= wies8 / md_in; else ies=1; end; Otherwise do; high_day=0; wies8=0; ies=0; end; end; *------------------------------------------------------------------*; *---------- Box 5: Total WIES -----*; *------------------------------------------------------------------*; wies8 = sum(wies8, mv_copay); * * Clean up temporary datasets * *; proc datasets library=work; delete test; run; options mlogic mrecall details merror mprint symbolgen; %mend w8ICD10;  Senior Analyst, Decision Support, Capital and Coast DHB  Project Analyst, Personal & Family Health Directorate Service Development, Ministry of Health  Senior Analyst, Hutt DHB  Financial Years run from 1 July through to 30 June of the following calendar year and are abbreviated by stringing together the last two digits of the portions of calendar years in question, i.e. 98/99, 99/00, 00/01 represent the 3 consecutive financial years from 1 July 1998 through 30 June 2001.  Two slightly different DRG versions are in use within the methodology. The DRG version currently in use within the NZ health sector is AR-DRG version 4.1 and all DRG tests on NMDS events refer to this version. However, for the purposes of applying costweights, some AR-DRGs are not clinically homogeneous and in these cases an AR-DRG may be reallocated to a different WIES DRG. The WIES DRGs contain all the AR-DRGs as well as two additional DRG codes (not used in AR-DRG) for the purpose of applying the appropriate costweights to NMDS events.  Costweights Project Group, , National Service Framework Project: Report of the Costweights Project Group, Ministry of Health, 23 March 2001 (available on Ministry of Health Website)  This adjustment was added on 3 August 2001 by NZHIS. The adjustment was already in the SAS programme but had been omitted from this documentation.  This was changed to greater than or equal to 6 on 1 October 2001.  This was changed on 10 October 2001. 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