South Australian Health Commission (Recognised Hospital and Incorporated Health Centre—Compensable and Non-Medicare Patients Fees) Regulations 1995 (SA)

Case
No judgment structure available for this case.

As in force at 1 July 2002.

South Australia

SOUTH AUSTRALIAN HEALTH COMMISSION (RECOGNISED

HOSPITAL AND INCORPORATED HEALTH CENTRE—COMPENSABLE

AND NON-MEDICARE PATIENTS FEES) REGULATIONS 1995

SUMMARY OF PROVISIONS

PART 1
PRELIMINARY

1.                    Citation

2.                    Commencement

3.                    Revocation

4.                    Interpretation

5.                    Determination of applicable AN-DRG

PART 2
DETERMINATION OF FEES

6.                    Fees

7.                    Waiver or remission of fees

SCHEDULE 1

Recognised hospitals: determination of fees for admitted patients

SCHEDULE 2

Recognised hospitals: fees for non-admitted patients

SCHEDULE 3
Recognised hospitals and incorporated health centres: accommodation,
rehabilitation, domiciliary care and related fees
SCHEDULE 4

Classification of recognised hospitals

APPENDIX
LEGISLATIVE HISTORY
REGULATIONS UNDER THE SOUTH AUSTRALIAN HEALTH COMMISSION
ACT 1976

South Australian Health Commission (Recognised Hospital and Incorporated Health Centre—Compensable and Non-Medicare

Patients Fees) Regulations 1995

being

No. 34 of 1995: Gaz. 13 April 1995 p. 14421

as varied by

No. 46 of 1995: Gaz. 4 May 1995, p. 17232
No. 116 of 1996: Gaz. 30 May 1996, p. 27253
No. 98 of 1997: Gaz. 13 May 1997, p. 19034
No. 88 of 1998: Gaz. 28 May 1998, p. 23605
No. 89 of 1999: Gaz. 27 May 1999, p. 28686
No. 145 of 1999: Gaz. 1 July 1999, p. 656
No. 96 of 2000: Gaz. 25 May 2000, p. 27837
No. 61 of 2001: Gaz. 31 May 2001, p. 19708
No. 48 of 2002: Gaz. 20 June 2002, p. 25079

1            Came into operation 13 April 1995: reg. 2.

2            Came into operation (except reg. 4) 4 May 1995: reg. 2(1); reg. 4 came into operation 1 July 1995: reg. 2(2).

3            Came into operation 1 July 1996: reg. 2

4            Came into operation 1 July 1997: reg. 2.

5            Came into operation 1 July 1998: reg. 2.

6            Came into operation 1 July 1999: reg. 2.

7            Came into operation 1 July 2000: reg. 2.

8            Came into operation 1 July 2001: reg. 2.

9            Came into operation 1 July 2002: reg. 2.

NOTE:

Asterisks indicate repeal or deletion of text.
Entries appearing in bold type indicate the amendments incorporated since the last
consolidation.
For the legislative history of the regulations see Appendix.

PART 1

PRELIMINARY

Citation

1. These regulations may be cited as the South Australian Health Commission (Recognised Hospital and Incorporated Health Centre—Compensable and Non-Medicare Patients Fees) Regulations 1995.

Commencement

2. These regulations come into operation on the day on which they are made.

Revocation

3. The South Australian Health Commission (Recognised Hospitals and Incorporated Health Centres—Compensable and Non-Medicare Patients Fees) Regulations 1993 (see Gazette 30 September 1993 p. 1458) are revoked.

Interpretation

4. (1) In these regulations, unless the contrary intention appears—

"admission" means the formal administrative process of a recognised hospital or incorporated health centre by which a patient commences a period of treatment, care and accommodation in that hospital or health centre;

"admitted patient" means a patient who has undergone the formal admission process of a

recognised hospital or incorporated health centre;

"AN-DRG" means Australian National Diagnosis Related Group as referred to in the
Manual (see also subregulation (2));

"compensable patient" means a person receiving services from a recognised hospital or incorporated health centre who is, or may be, entitled to payment, or has received payment, by way of compensation in respect of the injury, illness or disease for which the patient is receiving services;

"country hospital" means a recognised hospital specified in schedule 4 as a country

regional, country sub-regional or other country hospital;

"country regional hospital" means a recognised hospital specified in schedule 4 as a

country regional hospital;

"country sub-regional hospital" means a recognised hospital specified in schedule 4 as a
country sub-regional hospital;

"discharge" means the formal administrative process of a recognised hospital or incorporated health centre by which a patient ceases a period of treatment, care and accommodation in that hospital or health centre;

"inpatient" means a person who is admitted as a patient of a recognised hospital or incorporated health centre and is not discharged until a day subsequent to the day of admission;

"the Manual" means the Australian National Diagnosis Related Groups Definitions Manual Version 2.0 published in 1993 by the Commonwealth Department of Health, Housing, Local Government and Community Services;

"Medicare patient" means a patient who is an eligible person for the purpose of receiving

medical benefits under the Health Insurance Act 1973 of the Commonwealth;

"metropolitan hospital" means a recognised hospital specified in schedule 4 as a

metropolitan teaching hospital or other metropolitan hospital;

"metropolitan teaching hospital" means a recognised hospital specified in schedule 4 as a

metropolitan teaching hospital;

"non-admitted patient" means a patient who is not an admitted patient;

"prescription item" means—

(a) a pharmaceutical or other item supplied on the prescription of a medical practitioner, dentist or other person authorised to prescribe the item; or
(b) an ancillary item required for the administration of such pharmaceutical or other item;

"private", in relation to a patient of a recognised hospital or incorporated health centre, connotes that the patient receives medical or diagnostic services from a medical practitioner selected by the patient;

"public", in relation to a patient of a recognised hospital or incorporated health centre, connotes that the patient receives medical or diagnostic services from a medical practitioner nominated by the hospital or health centre.

(2) For the purposes of these regulations—

(a)

AN-DRG reference numbers or descriptions are as set out in Appendix A of the Manual, but excluding any codes in that Appendix used for compiling statistical information; and

(b)

terms and abbreviations used in AN-DRG descriptions have the meanings given by the definitions contained in Appendix G of the Manual.

Determination of applicable AN-DRG

5. For the purposes of these regulations, the AN-DRG applicable to a patient must be determined in accordance with the guidelines contained in Coding and DRGS, A Handbook for Clinical Staff, published by the South Australian Health Commission in 1993.

PART 2

DETERMINATION OF FEES

Fees

6. (1) Subject to subregulation (3), the fee to be charged by a recognised hospital for services of a kind set out in schedule 1 provided to an admitted patient—

(a) who is a compensable patient; or
(b) who is not a Medicare patient,

is the fee determined in accordance with that schedule.

(2) Subject to subregulation (3), the fee (or, where specified, the maximum fee) to be charged by a recognised hospital for services of a kind set out in schedule 2 provided to a non- admitted patient—

(a) who is a compensable patient; or
(b) who is not a Medicare patient,

is as set out in that schedule.

(3) The fee (or, where specified, the maximum fee) to be charged by a recognised hospital or incorporated health centre for services of a kind set out in schedule 3 provided to a patient—

(a) who is a compensable patient; or
(b) who is not a Medicare patient,

is as set out in that schedule.

Waiver or remission of fees

7. A recognised hospital or incorporated health centre may waive payment of, or remit, the whole or any part of a fee payable to it under these regulations.

SCHEDULE 1
Recognised hospitals: determination of fees for

admitted patients

Interpretation

1. In this schedule, unless the contrary intention appears—

"day" means calendar day;

"inlier patient" means an admitted patient whose length of stay in a recognised hospital lies between the upper and lower trim points (or equals the upper or lower trim point) shown in the third and fourth columns of the table in this schedule corresponding to the AN-DRG applicable to the patient (except where the upper trim point is zero, in which case an inlier patient is one whose length of stay is greater than the upper trim point);

"leave day" means a day on which an admitted patient is on leave from a hospital without being

discharged from that hospital—

(a) counting the day on which the patient goes on leave as one day; and
(b) excluding the day on which the patient returns (unless it is also the day on which the patient goes on leave);

"length of stay", in relation to an admitted patient in a recognised hospital, means the number of days between the day of admission of the patient into the hospital and the day of discharge of the patient from the hospital—

(a) counting the day of admission as one day; and
(b) excluding the day of discharge (unless it is also the day of admission); and
(c) excluding any leave days;

"long stay outlier patient" means an admitted patient whose length of stay in a recognised hospital is, where the upper trim point shown in the third column of the table in this schedule corresponding to the AN-DRG applicable to the patient is more than zero, greater than that upper trim point;

"short stay outlier patient" means an admitted patient whose length of stay in a recognised hospital is less than the lower trim point shown in the fourth column of the table in this schedule corresponding to the AN-DRG applicable to the patient.

Inlier patients

2. Subject to this schedule, the fee to be charged by a recognised hospital for a period of treatment, care and accommodation of an admitted patient to whom an AN-DRG specified in the first and second columns of the table in this schedule is applicable must, where the patient is an inlier patient, be calculated as follows:

Fee = Benchmark Price x Inlier Cost Weight x Severity Index

where—

(a) the "Benchmark Price" is—
(i) in the case of a public patient: $2 776;
(ii) in the case of a private patient: $2 096;

(b)

the "Inlier Cost Weight" is the inlier cost weight for that recognised hospital shown in the fifth or sixth columns of the table in this schedule corresponding to the AN-DRG applicable to the patient;

(c) the "Severity Index" is—
(i) 1.1 in the case of a metropolitan teaching hospital;
(ii) 1.05 in the case of—
(A) a metropolitan hospital other than a metropolitan teaching hospital; or
(B) a country regional hospital;

(iii)             1.0 in the case of any other hospital.

Short stay outlier patients

3. Subject to this schedule, the fee to be charged by a recognised hospital for a period of treatment, care and accommodation of an admitted patient to whom an AN-DRG specified in the first and second columns of the table in this schedule is applicable must, where the patient is a short stay outlier patient, be calculated as follows:

Fee = (Benchmark Price x LOS x OBD Cost Weight) + (Benchmark Theatre Price x Theatre Cost Weight) where—

(a) the "Benchmark Price" is—
(i) in the case of a short stay outlier patient who is a public patient—$532;
(ii) in the case of a short stay outlier patient who is a private patient—$426;
(b) "LOS" is the length of stay of the patient in the recognised hospital;

(c)

the "OBD Cost Weight" is the OBD (occupied bed day) cost weight shown in the seventh column of the table in this schedule corresponding to the AN-DRG applicable to the patient;

(d) the "Benchmark Theatre Price" is—
(i) in the case of a short stay outlier patient who is a public patient—$1 038;
(ii) in the case of a short stay outlier patient who is a private patient—$692;

(e)

the "Theatre Cost Weight" is the theatre cost weight shown in the eighth column of the table in this schedule corresponding to the AN-DRG applicable to the patient.

Long stay outlier patients

4. (1) Subject to this schedule, the fee to be charged by a recognised hospital for a period of treatment, care and accommodation of an admitted patient to whom an AN-DRG specified in the first and second columns of the table in this schedule is applicable must, where the patient is a long stay outlier patient, be calculated as follows:

(a) if the length of stay of the patient in the recognised hospital is less than or equal to 90 days—

Fee = (Inlier Price) + (Benchmark Price A x (LOS - Upper Trim Point) x OBD Cost Weight);

(b) if—
(i) the length of stay of the patient in the recognised hospital is greater than 90 days; and
(ii) the upper trim point for the AN-DRG applicable to the patient is less than 90 days—
Fee = (Inlier Price) + (Benchmark Price A x (90 - Upper Trim Point) x OBD Cost Weight) +
(Benchmark Price B x (LOS - 90));
(c) if—
(i) the length of stay of the patient is greater than 90 days; and

(ii)

the upper trim point for the AN-DRG applicable to the patient is greater than 90 days—

Fee = (Inlier Price) + (Benchmark Price B x (LOS - Upper Trim Point)).

(2) For the purposes of subclause (1):

(a)

"Inlier Price" is the fee that would have been chargeable by the recognised hospital under this schedule in respect of that patient for the relevant period of treatment, care and accommodation had the patient been an inlier patient;

(b) "Benchmark Price A" is—

(i)

in the case of a metropolitan hospital (other than Noarlunga Health Services Incorporated or Gawler Health Services Incorporated) or a country regional hospital—$325;

(ii)

in the case of all other recognised hospitals (including Noarlunga Health Services Incorporated and Gawler Health Services Incorporated)—$234;

(c) "LOS" is the length of stay of the patient in the recognised hospital;

(d)

"OBD Cost Weight" is the OBD (occupied bed day) cost weight shown in the seventh column of the table in this schedule corresponding to the AN-DRG applicable to the patient;

(e) "Benchmark Price B" is $149;

(f)

"Upper Trim Point" is the upper trim point shown in the third column of the table in this schedule corresponding to the AN-DRG applicable to the patient.

Rehabilitation fee, Hampstead Centre

5. (1) Despite clauses 2, 3 and 4, the fee to be charged by the Hampstead Centre of the Royal Adelaide Hospital for a period of treatment, care and accommodation of an admitted patient for whom the applicable AN-DRG is AN-DRG 931 rehabilitation services is as follows:

(a) in the case of a public patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 623 per day;
(b)
in the case of a private patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 561 per day.

(2) For the purposes of this clause—

"day" includes the day of admission, but does not include—

(a) a leave day; or
(b) the day of discharge (unless it is also the day of admission).

Medical or diagnostic services for private patients

6. In the case of a private patient, a fee determined in accordance with this schedule does not include a fee for the cost of medical or diagnostic services provided by a medical practitioner selected by the patient.

Transportation fee

7. Where, in addition to providing a service referred to in this schedule, a recognised hospital transports, or arranges for the transportation of, a patient to or from (or between different campuses of) the hospital, the hospital may charge an additional fee equal to the cost to the hospital of providing, or arranging for the provision of, that transportation.

SCHEDULE 1 TABLE: COST WEIGHTS AND TRIM POINTS FOR AN-DRG CHARGES FOR ADMITTED PATIENTS

1. 2. 3. 4. 5. 6. 7. 8.
Upper Lower Inlier Inlier OBD Theatre
AN-DRG DESCRIPTION Trim Trim Cost Cost Cost Cost
Point Point Weight Weight— Weight Weight
(Version 2) (Days) (Days) (except W&CH,
W&CH, ACH
ACH)
001 MOUTH, LARYNX OR PHARYNX DISORDER W TRACHEOSTOMY AGE >15 93.91 13.78 7.7835 7.8301 1.3792 2.3584
002 MOUTH, LARYNX OR PHARYNX DISORDER W TRACHEOSTOMY AGE <16 48.25 4.64 7.2684 9.0429 2.2321 0.3135
003 TRACHEOSTOMY OTH THAN FOR MOUTH, LARYNX OR PHARYNX DISORDER AGE >15 98.34 11.70 17.0910 14.7303 2.0982 1.9449
004 TRACHEOSTOMY OTH THAN FOR MOUTH, LARYNX OR PHARYNX DISORDER AGE <16 67.64 6.10 9.6563 9.1457 2.2147 0.6538
005 LIVER TRANSPLANT 101.62 14.75 28.8463 28.8702 4.2913 12.6019
006 BONE MARROW TRANSPLANT 53.64 9.96 15.2238 18.4075 2.2787 1.4279
020 CRANIOTOMY EXCEPT FOR TRAUMA AGE >9 39.96 5.16 4.4254 6.4610 1.2273 2.2093
021 CRANIOTOMY FOR TRAUMA AGE >9 37.54 4.50 4.8300 7.9074 1.3686 1.4144
022 VENTRICULAR SHUNT REVISION AGE <10 19.77 2.06 1.8485 1.8501 1.2825 0.7249
023 CRANIOTOMY AGE <10 W CC 26.17 4.67 3.6559 3.6589 1.3973 0.7697
024 CRANIOTOMY AGE <10 W/O CC 17.19 2.81 1.9952 2.0053 1.3051 0.7426
025 SPINAL PROCEDURES 32.72 3.79 5.1186 3.3118 1.2053 1.2083
026 EXTRACRANIAL VASCULAR PROCEDURES 21.63 2.48 2.3690 2.2732 1.3225 1.6239
027 CARPAL TUNNEL RELEASE 7.69 - 0.5255 0.5368 1.1481 0.7628
028 PERIPH & CRANIAL NERVE & OTHER NERV SYST PROC 14.91 1.37 1.7661 1.8661 1.1636 0.9158
029 SPINAL DISORDERS & INJURIES 24.24 2.74 2.8431 2.2124 0.9697 0.0000
030 NERVOUS SYSTEM NEOPLASMS 29.02 3.06 2.0999 5.5505 0.9547 0.0000
031 DEGENERATIVE NERVOUS SYSTEM DISORDERS W CC 47.03 5.22 3.1203 2.6460 0.6664 0.0000
032 DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O CC 77.52 5.33 1.8985 1.8431 0.6057 0.0000
033 MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA 40.78 3.04 1.4568 1.5636 0.8600 0.0000
034 SPECIFIC CEREBROVASCULAR DISORDERS EXCEPT TIA 50.26 4.77 2.8939 1.9904 0.7761 0.0000
035 TRANSIENT ISCHAEMIC ATTACK & PRECEREBRAL OCCLUSIONS W CC 20.94 2.13 1.2655 1.0172 0.7442 0.0000
036 TRANSIENT ISCHAEMIC ATTACK & PRECEREBRAL OCCLUSIONS W/O CC 13.09 1.38 0.6126 0.5634 0.7208 0.0000
037 NONSPECIFIC CEREBROVASCULAR DISORDERS W CC 65.80 6.31 4.0288 2.2791 1.0427 0.0000
038 NONSPECIFIC CEREBROVASCULAR DISORDERS W/O CC 44.42 3.82 1.8140 0.8904 0.6263 0.0000
039 CRANIAL & PERIPHERAL NERVE DISORDERS W CC 53.96 4.89 3.0347 5.9162 1.0757 0.0000
040 CRANIAL & PERIPHERAL NERVE DISORDERS W/O CC 22.59 2.04 1.8181 1.2704 1.4616 0.0000

SCHEDULE 1 TABLE: COST WEIGHTS AND TRIM POINTS FOR AN-DRG CHARGES FOR ADMITTED PATIENTS

1. 2. 3. 4. 5. 6. 7. 8.
Upper Lower Inlier Inlier OBD Theatre
AN-DRG DESCRIPTION Trim Trim Cost Cost Cost Cost
Point Point Weight Weight— Weight Weight
(Version 2) (Days) (Days) (except W&CH,
W&CH, ACH
ACH)
041 NERVOUS SYSTEM INFECTION EXCEPT VIRAL MENINGITIS 22.51 2.56 1.9557 2.5840 1.2352 0.0000
042 VIRAL MENINGITIS 9.33 - 0.6236 0.6231 1.0337 0.0000
043 HYPERTENSIVE ENCEPHALOPATHY 12.17 1.77 0.9713 0.9774 0.8782 0.0000
044 NONTRAUMATIC STUPOR & COMA 14.35 - 0.7019 1.1100 1.0461 0.0000
045 SEIZURE AGE >9 W CC 14.34 1.57 0.8635 1.4698 0.8506 0.0000
046 SEIZURE AGE >9 W/O CC 11.90 - 0.5197 0.6502 0.9464 0.0000
047 SEIZURE AGE <10 13.91 - 0.4104 0.4010 1.1506 0.0000
048 HEADACHE 9.06 - 0.4708 0.4357 1.0386 0.0000
050 TRAUMATIC STUPOR & COMA,COMA > 1 HOUR 10.60 - 0.9275 0.9344 1.3753 0.0000
051 TRAUMATIC STUPOR & COMA, COMA < 1 HOUR 13.40 - 0.4664 0.4748 1.2764 0.0000
052 CONCUSSION 4.75 - 0.3086 0.3207 1.1843 0.0000
053 OTHER DISORDERS OF NERVOUS SYSTEM W CC 21.17 2.29 2.2046 3.7480 0.9897 0.0000
054 OTHER DISORDERS OF NERVOUS SYSTEM W/O CC 17.72 1.67 1.1927 1.9318 1.0226 0.0000
070 RETINAL PROCEDURES 11.84 1.58 1.3090 1.2071 1.0404 1.2618
071 ORBITAL PROCEDURES 20.04 2.24 1.4511 2.0878 0.9352 0.9049
072 PRIMARY IRIS PROCEDURES EXCEPT GLAUCOMA 2.00 - 0.8567 0.8678 0.9454 0.9696
073 LENS PROCEDURES W CC 12.65 - 0.9102 1.2681 1.2272 1.0379
074 LENS PROCEDURES W/O CC 9.10 - 0.6791 1.1731 1.3949 1.0013
076 EXTRAOCULAR PROCEDURES EXCEPT BOTH ORBIT & LACRIMAL 9.11 - 0.6056 0.6037 1.2448 0.8130
077 EXTRAOCULAR PROCEDURES EXCEPT RETINA, IRIS, LENS & GLAUCOMA 14.93 - 1.3107 1.5360 1.0471 1.2398
078 MAJOR CORNEAL,SCLERAL & CONJUNCTIVAL PROCEDURES 13.95 1.55 1.4075 1.4915 1.1686 1.1314
079 OTHER CORNEAL, SCLERAL & CONJUNCTIVAL PROCEDURES 22.47 2.29 1.0715 1.1793 1.0085 0.7898
080 GLAUCOMA PROCEDURES 15.27 1.96 1.0321 0.9792 0.9795 1.0404
081 LACRIMAL PROCEDURES 5.00 - 0.6771 0.6003 1.6355 0.8456
082 HYPHEMA 7.16 - 0.5307 0.7788 0.8696 0.0000
083 ACUTE MAJOR EYE INFECTIONS 16.97 1.94 0.7869 0.7661 0.8958 0.0000
084 NEUROLOGICAL EYE DISORDERS 8.83 - 0.6859 0.7692 0.9242 0.0000

SCHEDULE 1 TABLE: COST WEIGHTS AND TRIM POINTS FOR AN-DRG CHARGES FOR ADMITTED PATIENTS

1. 2. 3. 4. 5. 6. 7. 8.
Upper Lower Inlier Inlier OBD Theatre
AN-DRG DESCRIPTION Trim Trim Cost Cost Cost Cost
Point Point Weight Weight— Weight Weight
(Version 2) (Days) (Days) (except W&CH,
W&CH, ACH
ACH)
085 OTHER DISORDERS OF THE EYE AGE >9 W CC 25.68 2.16 1.2715 0.9764 1.0115 0.0000
086 OTHER DISORDERS OF THE EYE AGE >9 W/O CC 11.50 - 0.4733 0.5556 0.9510 0.0000
087 OTHER DISORDERS OF THE EYE AGE<10 9.00 - 0.4399 0.4475 1.0851 0.0000
110 MAJOR HEAD & NECK PROCEDURES 43.62 6.18 5.7339 4.7246 1.2496 2.8790
111 SIALOADENECTOMY 8.64 - 0.9674 2.3338 0.9774 1.1555
112 SALIVARY GLAND PROCEDURES EXCEPT SIALOADENECTOMY 5.94 - 0.6939 0.9663 0.9290 0.8024
113 CLEFT LIP & PALATE REPAIR 11.14 2.26 1.7033 1.8863 1.0090 1.1048
114 MOUTH PROCEDURES 9.60 - 0.8290 0.7958 1.1937 0.8084
115 SINUS & MASTOID PROCEDURES 7.38 - 0.8238 1.0391 1.0621 1.0188
117 MISCELLANEOUS EAR, NOSE MOUTH & THROAT PROCEDURES 6.66 - 0.5918 0.6606 1.1187 0.7697
118 RHINOPLASTY 13.97 - 0.5374 0.7570 0.9895 0.8333
119 T&A PROC, EXCEPT TONSILLECTOMY &/OR ADENOIDECT ONLY AGE >9 10.67 - 0.6512 0.6192 1.1662 0.7476
120 T&A PROC, EXCEPT TONSILLECTOMY &/OR ADENOIDECT ONLY AGE <10 2.85 - 0.5410 0.5399 1.5744 0.5603
121 TONSILLECTOMY &/OR ADENOIDECTOMY ONLY AGE >9 4.37 - 0.5188 0.5184 0.9609 0.5366
122 TONSILLECTOMY &/OR ADENOIDECTOMY ONLY AGE <10 3.83 - 0.5083 0.5073 1.1765 0.5122
123 MYRINGOTOMY W TUBE INSERTION AGE >9 4.87 - 0.4875 0.4404 1.3944 0.5808
124 MYRINGOTOMY W TUBE INSERTION AGE<10 10.56 - 0.4238 0.4266 1.3767 0.5625
125 OTHER EAR, NOSE MOUTH & THROAT O.R. PROCEDURES 12.61 1.62 1.2715 2.4499 1.1615 1.1293
126 DENTAL & ORAL DIS EXCEPT EXTRACTIONS & RESTORATIONS AGE >9 10.19 - 0.4451 0.4701 1.1273 0.0000
127 DENTAL & ORAL DIS EXCEPT EXTRACTIONS & RESTORATIONS AGE <10 6.85 - 0.3407 0.3243 1.1758 0.0000
128 DENTAL EXTRACTIONS & RESTORATIONS 5.49 - 0.2814 0.2951 1.3242 0.0000
129 EAR, NOSE MOUTH AND THROAT MALIGNANCY 21.39 2.20 1.6836 0.9392 0.9531 0.0000
130 DYSEQUILIBRIUM 12.81 - 0.4534 0.3681 0.7250 0.0000
131 EPISTAXIS 8.67 - 0.4186 0.3619 0.9628 0.0000
132 EPIGLOTITIS 10.52 1.48 1.2441 1.2597 1.9315 0.0000
133 OTITIS MEDIA & URI AGE >9 W CC 13.40 1.61 0.9724 0.9495 0.8717 0.0000
134 OTITIS MEDIA & URI AGE >9 W/O CC 37.27 - 0.4187 0.4689 0.9306 0.0000

SCHEDULE 1 TABLE: COST WEIGHTS AND TRIM POINTS FOR AN-DRG CHARGES FOR ADMITTED PATIENTS

1. 2. 3. 4. 5. 6. 7. 8.
Upper Lower Inlier Inlier OBD Theatre
AN-DRG DESCRIPTION Trim Trim Cost Cost Cost Cost
Point Point Weight Weight— Weight Weight
(Version 2) (Days) (Days) (except W&CH,
W&CH, ACH
ACH)
135 OTITIS MEDIA & URI AGE <10 9.25 - 0.4098 0.4018 1.0704 0.0000
136 LARYNGOTRACHEITIS 3.68 - 0.2939 0.2921 1.0814 0.0000
137 NASAL TRAUMA & DEFORMITY 8.08 - 0.3046 0.3474 1.2675 0.0000
138 OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES AGE >9 9.29 - 0.4430 0.5998 1.0986 0.0000
139 OTHER EAR, NOSE, MOUTH AND THROAT DAIGNOSES AGE < 10 4.73 - 0.4168 0.4106 1.4021 0.0000
160 MAJOR CHEST PROCEDURES W MAJOR CC 38.31 6.29 6.1531 5.4093 1.4040 3.2767
161 MAJOR CHEST PROCEDURES W NON-MAJOR CC 24.54 3.88 4.3100 6.5209 1.1843 4.4948
162 MAJOR CHEST PROCEDURES W/O CC 19.52 3.28 3.3174 2.1813 1.0667 3.9968
163 OTHER RESP SYSTEM O.R. PROCEDURES W MAJOR CC 30.83 4.91 3.3981 3.9235 1.2008 1.1652
164 OTHER RESP SYSTEM O.R. PROCEDURES W NON-MAJOR CC 37.63 3.43 2.5540 1.7900 0.9365 0.9319
165 OTHER RESP SYSTEM O.R. PROCEDURES W/O CC 14.38 1.96 1.3952 1.3234 1.0685 1.1962
166 RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 27.49 3.34 2.9115 2.3578 1.6872 0.0000
167 PULMONARY EMBOLISM 24.69 3.11 1.6315 1.5649 0.8894 0.0000
168 RESPIRATORY INFECTIONS & INFLAMMATIONS AGE >9 33.95 3.84 2.5628 2.6949 1.0482 0.0000
169 RESPIRATORY INFECTIONS & INFLAMMATIONS AGE <10 206.51 10.54 1.5479 3.4106 1.0739 0.0000
170 RESPIRATORY NEOPLASMS 28.87 2.96 1.6759 2.2748 0.9269 0.0000
171 MAJOR CHEST TRAUMA W CC 23.43 3.03 1.6292 1.5527 1.0300 0.0000
172 MAJOR CHEST TRAUMA W/O CC 10.84 1.43 0.6745 0.6537 0.8441 0.0000
173 CYSTIC FIBROSIS 35.07 5.15 2.8974 3.6167 1.2740 0.0000
174 SLEEP APNOEA 14.35 - 0.4414 0.4051 1.3905 0.0000
175 PLEURAL EFFUSION 17.04 2.00 1.3191 1.0927 0.8569 0.0000
176 PULMONARY OEDEMA & RESPIRATORY FAILURE 18.14 2.08 1.5642 1.2530 0.9585 0.0000
177 CHRONIC OBSTRUCTIVE AIRWAYS DISEASE 40.79 3.08 1.1955 2.3506 0.6804 0.0000
178 SIMPLE PNEUMONIA & PLEURISY AGE >9 W CC 30.21 3.00 1.6672 1.6585 0.8941 0.0000
179 SIMPLE PNEUMONIA & PLEURISY AGE >9 W/O CC 15.66 1.92 0.8226 0.6887 0.7356 0.0000
180 SIMPLE PNEUMONIA & PLEURISY AGE <10 9.68 - 0.7298 0.7218 1.0212 0.0000
181 INTERSITIAL LUNG DISEASE W CC 27.57 3.61 2.1149 1.8583 1.0528 0.0000

SCHEDULE 1 TABLE: COST WEIGHTS AND TRIM POINTS FOR AN-DRG CHARGES FOR ADMITTED PATIENTS

1. 2. 3. 4. 5. 6. 7. 8.
Upper Lower Inlier Inlier OBD Theatre
AN-DRG DESCRIPTION Trim Trim Cost Cost Cost Cost
Point Point Weight Weight— Weight Weight
(Version 2) (Days) (Days) (except W&CH,
W&CH, ACH
ACH)
182 INTERSITIAL LUNG DISEASE W/O CC 23.62 2.53 1.5459 2.4824 0.8066 0.0000
183 PNEUMOTHORAX W CC 21.41 2.72 1.3794 0.8909 0.9356 0.0000
184 PNEUMOTHORAX W/O CC 8.74 1.36 0.7226 0.8960 0.8024 0.0000
185 BRONCHITIS & ASTHMA AGE >9 W CC 19.04 2.30 1.1182 1.1555 0.8048 0.0000
186 BRONCHITIS & ASTHMA AGE <10 8.13 - 0.4868 0.4740 1.1188 0.0000
187 RESPIRATORY SIGNS & SYMPTOMS W CC 12.47 1.52 0.9933 1.4980 0.9092 0.0000
188 RESPIRATORY SIGNS & SYMPTOMS W/O CC 8.95 - 0.4108 0.5119 1.0242 0.0000
189 OTHER RESPIRATORY SYSTEM DIAGNOSES W CC 23.57 2.56 1.3905 0.7048 0.9407 0.0000
190 OTHER RESPIRATORY SYSTEM DIAGNOSES W/O CC 11.83 1.33 0.5585 0.7757 0.8028 0.0000
191 BPD & OTH CHRONIC RESP DISEASES ARISING IN PERINATAL PERIOD 16.31 1.39 1.1022 1.6374 1.2686 0.0000
192 OTHER RESPIRATORY PROBLEMS AFTER BIRTH 13.62 2.38 0.8669 0.8849 0.9066 0.0000
193 BRONCHITIS & ASTHMA AGE >9 W/O CC 11.49 - 0.5061 0.5616 0.8456 0.0000
220 HEART TRANSPLANT - - 9.1567 9.7738 1.9585 5.8642
221 CARDIAC VALVE PROC W PUMP & W INVASIVE CARDIAC INVES PROC W CC 44.91 7.42 11.5386 11.2542 2.3454 5.1289
222 CARDIAC VALVE PROC W PUMP & W INVASIVE CARDIAC INVES PROC W/O CC - - 4.8478 4.8524 1.1787 3.6888
223 CARDIAC VALVE PROC W PUMP & W/O INVASIVE CARDIAC INVES PROC 25.97 4.68 6.6973 6.5478 2.0793 5.0731
224 CORONARY BYPASS W INVASIVE CARDIAC INVESTIGATION PROCEDURE 32.35 5.83 6.6718 6.7727 1.8652 2.7312
225 CORONARY BYPASS W/O INVASIVE CARDIAC INVESTIGATION PROCEDURE 19.75 3.59 3.9805 3.6390 1.6893 2.9249
226 OTHER CARDIOTHORCIC OR VASCULAR PROCEDURES, W PUMP 26.07 3.88 7.0712 5.9608 2.3563 3.0406
227 OTHER CARDIOTHORCIC PROCEDURES W/O PUMP 19.66 2.19 5.0581 4.0890 2.4525 1.5246
228 MAJOR RECONSTRUCT VASCULAR PROC W/O PUMP W MAJOR CC 59.13 6.88 6.6260 6.0976 1.1901 2.4605
229 MAJOR RECONSTRUCT VASCULAR PROC W/O PUMP W NON-MAJOR CC 29.24 4.84 4.3169 4.3419 1.1516 2.2334
230 MAJOR RECONSTRUCT VASCULAR PROC W/O PUMP W/O CC 31.35 4.10 2.7061 3.1471 1.0334 2.0166
231 VASCULAR PROCEDURES EXCEPT MAJOR RECONSTRUCTION W/O PUMP W CC 33.29 3.63 4.0942 3.0195 1.4836 0.9323
232 VASCULAR PROCEDURES EXCEPT MAJOR RECONSTRUCTION W/O PUMP W/O CC 11.80 1.38 2.0724 1.8377 2.0157 0.8416
233 AMPUTATION FOR CIC SYSTEM DISORDERS EXCEPT UPPER LIMB & TOE 46.89 6.67 7.9437 7.4312 0.8909 1.3119
234 UPPER LIMB & TOE AMPUTATION FOR CIC SYSTEM DISORDERS 52.21 6.25 3.5397 3.3187 0.7631 0.8716

SCHEDULE 1 TABLE: COST WEIGHTS AND TRIM POINTS FOR AN-DRG CHARGES FOR ADMITTED PATIENTS

1. 2. 3. 4. 5. 6. 7. 8.
Upper Lower Inlier Inlier OBD Theatre
AN-DRG DESCRIPTION Trim Trim Cost Cost Cost Cost
Point Point Weight Weight— Weight Weight
(Version 2) (Days) (Days) (except W&CH,
W&CH, ACH
ACH)
235 PERM CARDIAC PACEMAKER IMP W AMI, HEART FAILURE OR SHOCK 39.61 5.39 5.7248 5.1324 1.9416 2.2559
236 PERM CARDIAC PACEMAKER IMP W/O AMI, HEART FAILURE OR SHOCK 16.93 2.08 3.7543 3.5947 3.2286 2.3778
237 CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT 11.98 1.50 2.1130 1.7376 1.8327 1.1155
238 CARDIAC PACEMAKER DEVICE REPLACEMENT 18.74 2.15 4.1351 4.1278 2.1841 2.9263
239 VEIN LIGATION & STRIPPING 13.52 - 0.7781 0.8001 0.9175 1.0691
240 OTHER CIRCULATORY SYSTEM O.R. PROCEDURES 51.87 3.60 4.9357 4.3816 0.9738 1.3202
241 IMPLANTATION OR REPLACEMENT OF AICD, TOTAL SYSTEM - - 9.3562 9.2842 2.4425 5.4116
242 AICD COMPONENT IMPLANTATION/REPLACEMENT 3.91 - 3.9322 3.9249 3.7645 1.9450
245 CIRC DISORD W AMI W INVASIVE CARDIAC INVESTIGATION PROC W CC 26.62 4.47 3.3064 3.2097 1.4431 0.0000
246 CIRC DISORD W AMI W INVASIVE CARDIAC INVESTIGATION PROC W/O CC 18.57 3.04 2.2625 2.1807 1.4659 0.0000
247 CIRC DISORD W AMI W/O INVASIVE CARDIAC INVESTIGATION PROC, DIED 18.33 1.82 1.5611 1.2476 1.4677 0.0000
248 CIRC DISORD W AMI W/O INVASIVE CARDIAC INVESTIGATION PROC W CC 24.54 3.60 2.4819 2.3885 1.0542 0.0000
249 CIRC DISORD W AMI W/O INVASIVE CARDIAC INVESTIGATION PROC W/O CC 16.60 2.78 1.5315 1.4578 1.0357 0.0000
250 CIRC DISORDER EXCEPT AMI, W INVASIVE CARDIAC INVESTIGATION PROC 11.49 - 0.9057 1.3397 1.7379 0.0000
251 INFECTIVE ENDOCARDITIS 37.33 5.09 5.6789 3.1746 0.9287 0.0000
252 HEART FAILURE & SHOCK 29.82 2.87 1.3338 1.3944 0.7984 0.0000
253 DEEP VEIN THROMBOSIS 21.91 2.77 1.1066 1.1213 0.7282 0.0000
254 PERIPHERAL VASCULAR DISORDERS 45.09 2.41 1.5504 0.8816 0.9007 0.0000
255 ATHEROSCLEROSIS W CC 21.15 2.19 1.4640 1.2624 0.9175 0.0000
256 ATHEROSCLEROSIS W/O CC 12.52 1.50 0.8788 0.7640 0.9129 0.0000
257 HYPERTENSION W CC 17.70 2.34 0.8479 0.8479 0.7144 0.0000
258 HYPERTENSION W/O CC 29.60 1.84 0.4840 0.7487 0.6653 0.0000
259 SYNCOPE & COLLAPSE W CC 18.67 1.89 0.8058 0.7798 0.7773 0.0000
260 SYNCOPE & COLLAPSE W/O CC 10.46 - 0.4160 0.4495 0.8285 0.0000
261 CHEST PAIN 31.10 - 0.3769 0.4494 1.0725 0.0000
262 OTHER CIRCULATORY SYSTEM DIAGNOSES W CC 19.66 2.13 1.8291 2.6575 1.0758 0.0000
263 OTHER CIRCULATORY SYSTEM DIAGNOSES W/O CC 86.32 3.06 1.0623 3.9600 1.0823 0.0000

SCHEDULE 1 TABLE: COST WEIGHTS AND TRIM POINTS FOR AN-DRG CHARGES FOR ADMITTED PATIENTS

1. 2. 3. 4. 5. 6. 7. 8.
Upper Lower Inlier Inlier OBD Theatre
AN-DRG DESCRIPTION Trim Trim Cost Cost Cost Cost
Point Point Weight Weight— Weight Weight
(Version 2) (Days) (Days) (except W&CH,
W&CH, ACH
ACH)
264 CONGENITAL HEART DISEASE AGE >9 12.42 1.44 1.2007 0.8398 1.0316 0.0000
265 CONGENITAL HEART DISEASE AGE <10 10.14 1.33 1.5478 1.6087 1.4888 0.0000
266 MAJOR ARRHYTHMIA & CARDIAC ARREST W CC 21.02 2.01 1.5718 1.4128 1.2777 0.0000
267 MAJOR ARRHYTHMIA & CARDIAC ARREST W/O CC 16.51 1.61 0.6988 0.9969 1.1829 0.0000
268 NON-MAJOR ARRHYTHMIA & CONDUCTION DISORDERS W CC 21.14 1.95 1.0660 1.0743 0.9276 0.0000
269 NON-MAJOR ARRHYTHMIA & CONDUCTION DISORDERS W/O CC 7.76 - 0.5224 0.4599 1.0436 0.0000
270 UNSTABLE ANGINA 11.42 1.35 0.8970 0.8183 0.9856 0.0000
271 VALVULAR DISORDERS W CC 17.05 1.99 1.1742 0.9681 0.9231 0.0000
272 VALVULAR DISORDERS W/O CC 6.90 - 0.4694 0.4640 0.9198 0.0000
300 RECTAL RESECTION W CC 42.09 6.10 4.2287 4.1773 1.0270 1.9038
301 RECTAL RESECTION W/O CC 23.79 4.08 2.6656 3.0713 0.9382 1.8403
302 MAJOR SMALL & LARGE BOWEL PROCEDURES W CC 52.59 6.01 4.2312 4.7749 1.1104 1.6685
303 MAJOR SMALL & LARGE BOWEL PROCEDURES W/O CC 20.46 3.52 2.4669 3.1840 0.8875 1.4780
304 PERITONEAL ADHESIOLYSIS W CC 42.94 5.33 3.2964 3.1375 1.0109 1.1910
305 PERITONEAL ADHESIOLYSIS W/O CC 17.87 2.05 1.7016 3.2895 0.8617 1.1434
306 MINOR SMALL & LARGE BOWEL PROCEDURES W CC 18.49 3.55 2.4726 2.2097 0.9100 1.2387
307 MINOR SMALL & LARGE BOWEL PROCEDURES W/O CC 11.02 2.39 1.4130 1.6972 0.8149 1.0746
308 STOMACH, OESOPHAGEAL & DUODENAL PROCEDURES AGE >9 W MAJOR CC 47.42 6.02 5.8985 5.2414 1.3403 2.0032
309 STOMACH, OESOPHAGEAL & DUODENAL PROCEDURES AGE >9 W NON-MAJOR CC 36.08 5.24 4.2279 3.6151 1.1557 1.6533
310 STOMACH, OESOPHAGEAL & DUODENAL PROCEDURES AGE >9 W/O CC 18.59 2.71 1.8282 1.9824 0.9462 1.1507
311 STOMACH, OESOPHAGEAL & DUODENAL PROCEDURES AGE < 10 28.49 2.86 1.8350 1.8250 1.3194 0.9209
312 ANAL & STOMAL PROCEDURES 10.68 - 0.6723 0.7219 0.8784 0.5835
313 HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL AGE >9 17.81 1.76 0.9690 0.7512 0.8788 0.8128
314 INGUINAL & FEMORAL HERNIA PROCEDURES AGE >9 9.75 - 0.7850 0.7017 0.8692 0.8333
315 HERNIA PROCEDURES AGE <10 3.29 - 0.5170 0.5146 1.3644 0.7201
316 APPENDICECTOMY W COMPLICATED PRINCIPAL DIAG 13.00 2.09 1.2899 1.7132 0.9379 0.8264
317 APPENDICECTOMY W/O COMPLICATED PRINCIPAL DIAG 8.08 - 0.8323 0.9907 0.9406 0.7643

SCHEDULE 1 TABLE: COST WEIGHTS AND TRIM POINTS FOR AN-DRG CHARGES FOR ADMITTED PATIENTS

1. 2. 3. 4. 5. 6. 7. 8.
Upper Lower Inlier Inlier OBD Theatre
AN-DRG DESCRIPTION Trim Trim Cost Cost Cost Cost
Point Point Weight Weight— Weight Weight
(Version 2) (Days) (Days) (except W&CH,
W&CH, ACH
ACH)
318 OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W CC 42.71 4.74 3.5133 4.5107 1.0446 1.1140
319 OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W/O CC 31.23 1.82 1.2361 1.2429 1.1108 1.0435
320 DIGESTIVE MALIGNANCY 28.76 3.03 1.3634 1.0804 0.8438 0.0000
321 G.I. HAEMORRHAGE W CC 29.40 2.25 1.3329 1.5917 0.9307 0.0000
322 G.I. HAEMORRHAGE W/O CC 17.36 1.43 0.5261 1.2550 0.8974 0.0000
323 COMPLICATED PEPTIC ULCER W CC 16.49 2.19 1.5625 1.0835 0.9879 0.0000
324 COMPLICATED PEPTIC ULCER W/O CC 122.53 4.98 0.3595 1.3818 1.1912 0.0000
325 UNCOMPLICATED PEPTIC ULCER 57.07 2.52 0.5818 0.4271 0.9441 0.0000
326 INFLAMMATORY BOWEL DISEASE W CC 28.84 3.02 1.6126 1.7080 0.8502 0.0000
327 INFLAMMATORY BOWEL DISEASE W/O CC 17.99 2.05 0.6936 1.8030 0.9346 0.0000
328 G.I. OBSTRUCTION 15.30 1.68 0.8432 1.0253 0.8183 0.0000
329 OESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS AGE >9 W CC 17.05 1.78 0.9609 1.4248 0.8640 0.0000
330 OESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS AGE >9 W/O CC 9.56 - 0.3409 0.4035 0.9629 0.0000
331 OESOPHAGITIS, & MISC DIGEST DISORDERS AGE <10 8.08 - 0.4748 0.4680 1.1939 0.0000
332 OTHER DIGESTIVE SYSTEM DIAGNOSES AGE >9 W CC 18.54 1.95 1.2949 1.3775 1.0467 0.0000
333 OTHER DIGESTIVE SYSTEM DIAGNOSES AGE >9 W/O CC 8.23 - 0.2917 0.3834 0.9874 0.0000
334 OTHER DIGESTIVE SYSTEM DIAGNOSES AGE <10 7.63 - 0.3416 0.3287 1.0643 0.0000
335 GASTROENTERITIS AGE <10 6.05 - 0.4986 0.4970 1.0510 0.0000
360 PANCREAS, LIVER & SHUNT PROCEDURES W CC 61.54 7.15 6.4130 6.0684 1.2051 1.6646
361 PANCREAS, LIVER & SHUNT PROCEDURES W/O CC 33.95 3.83 2.7047 2.4121 0.9910 1.4664
362 BILIARY TRACT PROC EXC ONLY CHOLECYST W OR W/O C.D.E. W MAJOR CC 49.41 7.58 5.3339 4.9355 1.1318 1.7126
363 BILIARY TRACT PROC EXC ONLY CHOLECYST W OR W/O C.D.E. W NON-MAJOR CC 23.35 3.57 3.7825 11.6461 1.0227 1.7478
364 BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR W/O C.D.E. W/O CC 19.00 3.42 2.5160 2.3013 0.8986 1.4113
365 CHOLECYSTECTOMY W C.D.E. W CC 76.49 11.33 4.1969 3.8760 1.0165 1.5377
366 CHOLECYSTECTOMY W C.D.E. W/O CC 13.45 2.46 2.3352 2.1910 0.8366 1.2140
367 CHOLECYSTECTOMY W/O C.D.E. 13.48 1.58 1.2362 1.4946 0.9952 1.0779
368 HEPATOBILIARY DIAGNOSTIC PROCEDURE FOR MALIGNANCY 32.50 5.19 2.7674 2.8636 1.0764 1.1437

SCHEDULE 1 TABLE: COST WEIGHTS AND TRIM POINTS FOR AN-DRG CHARGES FOR ADMITTED PATIENTS

1. 2. 3. 4. 5. 6. 7. 8.
Upper Lower Inlier Inlier OBD Theatre
AN-DRG DESCRIPTION Trim Trim Cost Cost Cost Cost
Point Point Weight Weight— Weight Weight
(Version 2) (Days) (Days) (except W&CH,
W&CH, ACH
ACH)
369 HEPATOBILIARY DIAGNOSTIC PROCEDURE FOR NON-MALIGNANCY 42.24 4.27 2.7066 2.2598 1.2444 0.9085
370 OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES 38.62 4.97 8.0406 2.2056 1.3318 1.1389
371 CIRRHOSIS & ALCOHOLIC HEPATITIS W CC 29.38 3.26 2.0701 1.3024 0.8851 0.0000
372 CIRRHOSIS & ALCOHOLIC HEPATITIS W/O CC 14.42 1.83 1.1205 0.6094 0.7560 0.0000
373 MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS 28.86 3.16 1.8303 1.1052 0.9972 0.0000
374 DISORDERS OF PANCREAS EXCEPT MALIGNANCY W CC 23.46 2.44 1.5113 1.5835 0.8424 0.0000
375 DISORDERS OF PANCREAS EXCEPT MALIGNANCY W/O CC 13.92 1.71 0.7775 1.3725 0.7470 0.0000
376 DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA W CC 25.53 2.77 1.5398 3.5302 0.9265 0.0000
377 DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA W/O CC 13.51 1.42 0.7091 0.8283 1.3414 0.0000
378 DISORDERS OF THE BILIARY TRACT W CC 15.97 1.90 1.2305 0.7802 0.8761 0.0000
379 DISORDERS OF THE BILIARY TRACT W/O CC 43.60 1.40 0.5790 1.1232 0.8409 0.0000
400 BILATERAL OF MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY 57.34 10.24 7.7607 7.7660 0.8107 4.7275
401 OTHER MAJOR JOINT & LIMB REATTACHMENT PROCEDURES W CC 23.14 4.01 4.3357 4.2938 1.1861 2.2449
402 OTHER MAJOR JOINT & LIMB REATTACHMENT PROCEDURES W/O CC 22.69 3.78 3.4733 3.5157 1.1196 2.2522
403 HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT AGE >9 W CC 25.96 3.70 3.8033 4.0241 0.8596 1.2058
404 HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT AGE >9 W/O CC 18.44 2.62 2.3373 2.4567 0.8347 1.1414
405 HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT AGE <10 32.75 3.23 2.4659 2.4871 1.1278 1.0992
406 AMPUTATION FOR MUSCULOSKELET SYSTEM & CONN TISSUE DISORDERS 55.00 7.04 4.3866 2.7928 0.8565 0.9208
407 BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE 32.03 2.83 2.3541 1.9468 0.9947 0.7025
408 WND DEBRID & SKIN GRAFT EXC HAND, MS & CONN TISS DIS W CC 64.62 7.34 7.4915 4.1582 0.9024 1.9938
409 WND DEBRID & SKIN GRAFT EXC HAND, MS & CONN TISS DIS W/O CC 23.63 2.47 2.3689 3.9799 0.8120 1.0962
411 LOWER EXTREM & HUMER PROC EXC HIP, FOOT, FEMUR AGE >9 W CC 32.94 3.71 3.0958 3.5489 0.8338 1.2175
412 LOWER EXTREM & HUMER PROC EXC HIP, FOOT, FEMUR AGE < 10 5.75 - 0.9138 0.9216 1.2025 0.8881
413 KNEE PROCEDURES 10.18 - 0.7980 1.0777 1.2242 0.7989
414 MAJOR SHOULDER/ELBOW PROC 8.67 - 0.9271 1.1626 0.8834 0.9711
415 SHOULDER, ELBOW OR FOREARM PROCEDURE, EXC MAJOR JOINT PROCEDURE 7.71 - 0.8896 0.8999 0.9946 1.0169
416 FOOT PROCEDURES 47.96 1.81 1.0833 1.3458 0.9311 0.9988

SCHEDULE 1 TABLE: COST WEIGHTS AND TRIM POINTS FOR AN-DRG CHARGES FOR ADMITTED PATIENTS

1. 2. 3. 4. 5. 6. 7. 8.
Upper Lower Inlier Inlier OBD Theatre
AN-DRG DESCRIPTION Trim Trim Cost Cost Cost Cost
Point Point Weight Weight— Weight Weight
(Version 2) (Days) (Days) (except W&CH,
W&CH, ACH
ACH)
417 SOFT TISSUE PROCEDURES 10.25 - 0.7992 0.9529 0.9569 0.8208
418 MAJOR THUMB OR JOINT PROC 8.37 - 0.9310 1.0976 0.9914 0.8420
419 HAND OR WRIST PROC, EXCEPT MAJOR JOINT PROCEDURE 6.43 - 0.5703 0.7332 1.1438 0.7736
420 LOCAL EXCISION & REMOVAL OF INT FIX DEVICES OF HIP & FEMUR 9.07 - 0.9668 0.9992 0.9330 0.8260
421 LOCAL EXCISION & REMOVAL OF INT FIX DEVICES EXC HIP & FEMUR 14.07 - 0.7133 0.9874 1.2839 0.8312
422 ARTHROSCOPY 17.28 - 0.5880 0.7199 1.2117 0.8211
423 OTHER MUSCULOSKELETAL SYSTEM & CONN TISS O.R. PROC W CC 12.48 1.97 4.0419 4.9883 0.9019 0.9469
424 OTHER MUSCULOSKELETAL SYSTEM & CONN TISS O.R. PROC W/O CC 10.85 1.40 1.3091 1.9045 0.9821 0.9828
425 FRACTURES OF FEMUR 34.34 3.72 3.6428 3.5124 0.6891 0.0000
426 FRACTURES OF HIP & PELVIS 28.81 3.04 1.8719 4.7317 0.6932 0.0000
427 SPRAINS, STRAINS & DISLOCATIONS OF HIP, PELVIS AND THIGH 9.60 - 0.8067 0.6946 0.6215 0.0000
428 OSTEOMYELITIS 17.12 2.27 2.6765 1.8280 0.9101 0.0000
429 PATHOLOGICAL FRACTURES & MUSCULOSKELETAL & CONN TISSUE MALIG 39.92 3.79 2.2069 3.2000 0.8477 0.0000
430 CONNECTIVE TISSUE DISORDERS 31.59 2.90 1.8254 2.6695 0.8267 0.0000
431 SEPTIC ARTHRITIS 15.87 2.11 1.5452 1.9764 0.8851 0.0000
432 MEDICAL BACK PROBLEMS 20.91 2.02 1.0405 1.3232 0.7789 0.0000
433 BONE DISEASES & SPECIFIC ARTHROPATHIES W CC 24.05 3.02 1.3290 1.2468 0.6721 0.0000
434 BONE DISEASES & SPECIFIC ARTHROPATHIES W/O CC 20.51 2.07 0.8780 1.1754 0.6284 0.0000
435 NON-SPECIFIC ARTHROPATHIES 13.54 1.68 0.7893 0.9995 0.6603 0.0000
436 SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE 13.37 - 0.6237 0.5960 0.9012 0.0000
437 TENDONITIS, MYOSITIS & BURSITIS 19.63 1.67 0.6957 1.9802 0.8620 0.0000
438 AFTERCARE, MUSCOSKELETAL SYSTEM & CONNECTIVE TISSUE 46.64 2.61 1.1995 2.2883 0.7292 0.0000
439 FX, SPRAIN, STRAIN & DISL OF FOREARM, HAND, FOOT AGE > 9 W CC 17.51 1.86 1.2582 0.8455 0.9148 0.0000
440 FX, SPRAIN, STRAIN & DISL OF FOREARM, HAND, FOOT AGE < 10 2.75 - 0.2871 0.2816 1.4122 0.0000
441 FX, SPRAIN, STRAIN & DISL OF UPPERARM, LOWER LEG EXC FOOT AGE > 9 W CC 29.45 2.88 1.9676 1.2050 0.6895 0.0000
442 FX, SPRAIN, STRAIN & DISL OF UPPERARM, LOWER LEG EXC FOOT AGE > 9 W/O CC 19.93 1.41 0.6224 1.5358 0.7418 0.0000
443 FX, SPRAIN, STRAIN & DISL OF UPPERARM, LOWER LEG EXC FOOT AGE < 10 3.68 - 0.4056 0.4042 1.1695 0.0000

SCHEDULE 1 TABLE: COST WEIGHTS AND TRIM POINTS FOR AN-DRG CHARGES FOR ADMITTED PATIENTS

1. 2. 3. 4. 5. 6. 7. 8.
Upper Lower Inlier Inlier OBD Theatre
AN-DRG DESCRIPTION Trim Trim Cost Cost Cost Cost
Point Point Weight Weight— Weight Weight
(Version 2) (Days) (Days) (except W&CH,
W&CH, ACH
ACH)
444 MAJOR CRANIO-MAXILLO FACIAL SURGERY 23.38 3.56 2.8731 3.3428 1.1253 2.1652
445 MINOR CRANIO-MAXILLO FACIAL SURGERY 11.92 2.00 1.6018 1.6144 1.3993 1.2234
446 OTHER MUSCULOSKELETAL SYSTEM & CONN TISS DIAG AGE >9 18.93 1.79 0.6573 0.5064 0.8301 0.0000
447 BACK & NECK PROCEDURES W SPINAL FUSION 36.39 3.75 3.1681 3.5156 1.0504 1.4508
448 BACK & NECK PROCEDURES W/O SPINAL FUSION 22.87 3.08 1.8000 1.9179 0.8141 1.1296
449 HIP REPLACEMENT W CC 37.89 4.59 5.0113 4.8699 1.1043 3.1763
450 HIP REPLACEMENT W/O CC 24.45 3.52 3.5515 3.5051 1.0486 2.9683
451 LOWER EXTREM & HUMER PROC EXC HIP, FOOT, FEMUR AGE > 9 W/O CC 15.47 1.84 1.4612 2.0157 0.9201 1.0745
452 INFECT/INFLAM OF BONE & JOINT W MISC MS & CONN TISS PROC AGE <10 136.91 8.52 2.2282 2.6566 1.1039 0.6425
453 FX, SPRAIN, STRAIN & DISL OF FOREARM, HAND, FOOT AGE > 9 W/O CC 6.61 - 0.3469 0.3673 1.1447 0.0000
454 OTHER MUSCULOSKELETAL SYSTEM & CONN TISS DIAG AGE <10 43.39 2.02 3.4728 2.2122 0.9282 0.0000
480 SKIN GRAFT &/OR DEBRID FOR SKIN ULCER, CELLULITIS 81.44 8.77 5.0728 5.6380 0.8257 1.1058
481 SKIN GRAFT &/OR DEBRID EXC FOR SKIN ULCER, CELLULITIS 22.34 2.20 1.3314 3.6473 0.8593 0.8229
482 PERIANAL & PILONIDAL PROCEDURES 6.54 - 0.6058 0.5374 0.8521 0.5558
483 SKIN, SUBCUTANEOUS TISSUE & BREAST PLASTIC PROCEDURES 12.53 - 0.6128 1.7413 0.9035 0.6645
484 OTHER SKIN, SUBCUTANEOUS TISSUE & BREAST PROCEDURES 13.61 - 0.5352 0.5640 1.2314 0.5185
485 SKIN ULCERS 62.33 6.19 1.7689 1.9826 0.7330 0.0000
486 MAJOR SKIN DISORDERS 25.11 3.21 1.5208 1.5987 0.8380 0.0000
487 MALIGNANT BREAST DISORDERS 43.23 4.16 1.3582 1.2520 1.2154 0.0000
488 NON-MALIGNANT BREAST DISORDERS 5.92 - 0.3803 0.3885 0.9673 0.0000
489 CELLULITIS AGE >9 W CC 27.36 2.77 1.4803 3.8128 0.8246 0.0000
490 CELLULITIS AGE >9 W/O CC 12.39 1.50 0.6980 0.6227 0.7627 0.0000
491 CELLULITIS AGE <10 7.78 - 0.6602 0.6649 1.0255 0.0000
492 TRAUMA TO THE SKIN, SUBCUT TISSUE & BREAST AGE >9 W CC 19.35 1.96 0.9731 0.9945 0.8422 0.0000
493 TRAUMA TO THE SKIN, SUBCUT TISSUE & BREAST AGE >9 W/O CC 12.73 - 0.3374 0.3439 0.8785 0.0000
494 TRAUMA TO THE SKIN, SUBCUT TISSUE & BREAST AGE <10 3.53 - 0.2935 0.2937 1.1609 0.0000
495 MAJOR PROCEDURES FOR MALIGNANT BREAST CONDITIONS 26.09 2.81 1.4339 1.4765 0.7605 1.0144

SCHEDULE 1 TABLE: COST WEIGHTS AND TRIM POINTS FOR AN-DRG CHARGES FOR ADMITTED PATIENTS

1. 2. 3. 4. 5. 6. 7. 8.
Upper Lower Inlier Inlier OBD Theatre
AN-DRG DESCRIPTION Trim Trim Cost Cost Cost Cost
Point Point Weight Weight— Weight Weight
(Version 2) (Days) (Days) (except W&CH,
W&CH, ACH
ACH)
496 MINOR PROCEDURES FOR MALIGNANT BREAST CONDITIONS 8.22 - 0.7472 0.7512 0.9485 0.8117
497 MAJOR PROCEDURES FOR NON-MALIGNANT BREAST CONDITIONS 12.84 1.63 1.0489 1.0781 0.8635 0.9887
498 MINOR PROCEDURES FOR NON-MALIGNANT BREAST CONDITIONS 5.96 - 0.5695 0.5400 1.2324 0.7934
499 MINOR SKIN DISORDERS 11.51 1.37 0.7327 0.8704 0.9121 0.0000
520 AMPUTAT OF LOW LIMB FOR ENDOCRINE, NUTRIT, & METABOL DISORDERS 79.76 9.00 6.2723 5.3825 0.8451 1.0138
521 ADRENAL PROCEDURES 23.15 3.83 3.2981 3.3160 1.1238 1.5940
522 PITUITARY PROCEDURES 37.01 4.36 2.9049 2.7644 1.0959 1.8268
523 SKIN GRAFT & WOUND DEBRID FOR ENDOC, NUTRIT AND METABOL DISORDERS 62.53 8.48 3.3710 3.1623 0.7517 0.7613
524 O.R. PROCEDURES FOR OBESITY 19.92 2.64 1.0190 1.0631 0.9376 0.8523
525 PARATHYROID PROCEDURES 39.07 3.39 1.5877 1.6343 0.9423 1.1802
526 THYROID PROCEDURES 12.79 1.98 1.1196 1.2910 0.9176 1.1063
527 THYROGLOSSAL PROCEDURES 11.21 1.38 0.6610 1.3051 1.1318 0.7635
528 OTHER ENDOCRINE NUTRIT & METAB O.R. PROC 24.16 2.48 3.4694 2.1882 1.2903 0.9015
529 DIABETES AGE >35 48.52 2.99 1.1794 1.1529 0.8144 0.0000
530 DIABETES AGE <36 14.78 1.66 0.9302 1.0086 0.9889 0.0000
531 NUTRITIONAL & MISC METABOLIC DISORDERS AGE >9 W CC 19.72 2.27 1.5275 0.9466 0.8602 0.0000
532 NUTRITIONAL & MISC METABOLIC DISORDERS AGE >9 W/O CC 11.99 1.35 0.6519 1.2924 0.7402 0.0000
533 NUTRITIONAL & MISC METABOLIC DISORDERS AGE <10 10.71 - 0.8283 0.8177 0.9371 0.0000
534 INBORN ERRORS OF METABOLISM 15.45 1.44 0.4336 0.7251 1.3070 0.0000
535 ENDOCRINE DISORDERS 21.54 2.30 1.4628 2.8974 1.0829 0.0000
536 COMPULSIVE NUTRITION DISORDER REHABILIATION 87.22 9.24 4.1926 10.9787 0.7901 0.0000
550 KIDNEY TRANSPLANT 46.34 5.98 7.3212 7.4306 2.2333 3.0467
551 KIDNEY, URETER & MAJOR BLADDER PROC FOR NEOPLASM W CC 58.95 7.35 3.9763 4.3029 1.0651 1.9650
552 KIDNEY, URETER & MAJOR BLADDER PROC FOR NEOPLASM W/O CC 21.49 3.61 2.4685 3.3055 0.9556 1.7972
553 KIDNEY, URETER & MAJOR BLADDER PROC FOR NON-NEOPLASM 22.65 2.92 2.6313 2.7371 1.0886 1.3291
554 PROSTATECTOMY W CC 21.18 3.24 2.5167 2.1165 0.6897 0.9570
555 PROSTATECTOMY W/O CC 30.67 2.95 1.0190 1.0996 0.7676 0.7964

SCHEDULE 1 TABLE: COST WEIGHTS AND TRIM POINTS FOR AN-DRG CHARGES FOR ADMITTED PATIENTS

1. 2. 3. 4. 5. 6. 7. 8.
Upper Lower Inlier Inlier OBD Theatre
AN-DRG DESCRIPTION Trim Trim Cost Cost Cost Cost
Point Point Weight Weight— Weight Weight
(Version 2) (Days) (Days) (except W&CH,
W&CH, ACH
ACH)
556 MINOR BLADDER PROCEDURES 16.15 1.88 1.6649 3.5016 0.9652 1.0662
557 TRANSURETHRAL PROCEDURES W MAJOR CC 17.75 2.25 2.1187 1.8235 0.8774 0.9267
558 TRANSURETHRAL PROCEDURES W/O CC 8.29 - 0.6720 0.7024 1.0661 0.8185
559 URETHRAL PROCEDURES AGE >9 W CC 22.25 2.69 1.8223 1.5734 0.8214 0.9426
560 URETHRAL PROCEDURES AGE >9 W/O CC 8.10 - 0.7253 0.5950 0.8148 0.8198
561 URETHRAL PROCEDURES AGE <10 7.38 - 0.8656 0.8632 1.1805 0.8982
562 OTHER KIDNEY & URINARY TRACT O.R. PROCEDURES 33.02 3.50 3.8739 2.8727 1.2483 1.1075
563 RENAL FAILURE W CC 26.52 2.73 2.1822 1.1066 1.1015 0.0000
564 RENAL FAILURE W/O CC 30.72 2.85 0.8488 3.8479 0.7108 0.0000
565 ADMIT FOR RENAL DIALYSIS 4.78 - 0.2218 0.2687 1.1616 0.0000
566 KIDNEY & URINARY TRACT NEOPLASMS W CC 29.93 3.14 1.5950 1.1617 0.8438 0.0000
567 KIDNEY & URINARY TRACT NEOPLASMS W/O CC 11.59 - 0.3974 0.5132 0.9755 0.0000
568 KIDNEY & URINARY TRACT INFECTIONS AGE >9 W CC 20.54 2.37 1.3629 0.6301 0.8466 0.0000
569 KIDNEY & URINARY TRACT INFECTIONS AGE >9 W/O CC 11.88 1.39 0.6902 1.1302 0.8011 0.0000
570 KIDNEY & URINARY TRACT INFECTIONS AGE <10 7.04 - 0.6063 0.6053 1.0639 0.0000
571 URINARY STONES W ESW LITHOTRIPSY 2.17 - 0.4910 0.4915 1.5959 0.0000
572 URINARY STONES W/O ESW LITHOTRIPSY 12.28 - 0.3903 0.4827 0.8883 0.0000
573 KIDNEY & URINARY TRACT SIGNS & SYMPTOMS AGE >9 W CC 18.30 1.79 0.7957 0.7665 0.8000 0.0000
574 KIDNEY & URINARY TRACT SIGNS & SYMPTOMS AGE <10 2.37 - 0.4053 0.4057 1.0575 0.0000
575 URETHRAL STRICTURE W CC 18.39 1.65 0.7872 0.5135 0.9292 0.0000
576 URETHRAL STRICTURE W/O CC 6.88 - 0.2597 0.2538 0.9398 0.0000
578 OTHER KIDNEY & URINARY TRACT DIAGNOSES W MAJOR CC 57.84 4.30 2.6255 2.0132 1.1407 0.0000
579 OTHER KIDNEY & URINARY TRACT DIAGNOSES W NON-MAJOR CC 15.41 1.44 1.2216 1.8202 0.9388 0.0000
580 OTHER KIDNEY & URINARY TRACT DIAGNOSES W/O CC 9.82 - 0.4748 0.8364 1.0676 0.0000
581 KIDNEY & URINARY TRACT SIGNS & SYMPTOMS AGE >9 W/O CC 22.14 1.35 0.3724 0.3924 0.9490 0.0000
582 TRANSURETHRAL PROCEDURES W NON-MAJOR CC 16.09 1.51 1.0755 0.5315 0.8626 0.8777
600 MAJOR MALE PELVIC PROCEDURES 24.38 4.20 2.4970 2.5610 0.8904 1.5821

SCHEDULE 1 TABLE: COST WEIGHTS AND TRIM POINTS FOR AN-DRG CHARGES FOR ADMITTED PATIENTS

1. 2. 3. 4. 5. 6. 7. 8.
Upper Lower Inlier Inlier OBD Theatre
AN-DRG DESCRIPTION Trim Trim Cost Cost Cost Cost
Point Point Weight Weight— Weight Weight
(Version 2) (Days) (Days) (except W&CH,
W&CH, ACH
ACH)
601 TRANSURETHRAL PROSTATECTOMY W MAJOR CC 28.22 4.13 2.4736 2.5042 0.7685 1.2100
602 TRANSURETHRAL PROSTATECTOMY W NON-MAJOR CC 19.16 2.74 1.6172 1.6500 0.7468 1.0152
603 TRANSURETHRAL PROSTATECTOMY W/O CC 10.97 1.75 1.0401 1.0492 0.7593 0.8901
604 TESTES PROCEDURES, FOR MALIGNANCY W MAJOR CC 25.13 3.33 2.2025 2.2067 1.0184 0.8952
605 TESTES PROCEDURES, FOR MALIGNANCY W NON-MAJOR CC 24.31 2.46 1.5302 1.3242 0.8047 0.8746
606 TESTES PROCEDURES, FOR MALIGNANCY W/O CC 7.51 - 0.7482 0.7589 0.8654 0.7593
607 TESTES PROCEDURES, NON-MALIGNANCY AGE > 9 W CC 23.86 2.45 1.3195 0.8995 0.9572 0.8101
608 TESTES PROCEDURES, NON-MALIGNANCY AGE< 10 2.86 - 0.4733 0.4749 1.3367 0.7461
609 PENIS PROCEDURES 18.95 1.95 1.4554 2.2853 1.3446 1.1975
610 CIRCUMCISION AGE >9 10.43 - 0.5959 0.6848 1.2955 0.5818
611 CIRCUMCISION AGE <10 2.15 - 0.3632 0.3637 1.1207 0.4894
612 OTHER MALE REPRODUCTIVE SYST O.R. PROC FOR MALIGNANCY 28.10 2.92 1.3860 1.2639 1.1152 0.8522
613 OTHER MALE REPRODUCTIVE SYST O.R. PROC EXCEPT FOR MALIGNANCY 14.21 2.00 0.8598 2.1151 0.9369 0.7930
614 MALIGNANCY, MALE REPRODUCTIVE SYSTEM 47.49 4.50 1.5091 0.9504 0.7588 0.0000
615 BENIGN PROSTATIC HYPERTROPHY W MAJOR CC 25.10 3.33 2.0393 1.5863 0.8942 0.0000
616 BENIGN PROSTATIC HYPERTROPHY W NON-MAJOR CC 8.19 - 0.8370 0.8394 0.8459 0.0000
617 BENIGN PROSTATIC HYPERTROPHY W/O CC 7.55 - 0.3507 0.3627 0.9325 0.0000
618 INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM 14.92 1.50 0.6178 2.7157 0.9047 0.0000
619 STERILISATION, MALE 2.20 - 0.3795 0.3800 2.0687 0.0000
620 OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES 9.45 - 0.4426 0.4603 1.1816 0.0000
621 TESTES PROCEDURES, NON-MALIGNANCY AGE >9 W/O CC 18.79 - 0.5453 0.5765 1.0948 0.7481
640 PELVIC EVISCERATION & RADICAL VULVECTOMY 38.02 5.61 3.2174 3.2231 0.8855 1.6332
641 UTERINE ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIGNANCY W CC 35.38 5.27 2.2876 2.3094 0.8078 1.2611
642 UTERINE ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIGNANCY W/O CC 15.02 2.89 1.3865 1.4201 0.6813 1.2767
643 FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES 14.02 2.38 1.2185 1.0743 0.7418 0.9881
644 UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY 31.04 4.49 2.3013 2.3621 0.9499 1.1683
645 UTERINE & ADNEXA PROC FOR NON-MALIGNANCY 27.32 2.14 1.1617 1.2218 0.8524 0.9717

SCHEDULE 1 TABLE: COST WEIGHTS AND TRIM POINTS FOR AN-DRG CHARGES FOR ADMITTED PATIENTS

1. 2. 3. 4. 5. 6. 7. 8.
Upper Lower Inlier Inlier OBD Theatre
AN-DRG DESCRIPTION Trim Trim Cost Cost Cost Cost
Point Point Weight Weight— Weight Weight
(Version 2) (Days) (Days) (except W&CH,
W&CH, ACH
ACH)
646 CONISATION, VAGINA, CERVIX & VULVA PROCEDURES 11.38 - 0.5326 0.7525 1.2852 0.7811
647 LAPAROSCOPY & INCISIONAL TUBAL INTERRUPTION 6.90 - 0.5313 0.5401 1.3253 0.7512
648 ENDOSCOPIC TUBAL INTERRUPTION 3.70 - 0.4619 0.4652 1.3849 0.6835
649 OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES 15.00 2.32 1.3008 1.1525 1.0328 0.6931
650 MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM 40.56 3.48 1.2010 0.9849 0.8907 0.0000
651 INFECTIONS, FEMALE REPRODUCTIVE SYSTEM 12.33 - 0.4820 0.5871 0.8211 0.0000
652 MENSTURAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS 8.71 - 0.3140 0.3884 0.9252 0.0000
653 D & C WITHUT OTHER O.R. PROCEDURES 7.14 - 0.3757 0.3832 1.1196 0.4878
670 CAESAREAN DELIVERY W/O COMPLICATION DIAGNOSIS 10.89 2.18 1.4898 1.4870 1.0211 1.0951
671 CAESAREAN DELIVERY WITH MODERATE COMPLICATING DIAGNOSIS 16.72 2.61 1.7122 1.7110 1.0509 1.0370
672 CAESAREAN DELIVERY WITH SEVERE COMPLICATING DIAGNOSIS 27.34 3.46 2.1585 2.1833 0.9656 1.1137
674 VAGINAL DELIVERY W/O COMPLICATING DIAGNOSIS 8.54 1.43 0.7876 0.7532 1.0352 0.0000
675 VAGINAL DELIVERY WITH COMPLICATING DIAGNOSIS 9.21 1.54 0.9934 0.9241 1.0222 0.0000
676 VAGINAL DELIVERY WITH SEVERE COMPLICATING DIAGNOSIS 17.07 2.04 1.1907 1.1019 0.9965 0.0000
677 VAGINAL DELIVERY WITH O.R. PROCEDURE 24.27 2.42 1.3494 1.4082 1.1886 0.7026
678 POSTPARUM & POST ABORTION DIAGNOSES W/O O.R. PROCEDURE 34.56 1.60 0.6851 0.7231 0.9021 0.0000
679 POSTPARUM & POST ABORTION DIAGNOSES W O.R. PROCEDURE 6.28 - 0.5654 0.5823 1.4020 0.5211
680 ECTOPIC PREGNANCY 8.09 - 0.6783 0.6853 1.0600 0.0000
681 THREATENED ABORTION 11.49 - 0.4233 0.4503 1.0332 0.0000
682 ABORTION W/O D & C 5.69 - 0.3712 0.3815 1.2837 0.0000
683 ABORTION W D&C ASPIRATION CURETTAGE OR HYSTEROTOMY 3.90 - 0.4262 0.4288 1.4398 0.4544
684 PRETERM LABOUR 3.68 - 0.4065 0.4123 1.7345 0.0000
685 OTHER ANTEPARTUM DIAGNOSES W COMPLICATING PRINCIPAL DIAGNOSIS 8.66 - 0.4859 0.4997 0.9839 0.0000
686 OTHER ANTEPARTUM DIAGNOSES W/O COMPLICATING PRINCIPAL DIAGNOSIS 12.24 - 0.4531 0.4747 0.9872 0.0000
701 NEONATE, DIED/TRANS <5 DAYS OF ADM W/O SIG O.R. PROC, BORN HERE 3.51 - 0.3230 0.3238 0.8686 0.0000
702 NEONATE, DIED/TRANS <5 DAYS OF ADMISSION W SIG O.R. PROC 3.30 - 1.2289 1.2242 2.7474 0.4565
703 NEONATE, DIED/TRANS <5 DAYS OF ADM W/O SIG O.R. PROC, NOT BORN HERE 3.99 - 0.6694 0.6699 1.8600 0.0000

SCHEDULE 1 TABLE: COST WEIGHTS AND TRIM POINTS FOR AN-DRG CHARGES FOR ADMITTED PATIENTS

1. 2. 3. 4. 5. 6. 7. 8.
Upper Lower Inlier Inlier OBD Theatre
AN-DRG DESCRIPTION Trim Trim Cost Cost Cost Cost
Point Point Weight Weight— Weight Weight
(Version 2) (Days) (Days) (except W&CH,
W&CH, ACH
ACH)
704 DIED >4 DAYS OF ADMISSION 44.84 8.56 7.7563 7.7627 1.7878 0.0000
705 NEONATE ADMISSION WT <750G 95.90 7.51 62.2563 27.6457 1.5714 0.0000
706 NEONATE, ADMISSION WT 750-999G 144.04 27.89 20.1678 19.3164 1.4555 0.0000
707 NEONATE, ADMISSION WT 1000-1499G, W SIGNIF O.R. PROCEDURE 104.90 24.06 14.9463 14.9618 1.3731 0.6749
708 NEONATE, ADMISSION WT 1000-1499G, W/O SIGNIF O.R. PROCEDURE 79.09 13.40 9.3539 8.6940 1.2014 0.0000
709 NEONATE ADM WT 1500-1999G, W SIGNIF O.R. PROC, MULT MAJOR PROB 73.37 14.42 12.2401 10.9045 1.5641 0.8948
710 NEONATE ADM WT 1500-1999G, W SIGNIF O.R. PROC, W/O MULT MAJOR PROB 55.81 8.89 5.3309 5.3353 0.8999 0.5274
711 NEONATE ADM WT 1500-1999G, W/O SIGNIF O.R. PROC, W MULT MAJOR PROB 66.93 12.24 7.1867 6.8882 1.1765 0.0000
712 NEONATE ADM WT 1500-1999G, W/O SIGNIF O.R. PROC W MAJOR PROB 47.22 8.16 5.1359 4.7305 1.0743 0.0000
713 NEONATE ADM WT 1500-1999G, W/O SIGNIF O.R. PROC W OTHER MAJOR PROB 52.37 8.05 4.5565 3.9227 0.9458 0.0000
714 NEONATE ADM WT 1500-1999G, W/O SIGNIF O.R. PROC, W/O PROBLEM 38.45 5.50 3.6608 3.2311 1.0455 0.0000
715 NEONATE ADM WT 2000-2499G, W SIGNIF O.R. PROC, W MULT MAJOR PROB 44.46 13.67 9.5701 9.5781 1.4331 1.4053
716 NEONATE ADM WT 2000-2499G, W SIGNIF O.R. PROC, W/O MULT MAJOR PROB 24.49 5.33 4.6179 4.6217 1.3253 0.4545
717 NEONATE ADM WT 2000-2499G, W/O SIGNIF O.R. PROC, W MULT MAJOR PROB 46.96 6.73 4.4149 4.0546 1.2452 0.0000
718 NEONATE ADM WT 2000-2499G, W/O SIGNIF O.R. PROC, W MAJOR PROBLEM 42.74 5.65 3.0684 2.7757 1.0861 0.0000
719 NEONATE ADM WT 2000-2499G, W/O SIGNIF O.R. PROC, W OTHER PROBLEM 33.35 4.24 2.6739 0.9746 0.9238 0.0000
720 NEONATE ADM WT 2000-2499G, W/O SIGNIF O.R. PROC, W/O PROBLEM 18.99 2.13 1.8877 1.2530 0.8015 0.0000
721 NEONATE ADM WT >2499G, W SIGNIF O.R. PROC, W MULT MAJOR PROBLEM 67.84 7.83 9.4349 8.9857 1.7467 1.2000
722 NEONATE ADM WT >2499G,W SIGNIF O.R. PROC, W/O MULT MAJOR PROBLEM 20.20 2.49 4.1787 3.7115 1.4973 0.6226
723 NEONATE ADM WT >2499G, W MINOR ABDOMINAL PROCEDURE 4.81 - 1.0436 1.0445 1.1419 0.8307
724 NEONATE ADM WT >2499G, W/O SIGNIF O.R. PROC, W MULT MAJOR PROBLEM 21.91 2.83 2.6992 2.4487 1.4297 0.0000
725 NEONATE ADM WT >2499G, W/O SIGNIF O.R. PROC, W MAJOR PROBLEM 18.04 1.87 1.4897 1.9979 1.1310 0.0000
726 NEONATE ADM WT >2499G, W/O SIGNIF O.R. PROC, W OTHER PROBLEM 46.83 1.74 0.9685 0.8394 0.9573 0.0000
727 NEONATE ADM WT >2499G, W/O SIGNIF O.R. PROC, W/O PROBLEM 8.76 - 0.5009 0.4888 0.7303 0.0000
750 SPLENECTOMY 26.30 3.79 2.3668 2.7496 1.0754 1.1765
752 OTHER O.R. PROCEDURES OF BLOOD & BLOOD FORMING ORGANS 17.30 1.66 0.9805 4.1185 1.1197 0.8251
753 RED BLOOD CELL DISORDERS AGE >9 17.00 1.56 1.0231 2.2650 0.9076 0.0000

SCHEDULE 1 TABLE: COST WEIGHTS AND TRIM POINTS FOR AN-DRG CHARGES FOR ADMITTED PATIENTS

1. 2. 3. 4. 5. 6. 7. 8.
Upper Lower Inlier Inlier OBD Theatre
AN-DRG DESCRIPTION Trim Trim Cost Cost Cost Cost
Point Point Weight Weight— Weight Weight
(Version 2) (Days) (Days) (except W&CH,
W&CH, ACH
ACH)
754 RED BLOOD CELL DISORDERS AGE <10 13.48 1.81 1.2442 3.3187 1.2091 0.0000
755 COAGULATION DISORDERS 16.30 1.54 1.9185 1.4362 1.1844 0.0000
756 RETICULOENDOTHELIAL & IMMUNITY DISORDERS W MAJOR CC 29.16 3.49 2.2500 3.8814 1.4102 0.0000
757 RETICULOENDOTHELIAL & IMMUNITY DISORDERS W NON-MAJOR CC 20.60 2.39 1.4229 1.1560 1.1573 0.0000
758 RETICULOENDOTHELIAL & IMMUNITY DISORDERS W/O CC 12.63 1.42 0.9865 1.5535 0.9628 0.0000
770 LYMPHOMA & LEUKAEMIA W MAJOR O.R. PROCEDURE W CC 56.95 7.04 6.8320 6.3300 1.3864 1.8412
771 LYMPHOMA & NON-ACUTE LEUKAEMIA W OTHER O.R. PROC AGE >9 W CC 54.79 5.08 3.9821 3.0175 1.0726 0.9351
772 LYMPHOMA & NON-ACUTE LEUKAEMIA W OTHER O.R. PROC AGE >9 W/O CC 16.59 1.78 1.2268 1.0362 0.9927 0.8605
773 LYMPHOMA & NON-ACUTE LEUKAEMIA W OTHER O.R. PROC AGE <10 - - 5.1153 5.1195 1.2774 0.4990
774 LYMPHOMA & NON-ACUTE LEUKAEMIA 28.84 2.71 2.2176 5.6759 1.1880 0.0000
775 ACUTE LEUKAEMIA W/O MAJOR O.R. PROCEDURE 39.88 3.90 7.0785 7.4158 2.5409 0.0000
776 MYELOPROLIF DISORD OR POORLY DIFF NEOPL W MAJ O.R. PROC W CC 51.05 7.67 4.2391 3.6486 1.1302 1.3067
777 MYELOPROLIF DISORD OR POORLY DIFF NEOPL W MAJ O.R. PROC W/O CC 14.47 2.43 2.1803 2.2366 1.0369 1.1338
778 MYELOPROLIF DISORD OR POORLY DIFF NEOPL W OTHER O.R. PROC 28.68 2.45 1.9150 1.3316 1.1879 1.0248
779 RADIOTHERAPY 30.52 3.25 2.3314 1.5677 1.3368 0.0000
780 CHEMOTHERAPY 36.17 1.35 0.8255 0.7229 1.6935 0.0000
783 OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W CC 31.10 3.02 2.6121 1.4719 0.7542 0.0000
784 OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W/O CC 133.94 5.11 0.9558 0.5969 0.9078 0.0000
785 LYMPHOMA & LEUKAEMIA W MAJOR O.R. PROCEDURE W/O CC 42.57 4.57 2.2813 2.1038 0.9833 1.3043
800 HIV W SPECIFIED RELATED CONDITION, AGE <10 - - 1.1263 1.1272 3.2431 0.0000
801 HIV RELATED CNS DISEASE, AGE > 9 40.71 5.26 6.8272 4.9129 1.3840 0.0000
802 HIV RELATED MALIGNANCY, AGE > 9 14.21 2.14 2.5491 2.2242 2.1554 0.0000
803 HIV RELATED INFECTION, AGE > 9 22.98 2.91 2.7848 1.7758 2.8012 0.0000
804 HIV W OTHER RELATED CONDITION, AGE > 9 11.67 1.76 1.5007 1.1070 1.9451 0.0000
805 HIV W/O SPECIFIED RELATED CONDITION, AGE < 10 - - 0.6800 0.6806 1.8894 0.0000
806 HIV W/O SPECIFIED RELATED CONDITION, AGE > 9 1.00 - 0.6918 0.6865 1.2257 0.0000
807 O.R. PROCEDURE FOR INFECTIOUS & PARASITIC DISEASES 42.64 4.39 4.5071 5.0382 1.0458 0.9977

SCHEDULE 1 TABLE: COST WEIGHTS AND TRIM POINTS FOR AN-DRG CHARGES FOR ADMITTED PATIENTS

1. 2. 3. 4. 5. 6. 7. 8.
Upper Lower Inlier Inlier OBD Theatre
AN-DRG DESCRIPTION Trim Trim Cost Cost Cost Cost
Point Point Weight Weight— Weight Weight
(Version 2) (Days) (Days) (except W&CH,
W&CH, ACH
ACH)
808 SEPTICAEMIA AGE >9 28.57 3.30 2.0872 1.7756 0.9992 0.0000
809 SEPTICAEMIA AGE <10 24.13 2.33 1.0003 0.8172 1.2035 0.0000
810 POSTOPERATIVE & POST-TRAUMATIC INFECTIONS 22.30 2.11 1.1734 2.2736 0.8347 0.0000
811 FEVER OF UNKNOWN ORIGIN AGE >9 W CC 18.07 2.17 1.4799 1.1603 0.8367 0.0000
812 FEVER OF UNKNOWN ORIGIN AGE >9 W/O CC 8.92 - 0.6988 0.5290 0.8580 0.0000
813 FEVER OF UNKNOWN ORIGIN AGE <10 5.09 - 0.3371 0.3374 0.9579 0.0000
814 VIRAL ILLNESS AGE >9 8.49 - 0.5918 0.5866 0.9489 0.0000
815 VIRAL ILLNESS AGE <10 5.99 - 0.4049 0.4020 1.1057 0.0000
816 OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES W CC 22.21 2.92 2.2901 1.8098 1.2678 0.0000
817 OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES W/O CC 10.76 1.40 1.0981 1.3012 1.1315 0.0000
830 O.R. PROCEDURE W PRINCIPAL DIAGNOSES OF MENTAL ILLNESS 123.40 8.60 6.4393 5.6672 0.7329 1.0514
831 ACUTE ADJUST REACT & DISTURUBANCE OF PSYCHOSOCIAL DYSFUNCTION 16.99 1.70 0.8020 1.3467 0.7796 0.0000
832 DEPRESSIVE NEUROSES 30.72 2.66 0.7595 1.4677 0.6134 0.0000
833 NEUROSES EXCEPT DEPRESSIVE 22.28 2.26 0.9651 2.3189 0.6783 0.0000
834 DISORDERS OF PERSONALITY & IMPULSE CONTROL 112.79 5.02 1.6125 0.5122 0.7136 0.0000
835 ORGANIC DISTURBANCES & MENTAL RETARDATION 65.34 5.32 2.8970 4.1525 0.5033 0.0000
836 PSYCHOSES 52.82 4.90 3.6802 2.5694 0.6492 0.0000
837 CHILDHOOD MENTAL DISORDERS 17.68 2.04 1.4576 1.4264 0.6801 0.0000
838 OTHER MENTAL DISORDER DIAGNOSES 9.89 - 0.8248 0.9344 0.9586 0.0000
850 OPIOID ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE 8.42 - 0.4777 0.4859 0.8353 0.0000
851 OPIOID ABUSE OR DEPENDENCE 16.31 1.59 0.5776 0.4858 0.5847 0.0000
852 COCAINE OR OTHER DRUG ABUSE OR DEPENDENCE, LEFT AMA 12.29 - 0.4122 0.4177 1.0542 0.0000
853 COCAINE OR OTHER DRUG ABUSE OR DEPENDENCE 25.53 2.12 1.1087 0.9881 0.8279 0.0000
854 ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE 6.05 - 0.4309 0.4429 0.9682 0.0000
855 ALCOHOL ABUSE OR DEPENDENCE 13.28 1.38 0.7862 1.2445 0.7488 0.0000
870 TRACHEOSTOMY FOR MULTIPLE SIGNIFICANT TRAUMA AGE >15 88.37 13.92 21.4604 18.9133 2.3385 5.4400
871 TRACHEOSTOMY FOR MULTIPLE SIGNIFICANT TRAUMA AGE <16 20.54 2.58 21.4193 21.5234 2.7151 1.9158

SCHEDULE 1 TABLE: COST WEIGHTS AND TRIM POINTS FOR AN-DRG CHARGES FOR ADMITTED PATIENTS

1. 2. 3. 4. 5. 6. 7. 8.
Upper Lower Inlier Inlier OBD Theatre
AN-DRG DESCRIPTION Trim Trim Cost Cost Cost Cost
Point Point Weight Weight— Weight Weight
(Version 2) (Days) (Days) (except W&CH,
W&CH, ACH
ACH)
872 CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA 49.00 16.33 10.7034 10.7303 1.9110 3.0931
873 HIP, FEMUR & LIMB REATTACHMENT PROC FOR MULTIPLE SIGNIFICANT TRAUMA 52.88 7.02 5.8964 6.4815 1.1713 3.0274
874 OTHER O.R. PROCEDURE FOR MULTIPLE SIGNIFICANT TRAUMA 51.77 6.02 6.3654 5.5272 1.3038 1.9269
875 HEAD, CHEST & LOWER LIMB DIAGNOSES OF MULTIPLE SIGNICANT TRAUMA 36.74 4.44 2.2354 2.7664 1.2093 0.0000
876 OTHER DIAGNOSES OF MULTIPLE SIGNIFICANT TRAUMA 9.73 - 2.1003 1.3352 1.1205 0.0000
877 SKIN GRAFTS FOR INJURIES 55.22 4.41 2.6721 2.8656 0.7536 1.1355
878 WOUND DEBRIDEMENTS FOR INJURIES 30.51 2.15 2.0530 1.5496 1.0986 1.0190
879 HAND PROCEDURES FOR INJURIES 8.30 - 0.7925 1.2541 1.0871 1.0049
880 OTHER O.R. PROCEDURES FOR INJURIES W CC 41.62 4.14 5.4284 4.4225 1.0829 1.2509
881 OTHER O.R. PROCEDURES FOR INJURIES W/O CC 10.85 - 1.1311 1.0875 1.0117 0.7992
882 INJURIES TO UNSPECIFIED OR MULITPLE SITES AGE >9 W MAJOR CC 37.04 3.53 1.3418 1.1109 0.7695 0.0000
883 INJURIES TO UNSPECIFIED OR MULITPLE SITES AGE >9 W NON-MAJOR CC 18.89 1.77 0.8762 0.8417 0.7234 0.0000
884 INJURIES TO UNSPECIFIED OR MULITPLE SITES AGE >9 W/O CC 14.24 - 0.3627 0.3718 0.8430 0.0000
885 INJURIES TO UNSPECIFIED OR MULITPLE SITES AGE <10 4.43 - 0.3741 0.3719 1.0478 0.0000
886 ALLERGIC REACTIONS AGE >9 6.33 - 0.3740 0.3545 0.9755 0.0000
887 ALLERGIC REACTIONS AGE <10 3.95 - 0.3353 0.3356 1.4009 0.0000
888 POISONING & TOXIC EFFECTS OF DRUGS AGE >9 W CC 17.66 - 0.8868 0.9423 1.0674 0.0000
889 POISONING & TOXIC EFFECTS OF DRUGS AGE >9 W/O CC 34.76 - 0.4330 0.7187 1.1263 0.0000
890 POISONING & TOXIC EFFECTS OF DRUGS AGE <10 2.71 - 0.2306 0.2244 1.1339 0.0000
891 COMPLICATIONS OF TREATMENT 16.11 1.42 0.8172 1.5157 0.8966 0.0000
892 OTHER INJURY, POISONING & TOXIC EFFECT DIAGNOSIS W CC 33.56 3.24 1.6954 1.1016 0.9048 0.0000
893 OTHER INJURY, POISONING & TOXIC EFFECT DIAGNOSIS W/O CC 9.78 - 0.4509 0.3715 1.2844 0.0000
894 LEAD POISONING 5.00 1.67 0.6953 0.8548 0.8848 0.0000
910 BURNS, TRANSFERRED TO ANOTHER ACUTE CARE FACILITY 38.81 2.33 3.2527 2.8629 1.7130 0.0000
911 EXTENSIVE BURNS W O.R. PROCEDURE 113.30 10.25 36.7432 19.7895 2.5160 6.0308
912 EXTENSIVE BURNS W/O O.R. PROCEDURE 14.66 3.00 1.7660 1.7714 2.0238 0.0000
913 NON-EXTENSIVE BURNS W SKIN GRAFT 31.19 4.07 5.6443 8.6476 1.2346 1.4171

SCHEDULE 1 TABLE: COST WEIGHTS AND TRIM POINTS FOR AN-DRG CHARGES FOR ADMITTED PATIENTS

1. 2. 3. 4. 5. 6. 7. 8.
Upper Lower Inlier Inlier OBD Theatre
AN-DRG DESCRIPTION Trim Trim Cost Cost Cost Cost
Point Point Weight Weight— Weight Weight
(Version 2) (Days) (Days) (except W&CH,
W&CH, ACH
ACH)
914 NON-EXTENSIVE BURNS W WOUND DEBRIDEMENT OR OTHER O.R. PROC 14.24 1.67 5.5235 6.5365 0.9750 0.8093
915 NON-EXTENSIVE BURNS W/O O.R. PROCEDURE 12.11 - 0.8189 0.9158 0.9193 0.0000
930 O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES 37.51 1.96 2.8025 2.8692 1.2124 0.8009
931 REHABILITATION 97.72 10.19 2.8463 4.5614 0.9412 0.0000
932 SIGNS & SYMPTOMS 22.27 2.26 0.9471 0.8575 0.8469 0.0000
933 AFTERCARE WITHOUT SDX OF HISTORY OF MALIGNANCY 22.88 2.21 0.6199 2.4217 0.9812 0.0000
934 OTHER FACTORS INFLUENCING HEALTH STATUS 40.53 3.65 0.7551 2.4373 0.6333 0.0000
935 MULTIPLE, OTHER & UNSPECIFIED CONGENITAL ANOMALIES 1.00 - 0.6618 0.4837 1.1266 0.0000
936 AFTERCARE WITH SDX OF HISTORY OF MALIGNANCY WITH ENDOSCOPY 24.63 - 0.2089 0.2388 1.2166 0.0000
937 AFTERCARE WITH SDX OF HISTORY OF MALIGNANCY W/O ENDOSCOPY 18.82 2.07 0.7570 0.4367 1.0242 0.0000
950 EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS 37.43 3.37 3.1122 6.3501 1.1149 1.4283
951 UNACCEPTABLE AS OBSTETRIC PRINCIPAL DIAGNOSIS 9.28 - 0.7497 0.7503 1.2819 0.0000
952 UNGROUPABLE 23.11 2.02 0.0000 0.0000 0.0000 0.0000
953 PROSTATIC O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS 47.77 7.38 3.9440 3.8646 0.7867 0.7741
954 NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS 52.51 3.49 1.5640 2.3067 0.9172 0.6486
955 NEONATAL DIAGNOSIS NOT CONSISTENT WITH AGE (>28 DAYS) 26.29 3.77 2.3452 2.1898 0.7370 0.0000
956 UNACCEPTABLE PRINCIPAL DIAGNOSIS 1.00 - 0.5123 0.6233 1.2550 0.0000

In this table:

"W & CH, ACH" means the Adelaide Children’s Hospital campus of the Women’s and Children’s Hospital;

"-", in relation to an upper or lower trim point, means 0 (zero).

SCHEDULE 2

Recognised hospitals: fees for non-admitted patients

Interpretation

1. In this schedule, unless the contrary intention appears—

"occasion of service", in relation to a service specified in this schedule provided by a recognised hospital,

means—

(a)

each occasion on which that service is provided to a patient in a functional unit of the recognised hospital; or

(b)

in the case of diagnostic tests, each diagnostic test, or simultaneous set of diagnostic tests, for a given patient.

Fees for non-admitted public patients in metropolitan hospitals

2. Fee to be charged by a metropolitan hospital (other than Noarlunga Health Services Incorporated and Gawler Health Services Incorporated) for services to a non-admitted public patient, for each occasion of service:

(a) accident and emergency service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $169
(b)
service provided by a medical practitioner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $100
(c) service provided by a surgeon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 52
(d)
service provided by an obstetrician or gynaecologist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 64
(e)
service provided by a dentist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 79
(f)
service provided by a paediatrician . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 71
(g)
service provided by a psychiatrist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 93
(h)
service provided by a radiologist/radiographer other than Magnetic Resonance Imaging . . . . $ 91

(i)        Magnetic Resonance Imaging (maximum fee, per scan) . . . . . . . . . . . . . . . . . . . . . . . . . . . $454

(j) service provided by a radiotherapist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $134

(k)

service provided by a person who is not a medical practitioner other than a radiologist/radiotherapist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 62

(l)
supply of a prescription item (per item) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 13.

Fees for non-admitted patients in country (etc.) hospitals

3. Fee to be charged by a country hospital, the Noarlunga Health Services Incorporated and the Gawler Health Services Incorporated for services to a non-admitted patient, for each occasion of service:

(a) service provided to a non-admitted public patient by a person other than a medical practitioner—

(i)

country regional hospital, country sub-regional hospital, Noarlunga Health Services Incorporated, Gawler Health Services Incorporated . . . . . . . . . . . . . $ 45

(ii) country hospital other than country regional or country sub-regional hospital . . . . . . $ 26;

(b)

nursingserviceprovidedtoanon-admittedprivatepatientduringattendancebymedical practitioner—

(i)

country regional hospital, country sub-regional hospital, Noarlunga Health Services Incorporated, Gawler Health Services Incorporated . . . . . . . . . . . . . $ 45

(ii) country hospital other than country regional or country sub-regional hospital . . . . . . $ 26.

Transportation fee

4. Where, in addition to providing a service referred to in this schedule, a recognised hospital transports, or arranges for the transportation of, a non-admitted patient to or from (or between different campuses of) the hospital, the hospital may charge an additional fee equal to the cost to the hospital of providing, or arranging for the provision of, that transportation.

SCHEDULE 3
Recognised hospitals and incorporated health centres: accommodation, rehabilitation,
domiciliary care and related fees

1.      Glenside Hospital, Hillcrest Hospital (Howard House):

fee for inpatient accommodation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $355.00 per day.

2.      Hampstead Centre:

Head Injury Service—

(a) Inpatient—
(i) inpatient accommodation fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $390.00 per day
(ii) professional service fee (not payable by private patient) . . . . . . . . . . . . . $101.00 per day
(b) Rehabilitation service for non-admitted patients—
(i) assessment or treatment provided by a medical practitioner, per hour of attendance
by the patient (maximum fee) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $146.00

(ii)          individual assessment or treatment provided by a person who is not a medical

practitioner, per hour of attendance by the patient (maximum fee) . . . . . . . . . . . $111.00

(iii)         treatment as one of a group of patients provided by a person who is not a medical practitioner, per hour of attendance by the patient

(maximum fee) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $46.25.

3.      Intellectual Disability Services Council Incorporated:

(a) Strathmont Centre—
fee for inpatient accommodation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $214.00 per day
(b) Other—
fee for inpatient or resident accommodation . . . . . . . . . . . . . . . . . . . . . $307.00 per day
(c) Fee for arrangement or co-ordination
of access of patient to disability services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $25.00 per hour
or part hour
(d) Fee for preparation of report on access of patient to disability services
(for purpose of compensation or legal proceedings) . . . . . . . . . . . . . . . . . . . . $248.00 per report.

4.      Julia Farr Services:

fee for inpatient accommodation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $307.00 per day.

5.      All Recognised Hospitals and Incorporated Health Centres:

Domiciliary maintenance and care visit—

(a) attendance involving a service provided by a medical practitioner, registered
nurse or other health professional (other than a paramedical aide)—per visit . . . . . $ 67.00
(b) any other attendance—per visit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 29.50.

SCHEDULE 4
Classification of recognised hospitals

1.        Metropolitan Hospitals

(a) Metropolitan Teaching Hospitals

Flinders Medical Centre
Repatriation General Hospital Incorporated
Royal Adelaide Hospital
The Queen Elizabeth Hospital

Women’s and Children’s Hospital

(b) Other Metropolitan Hospitals

Modbury Hospital
Lyell McEwin Health Service
Gawler Health Service Incorporated
Noarlunga Health Services Incorporated
St Margaret’s Hospital Inc.

2.        Country Hospitals

(a) Country Regional Hospitals

Mount Gambier Regional Health Service Incorporated
Port Pirie Regional Health Service Incorporated
Port Augusta Hospital Incorporated

The Whyalla Hospital and Regional Health Services Incorporated

(b) Country Sub-Regional Hospitals

Angaston and District Hospital Incorporated
Clare District Hospital Incorporated
Millicent and District Hospital and Health Services Incorporated
Mount Barker District Soldiers’ Memorial Hospital Incorporated
The Murray Bridge Soldiers’ Memorial Hospital Incorporated
Naracoorte Health Service Incorporated
Northern Yorke Peninsula Regional Health Service Incorporated
Port Lincoln Health and Hospital Services Incorporated
Riverland Regional Health Service Incorporated

South Coast District Hospital Incorporated

(c) Other Country Hospitals

Andamooka Outpost Hospital
Australian Inland Mission Hospital (Oodnadatta)
The Balaklava Soldiers’ Memorial District Hospital Incorporated
Barmera District Health Services Incorporated
Bishop Kirkby Memorial Hospital
Booleroo Centre District Hospital Inc.
Bordertown Memorial Hospital Incorporated
Burra Burra Hospital Incorporated
Ceduna Hospital Incorporated
Central Eyre Peninsula Hospital Incorporated
Cleve District Hospital Incorporated
Coober Pedy Hospital Incorporated
Cowell District Hospital Inc.
Cummins and District Memorial Hospital Incorporated
Crystal Brook District Hospital Incorporated
Elliston Hospital Incorporated
Eudunda Hospital Incorporated
Great Northern War Memorial Hospital Incorporated
Gumeracha District Soldiers’ Memorial Hospital Incorporated
The Jamestown Hospital and Health Service Incorporated
Kangaroo Island General Hospital Incorporated
Kapunda Hospital Incorporated
Karoonda and District Soldiers’ Memorial Hospital Incorporated
Kimba District Hospital Incorporated
Kingston Soldiers’ Memorial Hospital Incorporated
Lameroo District Hospital Incorporated
Laura and Districts Hospital Incorporated
Leigh Creek Hospital Incorporated
Lower Murray District Hospital Incorporated
Loxton Hospital Complex Incorporated
Maitland Hospital Incorporated
Mannum District Hospital Incorporated
Meningie and Districts Memorial Hospital Incorporated
Mount Pleasant District Hospital Incorporated
Orroroo and District Health Service Incorporated
Penola War Memorial Hospital Incorporated
Peterborough Soldiers’ Memorial Hospital Inc.
Pinnaroo Soldiers’ Memorial Hospital Incorporated
Port Broughton District Hospital and Health Services Incorporated
Quorn and District Memorial Hospital Incorporated
Renmark and Paringa District Hospital Incorporated
Riverton District Soldiers’ Memorial Hospital Incorporated
Royal District Nursing Society Hospital (Marree)
Snowtown Memorial Hospital Inc.
Southern Yorke Peninsula Health Service Incorporated
Strathalbyn and District Soldiers’ Memorial Hospital and Health Services
Streaky Bay Hospital Incorporated
Tanunda War Memorial Hospital Inc.
Tarcoola Hospital
Tumby Bay Hospital Inc.
Waikerie Hospital and Health Services Incorporated

APPENDIX

LEGISLATIVE HISTORY

(entries in bold type indicate amendments incorporated since the last consolidation)

Schedule 1
Clause 1: 		 definition of "inlier patient" substituted by 46, 1995, reg. 3(a)
definition of "long stay outlier patient" substituted by 46, 1995,

reg. 3(b)

Schedule 3:  substituted by 46, 1995, reg. 4; 116, 1996, reg. 3; 98, 1997, reg. 3; 88, 1998, reg. 3; 89, 1999, reg. 3; varied by 145, 1999, reg. 3; 96, 2000, reg. 3; 61, 2001, reg. 3; substituted by 48, 2002, reg. 3
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