The 2003 Index of Hospital Quality

Current AP-DRG Structure
In 1987, the New York State Department of Health entered into an agreement with
3M-HIS to evaluate the applicability of DRGs to a non-Medicare population with a
specific focus on neonates and patients with Human Immunodeficiency Virus (HIV)
infections. The DRG definitions developed by this relationship are referred to as the
AP-DRGs.
The AP-DRGs are modeled after the HCFA DRGs and attempt to improve the DRGs
in an effort to more accurately predict a hospital’s resource demands and associated
costs for all acute care patients. In the creation of AP-DRGs, the modifications
made to the DRG structure can be summarized as follows:
C Except for neonates who die or are transferred within the first few days of
life, AP-DRGs define six ranges of birth weight that represent distinct
demands on hospital resources. Within each birth weight range, neonates
are then subdivided based on the presence of a significant operating room
procedure, and then further subdivided based on presence of multiple major,
minor, or other problems.
C Assignment to neonatal MDC is based on age. Specifically, the AP-DRGs
assign a patient to the neonatal MDC when the age of the patient is less
than 29 days at admission regardless of the principal diagnosis.
C MDC 25 was created to account for the highly specialized treatment of
multiple trauma patients. Patients assigned to MDC 25 have at least two
significant trauma diagnoses from different body sites.
C MDC 20 for alcohol and substance abuse was restructured to differentiate
patients based on the substance being abused.
C Across all MDCs, patient with a tracheostomy were put into either of two
tracheostomy AP-DRGs: tracheostomy performed for therapeutic reasons
and tracheostomy representing long-term ventilation.
C All liver, bone marrow, heart, kidney, and lung transplant patients were
assigned to an AP-DRG independent of the MDC of the principal diagnosis.