Table 1 Table of diseases selected for Algorithm Creation with clinical definitions. Table 1 includes a list of the nineteen disease-based algorithms that were coded with clinical definitions. Furthermore, there is a column of ICD codes that represent the clinical disease and equate the use of a DRG modifier. If an admission has any of the listed ICD codes billed, then the billing would be considered appropriate given the clinical condition

Acidemia

CC

E71.*, E87.2, E72.*

Any hospital admission with an arterial pH lab result < 7.35.

Lab Results

Bacteremia

CC

R78.81, R65.10,

Any hospital admission with at least two positive blood cultures results during the hospitalization.

Lab Results (cultures)

Blood Loss Anemia

CC

D62

Any hospital admission with a case that has intraoperative blood loss documented as greater than or equal to 300 mL with a corresponding hemoglobin < 12 g/dl within the first 24 h after surgery.

Lab Results

Flowsheets

Chronic CHF

CC

I50.*

Any hospital admission with one of:

• A documented EF < = 30% by echocardiography within the 12 months prior to admission,

• Brain Natriuretic Peptide (BNP) lab value > 900 pg/mL within the 12 months prior to admission

• Active medical record problem list of heart failure within the 12 months prior to admission.

Flowsheets

Lab Results

Past ICD Codes

Chronic Kidney Disease

CC

N18.4, N18.5, N18.8, N18.9

Any hospital admission with a Glomerular Filtration Rate (FGR) < = 30 by using the MDRD calculation.

Lab Results

Delirium

CC

F05, R41.4, R40.3

Any hospital admission with a positive Confusion Assessment Method (CAM) score as documented by ICU nursing.

Flowsheets

Extremes of BMI

CC

E66.2, Z68.1, Z68.4, R64

Any hospital admission with a patient having a recorded BMI > 40 or < 19.

Flowsheets

HIV

CC

B20

Any hospital admission with a historic positive HIV screen or active Zidovudine medication.

Lab Results

Medication Orders

Hyponatremia

CC

E87.1

Any hospital admission with a resulted serum amylase sodium value < = 134 mmol/L during the hospitalization.

Lab Results

Myocardial injury

CC

S26.90XA, I25.*, I24.8, I24.9

Any hospital admission with a positive troponin lab result.

Lab Results

Transplant

CC

T86.*, Z94.*

Any hospital admission with a historical transplant surgery or tacrolimus medication administration.

Surgery Logs

Medication Orders

UTI

CC

N39.0, O23.40,

O23.41, O86.2, O03.38, O04.88, O08.83, O23.41, O23.42, O23.43

Any hospital admission with a bacterial urine culture result showing at least 100,000 colonies.

Lab Results (cultures)

Acute MI

MCC

I21.*, I22.*

Any hospital admission that has a positive troponin lab result during the admission and has a coronary stent implanted during the admission (from CPT codes).

Lab Results

Surgery Logs

Acute Pancreatitis

MCC

K85.*

Any hospital admission with either:

• a serum amylase lab result > 1000 U/L

• serum lipase lab result > 450 U/L.

Lab Results

Altered Mental Status

MCC

R40.*

Any hospital admission with a Glasgow Coma Scale (GCS) < = 8 entered by nursing staff.

Flowsheets

End Stage Renal Disease

MCC

N18.6, N17.0, N17.1,

Any hospital admission with documentation of dialysis flow and volumes using flowsheet data or ultrafiltration data as entered by dialysis technicians.

Flowsheets

Inpatient death

MCC

Any hospital admission resulting in an inpatient death.

Admission Logs

Respiratory Failure

MCC

J96.*, J95.*

Any hospital admission with a documented endotracheal tube or high flow nasal cannula (HFNC) and no surgical procedures done during the index admission.

Surgery Logs

Flowsheets

Airway Documentation

Severe Malnutrition

MCC

E40.*, E41.*, E42.*, E43.*

Any hospital admission with documentation of total parenteral nutrition (TPN).

Medication Orders