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Variable: DGNS_DRG_OUTLIER_CD

Claim Diagnosis Related Group Outlier Stay Code

Description:

On an institutional claim, the code that indicates the beneficiary stay under the prospective payment system (PPS) which, although classified into a specific diagnosis related group, has an unusually long length (day outlier) or exceptionally high cost (cost outlier).

Values

This variable is coded, and will contain one of the following values.

Value Description
0 No outlier
1 Day outlier (condition code 60)
2 Cost outlier (condition code 61)
6 Valid diagnosis related groups (DRG) received from the intermediary *** Non-PPS Only ***
7 CMS developed DRG *** Non-PPS Only ***
8 CMS developed DRG using patient status code *** Non-PPS Only ***
9 Not groupable *** Non-PPS Only ***

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