Variable: CLM_DRG_OUTLIER_STAY_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).
Comment
n/a
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) *** Non-PPS Only *** |
| 6 | Valid diagnosis related groups (DRG) received from the intermediary |
| 7 | CMS developed DRG |
| 8 | CMS developed DRG using patient status code |
| 9 | Not groupable |
Other Info
Some additional information on this variable:
- Short Name: OUTLR_CD
- Long Name: CLM_DRG_OUTLIER_STAY_CD
- Type: CHAR
- Length: 1
- Source: NCH
- Value Format: