The EDC Analyzer™ reviews all principal and secondary diagnosis codes on the claim looking for complicating conditions that may impact the level of facility resource utilization. The EDC Analyzer™ then assigns a weight to each complicating diagnosis code that is found. The highest weighted diagnosis code on the claim is used to determine the overall patient complexity cost weight. If a reason for visit diagnosis code is billed as a principal or secondary diagnosis code it is excluded from acting as a complicating condition during this step.
Patient complexity cost weights were developed for each complicating condition by analyzing the additional services typically provided to patients with that complicating condition.
Below are some examples showing how the EDC Analyzer™ assigns a patient complexity cost weight based on a diagnosis code:
|Diagnosis Code||Code Description||Patient Complexity Cost Weight*|
|F63.81||INTERMITTENT EXPLOSIVE DISORDER||***|
|F63.89||OTHER IMPULSE DISORDERS||***|
|X78.0XXA||INTENTIONAL SELF-HARM BY SHARP GLASS, INITIAL ENCOUNTER||***|
|F10.921||ALCOHOL USE, UNSPECIFIED WITH INTOXICATION DELIRIUM||***|
|G40.801||OTHER EPILEPSY, NOT INTRACTABLE, WITH STATUS EPILEPTICUS||***|
|R40.3||PERSISTENT VEGETATIVE STATE||***|
|E11.29||TYPE 2 DIABETES MELLITUS WITH OTHER DIABETIC KIDNEY COMPLICATION||***|