Health funding principles and guidelines 2014 2015
Contributors A special thanks goes to all who contributed to the development of this document and in particular to all members of the Hospital and Health Service Costing and Funding Network with representatives from the Department of Health, and Hospital and Health Services (HHSs). Document overview This document is presented in three parts: Part 1 provides an overview of how healthcare services are funded in Queensland and includes key inputs into the final budget allocations for each HHS. Part 2 provides the operational guidelines for activity based funding (ABF) in Queensland, including technical information and funding tables. Part 3 contains detailed information on non-abf or block funded services. Health funding principles and guidelines 2014 2015 Published by the State of Queensland (Queensland Health), December 2014 This document is licensed under a Creative Commons Attribution 3.0 Australia licence. To view a copy of this licence, visit creativecommons.org/licenses/by/3.0/au State of Queensland (Queensland Health) 2014 You are free to copy, communicate and adapt the work, as long as you attribute the State of Queensland (Queensland Health). For more information contact: HHS Funding, Costing and Performance Management Unit, Provider Engagement and Contract Delivery Branch, Health Commissioning Queensland, Department of Health, GPO Box 48, Brisbane QLD 4001, email QABFM@health.qld.gov.au Phone: 07 3235 4184 An electronic version of this document is available on QHEPS. Disclaimer: The content presented in this publication is distributed by the Queensland Government as an information source only. The State of Queensland makes no statements, representations or warranties about the accuracy, completeness or reliability of any information contained in this publication. The State of Queensland disclaims all responsibility and all liability (including without limitation for liability in negligence) for all expenses, losses, damages and costs you might incur as a result of the information being inaccurate or incomplete in any way, and for any reason reliance was placed on such information. Health Funding Principles And Guidelines 2014-2015 - i -
Contents 1. Overview of health service funding... 1 1.1 Principles for health service funding... 1 1.2 The National Health Reform Agreement... 1 1.3 2014 2015 health portfolio budget... 2 1.4 Own source revenue... 3 1.5 Service agreements... 4 1.6 Annual process for determining Hospital and Health Service funding... 5 1.7 Healthcare purchasing initiatives... 5 2. Operational guidelines for activity based funding in Queensland... 8 2.1 Activity based funding an overview... 8 2.2 National approach to activity based funding... 9 2.3 Activity based funding hospitals... 14 2.4 Data collection systems... 15 2.5 Acute admitted inpatients... 16 2.6 Sub-acute and non-acute patients... 20 2.7 Mental health inpatients... 22 2.8 Emergency departments and services... 25 2.9 Non-admitted patients (outpatients)... 26 2.10 Renal dialysis... 28 2.11 Private and ineligible patients... 29 2.12 Funding model loadings... 29 2.13 Grants for activity based funding facilities... 31 3. Facilities and services not funded through activity based funding... 33 3.1 Block funding for small rural hospitals... 33 3.2 Specialist block funded hospitals... 34 3.3 Other block funded services... 34 3.4 Output based funded services... 35 3.5 Governance, audit and compliance... 38 Appendix 1 Acute admitted patients AR-DRG v 7.0 Queensland... 41 Appendix 2 Acute admitted patients AR-DRG v7.0 national... 56 Appendix 3 Mental health per diem rates for designated wards... 70 Appendix 4 Sub and non-acute patient admitted AN-SNAP v3.0... 72 Appendix 5 Non sub and non-acute care type per diem rates... 75 Appendix 6 Tier 2 non-admitted services v3.0... 77 Appendix 7 Emergency departments URG v1.4.2... 82 Appendix 8 Emergency services UDG v 1.3... 85 Appendix 9 Adjustments... 87 Appendix 10 Intensive care units eligible to receive adjustments... 91 Appendix 11 Radiotherapy procedure codes eligible for adjustments... 92 2014 2015 - ii -
Appendix 12 2014 2015 site specific grants... 94 Appendix 13 2014 2015 clinical education and training grants... 96 Appendix 14 Block funded hospitals... 97 Appendix 15 Activity based funding and non-activity based funding budgeted services... 100 2014 2015 - iii -
1. Overview of health service funding 1.1 Principles for health service funding To increase transparency and better allocate funding to where resources are required, the Queensland healthcare funding model aims to: increase the level of hospital activity for a given level of inputs through technical efficiency ensure hospital resources are allocated to those activities which maximise health outcomes through allocative efficiency provide incentives for technological and clinical innovations that lead to better health outcomes through dynamic efficiency ensure that hospitals are funded on a comparable basis for the activity they provide, and that unavoidable differences in costs between hospitals are taken into account through equitable funds distribution provide incentives to support continuous improvement in patient safety and quality provide the public with information on hospital performance and accountability. 1.2 The National Health Reform Agreement The National Health Reform Agreement (NHRA) of August 2011 sets out the intention of the Australian Government, and state and territory governments to work in partnership to improve health outcomes for all Australians. This included: the states being recognised as system managers of the public hospital system the establishment of local hospital networks (known in Queensland as HHSs) funding public hospitals using ABF based on a national efficient price where practicable, and block funding in other cases the Commonwealth Government increasing its contribution to efficient growth funding for public hospital services to 45 per cent from 1 July 2014. Under the NHRA, the Commonwealth was to also increase its funding share to 50 per cent from 1 July 2017. However, as part of its 2014 2015 budget announcements, the Commonwealth announced it would no longer fund on an activity basis from 1 July 2017 hospital funding being provided through a single national health funding pool. Payments will be made from this funding pool directly to HHSs, using a nationally consistent approach to ABF the Independent Hospital Pricing Authority (IHPA) setting the efficient price of delivering hospital services. 2014 2015-1 -
1.2.1 Purchasing health services Service agreements between the Department of Health (the department) and each HHS are based on the department s funding and purchasing models. In broad terms, the funding model determines the price at which the department purchases services from HHSs, and the purchasing model determines the volume of services that are purchased. In terms of the funding model: 34 of the largest public hospitals are funded through the Queensland ABF model, which sets prices at a disaggregated level for each type of public hospital service. The Queensland ABF model is based largely on the national ABF model, but includes a number of modifications to reflect Queensland priorities or more suitable pricing models. 89 public hospitals are funded through block funding arrangements, 86 predominantly small regional and rural hospitals, and three specialist mental health hospitals. Given the high fixed costs facing smaller hospitals, and economies of scale, these facilities would not be financially viable in an ABF model. Most non-hospital services (e.g. preventive health, primary and community health) are funded based on historical funding levels. However, some services, such as oral health and breast screening are funded based on a price per unit of output. The purchasing model determines the volume of services that the department agrees to purchase from each HHS through the service agreement. The level of purchasing is informed by the key priorities for investment as identified in the publication Health Priorities 2014 2015 and in negotiation with the HHSs. 1.3 2014 2015 health portfolio budget The 2014 2015 Queensland Health portfolio operating budget is $13.622 billion, an increase of $914 million or 7.2 per cent on the 2013-2014 estimated actual. In 2014 2015, $11.006 billion (or 80.8 per cent of the total budget) will be allocated to HHSs and other organisations, including Mater Health Services through service agreements to provide public hospital and non-hospital based services. In 2014 2015, the State Government will continue to provide the majority (61.31 per cent) of funding for Queensland s public hospital and health system at $7.549 billion. The Commonwealth Government s 2014 2015 funding towards Queensland s Health portfolio is $3.242 billion (27.6 per cent). Along with state and federal government funding, revenue from user charges is expected to total $1.045 billion (8.5 per cent), while other revenue will comprise $166.85 million (1.4 per cent). 1.3.1 Hospital and Health Service funding HHS funding is provided from the Purchasing Pool that holds funding for the following purposes: ABF for HHSs via the state pool account block funding via the state managed fund 2014 2015-2 -
locally receipted grants locally receipted own source revenue department grants. This pool of funds is used to fund enterprise bargaining and non-labour escalation, specific initiatives, such as service delivery growth. 1.4 Own source revenue Own source revenue (OSR) is a key component of the department s funding source. Section G3 of the NHRA states that private patients, compensable patients and ineligible patients can be charged for public hospital services. Funding obtained via this method is referred to as OSR. The types of patients and flow of revenue is outlined in the following list. Revenue generated, managed and retained by Hospital and Health Services/commercial business units: private inpatients private outpatients Medicare ineligible patients: overseas visitors (not covered by a reciprocal health care agreement), asylum seekers workers compensation other than WorkCover Qld patient motor vehicle accident outside the Queensland compulsory third party scheme personal injury insurers Department of Defence Department of Veterans Affairs (ward medical, imaging, pathology) non-patient revenue (retail proceeds, pharmaceutical recoveries, prosthetic recoveries, non-government organisation (NGO) research grants). Revenue centrally negotiated and Hospital and Health Services reimbursed for activity: compensable patients: WorkCover Qld Queensland compulsory third party scheme Motor Accident Insurance Commission Department of Veterans Affairs (hospital inpatient service and non-admitted public service fees) interstate (cross border residents) The department and individual HHSs agree OSR targets as part of the service agreement negotiations.this includes estimates for: 2014 2015-3 -
the use of private health insurance for admitted patients who hold valid health insurance improvements to the rate of bulk billed outpatient consultation and diagnostic services provided by medical officers. 1.5 Service agreements The Hospital and Health Boards Act 2011 stipulates that a service agreement must be in place between the department and each HHS for the provision of public health services. Service agreements formalise the hospital, health and other services to be provided by the HHS, and includes the detail of the funding provided to the HHS for the provision of these services (both ABF and non-abf services), the volume of purchased activity and key performance indicators. The service agreement framework is in place for two years in order to provide HHSs with a level of guidance regarding funding and purchased activity for the years 2014 2015 and 2015 2016. However, finance and activity schedules within the agreement (Schedule 2 and 7) are subject to change via an agreed amendment process. Further information on service agreements is available on QHEPS or the Queensland Health website. The figure below summarises the processes behind the development of service agreements with the HHSs. DoH Strategic Priorities HHS Strategic Plans/priorities ABF plus SSGs, Educational Grants Budget Estimated Future Activity HHS Service Agreements Healthcare service delivery Non-ABF Budget Existing service utilisation Health Portfolio Budget (state and federal funding) 2014 2015-4 -
1.6 Annual process for determining Hospital and Health Service funding Funding for each successive financial year is determined in advance to allow sufficient time for HHS planning. The starting point for the funding for each HHS is the previous years Service Level Agreement. HHS funding will consist of allocations for ABF services as well as non-abf services. Funding is then built via allocations/deductions based on the following: wage increases as a result of enterprise bargaining non-labour escalation additional purchased activity for services identified by the Health Priorities 2014 2015 paper highlighting key priorities for investment in 2014 2015 in relation to: commonwealth and state directions population projections burden of disease estimated future activity current system constraints. A number of other factors may also influence budget determination, such as: election commitments national partnership agreements regional cancer care funding up-front adjustments for purchasing initiatives efficiency dividends savings requirements, such as employee related savings, specified saving targets for contractors, consultants, travel and advertising. 1.7 Healthcare purchasing initiatives As well as defining activity targets, the 2014 2015 purchasing framework comprises a range of purchasing intentions which apply financial levers to drive the delivery of efficient and effective care. Purchasing intentions are targeted in three main areas: improving access to services (e.g. pay for outcomes specialist outpatients) more care closer to home (e.g. incentives for local service provision and telehealth) improving patient safety and quality (e.g. reducing adverse events and quality improvement payments). Purchasing initiatives can take the form of: 2014 2015-5 -
volume adjustments purchase more or less of certain activity from HHS e.g. additional activity in targeted areas (more care in rural hospitals and increased telehealth activity). price adjustments incentive payments, such as quality improvement payments (QIP) and pay for outcomes (PfO) financial disincentives, such as nil payment for never events. Table 1 summarises the new purchasing initiatives for 2014 2015, and Table 2 and 3 outline the prior year initiatives applicable in 2014 2015. Further information on the complete suite of purchasing initiatives. Summary of new healthcare purchasing initiatives 2014 2015 Initiative PfO specialist outpatient access PfO chronic disease readmissions QIP Rural care activity volume Nurse endoscopist Telehealth Description Incentive payments for the increase in the percentage of people being seen within the clinically recommended time for their urgency category for an initial specialist outpatient appointment. Incentive payments for a reduction in patients with chronic conditions being readmitted as an emergency with a chronic condition within 28 days. Smoking cessation payment for reaching target for inpatients offered a smoking cessation clinical pathway. Childhood immunisation payments for reaching targets on child immunisation. Palliative care payment for initiating communication with patient on advance care planning. Non-admitted data payment for reaching targets in the quality of nonadmitted patient level data for national reporting requirements. Additional payment to block funded NEC category F&G facilities for additional activity in targeted areas. Same payment for the provision of endoscopy services whether undertaken by doctor or nurse endoscopist. Incentivise uptake of telehealth activity by paying for additional outpatient activity volume or provision of telehealth consultancy for inpatients (Note: Queensland modification of reimbursing both outpatient provider and recipient maintained in ABF pricing model). Table 1 Summary of changed 2013 2014 healthcare purchasing initiatives, applicable in 2014 2015 Initiative Description Change in 2014 15 High cost/low volume activity Fractured neck of femur timely surgical access Additional payments for unforeseen variations in high cost, low volume activity and high cost individual patients. DRG payment discounted by 20 per cent if surgical treatment of fractured neck of femur (#NoF) is not within two days. Change in scope Diagnosis Related Groups (DRG) Change from QIP to disincentive 2014 2015-6 -
Table 2 Initiative Summary of unchanged 2013 2014 healthcare purchasing initiatives, applicable in 2014 2015 Description Adverse events blood stream infections (BSI) Adverse events pressure injury Adverse events psychotropic medication Mental health frequent re-admissions Healthcare innovation fund Emergency department did not wait (DNW) Pre-operative elective bed days Outpatients Out-of-scope activity Never events Hospital in the home (HITH) Disincentives to minimise hospital acquired BSIs. Disincentives to minimise hospital acquired Stage 3 and 4 pressure injuries. Disincentives to minimise hospital acquired injury associated with administration of psychotropic medication for mental health inpatients. No payment for more than 10 admissions to acute mental health inpatient units within 12 months. Still to be confirmed for 2014 2015. Commitment to honour existing schemes in 2014 2015 (and 2015 2016 where applicable). No payment for DNWs. For elective surgery, reduction in the payment of long day stays is applied where there is a pre-operative admission and the Length Of Stay (LOS) is greater than the trim point. Retain Queensland price differential between new and review outpatient price weight. No payment for activity identified as out-of-scope i.e. vasectomies, reversal of vasectomies and laser refraction. Zero payment for six never events. HITH price of 85 per cent and applied to three specific noncomplex DRGs (pulmonary embolus, venous thrombosis and cellulitis). 2014 2015-7 -
2. Operational guidelines for activity based funding in Queensland 2.1 Activity based funding an overview ABF is a way of funding hospitals, whereby they are reimbursed based on the mix and volume of patients treated. ABF is based on three key elements: classification of patient activity (i.e. the classification system used) counting the activity (i.e. the counting unit) costing the activity (determining a cost per counting unit). The different types of activity funded by ABF are identified and counted in a standardised manner. Used effectively, these elements result in pricing and funding transparency of the public hospital system. Table 4 shows the classification systems used for various activity types and the counting unit. Table 3 Activty based funding classification and information systems for 2014 2015 Activity type Counting unit Classification 2014 2015 Information needed to classify episode Acute inpatients Intensive care patients Subacute inpatients Emergency department (Level 3b and above) Emergency service (small or rural EDs) Patient episode and per diem for short or long stay outliers Patient episode and time spent in an intensive care unit (ICU) and per diem for short or long stay outliers Mixed model using patient episode and/or per diem Presentation Presentation Australian refined diagnosis related groups (AR-DRGs) classification V 7.0. Specific DRGS within the australian refined diagnosis related groups (AR-DRGs) classification V 7.0. Australian national subacute and non-acute patient (AN-SNAP) V3 Urgency related group (URG) V1.4.2 Urgency disposition groups (UDG) V1.3 Outpatients Service event IHPA Tier 2 non admitted services classification (V3) and OoS modality (new or review) ICD-10-AM (diagnosis and procedures codes) Hours in ICU Care type, impairment type (rehabilitation), age, phase (for palliative care), activity of daily living assessment score (i.e. RUG, FIM, HoNOS) Principal diagnosis, triage category and departure disposition Triage category and departure disposition Clinic type (specialty and provider), clinic mode (new or review) 2014 2015-8 -
Note: costing patient activity is not covered in this document, but is available in the costing guidelines. The basis of the ABF payment model is outlined in the diagram below. The overall funding for a service is determined using a combination of a standard or base price and a unit of activity that is weighted according to resource requirements, called a weighted activity unit or WAU. The principle behind applying a weighting to each of the service activities is to reflect the more resource intensive a procedure or treatment is, the greater the weight will be. Price (1.0 WAU) Activity weighting Funding ($) 2014 2015 Queensland efficient price (QEP) = $4676 Represents the relative resource consumption for the patient treatment. Educational and training resources on ABF are available on a number of HHS QHEPS sites as well as the department s activity based funding educational resource site. Within Queensland, 34 public hospitals are funded via ABF in 2014 2015, including the Mater Adult s, Mater Mother s and Mater Children s Hospitals. The NHRA states that ABF should be used wherever practicable. If ABF is not possible, Independent Hospital Pricing Authority (IHPA) have developed criteria to determine which public hospital services are better funded through block grants. The main criteria are: the technical requirements for applying ABF are unable to be met there is an absence of economies of scale that mean some services would not be financially viable under ABF. The intent is, where technical requirements can be met, to move to ABF funding over time. However, other services may need to be funded using only block grants or a combination of block grants and activity based funding on an ongoing basis. This includes screening programs, community allied health services, oral health and postnatal care. Eighty-six small rural hospitals will be block funded as well as three specialist mental health facilities (Baillie Henderson, The Park and Kirwan Rehabilitation Unit). Part three of this document provides further information on block funded services. 2.2 National approach to activity based funding Under the 2011 NHRA, the Commonwealth will fund 45 per cent of efficient growth in public hospital services between 2014 2015 and 2016 2017. 2014 2015-9 -
2.2.1 National efficient price and national efficient cost The IHPA was also established under the NHRA and is an independent statutory authority to oversee the phased implementation of a nationally consistent approach to ABF. The IHPA calculates and determines: 1. National efficient price (NEP) which is based on the average cost of providing acute admitted services across Australia, but also applies to emergency and nonadmitted services. All price weights are expressed as a single unit of measure being the national weighted activity unit (NWAU). It provides a scale that identifies the relative measure of resource use of each public hospital service and guides the commonwealth contribution for ABF services. 2014 2015 NEP per NWAU NEP $5007 = 1 NWAU 2. National efficient cost (NEC) determines the commonwealth contribution to block funded hospitals for services that do not meet the criteria for ABF (e.g. small rural hospitals). Individual funding levels are weighted relative to the NEC based on their size and location (e.g. very remote locations). Refer to part three for information on block funded services. The IHPA releases a pricing framework along with NEP and NEC determinations annually that includes: NEP price weights technical details of the national funding model scope of services basis for price setting, and block funding criteria. Further information on how the NEP is calculated and applied. 2.2.2 Indexation of the national effiecient price Because of the three year time lag in data collection to the year the NEP is being calculated, costs are indexed to the relevant model year to determine each NEP. That is, the NEP applied to 2014 2015 is based on costing data from 2011 2012 and therefore the 2011 2012 costs are indexed to account for costs growth over this three year period. A back-casting methodology is used to ensure changes in the model do not affect the level of funding to be provided by the commonwealth. 2.2.3 National efficient price vs the Queensland efficient price The NEP is a single national price based on costing information from all states and territories. It is developed by IHPA and is intended to provide a consistent and transparent method to determine commonwealth funding to states and territories for health services provided by ABF facilities. 2014 2015-10 -
The Queensland ABF model uses the QEP as the base price for ABF services in Queensland. The QEP is based on the NEP with adjustments applied to reflect the differences between the management of costs in Queensland and model variances for localisations. Examples include clinical education and training (CET), corporate overheads and the mental health localised model. This is a fairer way to fund HHSs as it is a truer reflection of the cost of services. 2014 2015 QEP per Queensland WAU QEP $4676 = 1 QWAU The derivation of the QEP involves the following steps: Step 1 Using the NEP as a baseline and adding costs that were excluded in determining the NEP, but which are borne by HHSs.This includes items, such as specialised services for blood transfusions and unlinked diagnostic activity. Step 2 Remove costs that are included in the NEP, but in Queensland are paid to HHSs as block grants, such as site specific grants (SSGs) and CET or those costs not borne by HHSs, such as overheads borne by the department rather than HHSs. Step 3 Specific discounts are then applied to reflect the localisations to the Queensland ABF model relating to mental health admitted patients in designated wards and clinical measurement. Table 5 summarises the calculation of the 2014 2015 QEP. 2014 2015-11 -
Table 4 Calculation of the Queensland ffficient price 2014 2015 National efficient price 2014 2015 $5007 Plus Queensland specific adjustments to price 2014 2015* Blood costs devolved to HHSs $31 Unlinked diagnostics $56 Subtotal +$87 Less Queensland specific adjustment to price 2014 2015 Site specific grants -$83 CET -$161 Corporate overheads -$103 Mental health inpatient localisation -$51 Clinical measurement localisation -$19 Subtotal -$418 Queensland eficient price 2014 2015 $4676 *High cost pharmaceuticals are now incorporated into the NEP rather than being administered via block grants 2.2.4 National weighted activity units vs Queensland weighted activity units The unit of measure for the 2014 2015 Queensland ABF model is the Queensland weighted activity unit (QWAU). Where the national model has been directly applied, the NWAUs and QWAUS will be equal. In a limited number of areas, NWAUs have been adjusted (or localised) to better support service delivery in Queensland and ensure financial levers appropriately reflect Queensland strategic directions and purchasing policy. Therefore, where localisations have occurred there will be variations between NWAUs and QWAUs. The department is required to report on the number of NWAUs for the purposes of the National Health Funding Body (NHFB). However, the state funding model will be based on QWAUs, not NWAUs. 2.2.5 Localisations to the Queensland activity based funding model from the national model In 2013 2014 and now in 2014 2015, Queensland s approach is to apply the national ABF model where practical and minimise the number of localisations. Table 5 identifies where localisations have been applied from the national ABF model. 2014 2015-12 -
Table 5 Queensland localisations from the national activity based funding model Service/funding National model Queensland localisation Efficient price NEP QEP. Emergency presentations Never event Pre-operative bed days Inpatients: HITH Inpatients:mental health wards All inpatients Out of scope activity (including vasectomies, Minimal payment in model No delineation in model for adverse patient outcomes No delineation in model No delineation for HITH episodes No delineation in payment for patients in designated mental health wards No delineated payment for telehealth activity for admitted patients Payment incorporated into model No payment for emergency department patients who did not wait. No payment for an episode of care that involves the following never events: death or likely permanent harm as a result of haemolytic blood transfusion reaction resulting from blood incompatibility death or likely permanent harm as a result of bed rail entrapment or entrapment in other bed accessories (no exclusions) infants discharged to the wrong family (no exclusions) death or neurological damage as a result of intravascular gas embolism procedures involving the retention of instruments or other material after surgery. procedures involving the wrong patient or body part resulting in death or major permanent loss of function. Elective episodes with surgical DRGs that have both pre-operative days and long stay days (above trim point) will have the number of paid long day stays reduced by the number of preoperative bed days, up to a maximum of three days. Episodes with the following DRGs will be funded at 85 per cent of DRG price weights. E61B non-complex pulmonary embolism J64B non-complex cellulitis F63B non-complex venous thrombosis. Funding for all other episodes with a HITH component will be funded as follows: episodes that do not exceed the DRG inlier period will be paid at 100 per cent of DRG price weights. That is, if patient is receiving care via HITH and the episode in within the inlier period, 100 per cent of the DRG payment will apply episodes with a length of stay exceeding the DRG inlier period will have the long stay component paid at 85 per cent of the long stay per diem rate. Per diems for admitted mental health patients in designated wards. Payment for a provider of a telehealth consultation to a patient at another facility. No payment. 2014 2015-13 -
Service/funding National model Queensland localisation reversal of vasectomies and laser refraction) Private patients Outpatients Inpatients sub and non-acute Partial funding for private and ineligible patients Same WAU for new or review outpatients Zero payment for Tier 2 clinical measurement outpatient service event (30.08) No delineation for telehealth activity and only fund the provider As per national model Full funding for private and ineligible patients. Variation in WAUs for new and review outpatients. Payment for clinical measurement (30.08). Telehealth activity funded at both provider and recipient sites. Private and ineligible outpatients attract the same funding as public patients. Private and ineligible outpatients in scope for payment (paid at discounted rate in national model). Telephone consultation occasions of service that meet the service event criteria 1 will be paid at the relevant Tier 2 clinic rate. Excluding mental health patients in designated wards. 2.3 Activity based funding hospitals As was the case in 2013 2014, there will be 34 public hospitals funded in 2014 2015 using the Queensland ABF model. These are listed in Table 6. Table 6 2014 2015 activity based funding hospitals* Hospital and Health Service Cairns and Hinterland Central Queensland Children s Health Queensland Darling Downs Gold Coast Mackay Mater Health Services Activity based funding hospital Atherton Hospital Cairns Base Hospital Innisfail Hospital Mareeba Hospital Gladstone Hospital Rockhampton Hospital Royal Children's Hospital Kingaroy Hospital Toowoomba Hospital Warwick Hospital Gold Coast University Hospital Robina Hospital Mackay Base Hospital Proserpine Hospital Mater Adult Hospital 1 See the MAC Manual for detailed definitions and counting rules for non-admitted services (which reflect the IHPA Tier 2 definitions) 2014 2015-14 -
Mater Children s Hospital Mater Mothers Hospital Caboolture Hospital Metro North Metro South North West Sunshine Coast Townsville West Moreton Wide Bay Redcliffe Hospital Royal Brisbane & Women's Hospital Prince Charles (The) Hospital Logan Hospital Princess Alexandra Hospital Queen Elizabeth II Jubilee Hospital Redland Hospital Mount Isa Base Hospital Caloundra Hospital Gympie Hospital Nambour General Hospital The Townsville Hospital Ipswich Hospital Bundaberg Base Hospital Hervey Bay Hospital Maryborough Hospital *Lady Cilento Children s Hospital opened 29 November 2014, with services transferring from Royal Children s and Mater Children s Hospitals. 2.4 Data collection systems The following table summarises the information systems used across HHSs to capture activity for various ABF services. Table 7 Information systems used across HHSs Activity type Acute inpatients Intensive care patients Subacute inpatients Mental health inpatients Emergency department (ED) Emergency service (small or rural EDs) Outpatients Administration system for patient activity data Hospital based corporate information system (HBCIS) Emergency department information system (EDIS) HBCIS or EDIS Monthly activity collection (MAC) online form For further information, including the datasets collected via these systems, refer to the QHAPDC Manual and/or the MAC Manual. 2014 2015-15 -
2.5 Acute admitted inpatients 2.5.1 Classification and counting unit Acute episodes of care are grouped into clinically similar and resource homogenous groups on the basis of the principal reason for admission using the Australian refined diagnosis related groups (AR-DRGs) classification version 7.0. The counting unit is an admitted patient episode. 2.5.2 Changes from previous year s model Item 2013 2014 2014 2015 Classification AR-DRG V6.0X AR-DRG V7.0. Same day payment list Long stay outlier per diems Long stay patients (>200 days) 136 DRGs Reduced to 88 DRGs in same day payment list, however additional DRGs with lower and upper boundaries limited to one day. n/a n/a Outlier per diems adjusted to reduce gap between short day outliers and inliers. This is to ensure there is no incentive to keep patients that would otherwise be short stay outliers, in hospital longer. Patients with a LOS of more than 200 days at 30 June each year will be assigned a provisional NWAU rate. On discharge, the provisional NWAU value assigned to the patient in previous year would be subtracted from the actual NWAU value calculated at the time of discharge. While this has been included in the national model, Qlueensland is yet to determine an technical solution for in year management of long stay patients spanning financial years. If a technical solution can be resolved, a proposal will be provided to the HHS funding committee, in year. 2.5.3 Payment based on inlier and outlier modelling Funding for acute admitted patients is based on payment for each episode of care, which is a phase of treatment that ends when the clinical intent of care changes or the patient is formally discharged from hospital. To establish an appropriate funding level, episodes within an AR-DRG are partitioned into four categories as shown in Figure 3 (i.e. same day, short stay outliers, inliers and long stay outliers) and costs are analysed to determine the relevant parameters. The resulting funding model is reflected by the pricing line. 2014 2015-16 -
Figure 3 Trim point parameters for the assignment of price weights The 2014 2015 Queensland model adopts the national L3H3 trimming method where: the low trim point is a third of the national mean length of stay for each AR-DRG, and the high trim point is three times the average length of stay. This (1/3, 3) boundary setting aims to balance financial incentives to drive inpatient throughput, but also incorporates financial disincentives to keep patients in hospital. 2.5.4 Payment methodology for acute admitted patients The payment model for acute admitted care is based on episodic payments plus per diem payments for outlier days, and includes adjustments for ICU, paediatric, Indigenous, psychiatric and remote areas. See section 2.12 for further information on adjustments available for acute admitted patients. 2.5.5 Same day Australian refined diagnosis related groups A number of AR-DRGs are set as same day AR-DRGs and price weights are based on the patient being admitted and discharged on the same day (i.e. the upper and lower boundaries are set at one day). 2.5.6 Same day payment list As opposed to the same day AR-DRGs, a number of other AR-DRGs have been designated under a same day payment list. The AR-DRGs identified on this list are those that show significant variation in length of stay, such as E62C respiratory infection/inflammation CC and the intent is to encourage selected overnight procedures to be undertaken as a same day procedure. 2014 2015-17 -
Having a same-day price avoids over-paying hospitals that are presented with a higher proportion of patients that can be safely admitted and discharged on the same day, while underpaying hospitals that are presented with patients requiring over night or lengthy stays. The number of same day payment list DRGs identified by IHPA has significantly reduced from 136 in 2013 2014 to 88 in 2014 2015. As has been the case in previous years, payment is based on a: same day price weight for episode that are day only, or short stay base price weight + short stay per diem price weight for episodes that are overnight but not in lower boundary, or inlier price weight (for episodes within the lower and upper boundaries) + long stay per diem price weight (for episodes exceeding the upper boundary). AR-DRGs designated for a separate same day payment are identified with a yes in the column same-day payment list in the acute admitted patients AR-DRG v 7.0 table (see Appendix 1). 2.5.7 Example of payments for acute care patients Example: DRG N11Z, other female reproductive system OR procedure DRG payment list Lower bound Upper Bound Same day Sameday Shortstay outlier base Shortstay outlier per diem Inlier Long stay per diem N11Z Yes 2 23 0.2988 0.4700 1.2354 2.9408 0.2918 1. If the DRG was performed as a same-day episode, it will attract a price of $1397 (WAU 0.2988 * $ base price of $4676) as this DRG is on the same day payment list. 2. If the episode was one day (overnight), it will attract a price of (0.4700 short stay outlier base +1.2354) * $ base price. 3. If the episode was 12 days (i.e. within the lower and upper boundaries and termed an inlier), the episode will attract a price of 2.9408 inlier weight * $ base price. 4. If the episode was 29 days (i.e. 6 days beyond the upper boundary), the episode will attract a price of [2.9408 inlier weight + (0.2918* 6 long stay outlier days)] * $ base price. Note: Adjustments applied where applicable (e.g. radiotherapy or Indigenous persons) 2.5.8 Critical care delivered via intensive care units Critical care is an area that requires significant resources to the treatment of patients which an AR-DRG alone does not reflect. Therefore additional funding over and above the acute inpatient payment, may be available for patients admitted to an ICU. 2.5.9 Changes from previous year s model In 2014 2015, IHPA have made changes to the funding model in relation to units eligible to receive ICU adjustments and additional bundled AR-DRGs. These are summarised in Table 8. Table 8 Changes to funding model for ICU adjustments Item 2013 2014 2014 2015 2014 2015-18 -
Eligibility for ICU adjustment ANZICS Level 3 or Queensland ICU Level 6 as defined in the Clinical Services Capability Framework Number of bundled AR-DRGs 54 69 Payment types Peer groups Bundled AR-DRGs Non-bundled DRGs Not applicable, largely bundled with acute inpatients Eligible units are those reporting more than 24,000 ICU hours and more than 20% of those hours used mechanical ventilation** No change No change ** Seven additional units in Queensland as a result of revised eligibility (see Appendix 10 for list of eligible facilities). 2.5.10 Adjustment for critical care Adjustments to cover costs for critical care are provided via two mechanisms: 1. Bundled critical care weigthed activity unit AR-DRGs with a yes in the bundled ICU field in the table of cost weights and prices for acute patients (Appendix 1), will have the ICU component bundled within the inlier weight as most patients within those AR-DRGs receive ICU care. As such, the DRG inlier price weight is high compared to other AR-DRGs to incorporate ICU costs. These DRGs are not eligible for an ICU adjustment (see section 2.13.3 for more detail). 2. Intensive care unit adjustment For those AR-DRGs not on the ICU bundled list, but delivered to a patient in an eligible ICU/PICU, an ICU adjustment of 0.0426 QWAUs will apply for each hour spent in the ICU. The ICU adjustment (based on number of hours spent in the ICU) is in addition to the inlier episodic WAU and a long stay per diem WAU (see Example 2). 2.5.11 Examples of intensie care unit calculation Example 1: Calculation for an episode with a bundled ICU AR-DRG F05A Coronary bypass and invasive investigations + re-opening + CCC DRG payment list Bundled ICU Lower bound Upper Bound Sameday Shortstay outlier base Shortstay outlier per diem Inlier Long stay per diem F05A Yes 6 55 2.559 1.4001 10.9595 0.3710 If the episode was 42 days (including 2 days in ICU), the episode will attract a 10.9595 inlier weight * $ base price. As ICU is bundled into the inlier price weight for this DRG it is therefore not eligible for the ICU adjustment. Example 2: Calculation for an episode where the AR-DRG was not a bundled ICU DRG and the ICU was determined as eligible to receive the ICU adjustment (i.e. on the eligibility list as determined by IHPA (see Appendix 10). F18A Other pacemaker procedures + CC DRG Same-day payment Bundled ICU Lower bound Upper Bound Shortstay outlier Shortstay outlier Inlier Long stay per 2014 2015-19 -
list base per diem diem F18A 3 27 0.5456 0.8483 3.0906 0.2068 If the episode was 10 days and the patient was also in an ICU for 20 hours, the episode calculated as 3.0906 inlier weight + 0.0426 * 20 ICU hours 2.6 Sub-acute and non-acute patients Sub-acute care is defined as specialised multidisciplinary care in which the primary need for care is optimisation of the patient s functioning and quality of life. A person s functioning may relate to their: whole body or a body part the whole person, or the whole person in a social context impairment of a body function or structure, activity limitation and/or participation restriction. Non-acute care refers to care which provides support for patients with a severe level of impairment, activity limitation or participation restriction due to a health condition. Following assessment or treatment, the patient does not require further complex assessment or stabilisation. There are no changes to the funding model from the previous year. 2.6.1 Classification and counting unit Sub and non-acute patients differ from patients under an acute care type in that their need for healthcare is predicted by their functional status, rather than their principal medical diagnosis, therefore an AR-DRG is not a good indicator of their resource requirements. As such, the Australian national sub and non-acute patient (AN-SNAP v 3) classification system is used to categorise patients into similar resource groupings based on the following care types. rehabilitation care (includes overnight and same day classes) palliative care (overnight and ambulatory classes) geriatric evaluation and management (GEM) (overnight and same day classes) psychogeriatric care (overnight and ambulatory classes) maintenance care non-acute care (overnight and ambulatory classes). It is important to note that a patient cannot be in an acute and sub-acute care type at the same time (i.e. a change in care type is a change in episode). These are mutually exclusive classification systems. The counting unit for admitted sub and non-acute care is a combination of patient episode and number of days in care. This will vary with the AN-SNAP class assigned (and if no AN-SNAP class is assigned the default counting unit is daily or per diem). All sub and non-acute inpatient information is collected via the Queensland Health Admitted Patient Data Collection (QHAPDC). Definitions for each of the care types and further detail on information requirements are available in the QHAPDC Manual. 2014 2015-20 -
Assignment to an AN-SNAP class relies on information, such as, care type, impairment type (for rehabilitation), age and phase (for palliative care) to assign a relevant class within the classification. In addition, a functional assessment score, using the relevant activity of daily living (ADL) tool for each care type must be provided for classification. Table 9 lists the ADL tools for assessment under each care type. Table 9 Care types and applicable assessment tools to determine activity of daily living scores Care type Rehabilitation OR GEM Psychogeriatric care Palliative care OR maintenance care ADL assessment tool Functional independence measure (FIM) with motor and cognitive subscales HoNOS (health of the nation outcome scales) Resource utilisation group (RUG) Where there is insufficient data to assign an AN-SNAP classification, within each care type the episode is classified by care type alone. As per all admitted episodes, sub and non-acute episodes are also grouped to an AR- DRG based on diagnoses and the procedures, however the patient is classified as sub or non-acute and funding is determined by the sub-acute care type. 2.6.2 Paediatric sub-acute care Sub-acute services such as rehabilitation and palliative care provided to paediatric patients use the same ADL assessment tools as adult patients. Work is being undertaken at the national level to determine what is specifically required for the paediatric subacute component of AN-SNAP. 2.6.3 Sub and non-acute patients Queensland weighted activity unit Episodes classified into an AN-SNAP class are allocated a QWAU, including episodic with inlier and outlier per diem WAU. Specific loading adjustments are also applicable for Indigenous, paediatric and remote patients receiving sub and non-acute care. Price weights vary across classes depending on factors, such as age, type of impairment and functional capacity of the patient (refer to Appendix 4). There are no episode price weights for overnight GEM, psychogeriatric care and maintenance care. These episode types are calculated using an outlier per diem weight (except for assessment only classes). Please see Example 2 for further information. Where AN-SNAP data is not available and, as such the episode is unable to be assigned to an AN-SNAP class, a per diem weight by care type will be the default (see Appendix 5). 2.6.4 Adjustments for patients receiving sub and non-acute care See section 2.12 for detailed information adjustments available to patients in various categories. 2014 2015-21 -
2.6.5 Examples of weighted activity unit calculations for subacute services Example 1: The calculation for a rehabilitation episode for a stroke patient that had undergone an ADL assessment using the FIM. 3-207 Overnight rehabilitation stroke, FIM motor 47-62, FIM cognition 5-15 AN-SNAP v3.0 class Lower bound Upper bound Price weight episode Price weight inlier per diem Price weight outlier per diem 3-207 13 38 1.8135 0.1367 0.2041 A patient is admitted after suffering a stroke. After an episode of acute treatment, the patient is then transferred to a rehabilitation care type. AN-SNAP data, including a FIM motor score and a FIM cognition score, was entered into HBCIS. If the episode was 10 days, the episode will attract a price weight of 0.2041 outlier per diem weight * 10). If the episode was 29 days, the episode will attract a price weight of 1.8135 episode + (0.1367 inlier per diem weight * 29). If the episode was 45 days, the episode will attract a price weight of 1.8135 episode + (0.1367 inlier per diem weight * 38) + (0.2041* 7 outlier per diem). Example 2: The calculation for a GEM episode for an 86 year old patient that had undergone an ADL assessment using the FIM. 3-403 Overnight GEM aged 86, FIM motor 44-91, FIM cognition <=15 AN-SNAP v3.0 class Lower bound Upper bound Price weight episode Price weight inlier per diem Price weight outlier per diem 3-403 0 0 0 0 0.1635 A patient is admitted after suffering experiencing a period of disorientation at home. AN-SNAP data, including a FIM motor score and a FIM cognition score, was entered into HBCIS If the episode was 4 days, the episode will attract a price weight of 0.1635 outlier per diem weight * 4) (Noting that the operating tables for this class only include a per diem price weight, as per the national model). Example 3: GEM patient without sufficient data to classify the episode into an AN- SNAP class GEM patient with no FIM ADL score entered into HBCIS A patient is admitted under the GEM care type. A FIM ADL assessment was not undertaken (therefore AN-SNAP classification not possible) The patient stays for 15 days and is then discharged back home. The episode will attract a price weight of 0.1402 GEM care type per diem * 15 admitted days). 2.7 Mental health inpatients Queensland Health is the major provider for mental health services and offers specialised care in a variety of settings to a broad range of age groups. 2014 2015-22 -
2.7.1 Classification and counting unit The IHPA is developing a new national mental health patient classification system to better explain resource consumption for mental health consumers across all service settings, as well as improving the relevance to clinical services. It is envisaged the new model will be available post June 2016. The counting unit in 2014 2015 for patients in designated mental health wards is the number of days in care (per diem). The patient AR-DRG episode is used for acute admissions to non-mental health wards. 2.7.2 Weighted activity unit calculation A composite model that considers the setting, hospital type (ABF hospital or public psychiatric hospital) and the ward designation is used in Queensland. QWAU calculations are based on the following criteria: 1. Mental healthcare delivered in the following designated mental health wards within ABF hospitals receive a per diem price weight which vary depending on the type of ward (as per Appendix 3). 2. Admitted mental healthcare delivered in the following public psychiatric hospitals is block funded: The Park Centre for Mental Health Baillie Henderson Hospital Kirwan Rehabilitation Unit. 3. Acute inpatients receiving mental healthcare outside a designated mental health ward will receive price weights via the relevant AR-DRG assigned for the episode of care (as per other acute inpatients, see Appendix 1). These patients will be eligible for psychiatric age adjustments (see section below). 4. Sub and non-acute mental health patients receiving care outside of a designated mental health ward will receive a price weight via the relevant AN-SNAP category (as per the national model, see Appendix 4 and 5). All non-admitted mental health services will continue to be block funded. Refer to Table 10 for a summary of funding according to acuity and/or setting. Table 10 Summary of mental health funding Admitted care Non-designated mental health ward (ABF hospital) Designated mental health ward (ABF hospital) Designated mental health ward (public psychiatric hospital) Specialised community/ambulatory mental Funding model according to patient acuity Acute patient AR-DRG assigned for the episode of care, as per other acute inpatients (see Appendix 1) *Per diem payment depending on type of ward (see Appendix 7) Non-acute patient AN-SNAP *Per diem payment depending on type of ward (see Appendix 7) Block funded (see Appendix 3) Block funded (see Appendix 3) Block funded 2014 2015-23 -
Admitted care health Funding model according to patient acuity *localisation from the 2014 2015 national ABF model. 2.7.3 Examples of funding for mental health inpatient services Example 1: Patient admitted to an acute ward and then transferred to a designated mental health ward. A patient is admitted to an acute general ward for 5 days with anxiety disorders and is then transferred to an adult acute inpatient designated mental health ward for a further 10 days. DRG Sameday payment list Lower bound Upper bound Same Day Shortstay outlier base Shortstay outlier per diem Inlier Long stay per diem U65Z 3 8 0.0000 0.4697 1.4092 0.2108 The component of the episode outside of the designated mental health ward will attract a price weight of 1.4092 inlier. The component of the episode in the designated mental health ward will attract a price weight of the Adult Acute Inpatient per diem ward rate 0.3329 * 10 (see Appendix 3). Example 2: Patient in an acute ward only (not a designated mental health ward) An acute patient aged 17 years is admitted to a non-designated mental health ward with an anxiety disorder DRG payment list Lower bound Upper bound Same day Sameday Shortstay outlier base Shortstay outlier per diem Inlier Long stay per diem U65Z 3 8 0.0000 0.4697 1.4092 0.2108 If the episode length was 10 days, the episode will attract a price weight of 1.4092 inlier + 0.2108 longstay per diem * 2. The episode will also attract a specialist psychiatric age adjustment (less than or equal to 17 years) of 40%, + 0.5637 weight. Example 3: Patient admitted to a designated mental health ward. An adult patient is admitted to an adult acute inpatient designated mental health ward for 25 days. The episode in the designated mental health ward will attract a price weight of the adult acute inpatient per diem ward rate 0.3329 * 25. Example 4: Patient admitted to a designated mental health ward and then transferred to a different designated mental health ward. A patient is admitted to an adult acute inpatient designated mental health ward for 32 days and then is transferred to a community care unit designated mental health ward for a further 100 days The price weight for the episode in the mental health ward is calculated as follows: (Adult acute inpatient per diem ward rate 0.3329 * 32) + (community care unit per diem ward rate 0.1282 * 100). 2014 2015-24 -
2.7.4 Psychiatric age adjustments See section 2.12 for detailed information on adjustments for psychiatric patients outside of designated mental health units/wards. 2.8 Emergency departments and services Emergency care services are delineated into seven levels (i.e. 1, 2, 3A, 3B, 4, 5 and 6) depending on a range of factors, including availability of support services, staffing, physical design and location. Levels 1, 2 and 3A are referred to as emergency services, and levels 3B, 4, 5 and 6 are referred to as emergency departments. 2.8.1 Emergency department classification and counting unit Two classification systems are used to classify emergency care for the purposes of ABF of these services: Urgency disposition groups This classification system defines 17 patient categories. Using the urgency disposition groups (UDG) classification system, patients are classified by the status (or disposition) recorded at the end of the patient s ED stay (i.e. admitted, non-admitted, did not wait or dead on arrival) and triage type according to the Australasian triage scale. UDG version 1.3 applies to small and medium size facilities with 1 to 3A emergency services. In terms of ABF facilities, this only includes Kingaroy and Warwick. Urgency related groups This classification system segments the UDG classification system further by using 13 major diagnostic blocks (MDB) which are derived from the diagnosis assigned to the ED presentation. Urgency related groups (URG) version 1.4.2 applies to large size facilities with ED levels 3B to 6. This includes all ABF facilities with EDs except for Kingaroy and Warwick. The counting unit for emergency care is an emergency department stay or presentation. 2.8.2 Emergency department and emergency service data collection and reporting Hospitals with EDs categorised as levels 3B to 6 collect and report patient level information via the EDIS. This information is managed by the Clinical Access and Redesign Unit (CARU). Hospitals with emergency services categorised as 1 to 3A do not all have access to EDIS and therefore only report total counts of activity at the aggregate level via the monthly activity collection (MAC) via an online form. The minimum data requirements for reporting are outlined in the National non-admitted patient emergency department care National Minimum Data Set 2012 2013 2014 2015-25 -
2.8.3 Weighted activity unit calculation Refer to Appendix 7 Queensland emergency services URG v 1.4.2 and Appendix 8 Queensland emergency department UDG v 1.3 for the full list of price weights. 2.8.4 Examples of payment for emergency departments/services The following examples apply to ED Levels 3B to 6. URG 6: Admitted triage 1 circulatory system illness A patient arrives at a Level 3B to 6 ED with stroke symptoms and is triaged as a Category 1 patient. The patient is discharged from the ED and admitted into a hospital ward for five days. ED URG 6 price weight of 0.3001 URG 44: Non-admitted triage 2 injury An Indigenous patient arrives at a Level 3B to 6 ED with head injuries and is triaged as a Category 2 patient. The patient is then discharged home after treatment. ED URG 44 Price weight of 0.1788 + indigenous adjustment (0.1788 * 4%) 0.007152 = 0.1860 (Indigenous adjustment of 4% applies) The example below applies to small and medium sized facilities with Queensland levels 1 to 3A emergency services (i.e. Kingaroy and Warwick). UDG 9: Non-admitted triage 4 A patient arrives at a small emergency services facility with an infected cut and is triaged as a Category 4 patient. The patient is then discharged home after treatment. ED UDG 9 price weight 0.0814 2.9 Non-admitted patients (outpatients) 2.9.1 Classification and counting unit Non-admitted patients are those that do not undergo a hospital s formal admission process. The national classification for non-admitted patients is the IHPA Tier 2 non-admitted services classification (V3). Clinic types (classes) specified in the Queensland clinic, diagnostic and procedures, and Telehealth MAC forms are aligned to IHPA s Tier 2 non-admitted services classification to allow Queensland to meet ABF reporting requirements, however, the calculation of the QWAU is applied to the MAC collection counts. The MAC manual provides a mapping of the MAC clinic types, IHPA Tier 2 classes and the Queensland s corporate clinic codes (CCC). For further information on the IHPA Tier 2 classes, including definitions and inclusions and exclusions. The IHPA counting unit for non-admitted care is referred to as a Non-admitted patient service event and is conceptually an algorithm applied to the counting unit for an occasion of service (OoS), which is still used by the department as it is the counting 2014 2015-26 -
unit defined and specified for Australian Government National Minimum Data Set (NMDS) reporting. 2 The counting unit a service event is an interaction between one or more healthcare provider(s) with one non-admitted patient, which must contain therapeutic/clinical content and result in a dated entry in the patient's medical record. The interaction may be for assessment, examination, consultation, treatment and/or education. It is independent of the service setting, thus services provided outside of the hospital setting are included. Group sessions (where two or more non-admitted patients receive services at the same time from one or more facility staff) and multidisciplinary clinics require that for each participant in the group session a service event is recorded. The MAC collects summary data on admitted and non-admitted patient activity. Detailed information on counting rules for service event is also available in the MAC manual. 2.9.2 Changes from previous year s model Item 2013 2014 2014 2015 Telephone consultation service event Block funded clinics in Tier 2 Services events contracted out No distinction in the count from face-toface service event. Counted as relevant new or review Tier 2 clinic rate to provider site. Nil Nil 2.9.3 Price weight Telephone consultation occasions of service that meet the service event criteria 3 will be counted and have applied the relevant Tier 2 clinic price weight. Four clinics to be block funded (see section 2.9.3). Activity is recorded by the facility where the patient is treated. There are scenarios where the non-admitted patient activity is performed offcampus or funded by another facility, health authority, HHS or external provider. Contracted out services events must be counted and reported as contracted out activity and reported by the common data items of the MAC SE forms, i.e. service events delivered or service events contracted out then by type (N/R), and funding source categories. As per MAC manual. The price weight varies depending on the clinic. See Appendix 6: Tier 2 non-admitted services. There are four clinics that IHPA were unable to price for the NEP for 2014 2015. As such, these clinics will be block funded in 2014 2015 and include: 2 MAC Manual V13.1, page 18. 3 See the MAC Manual for detailed definitions and counting rules for non-admitted services (which reflect the IHPA Tier 2 definitions) 2014 2015-27 -
10.17 Total parenteral nutrition: home delivered 10.18 Enteral nutrition: home delivered 10.19 Ventilation: home delivered 40.34 Specialist mental health. 2.9.4 Examples of weighted activity unit calculations for outpatient services Example: Tier 2 clinic 20.09 geriatric medicine (MAC form geriatric new patient) 20.09 Geriatric medicine A patient has an initial outpatient appointment with a geriatrician and has a blood test as part of the outpatient appointment. Subsequently, a telephone follow-up to the patient by the geriatrician is documented in the patient s medical record. A price weight will be added for the initial outpatient appointment as a geriatric medicine outpatient (new patient). A separate price weight will be added for the telephone consultation at the rate for telephone consultation under a separate encounter. Outpatient geriatric medicine price weight for a new patient = 0.1116 Outpatient telephone = 0.0122 price weight for telephone consult under clinic 20.09 2.10 Renal dialysis Dialysis forms part of a long-term treatment provision to patients and is offered in a flexible manner where patients can move between treatment settings as their condition changes. Dialysis patients can be treated in a hospital setting, via walk in centres or receive treatment at home. In-centre dialysis undertaken as an inpatient episode will be classified either as: haemodialysis (price weight is via AR-DRG L61Z) peritoneal dialysis (price weight is via AR-DRG L68Z). Home dialysis undertaken as an outpatient occasion of service will be classified either as: home haemodialysis self-care dialysis extended hours home dialysis continuous ambulatory peritoneal dialysis (CAPD) automated peritoneal dialysis (APD). 2.10.1 Weighted activity unit Home dialysis WAU is based on either the relevant Tier 2 code (e.g. 10.15, 10.16) per occasion of service and in-centre patients at the relevant AR-DRG (e.g. L61Z, L68Z) price weight. Patients admitted for other conditions who have dialysis as part of their treatment are classified into the DRG relating to their main reason for admission. 2014 2015-28 -
2.10.2 Reporting dialysis activity at the national level National reporting requirements state home dialysis activity is to be reported in terms of the number of treatments undertaken in each reporting period. Queensland will continue to supply aggregate data for home based renal dialysis for 2014 2015 and in order to report on the estimated number of treatments over the reporting period prescribing norms have been developed. 4 The following is the standard to estimate the number of dialysis sessions (in home) per person/per week, for national reporting purposes: home haemodialysis (5 hours x 3.5 sessions) extended hours home haemodialysis (8.5 hours x 4.5 sessions) self-care haemodialysis (4.5 hours x 3.5 sessions) continuous ambulatory peritoneal dialysis (4 bag exchanges x 7 days) automated peritoneal dialysis (4-6 bag exchanges x 7 days). These counts assist in informing service planning, costing and national reporting requirements. These counting norms per patient will be funded at the national model Tier 2 clinic price weights (which are similar for both hospital and home-based service delivery), thus are considered to incentivise home-based care. To more accurately capture home dialysis activity, additional fields are available in the MAC form to capture patients undertaking extended hour home dialysis and those patients residing outside of the HHS providing the dialysis service. 2.11 Private and ineligible patients WAU for private admitted patients under the national model is discounted in accordance with clause A41 of the NHRA. Under the national model, the NEP for private admitted patients is reduced to offset funding received from other Commonwealth programs (e.g. Medicare Benefits Schedule and Pharmaceutical Benefits Scheme ) and patient charges (including prostheses and accommodation/nursing related components equivalent to the Queensland private health insurance default bed day rate or equivalent). The Queensland ABF model varies to the national ABF model for acute admitted patients as there are no private patient adjustments due to the recognition of the HHS OSR in the funding and purchasing model, see section 1.4. 2.12 Funding model loadings There are eight loadings in the national model and Queensland applies six of these (as summarised in Table 11) Adjustments are to be applied in the following order: 4 Endorsed by the Queensland Statewide Renal Clinical Network 2014 2015-29 -
1. paediatric adjustment 2. specialist psychiatric age adjustment 3. patient remoteness area adjustment 4. Indigenous adjustment 5. radiotherapy adjustment (NEW), then 6. ICU adjustment 7. private patient service adjustment (not being applied in Queensland QWAU) 8. private patient accommodation adjustment (not being applied in Queensland QWAU). Table 11 Summary of adjustments Adjustment Acute admitted Sub and non-acute Paediatric (specialist hospital) DRG specific 196% Specialist psychiatric age Patient remoteness area <=17 and admitted to a specialist children s hospital <=17 and not in specialist children s hospital 30% 40% 65 84years 5% >=85 years 9% Outer regional 7% 7% Remote 15% 15% Very remote 21% 21% Indigenous 4% 17% Radiotherapy 24% ICU hourly rate (for eligible ICUs) 0.0426 2.12.1 Paediatric adjustment An acute admitted paediatric adjustment applies to patients up to and including 16 years, and is admitted to a specialised children s hospital (such as Mater Children s Hospital and Lady Cilento Children s Hospital).The adjustment does not apply to newborns or neonates. The level of loading varies according to the AR-DRG. Refer to the column headed paediatric adjustment in Appendix 1: Acute admitted price weights. Admitted sub-acute paediatric adjustment an admitted sub-acute adjustment of 196 per cent applies to patients up to and including 16 years classified under a sub-acute care type. Unlike the acute admitted paediatric adjustment, this adjustment applies to patients under 16 years of age treated in any facility. 2.12.2 Psychiatric age adjustment The following adjustments only apply to admitted patients who receive care outside a designated mental health ward. That is, patients who are grouped into an AR-DRG under major diagnostic Category (MDC) 19 mental diseases and disorders or MDC 20 alcohol/ drug use and induced organic mental disorders, and within the specified age category, will receive an adjustment. 2014 2015-30 -
Specialist psychiatric age adjustment (less than or equal to 17 years) This adjustment applies to a patient 17 years of age or less at the time of admission and has one or more total psychiatric cared recorded. The amount to be applied is +40 per cent of the price weight, except for patients admitted to a specialist children s hospital, who will receive + 30 per cent. Specialist psychiatric age adjustment (between 65 to 84 years) This adjustment applies to a patient between 65 to 84 years of age at the time of admission and has one or more total psychiatric care days recorded. The amount to be applied is five per cent. Specialist psychiatric age adjustment (greater than or equal to 85 years) This adjustment applies to a patient aged 85 years greater at the time of admission and has one or more total psychiatric care days recorded. The amount to be applied is nine per cent. 2.12.3 Intensive care unit adjustment An ICU adjustment is applied where the ABF activity is not represented by a newborn/neonate AR-DRG and is not identified as being ICU bundled in a DRG (Appendix 1), but is in respect of a person who has spent time within a specified ICU. The price weight to be applied is 0.0426 QWAU/hour spent by that person within an eligible ICU. 2.12.4 Outer regional/remote/very remote adjustment For all admitted patients, an adjustment applies to patients with a residential address within an area that is classified as outer regional (7 per cent), remote (15 per cent) or very remote (21 per cent). 2.12.5 Indigenous adjustment An adjustment applies to patients identifying as being of Aboriginal and/or Torres Strait Islander origin. For an admitted acute, emergency or non-admitted patient the Indigenous loading is four per cent. For admitted subacute patients the Indigenous loading is 17 per cent. 2.12.6 Radiotherapy adjustment For all admitted patients where a specified ICD-10-AM radiotherapy procedure has been undertaken, a 24 per cent adjustment is applicable. The relevant radiotherapy ICD-10-AM codes are identified in Appendix 11. 2.13 Grants for activity based funding facilities 2.13.1 Site specific grants The purpose of SSGs is to provide funding to HHSs for costs incurred by ABF facilities for services which cannot be appropriately funded through the ABF model. Commonly, SSGs are provided to support statewide and/or highly complex services, such as the 2014 2015-31 -
Queensland Spinal Injuries Service. SSGs may also be provided for clinical advisory and management services which do not generate activity that can be counted via classification models. SSGs are funded through a portion of the total ABF pool available for Queensland and thus are a reduction to the calculation of the QEP. In general, SSGs are provided where: the service is critical to the delivery of public hospital services, but does not give rise to activity that attracts funding under the ABF model, or there is classification failure in the ABF model such that an ABF hospital, when operating efficiently, cannot fund the activity through ABF funding. Refer to Appendix 12 for the list of SSGs by HHS. 2.13.2 Clinical education and training It is recognised that the public hospital system has a significant role in educating and training the clinical workforce. Clinical education funding is allocated for the mix and level of staffing employed and also the number of under-graduate and post-graduate student clinical placement in the HHS. For the purposes of the funding model, clinical education is defined as an activity where the primary aim is to transfer clinical knowledge for ongoing professional development via a teacher or mentor to a student or candidate in a recognised program/course resulting in either: qualifications that may meet registration requirements, or other admission to a specialised discipline where the right to practice in that discipline requires completion of the program or course. Due to difficulties in separating the resource time for education activity that is incurred during direct patient treatment, a notional value is determined based on methodologies applied to each of the following components of clinical education: salaried employees in clinical training positions under-graduate and post-graduate student scholarships and clinical placements, and jointly appointed clinical academics. Funding levels are based on a percentage of annual base salaries and are applicable to ABF facilities only. The funding provides incentives for ABF facilities and staff to build the capacities for future health workforce and influence student decisions when choosing their future employer. Jointly appointed clinical academic positions in Queensland public facilities provide the nexus between the university sector, professional colleges and the health industry. A notional estimate of the statewide cost of this activity is allocated on a prorata basis according to the distribution of positions in-scope for the salaried employee component. As with SSGs, block grants for CET are funded from a portion of the total ABF pool available for Queensland that is redirected to grants. Refer to Appendix 13 for facility CET grants. 2014 2015-32 -
3. Facilities and services not funded through activity based funding 3.1 Block funding for small rural hospitals Block funding is typically applied for small public hospitals where there is an absence of economies of scale that mean some hospitals may not be financially viable under ABF. States provide advice to the IHPA on how their hospital services and functions meet the block funding criteria. Facilities eligible for block grant funding under the national NEC model are public hospitals that provide admitted patient services and whereby: the technical requirements for applying ABF are not able to be satisfied there is an absence of economies of scale that mean some services would not be financially viable under ABF. IHPA has also determined low volume thresholds that form part of the block funding criteria for use in 2014 2015. Under these thresholds, hospitals are eligible for block funding if they are: in a metropolitan area (defined as major city in the Australian Standard Geographical Classification) and they provide 1,800 acute inpatient NWAUs per annum, or in a rural area (defined as inner regional, outer regional, remote and very remote in the Australian Standard Geographical Classification) with less than 3500 acute inpatient NWAUs per annum. The NEC in 2014 2015 is $5.725 million this represents the average cost of a block funded hospital as determined by IHPA. The block funding then made available to each hospital is based on total reported NWAU activity on activity and location. Table 12 identifies the funding categories based on activity and region. Table 12 Categorisation of small rural hospitals by size and location 2014 2015 ASGS region Major cities Inner regional Outer regional Service volume grouping (Total NWAU) Group A 0-199.9 Group B 200-374.9 Group C 375-674.9 Group D 675-1049.9 Group E 1050-1499.9 Group F 1500-2649.9 Group G 2650+ N/A N/A 0.645 N/A N/A 0.999 4.130 0.210 0.363 0.518 0.829 0.996 1.370 2.847 0.230 0.320 0.582 0.759 0.869 1.454 2.759 Remote 0.194 0.209 0.502 0.621 1.192 1.566 4.412 Very remote 0.214 0.491 0.476 0.823 1.302 2.143 4.039 N/A = no hospitals are present in that combination of size and locality. 2014 2015-33 -
Under the 2014 2015 national model hospitals in Groups F and G receive an additional service capability payment of $500 per NWAU, as per 2011 2012 actual activity. Therefore a Group F or G hospitals NEC funding is determined by the above amount listed in the table plus a $500/NWAU payment based on the 2011 2012 activity. In 2014 2015, Queensland is applying the NEC model developed by the IHPA for 86 small hospitals (three of the specialist psychiatric hospitals will also be block funded via a localisation for these unique facilities). The following outlines the process applied for the block funding for small rural hospitals in 2014 2015. The efficient cost of the block funded hospitals has been derived from IHPA s 2014 2015 NEC model. OSR has been added on (based on 2012 2013 actuals indexed by 2.5 per cent, per year), as IHPA excludes activity funded through OSR in developing the NEC model. Base funding (prior to transition and efficiency adjustments) was based on the 2012 13 submitted cost centre splits uplifted to 2014 2015 by adding overheads, subtracting Commonwealth funding for multi-purpose health services (MPHS), and indexing at a rate of 2.5 per cent, per annum. Appendix 14 lists Queensland s hospitals/facilities and service volume grouping categories to which block funding arrangements will apply for 2014 2015. 3.2 Specialist block funded hospitals A facility based block funding approach also applies to three of Queensland s specialist psychiatric hospitals. However, funding is based on historical costs indexed at a rate of 2.5 per cent per annum. The three specialist block funded psychiatric facilities are: Baillie Henderson Hospital The Park Centre for Mental Health Kirwan Rehabilitation Unit. For further information on the national model for block funded hospitals refer to the National Efficient Cost Determination 2014 2015. 3.3 Other block funded services In addition to hospital services, HHSs also provide a wide range of primary and community health, and other services that are outside the scope of ABF, including: Aboriginal and Torres Strait Islander health alcohol tobacco and other drug services 2014 2015-34 -
cancer screening services child and family health chronic disease management community mental health community rehabilitation oral health. Most of these services do not currently have the necessary systems in place that would enable funding to be linked to the production of outputs. Hence these services will continue to be funded through recurrent allocations based on historical levels with indexation provided to account for enterprise bargaining and non-labour cost escalation. Please refer to Appendix 15 for a comprehensive list of services not funded via ABF. 3.4 Output based funded services In 2014 2015, two HHS non-hospital services, oral health and breast cancer screening will continue to be funded via output based funding (OBF) models. OBF works in a similar fashion to ABF, by linking the production of services (outputs) to funding. Importantly, OBF arrangements still allow HHSs to maintain discretion in allocating resources in accordance with local health service priorities. Two key principles underpinning the direction of this work have been the provision of appropriate incentives for efficient service delivery, and to enable equitable service access across the state. Under OBF arrangements, HHSs are set budgets and activity targets based on pricing structures that reflect the average cost of service delivery across the state, adjusted where appropriate for factors that may affect the efficient cost of service delivery. Oral health services (OHS) and Breast Screen Queensland (BSQ) services were the first two of Queensland s non-hospital services to be funded via OBF. This was based on an evaluation that, from a systems capability perspective, they were in the best position to move to an OBF environment. It is intended that the other HHS non-hospital services will be funded via OBF models as the necessary data systems and service activity classifications are developed. 3.4.1 Oral health The 2014 2015 OHS OBF model is based on an update of the 2013 2014 model. The transition arrangements that commenced in 2013 2014 based on historical costs will continue, with 2014 2015 being year two in the three year transition to the target price. For 2014 2015, the metro/regional HHS group target price will remain at $58 per Weighted Occasion Of Service (WOOS). For those HHSs in the metro/regional group that had a budgeted cost per WOOS below the $58 target price in their 2013 2014 service agreements, their 2013 2014 budgeted cost per WOOS was indexed by 2.5 per cent in line with cost increases to 2014 2015-35 -
derive their 2014 2015 budgeted cost per WOOS. The HHSs in this group are Cairns and Hinterland, Central Queensland, Mackay, Sunshine Coast and Townsville. It is expected that they will continue to receive further adjustments to reflect cost increases until they reach the target price. For the other HHSs in the metro/regional group that had a budgeted cost/woos of above the $58 target price in their 2013 2014 service agreements, the process of transitioning to the target price of $58 over three years is continuing during 2014 2015. Darling Downs will have a budget cost per weighted service event of $59. This is lower than under the original transition pathway, reflecting an improvement in their actual cost per weighted service event in 2012 2013. In the case of Metro North, Metro South and Wide Bay, their 2014 2015 budget cost /weighted service event has been set at the midway point between their 2013 2014 budgeted cost/weighted service event and $58. This approach continues the transition pathways established in the 2013 2014 model and recognises these HHSs still have scope to increase their efficiency. It is expected that these three HHS, as well as Darling Downs, will transition to the target price in 2015 2016. The remote HHSs (Central West, North West, South West, and Torres and Cape) are out-of-scope for the OBF model. For these HHSs, the state funded budget for 2014 2015 has been set equal to the 2013 2014 state funded budget, plus 2.5 per cent cost indexation. This approach for the remote group HHSs recognises that the provision of services in these locations is more costly than in the metro/regional group, and there are ongoing issues around cost centre allocations and data comparability. Table 13 2014 2015 oral health services OBF model groups OHS OBF model group Metro/Regional Remote Hospital and Health Service Cairns and Hinterland Central Queensland Darling Downs Gold Coast Mackay Metro North Metro South Sunshine Coast Townsville West Moreton Wide Bay Central West North West South West Torres and Cape 2014 2015-36 -
3.4.2 Breast screen The 2014 2015 BSQ OBF model operates by setting an efficient price per screen of $131 for metropolitan HHSs and $167 for regional HHSs. These prices were based broadly on average funding levels in the 2012 2013 service agreements indexed to 2014 2015. This approach continues the three year transition pathways established in the 2013 2014 model and recognises that these BSQ services still have scope to increase their efficiency. The metro group comprises the Gold Coast, Metro North, Metro South and Sunshine Coast BSQ services, as these all exhibit considerably higher annual screen throughputs than the other seven services, as well as their services being predominantly provided at sites located in major cities. A second (regional) group comprises the other BSQ services, which generally deliver much lower numbers of screens services that the metro group services in more remotely located sites. The BSQ OBF model uses transition arrangements similar to those applying to oral health, with those HHSs with a projected cost per screen above their respective groups efficient price expected to transition to the efficient price over the next two years. With the exception of Sunshine Coast and West Moreton, all HHSs have transitioned to the 2014 2015 target prices of $131 per screen for metropolitan HHSs and $167 per screen for regional HHSs. For Sunshine Coast, its 2014 2015 price of $134 per screen has been set at the midway point between the 2013 2014 budgeted cost and the efficient price. For West Moreton, its 2014 2015 price of $171 per screen has been set equal to the 2012 2013 actual cost indexed at 2.5 per cent, per annum over two years. This is faster than the original transition pathway and reflects an improvement in actual cost per screen in 2012 2013. It is expected that both Sunshine Coast and West Moreton will transition to the efficient price in 2014 2015. The categorisation of the HHS BSQ services is provided in Table 14. Table 14 2014 2015 BSQ OBF model groups BSQ OBF model group Metro Remote BSQ service Gold Coast Metro North Metro South Sunshine Coast Cairns and Hinterland Central Queensland Darling Downs Mackay Townsville West Moreton Wide Bay 2014 2015-37 -
3.5 Governance, audit and compliance A sound governance framework supported by clear standards and definitions, and backed up with an auditing process supported by end users is pivotal to ensuring funding is transparent, reflects need and based on reliable data sources. 3.5.1 Governance Hospital and Health Service Funding Committee The committee reports to the System Management Team (SMT) which is the consultative body where HHS leaders have the opportunity to inform and shape system-level decisions that impact on HHS. Membership of the committee includes representation from: Chief Finance Officers representing metro, regional and rural HHSs Provider Engagement and Contract Delivery Branch Service Needs, Access and Planning Branch CARU Health Statistics Branch Finance Branch Health Information Management Queensland representatives on IHPA s committees and working groups. The purpose of the committee is to provide guidance and make recommendations to the Executive Director, Provider Engagement and Contract Delivery in relation to all aspects of HHS funding, including: providing technical oversight and detailed input into the: way in which estimated future health service activity is employed within the purchasing framework derivation of the technical details supporting the annual purchasing framework and its associated purchasing initiatives. derivation of the Queensland efficient price responses, which the department makes to proposals from the IHPA, the administrator of the national health funding pool and any associated working group technical implementation of the national activity based funding model and any agreed Queensland localisations within the ABF model, purchasing model and Decision Support System (DSS) derivation of any new output based funding models application and further development of the rural hospitals funding model management of the annual site specific grant process and ABF/non ABF splits identification of funding strategies to maximise OSR within Queensland 2014 2015-38 -
oversight of the national health cost data collection derivation and application of the annual purchasing model to ensure accuracy, transparency and equity of application oversight of the statewide clinical costing solution and the business requirements for the potential system replacement maintenance of Information Technology (IT) systems for HHS funding models. Hospital and Health Service Costing and Funding Network The purpose of the network is to: provide a forum for stakeholders to discuss operational or technical HHS costing and funding issues, resolutions and to provide advice to influence the development of future national models and classifications. The network reports to the HHS Funding Committee. 3.5.2 Audit and clinical coding A statewide clinical coding audit program was adopted in 2013. A three-year coding audit cycle will be conducted by suitably qualified and appointed Queensland Department of Health clinical coders. The audit program will be overseen by the Statewide Health Information Management Clinical Coding Network that reports to CARU and the HHS Funding Committee. 3.5.3 Counting, coding and costing compliance Compliance with relevant counting, coding and costing requirements is mandatory. The references/standards for each element are as follows: Coding: ICD-10-AM Australian Coding Standards Costing: Costing Standards: Australian Hospital Patient Costing Standards Queensland Clinical Costing Implementation Guidelines Counting: data definitions outlined in: Queensland Hospital Admitted Patient Data Collection (QHAPDC) Manual Monthly Activity Collection (MAC) Manual Queensland Perinatal Data Collection (PDC) EDIS User Guide. 3.5.4 Data quality The Planning Engagement and Performance (PEP) directorate, within the Health Services Information Agency (HSIA), houses the Data Quality Team (DQT). The DQT is primarily responsible for data quality improvement across HHS and the department, ensuring appropriate linkages from the clinical exchange through to statistical analysis and final performance reporting. 2014 2015-39 -
The DQT oversee the following: Data quality central repository tools and resources to assist business areas within HHS and the department to assess and improve data quality as well as assist with consistency and standardisation, organisation wide information sharing and reduced duplication of effort. Statewide Data Quality Network the purpose of this network is to support business areas within HHSs and the department to identify data quality issues and opportunities for improvement and to develop, implement and share solutions. Queensland Health data quality framework the framework was developed to support the capture, use and ongoing improvement of the quality of data within HHS and the department, commencing with clinical data. 2014 2015-40 -
Appendix 1 Acute admitted patients AR-DRG v 7.0 Queensland 2014 2015-41 -
1. Qld Acute Inpatient Price Weights 2014/15 Same-Day Payment List Queensland Price Weight Outlier Base Diem Inlier Long-Stay Diem Queensland Base Price Outlier Base $ Diem $ Inlier $ Long-Stay Diem $ Bundled Lower Upper Paediatric Same Same DRG v7.0 Description ICU Bound Bound Adjustment Day Day $ 801A OR PR UNREL TO PDX+CCC 6 58 196% 0.7160 1.0343 6.9219 0.2639 $3,348 $4,836 $32,367 $1,234 801B OR PR UNREL TO PDX+SMCC 2 25 138% 0.5015 1.3388 3.1790 0.2364 $2,345 $6,260 $14,865 $1,105 801C OR PR UNREL TO PDX-CC 1 8 115% 1.3101 0.2976 $6,126 $1,392 A01Z LIVER TRANSPLANT Yes 11 101 100% 3.5024 2.3895 29.7869 0.6775 $16,377 $11,173 $139,284 $3,168 A03Z LUNG OR HEART-LUNG TRANSPLANT Yes 10 98 100% 3.0438 2.5523 28.5670 0.7878 $14,233 $11,935 $133,579 $3,684 A05Z HEART TRANSPLANT Yes 13 121 100% 3.6724 1.9042 28.4269 0.7812 $17,172 $8,904 $132,924 $3,653 A06A TRACHE +VENT>=96 +CCC Yes 16 150 100% 1.1359 2.9348 48.0930 0.7157 $5,311 $13,723 $224,883 $3,347 A06B VENT>=96 +OR PROC Yes 9 89 138% 1.4241 2.4080 23.0958 0.4884 $6,659 $11,260 $107,996 $2,284 A06C TRACH -VENT / (VENT -OR PROC) Yes 6 62 123% 0.3658 2.4605 15.1286 0.4895 $1,710 $11,505 $70,741 $2,289 A07A ALLOG BMT AGE <17Y 21 197 100% 0.1158 1.7536 36.9424 0.6669 $541 $8,200 $172,743 $3,118 A07B ALLOG BMT AGE >=17Y 8 79 100% 2.2128 17.7021 0.5501 $10,347 $82,775 $2,572 A08A AUTO BONE MARROW TRANSPLNT+CCC 7 66 200% 0.0199 1.1944 8.3806 0.3751 $93 $5,585 $39,188 $1,754 A08B AUTO BONE MARROW TRANSPLNT-CCC 3 29 81% 1.5226 4.5678 0.2998 $7,120 $21,359 $1,402 A09A KIDNEY TRANSPLNT+AGE<17/+CCC 3 35 100% 1.3291 2.5160 8.8770 0.4602 $6,215 $11,765 $41,509 $2,152 A09B KIDNEY TRANSPLNT +AGE>=17 -CCC 2 24 100% 1.6232 3.3421 8.3074 0.5123 $7,590 $15,628 $38,845 $2,396 A10Z INSERTION OF VAD Yes 20 189 100% 10.9912 2.8896 68.7836 0.7718 $51,395 $13,512 $321,632 $3,609 A11A INS IMPLNT SP INFUS DEV+CCC 15 136 100% 2.0627 1.0096 17.2064 0.3536 $9,645 $4,721 $80,457 $1,653 A11B INS IMPLNT SP INFUS DEV-CCC 1 15 100% 4.4526 0.5624 $20,820 $2,630 A12Z INS NEUROSTIMULATOR DEV 1 8 100% 4.8070 0.6176 $22,478 $2,888 A40A ECMO +TRACHE Yes 17 155 100% 1.6307 3.3179 58.0351 0.9419 $7,625 $15,515 $271,372 $4,404 A40B ECMO -TRACHE Yes 8 73 148% 1.4658 3.1191 26.4188 0.7531 $6,854 $14,585 $123,534 $3,521 B01A VENTRICULAR SHUNT REV +CSCC 2 27 92% 0.9331 1.1983 3.3298 0.3179 $4,363 $5,603 $15,570 $1,487 B01B VENTRICULAR SHUNT REV -CSCC 1 14 94% 2.6900 0.2971 $12,578 $1,389 B02A CRANIAL PROC +CER HAEM +CCC Yes 6 56 100% 1.8520 1.9659 13.6472 0.4490 $8,660 $9,193 $63,814 $2,100 B02B CRAN PROC -HAEM+CCC/+HAEM+SCC 5 46 153% 1.4740 1.1847 7.3973 0.3116 $6,892 $5,540 $34,590 $1,457 B02C CRANIAL PROC -HAEM+SCC/-CSCC 2 22 100% 1.2051 1.6109 4.4269 0.2847 $5,635 $7,533 $20,700 $1,331 B03A SPINAL PROCEDURES +CSCC 4 45 100% 1.5017 1.3317 6.8285 0.3041 $7,022 $6,227 $31,930 $1,422 B03B SPINAL PROCEDURES -CSCC 1 12 111% 3.2325 0.2689 $15,115 $1,257 B04A EXTRACRANIAL VASCULAR PR +CCC 3 35 100% 1.3790 1.1955 4.9656 0.2670 $6,448 $5,590 $23,219 $1,248 B04B EXTRACRANIAL VASCULAR PR -CCC 1 12 100% 2.5511 0.2620 $11,929 $1,225 B05Z CARPAL TUNNEL RELEASE 1 3 100% 0.4608 0.1291 $2,155 $604 B06A CBL PSY,MUS DYSY,NPTHY PR+CSCC 5 48 110% 0.7331 0.9682 5.5739 0.2193 $3,428 $4,527 $26,064 $1,025 B06B CBL PSY,MUS DYSY,NPTHY PR-CSCC 1 9 172% 1.5449 0.2547 $7,224 $1,191 B06C CBL PSY,MUS DYSY,NPTHY PR +SD 1 1 100% 0.6884 $3,219 B07A CRANL/PRPHL NERV & OTH PR+CC 3 29 100% 0.6496 1.0321 3.7460 0.2400 $3,038 $4,826 $17,516 $1,122 B07B CRANL/PRPHL NERV & OTH PR-CC Yes 1 6 113% 0.6609 1.4022 0.3504 $3,090 $6,557 $1,638 B40Z PLASMAPHERESIS + NEURO DIS SD 1 1 100% 0.2167 $1,013 B41Z TELEMETRIC EEG MONITORING 1 14 80% 1.7015 0.3436 $7,956 $1,607 B42A NERV SYS DIS W VENT SUPP +CCC Yes 4 38 100% 0.1053 1.9293 7.8223 0.3536 $492 $9,021 $36,577 $1,653 B42B NERV SYS DIS W VENT SUPP -CCC Yes 1 16 119% 3.7306 0.3792 $17,444 $1,773 B60A ACUTE PARA/QUAD+/-OR PR +CCC 9 89 100% 0.2095 1.1304 10.3828 0.3185 $980 $5,286 $48,550 $1,489 B60B ACUTE PARA/QUAD+/-OR PR -CCC 3 32 100% 0.1448 1.4523 4.5017 0.2931 $677 $6,791 $21,050 $1,371 B61A SPINAL CORD COND+/-OR PR +CSCC 5 45 100% 0.4043 1.2255 6.5319 0.3333 $1,891 $5,730 $30,543 $1,559 B61B SPINAL CORD COND+/-OR PR -CSCC 1 14 88% 2.0853 0.3473 $9,751 $1,624 B62Z APHERESIS 1 3 80% 0.3463 0.2759 $1,619 $1,290 B63Z DMNTIA&CHRNIC DISTURB CRBRL FN 4 43 100% 0.7327 2.9309 0.1851 $3,426 $13,705 $866 B64A DELIRIUM+CCC 4 39 100% 0.7093 2.8371 0.2037 $3,317 $13,266 $953 B64B DELIRIUM-CCC Yes 2 19 100% 0.1188 0.7313 1.4626 0.1910 $556 $3,420 $6,839 $893 B65A CEREBRAL PALSY 1 14 114% 1.3849 0.2727 $6,476 $1,275 B65B CEREBRAL PALSY +SD 1 1 118% 0.3525 $1,648 B66A NERV SYS NEOPLASM +RADIO 4 39 100% 0.9795 3.9182 0.2359 $4,580 $18,322 $1,103 B66B NERV SYS NEOPLASM -RADIO +CSCC 2 22 158% 1.0399 2.0798 0.2218 $4,863 $9,725 $1,037 B66C NERV SYS NEOPLASM -RADIO -CSCC Yes 1 15 135% 0.3285 1.1980 0.2012 $1,536 $5,602 $941 B67A DEGNRTV NERV SYS DIS +CSCC 4 38 125% 0.7788 3.1152 0.2145 $3,642 $14,567 $1,003 B67B DEGNRTV NERV SYS DIS -CSCC 2 19 92% 0.7788 1.5576 0.1908 $3,642 $7,283 $892 B67C DEGNRTV NERV SYS DIS +SD 1 1 188% 0.1448 $677 Please note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 1/14
1. Qld Acute Inpatient Price Weights 2014/15 Queensland Price Weight Queensland Base Price Same-Day Long-Stay Long-Stay Payment Bundled Lower Upper Paediatric Same Same Outlier Base DRG v7.0 Description List ICU Bound Bound Adjustment Day Outlier Base Diem Inlier Diem Day $ $ Diem $ Inlier $ Diem $ B68A MLT SCLROSIS&CEREBEL ATAXIA+CC 3 29 100% 0.8365 2.5095 0.2329 $3,911 $11,734 $1,089 B68B MLT SCLROSIS&CEREBEL ATAXIA-CC Yes 1 13 135% 0.2912 0.9401 0.2377 $1,362 $4,396 $1,111 B69A TIA & PRECEREBRAL OCCLUSN+CSCC 1 17 100% 1.3056 0.2215 $6,105 $1,036 B69B TIA & PRECEREBRAL OCCLUSN-CSCC 1 8 100% 0.5780 0.2006 $2,703 $938 B70A STROKE & OTH CEREB DIS +CCC 5 46 100% 0.7394 3.6970 0.2313 $3,457 $17,287 $1,082 B70B STROKE & OTH CEREB DIS +SCC 2 21 100% 0.9662 1.9325 0.2249 $4,518 $9,036 $1,052 B70C STROKE & OTH CEREB DIS -CSCC Yes 1 17 200% 0.2778 1.3228 0.2298 $1,299 $6,185 $1,075 B70D STRKE&OTH CEREB DIS DIE/TRN<5D 1 4 100% 0.5180 $2,422 B71A CRANIAL & PERIPHL NERV DSRD+CC 2 24 180% 1.0731 2.1462 0.2355 $5,018 $10,036 $1,101 B71B CRANIAL & PERIPHL NERV DSRD-CC 1 12 200% 0.8899 0.2224 $4,161 $1,040 B71C CRANIAL & PERIPHL NERV DSRD+SD 1 1 141% 0.1591 $744 B72A NRVS SYS INF EX VRL MNGTS+CSCC 4 43 125% 0.9826 3.9306 0.2248 $4,595 $18,379 $1,051 B72B NRVS SYS INF EX VRL MNGTS-CSCC 1 14 140% 1.1261 0.2371 $5,266 $1,109 B73Z VIRAL MENINGITIS 1 10 114% 0.8017 0.2265 $3,749 $1,059 B74A NONTRAUMATC STUPR & COMA +CSCC 1 17 100% 1.3254 0.2224 $6,198 $1,040 B74B NONTRAUMATC STUPR & COMA -CSCC 1 6 105% 0.4044 0.2379 $1,891 $1,112 B75Z FEBRILE CONVULSIONS 1 4 100% 0.3638 0.2542 $1,701 $1,189 B76A SEIZURES +CSCC 2 19 130% 0.8501 1.7002 0.2273 $3,975 $7,950 $1,063 B76B SEIZURES -CSCC 1 7 155% 0.5845 0.2497 $2,733 $1,168 B76C SEIZURES +SD 1 1 200% 0.1421 $664 B77Z HEADACHE Yes 1 7 139% 0.1158 0.5156 0.2282 $541 $2,411 $1,067 B78A INTRACRANIAL INJURY +CSCC 3 30 100% 0.9148 2.7444 0.2355 $4,278 $12,833 $1,101 B78B INTRACRANIAL INJURY -CSCC 1 12 113% 1.0494 0.2437 $4,907 $1,140 B78C INTRACRANIAL INJURIES D/T<5D 1 4 100% 0.4542 $2,124 B79A SKULL FRACTURES +CSCC 1 17 100% 1.5066 0.2094 $7,045 $979 B79B SKULL FRACTURES -CSCC 1 6 125% 0.5413 0.2586 $2,531 $1,209 B80A OTHER HEAD INJURIES +CSCC 1 14 100% 1.0002 0.2028 $4,677 $948 B80B OTHER HEAD INJURIES -CSCC Yes 1 5 89% 0.1107 0.3439 0.2292 $518 $1,608 $1,072 B81A OTHER DSRD OF NERVOUS SYS+CSCC 3 28 150% 0.7532 2.2595 0.2095 $3,522 $10,565 $980 B81B OTHER DSRD OF NERVOUS SYS-CSCC Yes 1 13 117% 0.3838 0.9681 0.2176 $1,795 $4,527 $1,017 B82A CHR UNSP PARA/QUAD+/-OR+SGFR 24 218 100% 0.8582 0.9065 22.6152 0.2401 $4,013 $4,239 $105,749 $1,123 B82B CHR UNSP PARA/QUAD+/-PR+CCC 6 60 100% 1.0391 6.2343 0.2824 $4,859 $29,152 $1,321 B82C CHR UNSP PARA/QUAD+/- PR -CCC 2 21 143% 0.1051 0.9688 2.0427 0.2280 $491 $4,530 $9,552 $1,066 C01Z PROC FOR PENETRATNG EYE INJURY 1 9 125% 1.6731 0.3849 $7,823 $1,800 C02Z ENUCLEATIONS & ORBITAL PROCS Yes 1 12 128% 0.6644 2.1090 0.3170 $3,107 $9,862 $1,482 C03Z RETINAL PROCEDURES 1 4 115% 0.8054 0.2767 $3,766 $1,294 C04Z MAJOR CORN, SCLERAL&CONJNCT PR 1 7 100% 1.3667 0.3020 $6,391 $1,412 C05Z DACRYOCYSTORHINOSTOMY 1 3 89% 0.9453 0.3115 $4,420 $1,457 C10Z STRABISMUS PROCEDURES 1 3 100% 0.7718 0.2542 $3,609 $1,189 C11Z EYELID PROCEDURES Yes 1 6 100% 0.5940 1.0958 0.2249 $2,778 $5,124 $1,052 C12Z OTHER CORN, SCLERAL&CONJNCT PR 1 4 122% 0.6738 0.2217 $3,151 $1,037 C13Z LACRIMAL PROCEDURES 1 3 86% 0.4345 0.1699 $2,032 $794 C14Z OTHER EYE PROCEDURES 1 5 107% 0.5189 0.1764 $2,426 $825 C15Z GLAUCOMA/CX CATARACT PROCS 1 4 145% 0.7921 0.2538 $3,704 $1,187 C16Z LENS PROCEDURES 1 4 143% 0.5406 0.1934 $2,528 $904 C60A AC & MJR EYE INFECTN +CC 2 24 100% 1.2160 2.4320 0.2679 $5,686 $11,372 $1,253 C60B AC & MJR EYE INFECTN -CC 1 13 100% 1.2683 0.2975 $5,931 $1,391 C61A NEUROLOGICAL&VASCLR EYE DIS+CC 1 15 100% 1.3243 0.2378 $6,192 $1,112 C61B NEUROLOGICAL&VASCLR EYE DIS-CC Yes 1 10 138% 0.2220 0.8018 0.2310 $1,038 $3,749 $1,080 C62A HYPH&MED MNGD EYE TRAUMA +CC Yes 1 14 100% 0.1274 1.0146 0.2097 $596 $4,744 $981 C62B HYPH&MED MANGD EYE TRMA -CC Yes 1 6 200% 0.1289 0.4310 0.2373 $603 $2,015 $1,110 C63A OTH DIS OF THE EYE W CC Yes 1 13 118% 0.2082 1.1965 0.2520 $974 $5,595 $1,178 C63B OTH DIS OF THE EYE W/O CC Yes 1 8 150% 0.2220 0.7158 0.2597 $1,038 $3,347 $1,214 D01Z COCHLEAR IMPLANT 1 3 110% 6.8699 0.9339 $32,124 $4,367 D02A HEAD & NECK PROC +MVTT/+CSCC 4 37 100% 1.3346 1.2231 6.2269 0.3238 $6,241 $5,719 $29,117 $1,514 D02B HEAD & NECK PROC +MALIG/+MCC 1 14 100% 2.7801 0.4144 $13,000 $1,938 Please note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 2/14
1. Qld Acute Inpatient Price Weights 2014/15 Queensland Price Weight Queensland Base Price Same-Day Long-Stay Long-Stay Payment Bundled Lower Upper Paediatric Same Same Outlier Base DRG v7.0 Description List ICU Bound Bound Adjustment Day Outlier Base Diem Inlier Diem Day $ $ Diem $ Inlier $ Diem $ D02C HEAD & NECK PROC -MALG -CC 1 6 100% 1.7454 0.5131 $8,161 $2,399 D03Z SURGCL RPR CLEFT LIP/PAL DIS 1 7 117% 1.7072 0.4151 $7,983 $1,941 D04Z MAXILLO SURGERY Yes 1 7 100% 0.8827 2.0119 0.3598 $4,128 $9,408 $1,682 D05Z PAROTID GLAND PROCS 1 7 100% 2.3761 0.4205 $11,111 $1,966 D06Z SINUS &CMPLX MDDL EAR PR 1 4 100% 1.2549 0.4272 $5,868 $1,998 D10Z NASAL PROCEDURES 1 3 80% 0.9671 0.3688 $4,522 $1,725 D11Z TONSILLECTOMY, ADENOIDECTOMY 1 3 89% 0.7084 0.3452 $3,312 $1,614 D12A OTH EAR,NOSE,MTH & THRT PR +CC 1 13 125% 1.7481 0.3045 $8,174 $1,424 D12B OTH EAR,NOSE,MTH & THRT PR -CC Yes 1 5 100% 0.5533 1.1791 0.2995 $2,587 $5,513 $1,400 D13Z MYRINGOTOMY +TUBE INSERTION 1 3 100% 0.3850 0.1370 $1,800 $641 D14A MOUTH & SALIVRY GLAND PROC +CC 1 10 100% 1.6029 0.3211 $7,495 $1,501 D14B MOUTH & SALIVRY GLAND PROC -CC 1 4 89% 0.8278 0.2651 $3,871 $1,240 D15Z MASTOID PROCEDURES 1 6 93% 2.1191 0.5471 $9,909 $2,558 D40Z DENTAL EXTRACT & RESTORATIONS 1 3 100% 0.6523 0.1835 $3,050 $858 D60A EAR NOSE MOUTH&THROAT MAL+CSCC 2 26 100% 0.1158 1.4372 2.9903 0.2712 $541 $6,720 $13,983 $1,268 D60B EAR NOSE MOUTH&THROAT MAL-CSCC 1 7 129% 0.9024 0.2217 $4,220 $1,037 D60C EAR NOSE MOUTH&THROAT MAL +SD 1 1 100% 0.4160 $1,945 D61A DYSEQUILIBRIUM +CC 1 13 100% 0.9370 0.1977 $4,381 $924 D61B DYSEQUILIBRIUM -CC 1 7 148% 0.4810 0.2027 $2,249 $948 D61C DYSEQUILIBRIUM +SD 1 1 100% 0.0987 $462 D62A EPISTAXIS 1 7 149% 0.5192 0.2281 $2,428 $1,067 D62B EPISTAXIS +SD 1 1 198% 0.1326 $620 D63A OTITIS MEDIA AND URI +CC 1 10 110% 0.8613 0.2496 $4,027 $1,167 D63B OTITIS MEDIA AND URI -CC 1 5 129% 0.4377 0.2468 $2,047 $1,154 D63C OTITIS MEDIA AND URI +SD 1 1 127% 0.1364 $638 D64Z LARYNGOTRACHEITIS&EPIGLOTTITIS 1 4 92% 0.2992 0.2164 $1,399 $1,012 D65Z NASAL TRAUMA & DEFORMITY 1 4 85% 0.3635 0.1466 $1,700 $686 D66A OTH EAR,NOSE,MOUTH&THRT DX +CC 1 15 124% 1.2233 0.2330 $5,720 $1,090 D66B OTH EAR,NOSE,MOUTH&THRT DX -CC 1 6 100% 0.5568 0.2135 $2,604 $998 D66C OTH EAR,NOSE,MOUTH&THRT DX +SD 1 1 111% 0.2664 $1,246 D67A ORAL & DENTAL DISORDERS 1 8 124% 0.7057 0.2509 $3,300 $1,173 D67B ORAL & DENTAL DISORDERS +SD 1 1 136% 0.2113 $988 E01A MAJOR CHEST PROCEDURE +CCC 4 43 106% 0.6675 1.2529 5.6792 0.2735 $3,121 $5,859 $26,556 $1,279 E01B MAJOR CHEST PROCEDURE -CCC 2 22 111% 0.3852 1.4788 3.3428 0.2679 $1,801 $6,915 $15,631 $1,253 E02A OTHER RESPIRATRY SYS OR PR+CCC 4 42 147% 0.4090 1.1058 4.8321 0.2604 $1,912 $5,171 $22,595 $1,218 E02B OTH RESPIRATRY SYS OR PR+SMCC Yes 1 14 88% 0.5960 2.1198 0.2806 $2,787 $9,912 $1,312 E02C OTHER RESPIRATY SYS OR PR -CC 1 4 89% 0.8838 0.3130 $4,133 $1,464 E40A RESP DIS W VENT SUPP Yes 4 37 93% 0.0623 1.8893 7.6195 0.4355 $291 $8,834 $35,629 $2,036 E40B RESP DX W VENT SUPP D/T<5D Yes 1 4 100% 3.1766 $14,854 E41A RESP SYS DX +NON-INVS VENT+CCC 4 37 142% 0.0277 1.1401 4.5883 0.2604 $130 $5,331 $21,455 $1,218 E41B RESP SYS DX +NON-INVS VENT-CCC 2 23 100% 0.0574 1.4511 2.9595 0.2817 $268 $6,785 $13,839 $1,317 E42A BRONCHOSCOPY +CCC 5 49 111% 0.3796 0.9202 4.9805 0.2550 $1,775 $4,303 $23,289 $1,192 E42B BRONCHOSCOPY -CCC 2 21 133% 0.3474 0.9659 2.2793 0.2047 $1,624 $4,517 $10,658 $957 E42C BRONCHOSCOPY +SD 1 1 134% 0.4033 $1,886 E60A CYSTIC FIBROSIS +CSCC 4 38 118% 1.0516 4.2062 0.2689 $4,917 $19,668 $1,257 E60B CYSTIC FIBROSIS -CSCC 3 29 122% 1.0587 3.1760 0.2288 $4,950 $14,851 $1,070 E61A PULMONARY EMBOLISM +CCC 3 31 100% 0.9254 2.7763 0.2152 $4,327 $12,982 $1,006 E61B PULMONARY EMBOLISM -CCC Yes 2 18 100% 0.2262 0.5610 1.1220 0.1394 $1,058 $2,623 $5,246 $652 E62A RESPIRATRY INFECTN/INFLAMM+CCC 3 28 159% 0.7663 2.2990 0.2293 $3,583 $10,750 $1,072 E62B RESPIRATRY INFECTN/INFLAM+SMCC 1 16 130% 1.2030 0.2259 $5,625 $1,056 E62C RESPIRATORY INFECTN/INFLAMM-CC Yes 1 10 100% 0.1211 0.7701 0.2178 $566 $3,601 $1,018 E63Z SLEEP APNOEA 1 4 113% 0.3003 0.1308 $1,404 $612 E64A PULMONRY OEDEMA &RESP FAIL 2 20 100% 0.9123 1.8246 0.2230 $4,266 $8,532 $1,043 E64B PULMNRY OEDMA &RESP FL D/T<5D 1 4 100% 0.4806 $2,247 E65A CHRNIC OBSTRCT AIRWAY DIS +CCC 2 26 100% 0.9729 1.9458 0.2136 $4,549 $9,099 $999 E65B CHRNIC OBSTRCT AIRWAY DIS -CCC 1 14 200% 0.9841 0.2096 $4,602 $980 Please note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 3/14
1. Qld Acute Inpatient Price Weights 2014/15 Queensland Price Weight Queensland Base Price Same-Day Long-Stay Long-Stay Payment Bundled Lower Upper Paediatric Same Same Outlier Base DRG v7.0 Description List ICU Bound Bound Adjustment Day Outlier Base Diem Inlier Diem Day $ $ Diem $ Inlier $ Diem $ E66A MAJOR CHEST TRAUMA +CCC 3 35 100% 0.9634 2.8901 0.2036 $4,505 $13,514 $952 E66B MJR CHEST TRMA +SMCC 1 15 100% 1.1684 0.2108 $5,463 $986 E66C MAJOR CHEST TRAUMA -CC 1 8 100% 0.5751 0.2168 $2,689 $1,014 E67A RESPIRATRY SIGNS & SYMPTM 1 13 100% 1.0675 0.2315 $4,992 $1,082 E67B RESPIRTRY SIGNS & SYMPTM <2D Yes 1 1 80% 0.2061 0.2781 $964 $1,300 E68A PNEUMOTHORAX +CSCC 2 20 100% 0.9378 1.8757 0.2429 $4,385 $8,771 $1,136 E68B PNEUMOTHORAX -CSCC 1 9 93% 0.8003 0.2432 $3,742 $1,137 E69A BRONCHITIS & ASTHMA +CC 1 11 100% 0.8826 0.2099 $4,127 $981 E69B BRNCHTS&ASTHMA -CC Yes 1 6 87% 0.1245 0.4910 0.2267 $582 $2,296 $1,060 E70A WHOOPNG CGH &ACTE BRNCHIO +CC 1 12 100% 1.4266 0.3496 $6,671 $1,635 E70B WHOOPNG CGH &ACTE BRNCHIO -CC 1 7 92% 0.7050 0.3318 $3,297 $1,551 E71A RESPIRATORY NEOPLASMS +CCC 3 29 100% 0.8650 2.5951 0.2227 $4,045 $12,135 $1,041 E71B RESPIRATORY NEOPLASMS -CCC 1 16 121% 1.2925 0.2261 $6,044 $1,057 E71C RESPIRATORY NEOPLASMS +SD 1 1 185% 0.2945 $1,377 E72Z RESP PROBS FROM NEONATL PERIOD 1 11 87% 0.7913 0.3850 $3,700 $1,800 E73A PLEURAL EFFUSION +CCC 3 30 100% 0.8672 2.6015 0.2250 $4,055 $12,165 $1,052 E73B PLEURAL EFFUSION +SMCC Yes 2 19 100% 0.2397 0.7561 1.5122 0.2058 $1,121 $3,536 $7,071 $962 E73C PLEURAL EFFUSION -CC Yes 1 12 100% 0.2126 0.9007 0.2029 $994 $4,212 $949 E74A INTERSTITAL LUNG DIS +CCC 3 31 100% 0.7733 2.3200 0.2153 $3,616 $10,848 $1,007 E74B INTERSTITIAL LUNG DIS +SMCC 2 19 100% 0.7975 1.5950 0.2235 $3,729 $7,458 $1,045 E74C INTERSTITIAL LUNG DIS -CC Yes 1 15 95% 0.3375 1.1026 0.1978 $1,578 $5,156 $925 E75A OTHER RESP SYS DIS +CC Yes 1 16 137% 0.1465 1.2938 0.2282 $685 $6,050 $1,067 E75B OTHER RESP SYS DIS -CC Yes 1 8 95% 0.1293 0.5989 0.2233 $605 $2,800 $1,044 E76A RESPIRATORY TUBERCULOSIS +CC 8 80 100% 0.7086 5.6684 0.1892 $3,313 $26,505 $885 E76B RESPIRATORY TUBERCULOSIS -CC 1 14 100% 0.6557 0.2195 $3,066 $1,026 F01A IMPLNTN/REPLCMNT AICD TTL+CCC 3 34 100% 3.3398 2.3037 10.2509 0.3258 $15,617 $10,772 $47,933 $1,523 F01B IMPLNTN/REPLCMNT AICD TTL-CCC Yes 1 11 100% 3.4634 5.6456 0.2987 ####### $26,399 $1,397 F02Z OTHER AICD PROCEDURES 1 12 100% 2.3278 0.2965 $10,885 $1,386 F03A CRDC VALV PR+PMP+INV INVES+CCC Yes 7 66 100% 5.2763 1.2397 13.9545 0.3851 $24,672 $5,797 $65,251 $1,801 F03B CRDC VALV PR+PMP+INV INVES-CCC Yes 3 33 100% 3.6964 1.6495 8.6449 0.3518 $17,284 $7,713 $40,424 $1,645 F04A CRD VLV PR+PMP-INV INVES +CCC Yes 4 39 100% 4.1703 1.5262 10.2751 0.4117 $19,500 $7,137 $48,046 $1,925 F04B CRD VLV PR+PMP-INV INVES -CCC Yes 2 24 100% 2.6474 2.4223 7.4921 0.4074 $12,379 $11,327 $35,033 $1,905 F05A CRNRY BYPSS+INV INVES +CCC Yes 6 55 100% 2.5590 1.4001 10.9595 0.3710 $11,966 $6,547 $51,247 $1,735 F05B CRNRY BYPSS+INV INVES -CCC Yes 4 39 100% 2.4175 1.5328 8.5488 0.3231 $11,304 $7,167 $39,974 $1,511 F06A CRNRY BYPSS-INV INVS +CCC Yes 3 33 100% 2.4862 1.8095 7.9148 0.4034 $11,625 $8,461 $37,010 $1,886 F06B CRNRY BYPSS-INV INVS -CCC Yes 2 23 100% 2.0799 2.0730 6.2259 0.3317 $9,726 $9,693 $29,112 $1,551 F07A OTHER CARDTHOR/VASC PR+PMP+CCC Yes 4 37 122% 2.8234 1.6535 9.4376 0.4212 $13,202 $7,732 $44,130 $1,970 F07B OTHER CARDTHOR/VASC PR+PMP-CCC Yes 2 21 100% 2.0342 2.3562 6.7466 0.5142 $9,512 $11,018 $31,547 $2,404 F08A MJR RECONSTRC VASC PR-PUMP+CCC 5 45 100% 2.2328 1.0714 7.5897 0.2864 $10,441 $5,010 $35,489 $1,339 F08B MJR RECONSTRC VASC PR-PUMP-CCC 2 19 100% 1.3930 1.5519 4.4967 0.2664 $6,514 $7,257 $21,027 $1,246 F09A OTH CARDIOTHOR PR-PMP+CCC 3 28 136% 1.1842 1.3087 5.1103 0.3115 $5,537 $6,119 $23,896 $1,457 F09B OTH CARDIOTHOR PR-PMP -CCC 1 12 161% 2.6307 0.3108 $12,301 $1,453 F09C OTH CARDIOTHOR PR-PMP +D/T<5D 1 4 100% 1.9028 $8,897 F10A INTERVENTN CORONARY PR+AMI+CCC 2 25 100% 1.0031 1.3700 3.7432 0.2733 $4,690 $6,406 $17,503 $1,278 F10B INTERVENTN CORONARY PR+AMI-CCC 1 10 100% 2.1637 0.2930 $10,117 $1,370 F11A AMPUTN CIRC SYS-UP LMB&TOE+CCC 9 88 100% 1.1220 0.9943 10.0711 0.2744 $5,246 $4,649 $47,092 $1,283 F11B AMPUTN CIRC SYS-UP LMB&TOE-CCC 5 46 100% 0.7936 0.9797 5.6921 0.2868 $3,711 $4,581 $26,616 $1,341 F12A IMPLANT/REPLCE PM,TOT SYS +CCC 3 31 100% 1.5227 1.1006 4.8244 0.2676 $7,120 $5,146 $22,559 $1,251 F12B IMPLANT/REPLCE PM,TOT SYS -CCC Yes 1 11 100% 1.4404 2.6464 0.2443 $6,735 $12,375 $1,142 F13A UP LIMB&TOE AMP CIRC DIS +CSCC 5 52 100% 0.4418 1.1537 6.2105 0.2732 $2,066 $5,395 $29,040 $1,277 F13B UP LIMB&TOE AMP CIRC DIS -CSCC 2 21 100% 0.3932 0.9659 2.3251 0.2384 $1,839 $4,517 $10,872 $1,115 F14A VASC PR-MJR RECONSTRC-PUMP+CCC 3 32 100% 0.5888 1.3035 4.4993 0.2684 $2,753 $6,095 $21,039 $1,255 F14B VASC PR-MJR RECONSTR-PUMP+SMCC Yes 1 14 163% 0.8170 2.3233 0.2773 $3,820 $10,864 $1,297 F14C VASC PR-MJR RECONSTR-PUMP-CC Yes 1 7 139% 0.8215 1.6368 0.2586 $3,841 $7,654 $1,209 F15A INTER CORONARY PR-AMI+STN+CSCC 1 11 100% 2.5099 0.2750 $11,736 $1,286 F15B INTER CORONRY PR-AMI+STNT-CSCC 1 6 100% 1.7065 0.2030 $7,980 $949 Please note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 4/14
1. Qld Acute Inpatient Price Weights 2014/15 Queensland Price Weight Queensland Base Price Same-Day Long-Stay Long-Stay Payment Bundled Lower Upper Paediatric Same Same Outlier Base DRG v7.0 Description List ICU Bound Bound Adjustment Day Outlier Base Diem Inlier Diem Day $ $ Diem $ Inlier $ Diem $ F16A INTERVN CORONARY PR-AMI-STN+CC 1 11 100% 2.0052 0.2828 $9,376 $1,322 F16B INTERV CORONARY PR-AMI-STNT-CC 1 5 100% 1.3632 0.2546 $6,374 $1,191 F17Z INSERT/REPLACE PM GENERATOR 1 5 100% 1.5512 0.2728 $7,253 $1,276 F18A OTHER PACEMAKER PROCS +CC 3 27 100% 0.5456 0.8483 3.0906 0.2068 $2,551 $3,967 $14,452 $967 F18B OTHER PACEMAKER PROCS -CC 1 7 100% 1.2663 0.2591 $5,921 $1,212 F19A TRNS-VSCLR PERC CRDC >=80Y/+CC 2 20 100% 1.0269 1.4675 3.9619 0.2583 $4,802 $6,862 $18,526 $1,208 F19B TRNS-VSCLR PERC CRDC <80Y -CC 1 4 92% 2.3178 0.2952 $10,838 $1,380 F20Z VEIN LIGATION & STRIPPING 1 4 80% 0.9671 0.3085 $4,522 $1,443 F21A OTH CIRC SYS OR PR +CCC 5 48 100% 0.6091 0.9326 5.2722 0.2275 $2,848 $4,361 $24,653 $1,064 F21B OTH CIRC SYS OR PR -CCC Yes 1 16 100% 0.8556 1.9881 0.1998 $4,001 $9,296 $934 F40A CIRC DIS +VENT SUPP Yes 4 41 100% 0.1243 1.9891 8.0805 0.3802 $581 $9,301 $37,784 $1,778 F40B CIRC DIS+ VENT SUPP D/T<5D Yes 1 4 100% 2.9914 $13,988 F41A CRC DSRD+AMI+INVA INV PR+CSCC 2 23 100% 0.2500 1.2567 2.7634 0.2509 $1,169 $5,876 $12,922 $1,173 F41B CRC DSRD+AMI+INVA INV PR-CSCC Yes 1 13 100% 0.6007 1.5787 0.2395 $2,809 $7,382 $1,120 F42A CRC DSRD-AMI+IC IN PR +CSCC 2 22 100% 0.3712 1.1511 2.6734 0.2446 $1,736 $5,383 $12,501 $1,144 F42B CRC DSRD-AMI+IC IN PR -CSCC 1 9 133% 1.2912 0.1897 $6,038 $887 F42C CRC DSRD-AMI+IC IN PR +SD 1 1 193% 0.5714 $2,672 F43Z CIRC DIS W NIV 3 34 100% 0.0120 1.3297 4.0011 0.2557 $56 $6,218 $18,709 $1,196 F60A CRC DSRD+AMI-INVA INV 1 17 100% 1.4964 0.2337 $6,997 $1,093 F60B CRC DSRD+AMI-INVA INV D/T <5D Yes 1 4 100% 0.2263 0.7352 $1,058 $3,438 F61A INFECTIVE ENDOCARDITIS +CCC 8 72 100% 0.9152 7.3216 0.2252 $4,279 $34,236 $1,053 F61B INFECTIVE ENDOCARDITIS -CCC 4 37 100% 0.7926 3.1703 0.1574 $3,706 $14,824 $736 F62A HEART FAILURE & SHOCK +CCC 3 30 100% 0.8272 2.4815 0.2250 $3,868 $11,603 $1,052 F62B HEART FAILURE & SHOCK -CCC 1 15 100% 1.1173 0.2137 $5,224 $999 F62C HEART FAILURE & SHOCK D/T <5D 1 4 100% 0.4288 $2,005 F63A VENOUS THROMBOSIS +CSCC 2 24 100% 0.9547 1.9095 0.2058 $4,464 $8,929 $962 F63B VENOUS THROMBOSIS -CSCC Yes 1 18 100% 0.1293 0.7200 0.0959 $605 $3,367 $448 F64A SKN ULCERS CIRC DISORD +CSCC 4 39 100% 0.7277 2.9110 0.2163 $3,403 $13,612 $1,011 F64B SKN ULCERS CIRC DISORD -CSCC Yes 2 25 100% 0.2056 0.8084 1.6169 0.1688 $961 $3,780 $7,561 $789 F65A PERIPHERAL VASCULAR DSRD +CSCC 2 21 100% 0.9663 1.9325 0.2319 $4,518 $9,036 $1,084 F65B PERIPHERAL VASCULAR DSRD -CSCC Yes 1 10 92% 0.3322 0.9238 0.1935 $1,553 $4,320 $905 F66A CORONARY ATHEROSCLEROSIS +CSCC 1 14 100% 1.1139 0.2242 $5,209 $1,048 F66B CORONARY ATHEROSCLEROSIS -CSCC Yes 1 6 100% 0.1510 0.4709 0.2023 $706 $2,202 $946 F67A HYPERTENSION +CSCC 1 17 100% 1.2804 0.2181 $5,987 $1,020 F67B HYPERTENSION -CSCC Yes 1 9 166% 0.1211 0.5873 0.2082 $566 $2,746 $974 F68Z CONGENITAL HEART DISEASE 1 6 123% 0.4771 0.2206 $2,231 $1,032 F69A VALVULAR DISORDERS +CSCC 2 19 100% 0.8370 1.6741 0.2148 $3,914 $7,828 $1,004 F69B VALVULAR DISORDERS -CSCC Yes 1 7 178% 0.1905 0.4930 0.2166 $891 $2,305 $1,013 F72A UNSTABLE ANGINA +CSCC 1 14 100% 1.1268 0.2215 $5,269 $1,036 F72B UNSTABLE ANGINA -CSCC Yes 1 7 100% 0.1199 0.5801 0.2304 $561 $2,713 $1,077 F73A SYNCOPE & COLLAPSE +CSCC 1 17 100% 1.2529 0.2133 $5,859 $997 F73B SYNCOPE & COLLAPSE -CSCC 1 7 131% 0.5058 0.1983 $2,365 $927 F73C SYNCOPE & COLLAPSE +SD 1 1 100% 0.1372 $642 F74A CHEST PAIN 1 10 100% 0.8041 0.2009 $3,760 $939 F74B CHEST PAIN <2D 1 1 151% 0.1794 $839 F75A OTHER CIRCULATORY DIS +CCC 3 30 194% 0.9583 2.8750 0.2481 $4,481 $13,444 $1,160 F75B OTH CIRCULATORY DIS +SMCC 1 13 189% 1.1454 0.2353 $5,356 $1,100 F75C OTH CIRCULATORY DIS -CC Yes 1 8 165% 0.2737 0.7150 0.2303 $1,280 $3,343 $1,077 F76A ARRHY, CARD & COND DISDR +CSCC 2 18 100% 0.8090 1.6180 0.2123 $3,783 $7,566 $993 F76B ARRHY, CARD & COND DISDR -CSCC 1 8 192% 0.6108 0.1736 $2,856 $812 F76C ARRHY, CARD & COND DISDR +SD 1 1 118% 0.1861 $870 G01A RECTAL RESECTION +CCC 5 53 100% 1.5853 1.1084 7.1271 0.2785 $7,413 $5,183 $33,326 $1,302 G01B RECTAL RESECTION -CCC 2 27 100% 1.5190 1.4513 4.4215 0.2454 $7,103 $6,786 $20,675 $1,147 G02A MJR SMALL & LARGE BOWEL PR+CCC 5 51 132% 1.2041 1.0624 6.5162 0.2963 $5,630 $4,968 $30,470 $1,385 G02B MJR SMALL & LARGE BOWEL PR-CCC 2 22 100% 0.6367 1.3625 3.3616 0.2983 $2,977 $6,371 $15,719 $1,395 G03A STOMCH,OESPH&DUODNL PR+MAL/CCC 4 41 112% 1.1834 1.4180 6.8554 0.3404 $5,534 $6,631 $32,056 $1,592 Please note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 5/14
1. Qld Acute Inpatient Price Weights 2014/15 Queensland Price Weight Queensland Base Price Same-Day Long-Stay Long-Stay Payment Bundled Lower Upper Paediatric Same Same Outlier Base DRG v7.0 Description List ICU Bound Bound Adjustment Day Outlier Base Diem Inlier Diem Day $ $ Diem $ Inlier $ Diem $ G03B STMCH,OESPHGL&DDNL PR-MAL+SMCC 2 21 118% 0.9017 1.1199 3.1414 0.3064 $4,216 $5,237 $14,689 $1,433 G03C STMCH,OESPHGL&DDNL PR-MAL-CC 1 11 114% 2.1608 0.2945 $10,104 $1,377 G04A PERITONEAL ADHESOLYSIS +CCC 5 46 100% 0.9626 0.9392 5.6587 0.2964 $4,501 $4,392 $26,460 $1,386 G04B PRTNL ADHLY +SMCC 2 24 113% 0.7903 1.1725 3.1353 0.2832 $3,695 $5,483 $14,661 $1,324 G04C PERITONEAL ADHESOLYSIS -CC 1 12 115% 1.8266 0.2804 $8,541 $1,311 G05A MNR SMALL&LARGE BOWEL PR +CCC 4 43 100% 0.7721 0.9061 4.3963 0.2710 $3,610 $4,237 $20,557 $1,267 G05B MNR SMALL&LARGE BOWEL PR +SMCC 2 21 112% 0.6001 1.0395 2.6791 0.2760 $2,806 $4,861 $12,527 $1,291 G05C MNR SMALL & LARGE BOWEL PR -CC 1 12 80% 1.8149 0.3403 $8,486 $1,591 G06Z PYLOROMYOTOMY PROCEDURE 1 11 87% 1.8780 0.2863 $8,782 $1,339 G07A APPENDCTMY +MALIG/PERITON/CSCC 1 15 129% 1.8521 0.2936 $8,660 $1,373 G07B APPENDCTMY -MALIG-PERITON-CSCC 1 7 117% 1.1979 0.2528 $5,601 $1,182 G10A HERNIA PROCEDURES +CC 1 15 80% 2.2009 0.2714 $10,291 $1,269 G10B HERNIA PROCEDURES -CC 1 4 80% 1.0010 0.3065 $4,681 $1,433 G11Z ANAL & STOMAL PROCEDURES Yes 1 7 134% 0.4758 0.9315 0.1953 $2,225 $4,356 $913 G12A OTH DIGEST SYS OR PR+CCC 4 44 100% 0.4827 1.1703 5.1639 0.2740 $2,257 $5,472 $24,146 $1,281 G12B OTH DIGEST SYS OR PR+SMCC 1 17 115% 2.1500 0.2441 $10,053 $1,141 G12C OTH DIGEST SYS OR PR-CC Yes 1 13 184% 0.6397 1.6050 0.2245 $2,991 $7,505 $1,050 G46A COMPLEX GASTROSCOPY+CCC 4 39 100% 0.2786 0.9401 4.0392 0.2506 $1,303 $4,396 $18,887 $1,172 G46B COMPLEX GASTROSCOPY-CCC 1 14 150% 1.4215 0.2298 $6,647 $1,075 G46C COMPLEX GASTROSCOPY,SD 1 1 156% 0.3674 $1,718 G47A OTH GASTROSCOPY +CCC 3 32 100% 0.1899 0.8964 2.8792 0.2392 $888 $4,192 $13,463 $1,118 G47B OTH GASTROSCOPY -CCC 1 10 113% 0.9830 0.2166 $4,597 $1,013 G47C OTH GASTROSCOPY, SD 1 1 143% 0.1448 $677 G48A COLONOSCOPY +CSCC 3 28 100% 0.2047 0.8170 2.6555 0.2323 $957 $3,820 $12,417 $1,086 G48B COLONOSCOPY - CSCC 1 10 159% 1.0287 0.1992 $4,810 $931 G48C COLONOSCOPY, SD 1 1 147% 0.3261 $1,525 G60A DIGESTIVE MALIGNANCY + CCC 3 28 100% 0.8155 2.4466 0.2232 $3,813 $11,440 $1,044 G60B DIGESTIVE MALIGNANCY - CCC Yes 1 14 200% 0.2920 0.9069 0.2090 $1,365 $4,241 $977 G61A GI HAEMORRHAGE +CSCC 1 15 100% 1.1318 0.2202 $5,292 $1,030 G61B GI HAEMORRHAGE - CSCC Yes 1 8 113% 0.1376 0.5480 0.1971 $643 $2,562 $922 G64A INFLAMMATORY BOWEL DISEASE +CC Yes 2 19 156% 0.2572 0.7991 1.5982 0.2477 $1,203 $3,737 $7,473 $1,158 G64B INFLAMMATORY BOWEL DISEASE-CC Yes 1 11 116% 0.4815 0.8901 0.2473 $2,251 $4,162 $1,156 G65A GI OBSTRUCTION + CSCC 2 19 100% 0.8080 1.6161 0.2357 $3,778 $7,557 $1,102 G65B GI OBSTRUCTION - CSCC 1 9 90% 0.6902 0.2203 $3,227 $1,030 G66A ABDMNL PAIN/MESENT ADENTS, O/N 1 6 111% 0.4553 0.2164 $2,129 $1,012 G66B ABDMNL PAIN/MESENT ADENTS, SD 1 1 137% 0.1126 $527 G67A OESPHS, GASTR +CSCC 1 16 118% 1.2599 0.2293 $5,891 $1,072 G67B OESPHS, GASTR -CSCC Yes 1 6 119% 0.0968 0.4825 0.2049 $453 $2,256 $958 G70A OTHER DIGESTIVE SYS DIAG +CSCC 2 18 162% 0.7490 1.4981 0.2183 $3,502 $7,005 $1,021 G70B OTHER DIGESTIVE SYS DIAG -CSCC 1 8 136% 0.5823 0.2087 $2,723 $976 G70C OTHER DIGESTIVE SYS DIAG -SD 1 1 123% 0.1580 $739 H01A PANCREAS, LIVER & SHUNT PR+CCC Yes 5 49 100% 0.8337 1.5419 8.5432 0.3297 $3,898 $7,210 $39,948 $1,542 H01B PANCREAS, LIVER &SHUNT PR-CCC 2 19 100% 0.3050 1.8737 4.0523 0.3870 $1,426 $8,761 $18,949 $1,810 H02A MJR BILIARY TRACT PR +CCC 5 53 100% 0.8220 1.0858 6.2508 0.2537 $3,844 $5,077 $29,229 $1,186 H02B MJR BILIARY TRACT PR -CCC 2 21 154% 0.4923 1.3691 3.2304 0.2654 $2,302 $6,402 $15,105 $1,241 H05A HEPATOBILIARY DIAGNTIC PR +CCC 4 42 100% 0.9378 1.0906 5.3000 0.2399 $4,385 $5,100 $24,783 $1,122 H05B HEPATOBILIARY DIAGNTIC PR -CCC 1 11 100% 1.3775 0.2929 $6,441 $1,370 H06A OTH HEPTOBILRY & PANCRS PR+CCC 5 47 100% 0.1422 1.0985 5.6345 0.2688 $665 $5,137 $26,347 $1,257 H06B OTH HEPTOBILRY &PANCRS PR-CCC 1 11 100% 1.4070 0.2038 $6,579 $953 H07A OPEN CHOLECYSTECTOMY+CDE/+CCC 4 39 100% 1.1682 1.0041 5.1846 0.2622 $5,463 $4,695 $24,243 $1,226 H07B OPEN CHOLECYSTECTOMY-CDE-CCC 1 17 100% 2.7009 0.2749 $12,629 $1,285 H08A LAP CHOLECYSTECTMY+CDE/+CSCC 2 18 100% 0.8573 0.9637 2.7847 0.2520 $4,009 $4,506 $13,021 $1,178 H08B LAP CHOLECYSTECTMY-CDE-CSCC 1 6 116% 1.4630 0.2299 $6,841 $1,075 H40A ENDO PR BLEED OES VARICES +CCC 3 30 100% 0.2172 1.0047 3.2314 0.3060 $1,016 $4,698 $15,110 $1,431 H40B ENDO PR BLEED OES VARICES -CCC 1 14 100% 1.5034 0.3165 $7,030 $1,480 H43A ERCP PROCEDURE +CSCC 3 30 100% 0.3303 0.9680 3.2342 0.2466 $1,544 $4,526 $15,123 $1,153 Please note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 6/14
1. Qld Acute Inpatient Price Weights 2014/15 Queensland Price Weight Queensland Base Price Same-Day Long-Stay Long-Stay Payment Bundled Lower Upper Paediatric Same Same Outlier Base DRG v7.0 Description List ICU Bound Bound Adjustment Day Outlier Base Diem Inlier Diem Day $ $ Diem $ Inlier $ Diem $ H43B ERCP PROCEDURE -CSCC 1 13 100% 1.3362 0.2236 $6,248 $1,046 H43C ERCP PROCEDURE, SAMEDAY 1 1 100% 0.4558 $2,131 H60A CIRRHOSIS & ALC HEPATITIS +CCC 3 32 100% 1.0126 3.0378 0.2436 $4,735 $14,205 $1,139 H60B CIRRHOSIS & ALC HEPATITIS -CCC 1 15 100% 1.2525 0.2196 $5,857 $1,027 H60C CIRRHOSIS & ALC HEPATITIS, SD 1 1 100% 0.2784 $1,302 H61A MALG HEPATOBILIARY SYS PAN+CCC 3 28 100% 0.8755 2.6266 0.2173 $4,094 $12,282 $1,016 H61B MALG HEPATOBILIAY SYS PANC-CCC 1 15 118% 1.2479 0.2210 $5,835 $1,033 H61C MALG HEPATOBILIAY SYS PANC, SD 1 1 139% 0.3245 $1,517 H62A DISORDERS PANCREAS-MALIG+CSCC 2 22 100% 1.0197 2.0394 0.2536 $4,768 $9,536 $1,186 H62B DISORDERS PANCREAS-MALIG-CSCC Yes 1 11 177% 0.2521 0.8109 0.2219 $1,179 $3,792 $1,038 H63A DSRD LVR-MAL,CIRR,ALC HEP+CCC 3 29 100% 0.9478 2.8433 0.2360 $4,432 $13,295 $1,104 H63B DSRD LVR-MAL,CIRR,ALC HEP-CCC 1 13 128% 1.1270 0.2220 $5,270 $1,038 H63C DSRD LVR-MAL,CIRR,ALC HEP, SD 1 1 148% 0.2759 $1,290 H64A DISORDERS OF BILIARY TRACT +CC 2 18 158% 0.7987 1.5973 0.2310 $3,735 $7,469 $1,080 H64B DISORDERS OF BILIARY TRACT -CC 1 8 200% 0.6259 0.2106 $2,927 $985 H64C DISORDERS OF BILIARY TRACT, SD 1 1 100% 0.1320 $617 I01A BL/MLT MJ JT PR LWR EXT+RV/CCC 9 86 100% 3.7426 0.9428 12.2277 0.2470 $17,500 $4,409 $57,177 $1,155 I01B BL/MLT MJ JT PR LWR EXT-RV-CCC 2 23 100% 3.6876 1.1069 5.9014 0.3133 $17,243 $5,176 $27,595 $1,465 I02A MVTT/SKIN GRAFT+CSCC-HAND 9 88 100% 1.8283 1.1492 12.1707 0.2845 $8,549 $5,374 $56,910 $1,330 I02B SKIN GRAFT -CSCC -HAND 2 25 90% 0.6391 1.6785 3.9961 0.2596 $2,988 $7,849 $18,686 $1,214 I03A HIP REPLACEMENT + CCC 4 42 100% 2.2707 0.7967 5.4574 0.2385 $10,618 $3,725 $25,519 $1,115 I03B HIP REPLACEMENT - CCC 2 21 100% 2.1385 1.0313 4.2011 0.1935 $10,000 $4,822 $19,644 $905 I04A KNEE REPLACEMT +CSCC 3 27 100% 2.4881 0.8408 5.0106 0.2437 $11,634 $3,932 $23,430 $1,140 I04B KNEE REPLACEMT -CSCC 1 18 100% 4.0540 0.2206 $18,957 $1,032 I05A OTH JNT REPLACEMENT +CSCC 3 34 100% 2.5475 0.9733 5.4673 0.2249 $11,912 $4,551 $25,565 $1,052 I05B OTH JNT REPLACEMENT -CSCC 1 12 100% 3.6920 0.2597 $17,264 $1,214 I06Z SPINAL FUSION +DEFORMITY 2 26 92% 0.8438 5.0527 10.9492 0.6065 $3,946 $23,626 $51,198 $2,836 I07Z AMPUTATION 8 73 100% 0.8643 0.8355 7.5482 0.2511 $4,041 $3,907 $35,295 $1,174 I08A OTHER HIP & FEMUR PROC +CCC 5 49 123% 1.0493 0.8145 5.1217 0.2330 $4,907 $3,809 $23,949 $1,090 I08B OTHER HIP & FEMUR PR -CCC 2 25 100% 0.8345 1.1834 3.2012 0.2228 $3,902 $5,534 $14,969 $1,042 I09A SPINAL FUSION +CCC 5 51 100% 4.0023 1.2442 10.2232 0.3247 $18,715 $5,818 $47,804 $1,518 I09B SPINAL FUSION -CCC 2 20 107% 3.1206 1.3947 5.9101 0.3468 $14,592 $6,522 $27,636 $1,622 I10A OTHER BACK & NECK PROCS +CSCC 3 32 100% 1.0939 1.1346 4.4979 0.2828 $5,115 $5,305 $21,032 $1,322 I10B OTHER BACK & NECK PROCS -CSCC 1 12 100% 2.2730 0.2597 $10,629 $1,214 I11Z LIMB LENGTHENING PROCEDURES 1 14 134% 2.7824 0.3655 $13,011 $1,709 I12A INFC/INFM BONE/JNT+MISC PR+CCC 8 74 100% 0.4787 0.8098 6.9572 0.2282 $2,238 $3,787 $32,532 $1,067 I12B INFC/INFM BNE/JNT+MISC PR+SMCC 4 42 125% 0.5507 0.8751 4.0512 0.1698 $2,575 $4,092 $18,943 $794 I12C INFC/INFM BNE/JNT+MISC PR-CC 2 19 125% 0.4948 0.8561 2.2071 0.1760 $2,314 $4,003 $10,320 $823 I13A HUMER,TIBIA,FIBUL,ANKL PR+CC 3 33 100% 1.0440 1.0604 4.2252 0.2361 $4,882 $4,958 $19,757 $1,104 I13B HUM,TIB,FIB,ANKL PR-CC >=17 1 12 100% 2.1222 0.2669 $9,923 $1,248 I13C HUM,TIB,FIB,ANKL PR-CC <17 1 5 100% 1.2820 0.2740 $5,995 $1,281 I15Z CRANIO-FACIAL SURGERY 1 17 150% 3.0436 0.2976 $14,232 $1,392 I16Z OTHER SHOULDER PROCEDURES 1 4 100% 1.4886 0.4156 $6,961 $1,943 I17A MAXILLO-FACIAL SURGERY +CC 1 13 100% 2.3945 0.3097 $11,197 $1,448 I17B MAXILLO-FACIAL SURGERY -CC 1 5 100% 1.5915 0.3450 $7,442 $1,613 I18Z OTHER KNEE PROCEDURES Yes 1 8 107% 0.6466 1.3181 0.2063 $3,024 $6,163 $965 I19A OTHER ELBOW, FOREARM PROCS +CC 2 18 100% 1.1191 0.8372 2.7936 0.2327 $5,233 $3,915 $13,063 $1,088 I19B OTHER ELBOW, FOREARM PROCS -CC 1 6 86% 1.5585 0.2572 $7,288 $1,203 I20Z OTHER FOOT PROCEDURES Yes 1 8 106% 0.6879 1.5168 0.2555 $3,217 $7,093 $1,195 I21Z LOC EX, REM INT FIX DEV HP&FMR 1 7 89% 1.0773 0.3176 $5,037 $1,485 I23Z LOC EX,REM INT FIX-HP&FMR Yes 1 6 100% 0.5070 1.2340 0.2552 $2,371 $5,770 $1,193 I24Z ARTHROSCOPY 1 5 135% 0.8189 0.2411 $3,829 $1,127 I25A BNE,JNT DXTIC PR INC BIOPSY+CC 3 33 100% 0.1434 1.3392 4.1610 0.2265 $671 $6,262 $19,457 $1,059 I25B BNE,JNT DXTIC PR INC BIOPSY-CC Yes 1 16 113% 0.5647 1.8036 0.2154 $2,641 $8,434 $1,007 I27A SOFT TISSUE PROCEDURES +CSCC 3 35 84% 0.5585 1.2333 4.2583 0.2378 $2,612 $5,767 $19,912 $1,112 I27B SOFT TISSUE PROCEDURES -CSCC 1 8 110% 1.3406 0.2345 $6,269 $1,097 Please note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 7/14
1. Qld Acute Inpatient Price Weights 2014/15 Same-Day Payment List Queensland Price Weight Outlier Base Diem Inlier Long-Stay Diem Queensland Base Price Outlier Base $ Diem $ Inlier $ Long-Stay Diem $ Bundled Lower Upper Paediatric Same Same DRG v7.0 Description ICU Bound Bound Adjustment Day Day $ I27C SOFT TISSUE PROCEDURES +SD 1 1 100% 0.6016 $2,813 I28A OTH MUSCULOSKELETAL PR+CC 3 31 135% 0.6597 0.9044 3.3728 0.2067 $3,085 $4,229 $15,771 $967 I28B OTH MUSCULOSKELETAL PR-CC Yes 1 7 111% 0.6462 1.4608 0.2394 $3,022 $6,831 $1,119 I29Z KNEE RECONSTRUCTION/REVISION 1 4 100% 1.6819 0.4492 $7,865 $2,100 I30Z HAND PROCEDURES Yes 1 6 100% 0.6681 1.1951 0.3068 $3,124 $5,588 $1,435 I31A REV HIP +CCC / INFC/INFLM PROS 7 64 100% 3.2155 0.8685 9.2947 0.2242 $15,036 $4,061 $43,462 $1,048 I31B REV HIP -CCC -INFC/INFLM PROS 2 26 100% 2.6062 1.3588 5.3239 0.2062 $12,187 $6,354 $24,895 $964 I32A REV KNEE+CCC / INFC/INFLM PROS 6 58 100% 3.5844 0.7683 8.1942 0.1898 $16,761 $3,593 $38,316 $888 I32B REV KNEE -CCC -INFC/INFLM PROS 2 20 100% 2.3437 1.3323 5.0083 0.2446 $10,959 $6,230 $23,419 $1,144 I40Z INFUSIONS +SD 1 1 87% 0.3082 $1,441 I60Z FEMORAL SHAFT FRACTURES 3 27 121% 0.1978 0.9083 2.9226 0.2522 $925 $4,247 $13,666 $1,179 I61A DISTAL FEMORAL FRACTURES +CC 3 35 100% 0.9295 2.7886 0.2034 $4,346 $13,039 $951 I61B DISTAL FEMORAL FRACTURES -CC 1 15 123% 1.1403 0.2036 $5,332 $952 I63A SPR,STR&DSLC HIP,PELV&THIGH+CC 1 17 100% 1.3998 0.2143 $6,545 $1,002 I63B SPR,STR&DSLC HIP,PELV&THIGH-CC 1 6 100% 0.5201 0.2049 $2,432 $958 I64A OSTEOMYELITIS +CSCC 5 52 100% 0.7967 3.9835 0.1586 $3,725 $18,627 $742 I64B OSTEOMYELITIS -CSCC 3 34 118% 0.8029 2.4087 0.1189 $3,754 $11,263 $556 I65A MUSCSKEL MALIG NEO +CCC/+RADIO 3 34 187% 1.1035 3.3105 0.2371 $5,160 $15,480 $1,109 I65B MUSCSKEL MALIG NEO -CCC -RADIO 1 15 126% 1.4923 0.2069 $6,978 $967 I66A INFLAM MUSCULO DSR +CSCC 3 34 100% 1.1148 3.3445 0.2633 $5,213 $15,639 $1,231 I66B INFLAM MUSCULO DSR -CSCC 1 14 100% 1.1546 0.2299 $5,399 $1,075 I67A SEPTIC ARTHRITIS +CSCC 5 48 100% 0.8751 4.3756 0.1899 $4,092 $20,460 $888 I67B SEPTIC ARTHRITIS -CSCC 2 25 100% 0.8051 1.6103 0.1270 $3,765 $7,530 $594 I68A NON-SURG SPINAL DISORDERS +CC 2 26 140% 1.0009 2.0018 0.2089 $4,680 $9,360 $977 I68B NON-SURG SPINAL DISORDERS -CC 1 11 132% 0.7128 0.2117 $3,333 $990 I69A BONE DISEASES AND ARTHROP+CSCC 2 26 100% 0.9553 1.9105 0.2108 $4,467 $8,933 $986 I69B BONE DISEASES AND ARTHROP-CSCC 1 13 146% 0.8228 0.1827 $3,847 $854 I71A OTH MUSCTENDIN DISRD +CSCC 2 22 100% 0.8737 1.7474 0.2010 $4,085 $8,171 $940 I71B OTH MUSCTENDIN DISRD -CSCC 1 9 140% 0.6167 0.1990 $2,884 $931 I72A SPEC MUSCTEND DISRD +CSCC 3 27 100% 0.7519 2.2556 0.2121 $3,516 $10,547 $992 I72B SPEC MUSCTEND DISRD -CSCC 1 12 100% 0.7575 0.1756 $3,542 $821 I73A AFTCARE MUSCSK IMPL +CSCC 4 39 100% 0.7030 2.8119 0.1649 $3,287 $13,148 $771 I73B AFTCARE MUSCSK IMPL -CSCC 2 21 81% 0.6422 1.2843 0.1016 $3,003 $6,005 $475 I74A INJ FOREARM,WRIST,HAND,FT +CC 1 18 100% 1.1986 0.1914 $5,605 $895 I74B INJ FOREARM,WRIST,HAND,FT -CC 1 4 120% 0.4949 0.1790 $2,314 $837 I75A INJ SH,ARM,ELB,KN,LEG,ANKL +CC 2 26 100% 0.9658 1.9317 0.1934 $4,516 $9,033 $904 I75B INJ SH,ARM,ELB,KN,LEG,ANKL -CC 1 8 121% 0.5963 0.1949 $2,788 $911 I76A OTH MUSCULOSKELETAL DSRD +CSCC 2 24 100% 0.9662 1.9325 0.1980 $4,518 $9,036 $926 I76B OTH MUSCULOSKELETAL DSRD -CSCC 1 9 138% 0.6746 0.1925 $3,154 $900 I77A FRACTURE OF PELVIS +CSCC 3 35 100% 0.8415 2.5244 0.1978 $3,935 $11,804 $925 I77B FRACTURE OF PELVIS -CSCC 1 16 100% 1.1065 0.1891 $5,174 $884 I78A FRACTURE NECK OF FEMUR +CSCC 3 29 100% 0.7377 2.2130 0.1844 $3,449 $10,348 $862 I78B FRACTURE NECK OF FEMUR -CSCC 1 17 100% 1.0836 0.1951 $5,067 $912 I79A PATHOLOGICAL FRACTURE +CCC 5 49 100% 0.7769 3.8843 0.2373 $3,633 $18,163 $1,110 I79B PATHOLOGICAL FRACTURE -CCC 2 22 100% 0.8974 1.7949 0.1989 $4,196 $8,393 $930 I80Z FEM FRACT TRANS <2D Yes 1 1 100% 0.1201 0.2774 $562 $1,297 I81Z INJURIES +SD 1 1 200% 0.1572 $735 I82Z OTHER +SD 1 1 197% 0.1909 $893 J01A MICRVS TSS TRNSF SKN/BRST+CSCC 5 53 100% 3.7484 1.1016 9.2566 0.3083 $17,528 $5,151 $43,284 $1,442 J01B MICRVS TSS TRNSF SKN/BRST-CSCC 2 26 100% 2.1066 1.7289 5.5644 0.3444 $9,850 $8,084 $26,019 $1,610 J06A MAJOR PROC FOR MAL BREAST DIS 1 9 100% 1.7614 0.2093 $8,236 $979 J06B MAJOR PROC FOR NON-MAL BR DIS 1 7 100% 1.7073 0.2833 $7,983 $1,325 J07A MINOR PROC FOR MAL BREAST DIS 1 4 100% 0.8331 0.3286 $3,896 $1,537 J07B MINOR PROC FOR NON-MAL BR DIS 1 3 100% 0.6558 0.2292 $3,067 $1,072 J08A OTH SKN GRF&/DBRDMNT PR +CC 3 31 109% 0.4926 0.9853 3.4485 0.2263 $2,303 $4,607 $16,125 $1,058 J08B OTH SKN GRF&/DBRDMNT PR -CC 1 10 107% 1.4229 0.2029 $6,653 $949 Please note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 8/14
1. Qld Acute Inpatient Price Weights 2014/15 Same-Day Payment List Queensland Price Weight Outlier Base Diem Inlier Long-Stay Diem Queensland Base Price Outlier Base $ Diem $ Inlier $ Long-Stay Diem $ Bundled Lower Upper Paediatric Same Same DRG v7.0 Description ICU Bound Bound Adjustment Day Day $ J08C OTH SKN GRF&/DBRDMNT PR, SD 1 1 94% 0.6277 $2,935 J09Z PERIANAL & PILONIDAL PR 1 7 140% 0.7932 0.1201 $3,709 $562 J10Z SKN,SUBC TIS & BRST PLASTIC PR Yes 1 7 89% 0.5901 1.3551 0.2136 $2,759 $6,336 $999 J11Z OTHER SKIN, SUBC TIS & BRST PR Yes 1 10 100% 0.4238 1.1527 0.1800 $1,982 $5,390 $842 J12A L LMB PR +ULCR/CELS+CCC 8 75 100% 0.2713 0.7251 6.0721 0.2379 $1,269 $3,391 $28,393 $1,112 J12B L LMB PR+ULCR/CELS-CCC-GRAFT 4 38 100% 0.4107 0.8525 3.8206 0.2116 $1,920 $3,986 $17,865 $989 J12C L LMB PR+ULCR/CELS-CCC-GRAFT 2 26 100% 0.2949 1.0019 2.2988 0.1956 $1,379 $4,685 $10,749 $915 J13A L LMB PR-ULC/CEL+CCC/(GFT+SCC) 3 34 100% 0.4999 1.0874 3.7621 0.2434 $2,338 $5,085 $17,592 $1,138 J13B L LMB PR-ULC/CEL-CCC-(GFT+SCC) Yes 1 15 100% 0.5791 1.6515 0.2187 $2,708 $7,722 $1,023 J14Z MAJOR BREAST RECONSTRUCTIONS 2 23 100% 1.1462 2.0420 5.2302 0.3214 $5,360 $9,548 $24,456 $1,503 J60A SKIN ULCERS +CCC 5 45 100% 0.6652 3.3260 0.2245 $3,110 $15,552 $1,050 J60B SKIN ULCERS -CCC 2 25 100% 0.7346 1.4692 0.1645 $3,435 $6,870 $769 J60C SKIN ULCERS, SAMEDAY 1 1 100% 0.1831 $856 J62A MALIGNANT BREAST DIS, O/N 2 21 100% 0.9397 1.8793 0.2138 $4,394 $8,788 $1,000 J62B MALIGNANT BREAST DISORDERS, SD 1 1 100% 0.2717 $1,270 J63A NON-MALIGNANT BREAST DIS 1 10 100% 0.7739 0.1809 $3,619 $846 J63B NON-MALIGNANT BREAST DIS, SD 1 1 100% 0.2157 $1,009 J64A CELLULITIS +CSCC 2 25 100% 0.9860 1.9720 0.2153 $4,611 $9,221 $1,007 J64B CELLULITIS -CSCC Yes 1 12 116% 0.1301 0.6582 0.1278 $608 $3,078 $598 J65A TRAUMA TO SKN,SUB TIS&BST+CSCC 2 19 100% 0.7803 1.5605 0.1936 $3,649 $7,297 $905 J65B TRAUMA TO SKN,SUB TIS&BST-CSCC 1 7 125% 0.4669 0.1983 $2,183 $927 J65C TRAUMA TO SKN,SUB TIS&BST +SD 1 1 125% 0.1382 $646 J67A MINOR SKIN DISORDERS 1 10 114% 0.7718 0.2251 $3,609 $1,053 J67B MINOR SKIN DISORDERS, SAMEDAY 1 1 80% 0.2503 $1,170 J68A MAJOR SKIN DISORDERS +CSCC 2 26 113% 1.0993 2.1986 0.2243 $5,140 $10,281 $1,049 J68B MAJOR SKIN DISORDERS -CSCC 1 12 128% 0.9367 0.2182 $4,380 $1,020 J68C MAJOR SKIN DISORDERS, SAMEDAY 1 1 80% 0.2281 $1,067 J69A SKIN MALIGNANCY +CCC 4 38 100% 0.8196 3.2786 0.2323 $3,832 $15,331 $1,086 J69B SKIN MALIGNANCY -CCC 2 20 100% 0.8323 1.6645 0.1883 $3,892 $7,783 $880 J69C SKIN MALIGNANCY, SAMEDAY 1 1 100% 0.2191 $1,025 K01A OR PR DIABETIC COMPLICATNS+CCC 8 78 100% 0.3848 0.9009 7.5916 0.2601 $1,799 $4,213 $35,498 $1,216 K01B OR PR DIABETIC COMPLICATNS-CCC 4 39 100% 0.2990 0.8299 3.6187 0.2180 $1,398 $3,881 $16,921 $1,019 K02A PITUITARY PROCEDURES +CC 3 31 100% 1.4157 1.3511 5.4690 0.3756 $6,620 $6,318 $25,573 $1,756 K02B PITUITARY PROCEDURES -CC 1 16 100% 3.5021 0.2916 $16,376 $1,364 K03Z ADRENAL PROCEDURES 2 20 100% 1.1387 1.3018 3.7423 0.3870 $5,325 $6,087 $17,499 $1,810 K05A PARATHYROID PROCEDURES +CSCC 2 21 100% 0.8306 1.1746 3.1797 0.2474 $3,884 $5,492 $14,868 $1,157 K05B PARATHYROID PROCEDURES -CSCC 1 5 100% 1.3748 0.3202 $6,429 $1,497 K06A THYROID PROCEDURES +CSCC 1 15 100% 3.0244 0.3223 $14,142 $1,507 K06B THYROID PROCEDURES -CSCC 1 6 100% 1.7423 0.3630 $8,147 $1,697 K08Z THYROGLOSSAL PROCEDURES 1 4 84% 1.2977 0.3947 $6,068 $1,846 K09A OTH ENDCRN, NUTR& META PR +CCC 5 49 100% 0.3634 1.0892 5.8095 0.2377 $1,699 $5,093 $27,165 $1,111 K09B OTH ENDCRN, NUTR& META PR+SMCC 2 22 100% 0.3197 1.3649 3.0494 0.2496 $1,495 $6,382 $14,259 $1,167 K09C OTH ENDCRN, NUTR & META PR -CC 1 9 146% 1.3245 0.3108 $6,193 $1,453 K10A REV & OPEN BARIAT PROCS W CC 2 25 100% 1.9390 1.2120 4.3629 0.2914 $9,067 $5,667 $20,401 $1,363 K10B REV & OPEN BARIAT PROCS W/O CC 1 11 100% 2.7901 0.4562 $13,047 $2,133 K11A MAJ LAP BARIATRIC PROCS W CC 1 11 100% 2.6980 0.3138 $12,616 $1,467 K11B MAJ LAP BARIATRIC PROCS W/O CC 1 5 100% 1.8993 0.2716 $8,881 $1,270 K12Z OTHER BARIATRIC PROCS 1 6 100% 2.0504 0.2708 $9,588 $1,266 K13Z PLAS OR PROC - END,NUT,MET DIS 1 12 100% 1.8692 0.2672 $8,740 $1,249 K40A ENDO/INVEST PROC +CCC 7 64 100% 0.1777 0.8376 6.0407 0.2362 $831 $3,917 $28,246 $1,104 K40B ENDO/INVEST PROC -CCC 2 20 114% 0.2170 0.9274 2.0717 0.2340 $1,015 $4,337 $9,687 $1,094 K40C ENDO/INVEST PROC +SD 1 1 120% 0.3418 $1,598 K60A DIABETES +CSCC 2 23 189% 1.0134 2.0267 0.2133 $4,739 $9,477 $997 K60B DIABETES -CSCC 1 12 173% 0.9243 0.1979 $4,322 $925 K60C DIABETES +SD 1 1 108% 0.2132 $997 K61Z SEVERE NUTRITIONAL DISTURBANCE 4 36 100% 0.9134 3.6535 0.2431 $4,271 $17,084 $1,137 Please note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 9/14
1. Qld Acute Inpatient Price Weights 2014/15 Queensland Price Weight Queensland Base Price Same-Day Long-Stay Long-Stay Payment Bundled Lower Upper Paediatric Same Same Outlier Base DRG v7.0 Description List ICU Bound Bound Adjustment Day Outlier Base Diem Inlier Diem Day $ $ Diem $ Inlier $ Diem $ K62A MISC METABOLIC DISORDERS +CSCC 2 19 186% 0.8186 1.6373 0.2264 $3,828 $7,656 $1,059 K62B MISC METABOLIC DISORDERS -CSCC 1 10 160% 0.7267 0.2372 $3,398 $1,109 K62C MISC METABOLIC DISORDERS SDAY 1 1 182% 0.1744 $815 K63A INBORN ERR OF METAB +CSCC 2 22 179% 1.1210 2.2421 0.2131 $5,242 $10,484 $996 K63B INBORN ERR OF METAB -CSCC 1 4 159% 0.3062 0.1886 $1,432 $882 K64A ENDOCRINE DISORDERS +CSCC 2 24 150% 1.0682 2.1365 0.2126 $4,995 $9,990 $994 K64B ENDOCRINE DISORDERS -CSCC 1 9 135% 1.0865 0.2142 $5,080 $1,002 K64C ENDOCRINE DISORDERS +SD 1 1 127% 0.2650 $1,239 L02A OP INS PERI CATH DIALYSIS+CSCC 3 36 100% 0.5818 1.3038 4.4933 0.2760 $2,720 $6,097 $21,011 $1,291 L02B OP INS PERI CATH DIALYSIS-CSCC 1 6 100% 1.0766 0.3087 $5,034 $1,443 L03A KDNY,URT&MJR BLDR PR NPSM +CCC 5 46 100% 1.7807 1.0124 6.8429 0.3211 $8,327 $4,734 $31,997 $1,501 L03B KDNY,URT&MJR BLDR PR NPSM +SCC 2 26 100% 1.3595 1.5877 4.5348 0.3729 $6,357 $7,424 $21,205 $1,744 L03C KDNY,URT&MJR BLDR PR NPSM-CSCC 1 15 100% 2.9052 0.4109 $13,585 $1,921 L04A KDY,URT&MJR BLDR PR N-NPM+CCC 4 42 100% 0.6721 1.1401 5.2324 0.2960 $3,143 $5,331 $24,467 $1,384 L04B KDY,URT&MJR BLDR PR N-NPM-CCC 1 10 136% 1.8499 0.3059 $8,650 $1,430 L04C KDY,URT&MJR BLDR PR N-NPM +SD 1 1 80% 0.7695 $3,598 L05A TRANURETH PROSTATECTOMY +CSCC 3 33 100% 0.5100 0.9403 3.3308 0.2322 $2,385 $4,397 $15,575 $1,086 L05B TRANURETH PROSTATECTOMY -CSCC 1 9 100% 1.2978 0.2321 $6,069 $1,085 L06A MINOR BLADDER PROCEDURES+CSCC 2 26 100% 0.4155 1.3983 3.2120 0.2756 $1,943 $6,538 $15,019 $1,289 L06B MINOR BLADDER PROCEDURES -CSCC Yes 1 8 130% 0.4620 1.2155 0.2409 $2,160 $5,684 $1,126 L07A TRANSURETHRAL PROCS +CC 1 14 100% 1.6118 0.2554 $7,537 $1,194 L07B TRANSURETHRAL PROCS -CC 1 4 100% 0.7374 0.2659 $3,448 $1,243 L08A URETHRAL PROCEDURES +CC Yes 1 13 100% 0.6430 1.7385 0.2719 $3,007 $8,129 $1,271 L08B URETHRAL PROCEDURES -CC Yes 1 6 100% 0.4855 1.0866 0.2867 $2,270 $5,081 $1,341 L09A OTH KIDNY & URNRY TRACT PR+CCC 5 53 100% 0.7167 1.1051 6.2422 0.2826 $3,351 $5,167 $29,189 $1,321 L09B OTH KIDNY & URNRY TRACT PR+SCC 1 14 100% 2.0033 0.2612 $9,367 $1,221 L09C OTH KIDNY & URNRY TRCT PR-CSCC Yes 1 7 80% 0.7541 1.5124 0.2293 $3,526 $7,072 $1,072 L40Z URETEROSCOPY 1 6 100% 0.8202 0.2438 $3,835 $1,140 L41Z CYSTOURETHROSCOPY, SAMEDAY 1 1 157% 0.2530 $1,183 L42Z ESW LITHOTRIPSY+URINARY STONES 1 3 100% 0.7436 0.1986 $3,477 $929 L60A RENAL FAILURE +CCC 3 34 100% 1.0693 3.2078 0.2607 $5,000 $15,000 $1,219 L60B RENAL FAILURE +SCC 1 18 100% 1.5316 0.2445 $7,162 $1,143 L60C RENAL FAILURE -CSCC Yes 1 12 124% 0.2067 0.9657 0.2235 $967 $4,516 $1,045 L61Z HAEMODIALYSIS 1 3 200% 0.1147 0.0917 $536 $429 L62A KDNY&UNRY TRCT NEOPLASMS +CSCC 2 22 119% 1.0920 2.1841 0.2194 $5,106 $10,213 $1,026 L62B KDNY&UNRY TRCT NEOPLASMS -CSCC 1 7 161% 0.5825 0.2547 $2,724 $1,191 L63A KDNY & UNRY TRCT INF +CSCC 2 23 100% 0.8728 1.7457 0.2119 $4,081 $8,163 $991 L63B KDNY & UNRY TRCT INF -CSCC Yes 1 10 117% 0.1045 0.7089 0.2009 $489 $3,315 $939 L64A URINARY STONES & OBSTR+CSCC 1 14 100% 1.4383 0.2510 $6,725 $1,174 L64B URINARY STONES & OBSTR-CSCC 1 5 186% 0.5558 0.2608 $2,599 $1,220 L64C URINARY STONES & OBSTR +SD 1 1 100% 0.1308 $612 L65A KDNY & UNRY TR SGNS&SYMPS+CSCC 1 18 100% 1.3673 0.2289 $6,393 $1,070 L65B KDNY & UNRY TR SGNS&SYMPS-CSCC Yes 1 8 143% 0.1395 0.5995 0.1950 $652 $2,803 $912 L66Z URETHRAL STRICTURE 1 5 80% 0.5835 0.2397 $2,728 $1,121 L67A OTH KIDNY & URNRY TRCT DX+CSCC 2 20 142% 0.9378 1.8757 0.2352 $4,385 $8,771 $1,100 L67B OTH KIDNY & URNRY TRCT DX-CSCC 1 8 158% 0.7739 0.2297 $3,619 $1,074 L67C OTH KIDNY & URNRY TRCT DX +SD 1 1 197% 0.1693 $792 L68Z PERITONEAL DIALYSIS 1 3 151% 0.1920 0.1534 $898 $717 M01A MAJOR MALE PELVIC PROCS +CSCC 2 20 100% 2.2676 0.9962 4.2600 0.3128 $10,603 $4,658 $19,920 $1,463 M01B MAJOR MALE PELVIC PROCS -CSCC 1 11 100% 3.2947 0.1553 $15,406 $726 M02A TRANSURETHRAL PROSTECTOMY+CSCC 2 20 100% 0.5797 0.9390 2.4577 0.2435 $2,711 $4,391 $11,492 $1,139 M02B TRANSURETHRAL PROSTECTOMY-CSCC 1 8 100% 1.3799 0.2266 $6,452 $1,060 M03Z PENIS PROCEDURES 1 5 100% 0.9306 0.2787 $4,351 $1,303 M04Z TESTES PROCEDURES 1 4 80% 0.8044 0.2699 $3,761 $1,262 M05Z CIRCUMCISION 1 3 86% 0.5746 0.1927 $2,687 $901 M06A OTH MALE REPROD SYS OR PR +CC 1 17 100% 2.3762 0.2794 $11,111 $1,306 Please note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 10/14
1. Qld Acute Inpatient Price Weights 2014/15 Queensland Price Weight Queensland Base Price Same-Day Long-Stay Long-Stay Payment Bundled Lower Upper Paediatric Same Same Outlier Base DRG v7.0 Description List ICU Bound Bound Adjustment Day Outlier Base Diem Inlier Diem Day $ $ Diem $ Inlier $ Diem $ M06B OTH MALE REPROD SYS OR PR -CC Yes 1 6 100% 0.4993 1.5328 0.2535 $2,335 $7,167 $1,185 M40Z CYSTOURETHROSCOPY +SD 1 1 100% 0.2567 $1,200 M60A MALE REPR SYS MALIG +CSCC 2 23 100% 1.0620 2.1240 0.2226 $4,966 $9,932 $1,041 M60B MALE REPR SYS MALIG -CSCC Yes 1 12 138% 0.3168 0.9935 0.1700 $1,481 $4,646 $795 M61A BENIGN PROSTATIC HYPERTR+CC 1 14 100% 1.0783 0.2070 $5,042 $968 M61B BENIGN PROSTATIC HYPERTR-CC 1 4 100% 0.3322 0.1995 $1,553 $933 M62A INFLAMMATION MALE REPRD SYS+CC Yes 1 15 100% 0.1581 1.0937 0.1959 $739 $5,114 $916 M62B INFLAM MALE REPRD SYS -CC Yes 1 8 119% 0.1768 0.5615 0.1645 $827 $2,626 $769 M63Z MALE STERILISATION PROCS 1 3 100% 0.4048 0.1449 $1,893 $678 M64Z OTHER MALE REPROD SYS DIS 1 4 100% 0.3550 0.1722 $1,660 $805 N01A PELVIC EVISC & RAD VLVMY +CSCC 3 33 100% 1.2263 1.3932 5.4061 0.3367 $5,734 $6,515 $25,279 $1,574 N01B PELVIC EVISC & RAD VLVMY -CSCC 1 16 100% 2.8277 0.2369 $13,222 $1,108 N04A HYSTERECTOMY FOR NON-MALG+CSCC 1 16 100% 2.8416 0.3147 $13,287 $1,472 N04B HYSTERECTOMY FOR NON-MALG-CSCC 1 10 100% 1.9585 0.2646 $9,158 $1,237 N05A OOPH&COM FAL TUBE PR NMAL+CSCC 1 17 100% 2.6401 0.3093 $12,345 $1,446 N05B OOPH&COM FAL TUBE PR NMAL-CSCC 1 7 100% 1.5998 0.2904 $7,481 $1,358 N06Z FEM REP SYS RECONSTRCT PROC 1 7 100% 1.4412 0.3181 $6,739 $1,487 N07A OTH UTERS & ADNEXA PR N MAL 1 6 123% 1.4384 0.2595 $6,726 $1,213 N07B OTH UTRS & ADNEXA PR N MAL +SD 1 1 100% 0.6215 $2,906 N08Z ENDOS & LAPAR PR, FEM REPR SYS Yes 1 6 116% 0.7061 1.2696 0.2304 $3,302 $5,937 $1,077 N09Z OTH VAGINA, CERVIX &VULVA PROC 1 3 126% 0.5222 0.1819 $2,442 $851 N10Z DXC CURETTGE, DXC HYSTEROSCOPY 1 3 100% 0.4809 0.1487 $2,249 $695 N11Z OTH FEMALE REPRODUCTIVE SYS PR Yes 2 23 100% 0.2988 0.4700 1.2354 2.9408 0.2918 $1,397 $2,198 $5,777 $13,751 $1,364 N12A UTRS & ADNX PR FOR MAL +CCC 2 27 100% 1.3115 1.6008 4.5132 0.3444 $6,133 $7,485 $21,104 $1,610 N12B UTRS & ADNX PR FOR MAL -CCC 1 13 100% 2.3840 0.3294 $11,148 $1,540 N60A FEM REPROD SYS MALIG +CCC 2 27 100% 1.3685 2.7370 0.2467 $6,399 $12,798 $1,154 N60B FEM REPROD SYS MALIG -CCC 1 9 137% 0.8247 0.2522 $3,856 $1,179 N61Z FEMALE REPROD SYST INFECTIONS 1 7 128% 0.5195 0.2381 $2,429 $1,113 N62Z MNSTRL & OTH FEM REPR DIS 1 4 143% 0.2968 0.1747 $1,388 $817 O01A CAESAREAN DELIVERY +CCC 3 28 100% 0.6666 1.0087 3.6928 0.2459 $3,117 $4,717 $17,268 $1,150 O01B CAESAREAN DELIVERY +SCC 1 17 100% 2.5347 0.2775 $11,852 $1,298 O01C CAESAREAN DELIVERY -CSCC 1 12 100% 2.0409 0.2981 $9,543 $1,394 O02A VAGINAL DELIVERY +OR PR +CSCC 1 13 100% 2.2438 0.3513 $10,492 $1,643 O02B VAGINAL DELIVERY +OR PR -CSCC 1 10 100% 1.5877 0.3372 $7,424 $1,577 O03A ECTOPIC PREGNANCY +CC 1 8 100% 1.4584 0.2872 $6,819 $1,343 O03B ECTOPIC PREGNANCY -CC 1 5 100% 0.9836 0.2907 $4,599 $1,359 O04A POSTPARTUM&POST ABORTN+OR+CSCC 1 16 100% 2.2196 0.3114 $10,379 $1,456 O04B POSTPARTUM&POST ABORTN+OR-CSCC 1 8 100% 1.0688 0.2352 $4,998 $1,100 O04C POSTPARTUM&POST ABORTN +OR +SD 1 1 100% 0.5069 $2,370 O05Z ABORTION+ OR PROC 1 3 100% 0.4418 0.1810 $2,066 $846 O60A VAGINAL DELIVERY +CSCC 1 15 100% 1.9449 0.2675 $9,094 $1,251 O60B VAGINAL DELIVERY -CSCC 1 9 100% 1.3069 0.3133 $6,111 $1,465 O60C VAGINAL DELIVERY, UNCOMP 1 7 100% 0.9703 0.3196 $4,537 $1,494 O61Z POSTPARTUM & POST ABORTN-OR PR Yes 1 9 100% 0.1306 0.6453 0.2073 $611 $3,017 $969 O63Z ABORTION-OR PROC 1 4 100% 0.2857 0.1970 $1,336 $921 O66A ANTENATAL&OTH OBS ADM +CSCC 1 12 100% 0.8804 0.1870 $4,117 $874 O66B ANTENATAL&OTH OBS ADM -CSCC 1 6 100% 0.4701 0.2119 $2,198 $991 O66C ANTENATAL&OTH OBS ADM +SD 1 1 100% 0.1181 $552 P01Z NEO +OR, DIED/TR 5D Yes 1 4 100% 1.5029 $7,028 P02Z NEO,CARDIOTHORACIC/VASCULAR PR Yes 10 95 100% 2.8847 2.2179 25.0636 0.6638 $13,489 $10,371 $117,197 $3,104 P03A NEO,ADMWT 1000-1499G+OR+MMP Yes 18 164 100% 0.0742 1.3469 24.3180 0.4065 $347 $6,298 $113,711 $1,901 P03B NEO,ADMWT 1000-1499G+OR-MMP Yes 14 126 100% 0.0979 1.3349 18.7862 0.3891 $458 $6,242 $87,844 $1,819 P04A NEO,ADMWT 1500-1999G+OR+MMP Yes 12 111 100% 0.0879 1.2492 15.0787 0.3401 $411 $5,841 $70,508 $1,590 P04B NEO,ADMWT 1500-1999G+OR-MMP Yes 9 85 100% 0.0275 1.1008 9.9345 0.2577 $129 $5,147 $46,454 $1,205 P05A NEO,ADMWT 2000-2499G+OR+MMP Yes 11 108 100% 0.3342 1.4839 16.6571 0.3987 $1,563 $6,939 $77,889 $1,864 P05B NEO,ADMWT 2000-2499G+OR-MMP Yes 6 62 100% 0.3196 1.5057 9.3537 0.4271 $1,494 $7,041 $43,738 $1,997 Please note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 11/14
1. Qld Acute Inpatient Price Weights 2014/15 Queensland Price Weight Queensland Base Price Same-Day Long-Stay Long-Stay Payment Bundled Lower Upper Paediatric Same Same Outlier Base DRG v7.0 Description List ICU Bound Bound Adjustment Day Outlier Base Diem Inlier Diem Day $ $ Diem $ Inlier $ Diem $ P06A NEO,ADMWT >=2500G+OR PR+MMP Yes 9 90 100% 0.3079 1.6642 15.2856 0.4864 $1,440 $7,782 $71,475 $2,274 P06B NEO,ADMWT >=2500G+OR PR-MMP Yes 4 38 100% 0.4166 1.6087 6.8515 0.4190 $1,948 $7,522 $32,038 $1,959 P07Z NEONATE, ADMWT <750G +OR Yes 39 358 100% 0.4534 1.7655 69.3077 0.4547 $2,120 $8,255 $324,083 $2,126 P08Z NEONATE, ADMWT 750-999G +OR Yes 32 297 100% 0.3647 1.4481 46.7046 0.3849 $1,705 $6,771 $218,391 $1,800 P60A NEO -OR, DIED/TR <5D Yes 1 4 100% 0.9098 $4,254 P60B NEO -OR, DIED/TR +SD Yes 1 1 100% 0.2162 $1,011 P61Z NEONATE, ADMWT <750G -OR Yes 25 232 100% 1.9696 49.2400 0.4666 $9,210 $230,246 $2,182 P62Z NEONATE, ADMWT 750-999G -OR Yes 21 193 100% 1.6307 34.2438 0.4255 $7,625 $160,124 $1,990 P63A NEO,ADMWT 1000-1249G-OR+PRE Yes 11 105 100% 1.0930 12.0229 0.2866 $5,111 $56,219 $1,340 P63B NEO,ADMWT 1000-1249G-OR-PRE Yes 5 49 100% 1.5163 7.5814 0.2846 $7,090 $35,451 $1,331 P64A NEO,ADMWT 1250-1499G-OR+PRE Yes 9 87 100% 0.9982 8.9839 0.2617 $4,668 $42,009 $1,224 P64B NEO,ADMWT 1250-1499G-OR-PRE Yes 7 70 100% 1.0357 7.2497 0.2353 $4,843 $33,900 $1,100 P65A NEO,ADMWT 1500-1999G-OR+MMP Yes 8 74 100% 0.9056 7.2446 0.2645 $4,235 $33,876 $1,237 P65B NEO,ADMWT 1500-1999G-OR+MJP Yes 6 63 100% 1.0167 6.1000 0.2521 $4,754 $28,524 $1,179 P65C NEO,ADMWT 1500-1999G-OR+OTP Yes 6 56 100% 0.8274 4.9647 0.2287 $3,869 $23,215 $1,069 P65D NEO,ADMWT 1500-1999G-OR-PRB Yes 5 48 100% 0.8177 4.0885 0.2384 $3,824 $19,118 $1,115 P66A NEO,ADMWT 2000-2499G-OR+MMP Yes 5 51 100% 1.0004 5.0018 0.2373 $4,678 $23,388 $1,110 P66B NEO,ADMWT 2000-2499G-OR+MJP Yes 4 42 100% 0.9993 3.9972 0.2607 $4,673 $18,691 $1,219 P66C NEO,ADMWT 2000-2499G-OR+OTP Yes 3 33 100% 0.9544 2.8631 0.2350 $4,463 $13,388 $1,099 P66D NEO,ADMWT 2000-2499G-OR-PRB Yes 1 14 100% 1.0634 0.1957 $4,972 $915 P67A NEO,ADMWT >=2500G-OR+PRE+MMP Yes 4 43 100% 1.1125 4.4502 0.2544 $5,202 $20,809 $1,190 P67B NEO,ADMWT >=2500G-OR+PRE+MJP Yes 3 32 100% 1.0749 3.2248 0.2426 $5,026 $15,079 $1,134 P67C NEO,ADMWT >=2500G-OR+PRE+OTP Yes 2 24 100% 1.1552 2.3104 0.2397 $5,402 $10,803 $1,121 P67D NEO,ADMWT >=2500G-OR+PRE-PRB Yes 1 11 100% 1.0126 0.2255 $4,735 $1,054 P68A NEO,ADMWT >=2500G-OR-PRE+MMP Yes 3 28 100% 1.0768 3.2303 0.3056 $5,035 $15,105 $1,429 P68B NEO,ADMWT >=2500G-OR-PRE+MJP Yes 1 17 100% 1.5813 0.2750 $7,394 $1,286 P68C NEO,ADMWT >=2500G-OR-PRE+OTP Yes 1 10 100% 0.9671 0.2588 $4,522 $1,210 P68D NEO,ADMWT >=2500G-OR-PRE-PRB Yes 1 7 100% 0.6010 0.2003 $2,810 $937 Q01A SPLENECTOMY +CSCC 3 28 100% 1.2378 1.0144 4.2809 0.3040 $5,788 $4,743 $20,017 $1,422 Q01B SPLENECTOMY -CSCC 1 14 100% 2.6540 0.2589 $12,410 $1,211 Q02A BLD&IMM SYS DIS +OTH OR +CSCC 4 41 132% 0.3542 1.2354 5.2958 0.3010 $1,656 $5,777 $24,763 $1,407 Q02B BLD&IMM SYS DIS +OTH OR -CSCC Yes 1 10 105% 0.5777 1.5594 0.2010 $2,701 $7,292 $940 Q60A RETICLENDO&IMNTY DIS+CSCC 2 23 128% 1.2386 2.4771 0.3220 $5,792 $11,583 $1,506 Q60B RETICLENDO&IMNTY DIS-CSCC 1 11 125% 0.9855 0.2554 $4,608 $1,194 Q60C RETICLENDO&IMNTY DIS +SD 1 1 116% 0.1678 $785 Q61A RED BLOOD CELL DISDERS + CSCC 2 19 157% 0.7876 1.5752 0.2184 $3,683 $7,366 $1,021 Q61B RED BLOOD CELL DISDERS -CSCC 1 7 170% 0.5876 0.2215 $2,748 $1,036 Q61C RED BLOOD CELL DISDERS +SD 1 1 132% 0.2139 $1,000 Q62A COAGULATION DISORDERS 1 13 90% 0.9353 0.2207 $4,373 $1,032 Q62B COAGULATION DISORDERS +SD 1 1 83% 0.2337 $1,093 R01A LYMPHMA&LEUKMA+MJR OR PR +CSCC 7 68 100% 0.9653 1.3705 10.5587 0.3443 $4,514 $6,408 $49,372 $1,610 R01B LYMPHMA&LEUKMA+MJR OR PR -CSCC 1 18 100% 2.5921 0.3671 $12,121 $1,717 R02A OTH NPLSTC DSRD+MJR OR PR+CCC 5 53 100% 1.4129 1.1496 7.1609 0.2618 $6,607 $5,376 $33,484 $1,224 R02B OTH NPLSTC DSRD+MJR OR PR+SMCC 2 25 100% 1.0512 1.3851 3.8213 0.1942 $4,915 $6,477 $17,868 $908 R02C OTH NPLSTC DSRD+MJR OR PR-CC 1 14 100% 2.4346 0.2522 $11,384 $1,179 R03A LYMPHMA LEUKMA+OTH OR PR +CSCC 7 63 158% 0.5341 1.0520 7.8981 0.3219 $2,497 $4,919 $36,932 $1,505 R03B LYMPHMA LEUKMA+OTH OR PR -CSCC 1 14 175% 2.0552 0.2693 $9,610 $1,259 R03C LYMPHMA LEUKMA+OTH OR PR +SD 1 1 100% 0.7057 $3,300 R04A OTH NPLSTC DSRD+OTH OR PR+CC 2 18 100% 0.2864 1.2602 2.8067 0.2147 $1,339 $5,893 $13,124 $1,004 R04B OTH NPLSTC DSRD+OTH OR PR-CC Yes 1 11 111% 0.6800 1.8297 0.2789 $3,180 $8,556 $1,304 R60A ACUTE LEUKAEMIA +CCC 7 69 111% 1.4085 9.8598 0.3603 $6,586 $46,104 $1,685 R60B ACUTE LEUKAEMIA -CCC 2 19 93% 1.2455 2.4911 0.3335 $5,824 $11,648 $1,559 R60C ACUTE LEUKAEMIA +SD 1 1 155% 0.2954 $1,381 R61A LYMPHMA &N-ACUTE LEUKAEMIA+CCC 5 51 100% 1.1661 5.8305 0.3044 $5,453 $27,263 $1,423 R61B LYMPHMA &N-ACUTE LEUKAEMIA-CCC 1 15 120% 1.7766 0.2697 $8,307 $1,261 R61C LYMPHMA / N-A LEUKAEMIA +SD 1 1 136% 0.2742 $1,282 Please note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 12/14
1. Qld Acute Inpatient Price Weights 2014/15 Queensland Price Weight Queensland Base Price Same-Day Long-Stay Long-Stay Payment Bundled Lower Upper Paediatric Same Same Outlier Base DRG v7.0 Description List ICU Bound Bound Adjustment Day Outlier Base Diem Inlier Diem Day $ $ Diem $ Inlier $ Diem $ R62A OTHER NEOPLASTIC DIS+CC Yes 2 23 171% 0.3045 1.0294 2.0589 0.2235 $1,424 $4,813 $9,627 $1,045 R62B OTHER NEOPLASTIC DISORDERS-CC 1 4 93% 0.4318 0.2529 $2,019 $1,183 R63Z CHEMOTHERAPY 1 3 86% 0.3205 0.2563 $1,499 $1,198 S65A HIV +CCC 5 54 100% 1.5336 7.6682 0.3194 $7,171 $35,857 $1,494 S65B HIV +SCC 3 30 100% 1.1383 3.4150 0.3145 $5,323 $15,969 $1,471 S65C HIV -CSCC 1 17 100% 2.1289 0.3185 $9,955 $1,489 S65D HIV +SD 1 1 100% 0.2922 $1,366 T01A OR PROC INFECT& PARAS DIS+CCC 8 74 145% 0.5534 0.9764 8.3645 0.2700 $2,588 $4,566 $39,112 $1,263 T01B OR PROC INFECT& PARAS DIS+SMCC 3 33 100% 0.3536 1.0297 3.4426 0.2253 $1,653 $4,815 $16,098 $1,054 T01C OR PROC INFECT & PARAS DIS -CC 2 22 112% 0.3370 0.8319 2.0007 0.1743 $1,576 $3,890 $9,355 $815 T40Z INFECT&PARAS DIS+VENT SUPPORT Yes 3 35 100% 0.0472 2.4957 7.5342 0.3681 $221 $11,670 $35,230 $1,721 T60A SEPTICAEMIA +CCC 3 31 172% 1.0282 3.0847 0.2332 $4,808 $14,424 $1,090 T60B SEPTICAEMIA -CCC 1 17 137% 1.3763 0.2170 $6,436 $1,015 T61A POSTOP & POSTTRAUM INFECT+CSCC 2 24 100% 0.9884 1.9767 0.1935 $4,622 $9,243 $905 T61B POSTOP & POSTTRAUM INFECT-CSCC 1 13 117% 0.7945 0.1563 $3,715 $731 T62A FEVER OF UNKNOWN ORIGIN +CC 1 14 109% 1.1818 0.2460 $5,526 $1,150 T62B FEVER OF UNKNOWN ORIGIN -CC 1 7 108% 0.5292 0.2473 $2,475 $1,156 T63A VIRAL ILLNESS +CC Yes 1 12 90% 0.1488 1.0284 0.2782 $696 $4,809 $1,301 T63B VIRAL ILLNESS -CC Yes 1 6 100% 0.1067 0.4852 0.2670 $499 $2,269 $1,248 T64A OTH INFECTOUS&PARSTIC DIS +CCC 4 42 100% 1.1582 4.6329 0.2627 $5,416 $21,663 $1,228 T64B OTH INFECTOUS&PARSTIC DIS+SMCC 2 22 120% 0.9326 1.8652 0.1846 $4,361 $8,722 $863 T64C OTH INFECTOUS & PARSTIC DIS-CC Yes 1 14 93% 0.2605 0.9878 0.1879 $1,218 $4,619 $879 U40Z MENTAL HEALTH TREAT+ECT +SD 1 1 100% 0.3017 $1,411 U60Z MENTAL HEALTH TREAT -ECT +SD 1 1 200% 0.1054 $493 U61A SCHIZOPHRENIA DISODERS INVOL 20 46 100% 0.3346 6.6917 0.1781 $1,565 $31,290 $833 U61B SCHIZOPHRENIA DISRDRS 11 27 100% 0.3756 4.1318 0.1788 $1,756 $19,320 $836 U62A PAR&ACUTE PSYCH DSRD+CSCC/MHLS 14 32 100% 0.3475 4.8653 0.1874 $1,625 $22,750 $876 U62B PAR&ACUTE PSYCH DSRD-CSCC-MHLS 6 15 200% 0.4377 2.6265 0.1930 $2,047 $12,282 $902 U63A MAJOR AFF DIS AGE>69 +CSCC 19 44 100% 0.4029 7.6547 0.2055 $1,884 $35,793 $961 U63B MAJOR AFF DIS AGE<70 -CSCC 10 23 200% 0.3995 3.9953 0.2003 $1,868 $18,682 $937 U64Z OTH AFFECT & SOMATOFORM DSRD 5 12 170% 0.4128 2.0642 0.1900 $1,930 $9,652 $888 U65Z ANXIETY DISORDERS 3 8 182% 0.4697 1.4092 0.2108 $2,196 $6,589 $986 U66Z EATING & OBSESSV-COMPULSV DSRD 13 30 124% 0.4494 5.8419 0.2299 $2,101 $27,317 $1,075 U67Z PERSONLTY DSRD&ACUTE REACTIONS 3 9 200% 0.4985 1.4956 0.1994 $2,331 $6,993 $932 U68Z CHILDHOOD MENTAL DISORDERS 5 13 147% 0.6702 3.3512 0.2608 $3,134 $15,670 $1,220 V60A ALCOHOL INTOX & WITHDRWL +CC 2 6 100% 0.4585 0.9170 0.1908 $2,144 $4,288 $892 V60B ALCOHOL INTOX & WITHDRWL -CC 1 4 91% 0.4052 0.2311 $1,895 $1,081 V61Z DRUG INTOXICTN & WITHDRAWAL 4 11 100% 0.4653 1.8612 0.2065 $2,176 $8,703 $966 V62Z ALCOHOL USE & DEPENDENCE 3 9 100% 0.4796 1.4389 0.2037 $2,243 $6,728 $953 V63Z OPIOID USE & DEPENDENCE 3 8 100% 0.3955 1.1865 0.1704 $1,849 $5,548 $797 V64Z OTHER DRUG USE & DEPEND 3 8 100% 0.3763 1.1289 0.1637 $1,760 $5,279 $765 V65Z ALCOHOL DISORDERS +SD 1 1 183% 0.1295 $606 V66Z DRUG DISORDERS +SD 1 1 100% 0.1209 $565 W01A TRACHE MULT SIG TRAUMA Yes 16 146 100% 2.7368 2.6513 45.1570 0.5749 $12,797 $12,397 $211,154 $2,688 W01B VENT/CRAN MT -TRAC+VNT>96/+CCC Yes 8 79 105% 1.4959 2.3322 20.1531 0.4876 $6,995 $10,905 $94,236 $2,280 W01C VENT/CRAN MT -TRAC -VNT>96-CCC Yes 5 47 100% 1.0204 1.9277 10.6589 0.4494 $4,771 $9,014 $49,841 $2,101 W02A HIP,FEMR&LOW LIMB PR MT+CSCC 6 61 100% 2.0341 1.0530 8.3521 0.3275 $9,511 $4,924 $39,054 $1,531 W02B HIP,FEMR&LOW LIMB PR MT -CSCC 3 35 100% 1.1964 1.4829 5.6451 0.3544 $5,594 $6,934 $26,396 $1,657 W03Z ABDOMINAL PR MULT SIG TRAUMA 3 35 100% 1.0707 1.4377 5.3838 0.3825 $5,007 $6,723 $25,175 $1,789 W04A MULT TRAUMA W OTH OR PR +CSCC 6 62 100% 1.2717 1.2342 8.6768 0.3031 $5,946 $5,771 $40,573 $1,417 W04B MULT TRAUMA W OTH OR PR -CSCC 3 33 100% 0.8938 1.3663 4.9928 0.3363 $4,179 $6,389 $23,346 $1,573 W60Z MULTIPLE TRAUMA, DIED/TRANSF<5 1 4 100% 1.3470 $6,299 W61A MULTIPLE TRAUMA-SIGNIF PR+CSCC 4 44 100% 0.3764 0.8546 3.7949 0.2232 $1,760 $3,996 $17,745 $1,044 W61B MULTIPLE TRAUMA-SIGNIF PR-CSCC 2 20 136% 0.9397 1.8794 0.2226 $4,394 $8,788 $1,041 X02A MVTT/SKIN GFT+CSCC INJUR HAND 1 14 100% 2.2523 0.4558 $10,532 $2,131 X02B SKIN GRAFT INJURIES HAND -CSCC 1 5 100% 0.7923 0.4567 $3,705 $2,136 Please note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 13/14
1. Qld Acute Inpatient Price Weights 2014/15 Queensland Price Weight Queensland Base Price Same-Day Long-Stay Long-Stay Payment Bundled Lower Upper Paediatric Same Same Outlier Base DRG v7.0 Description List ICU Bound Bound Adjustment Day Outlier Base Diem Inlier Diem Day $ $ Diem $ Inlier $ Diem $ X04A OTHER PR INJ LWR LMB +CSCC 3 30 100% 0.3484 1.0930 3.6273 0.2545 $1,629 $5,111 $16,961 $1,190 X04B OTHER PR INJ LOWR LIMB -CSCC Yes 1 7 91% 0.4958 1.0995 0.2726 $2,318 $5,141 $1,275 X05A OTH PR FOR INJ TO HAND +CC 1 13 100% 1.6418 0.3069 $7,677 $1,435 X05B OTH PR FOR INJ TO HAND -CC 1 4 86% 0.7161 0.3420 $3,348 $1,599 X06A OTHER PR OTHER INJURIES +CSCC 2 26 94% 0.3757 1.2238 2.8233 0.2454 $1,757 $5,722 $13,202 $1,147 X06B OTHER PR OTHER INJURIES -CSCC 1 7 88% 0.9435 0.2696 $4,412 $1,261 X07A SK GRAFT INJ-HAND+MIC TT/+CSCC 5 48 100% 0.8207 0.9502 5.5715 0.2562 $3,838 $4,443 $26,052 $1,198 X07B SK GRAFT INJ-HAND-MIC TT-CSCC 2 20 125% 0.4004 0.9927 2.3859 0.2389 $1,872 $4,642 $11,156 $1,117 X40Z INJ,POIS,TOX EFF DRUG W VENT Yes 2 23 100% 0.0869 2.1265 4.3398 0.3061 $406 $9,944 $20,293 $1,431 X60A INJURIES +CSCC 2 19 100% 0.7096 1.4191 0.1828 $3,318 $6,636 $855 X60B INJURIES -CSCC Yes 1 7 134% 0.1337 0.4645 0.1754 $625 $2,172 $820 X61Z ALLERGIC REACTIONS 1 4 86% 0.2128 0.1470 $995 $687 X62A POISNG/TOXC EFF DRUGS +CSCC 1 15 116% 1.1508 0.2159 $5,381 $1,010 X62B POISNG/TOXC EFF DRUGS -CSCC Yes 1 7 125% 0.1063 0.5084 0.2094 $497 $2,377 $979 X63A SEQUELAE OF TREATMNT+CSCC Yes 2 21 141% 0.2273 0.8464 1.6928 0.2165 $1,063 $3,958 $7,916 $1,012 X63B SEQUELAE OF TREATMNT-CSCC Yes 1 9 100% 0.1847 0.6653 0.1855 $864 $3,111 $867 X64A OTH INJ, POIS & TOX EFF +CSCC Yes 2 19 100% 0.1972 0.7791 1.5583 0.1812 $922 $3,643 $7,287 $847 X64B OTH INJ, POIS &TOX EFF DX-CSCC Yes 1 5 113% 0.1328 0.4067 0.2004 $621 $1,902 $937 Y01Z VNT>96/TRACH / OR PR SEV BURN Yes 18 164 100% 1.3259 2.1654 40.3023 0.7722 $6,200 $10,125 $188,454 $3,611 Y02A SKIN GRAFT OTHER BURNS +CSCC 5 47 105% 0.4137 1.3939 7.3832 0.3953 $1,934 $6,518 $34,524 $1,848 Y02B SKIN GR OTH BRNS -CSCC +EMERG 2 23 111% 0.3350 1.7252 3.7854 0.3573 $1,566 $8,067 $17,701 $1,671 Y02C SKIN GR OTH BRNS -CSCC -EMERG 1 9 88% 1.3402 0.4180 $6,267 $1,955 Y03Z OTHER OR PROCS FOR OTHER BURNS 1 14 94% 1.7009 0.3581 $7,953 $1,674 Y60Z BURNS,TRANS OTH ACUT CARE <5D 1 4 100% 0.3929 $1,837 Y61Z SEVERE BURNS 1 10 88% 0.9067 0.3047 $4,240 $1,425 Y62A OTHER BURNS +CC 2 19 149% 0.8264 1.6527 0.2292 $3,864 $7,728 $1,072 Y62B OTHER BURNS -CC 1 8 137% 0.5830 0.2625 $2,726 $1,227 Y62C OTHER BURNS +SD 1 1 111% 0.1506 $704 Z01A OTH CNT HLTH SRV +OR PROC 1 12 100% 1.5107 0.2201 $7,064 $1,029 Z01B OTH CNT HLTH SRV +OR PROC +SD 1 1 107% 0.4785 $2,237 Z40Z OTH CNT HLTH SRV +ENDO +SD 1 1 128% 0.2550 $1,192 Z60Z REHABILITATION 6 55 100% 0.5471 3.2823 0.1727 $2,558 $15,348 $808 Z61A SIGNS AND SYMPTOMS 1 13 100% 0.8744 0.2109 $4,089 $986 Z61B SIGNS AND SYMPTOMS +SD 1 1 84% 0.1965 $919 Z63A OTH FU SURG/MED CARE +CCC 3 32 100% 0.8349 2.5046 0.2030 $3,904 $11,712 $949 Z63B OTH FU SURG/MED CARE -CCC 1 16 117% 0.8382 0.1591 $3,919 $744 Z64A OTH FACTOR INFL HEALTH STATUS 1 18 157% 0.7675 0.1679 $3,589 $785 Z64B OTH FCTR INFL HEALTH STATUS+SD 1 1 80% 0.2381 $1,113 Z65Z CNGNTL & PRB ARISING FRM NNT 1 12 121% 0.9106 0.2822 $4,258 $1,320 Z66Z SLEEP DISORDERS 1 8 178% 0.3182 0.0843 $1,488 $394 Please note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 14/14
Appendix 2 Acute admitted patients AR-DRG v7.0 national 2014 2015-56 -
2. National Acute Inpatient Price Weights 2014/15 Same-Day Payment List National Price Weights Outlier Base Diem Inlier Long-Stay Diem Outlier Base $ National Base Price Diem $ Inlier $ Bundled Lower Upper Private Paediatric Same Day DRG v7.0 Description ICU Bound Bound Adjustment Adjustment Same Day $ 801A OR PR UNREL TO PDX+CCC 0 0 6 58 0.15 1.96 0 0.7162 1.0222 6.8495 0.2617 $3,586 $5,118 $34,295 $1,310 801B OR PR UNREL TO PDX+SMCC 0 0 2 25 0.2 1.38 0 0.5014 1.3275 3.1564 0.2348 $2,511 $6,647 $15,804 $1,176 801C OR PR UNREL TO PDX-CC 0 0 1 8 0.25 1.16 0 0 0 1.3016 0.2972 $6,517 $1,488 A01Z LIVER TRANSPLANT 0 1 11 101 0.11 1 0 3.5009 2.3324 29.1574 0.6528 $17,529 $11,678 $145,991 $3,269 A03Z LUNG OR HEART-LUNG TRANSPLANT 0 1 10 98 0.11 1 0 3.0454 2.4861 27.9067 0.7742 $15,248 $12,448 $139,729 $3,876 A05Z HEART TRANSPLANT 0 1 13 121 0.11 1 0 3.6729 1.8829 28.1506 0.7737 $18,390 $9,428 $140,950 $3,874 A06A TRACHE +VENT>=96 +CCC 0 1 16 150 0.1 1 0 1.1362 2.9219 47.8862 0.7121 $5,689 $14,630 $239,766 $3,565 A06B VENT>=96 +OR PROC 0 1 9 89 0.15 1.38 0 1.4246 2.396 22.9884 0.488 $7,133 $11,997 $115,103 $2,443 A06C TRACH -VENT / (VENT -OR PROC) 0 1 6 62 0.11 1.23 0 0.3659 2.4473 15.05 0.4867 $1,832 $12,254 $75,355 $2,437 A07A ALLOG BMT AGE <17Y 0 0 21 197 0.07 1 0 0.1159 1.7133 36.0945 0.6509 $580 $8,578 $180,725 $3,259 A07B ALLOG BMT AGE >=17Y 0 0 8 79 0.07 1 0 0 2.0999 16.7991 0.5227 $10,514 $84,113 $2,617 A08A AUTO BONE MARROW TRANSPLNT+CCC 0 0 7 66 0.11 2 0 0.0199 1.1297 7.9276 0.3553 $100 $5,656 $39,693 $1,779 A08B AUTO BONE MARROW TRANSPLNT-CCC 0 0 3 29 0.06 0.82 0 0 1.4721 4.4164 0.2975 $7,371 $22,113 $1,490 A09A KIDNEY TRANSPLNT+AGE<17/+CCC 0 0 3 35 0.1 1 0 1.3295 2.3462 8.3681 0.4577 $6,657 $11,747 $41,899 $2,292 A09B KIDNEY TRANSPLNT +AGE>=17 -CCC 0 0 2 24 0.05 1 0 1.6236 3.1865 7.9965 0.5108 $8,129 $15,955 $40,038 $2,558 A10Z INSERTION OF VAD 0 1 20 189 0.11 1 0 10.9952 2.876 68.515 0.7567 $55,053 $14,400 $343,055 $3,789 A11A INS IMPLNT SP INFUS DEV+CCC 0 0 15 136 0.11 1 0 2.0626 1.0079 17.1816 0.3526 $10,327 $5,047 $86,028 $1,765 A11B INS IMPLNT SP INFUS DEV-CCC 0 0 1 15 0.11 1 0 0 0 4.4464 0.5622 $22,263 $2,815 A12Z INS NEUROSTIMULATOR DEV 0 0 1 8 0.11 1 0 0 0 4.8 0.6145 $24,034 $3,077 A40A ECMO +TRACHE 0 1 17 155 0.12 1 0 1.6311 3.3029 57.7801 0.999 $8,167 $16,538 $289,305 $5,002 A40B ECMO -TRACHE 0 1 8 73 0.12 1.48 0 1.4665 3.1044 26.3018 0.7475 $7,343 $15,544 $131,693 $3,743 B01A VENTRICULAR SHUNT REV +CSCC 0 0 2 27 0.22 0.92 0 0.9334 1.1897 3.3128 0.3238 $4,674 $5,957 $16,587 $1,621 B01B VENTRICULAR SHUNT REV -CSCC 0 0 1 14 0.22 0.94 0 0 0 2.6816 0.2951 $13,427 $1,478 B02A CRANIAL PROC +CER HAEM +CCC 0 1 6 56 0.22 1 0 1.8528 1.9573 13.5966 0.4472 $9,277 $9,800 $68,078 $2,239 B02B CRAN PROC -HAEM+CCC/+HAEM+SCC 0 0 5 46 0.21 1.53 0 1.4744 1.1763 7.3557 0.3086 $7,382 $5,890 $36,830 $1,545 B02C CRANIAL PROC -HAEM+SCC/-CSCC 0 0 2 22 0.28 1 0 1.2055 1.6035 4.4125 0.2841 $6,036 $8,029 $22,093 $1,422 B03A SPINAL PROCEDURES +CSCC 0 0 4 45 0.18 1 0 1.502 1.3232 6.7948 0.3021 $7,521 $6,625 $34,022 $1,513 B03B SPINAL PROCEDURES -CSCC 0 0 1 12 0.28 1.11 0 0 0 3.2245 0.2685 $16,145 $1,344 B04A EXTRACRANIAL VASCULAR PR +CCC 0 0 3 35 0.28 1 0 1.3795 1.1877 4.9425 0.2657 $6,907 $5,947 $24,747 $1,330 B04B EXTRACRANIAL VASCULAR PR -CCC 0 0 1 12 0.28 1 0 0 0 2.5449 0.2611 $12,742 $1,307 B05Z CARPAL TUNNEL RELEASE 0 0 1 3 0.23 1 0 0 0 0.4597 0.1279 $2,302 $640 B06A CBL PSY,MUS DYSY,NPTHY PR+CSCC 0 0 5 48 0.22 1.1 0 0.7331 0.9603 5.5347 0.2181 $3,671 $4,808 $27,712 $1,092 B06B CBL PSY,MUS DYSY,NPTHY PR-CSCC 0 0 1 9 0.2 1.72 0 0 0 1.5392 0.2532 $7,707 $1,268 B06C CBL PSY,MUS DYSY,NPTHY PR +SD 0 0 1 1 0.2 1 0 0 0 0.6861 0 $3,435 B07A CRANL/PRPHL NERV & OTH PR+CC 0 0 3 29 0.13 1 0 0.6499 1.0179 3.7035 0.2373 $3,254 $5,097 $18,543 $1,188 B07B CRANL/PRPHL NERV & OTH PR-CC 1 0 1 6 0.15 1.13 0.6602 0 0 1.3983 0.3484 $3,306 $7,001 $1,744 B40Z PLASMAPHERESIS + NEURO DIS SD 0 0 1 1 0.06 1 0 0 0 0.2104 0 $1,053 B41Z TELEMETRIC EEG MONITORING 0 0 1 14 0.11 0.8 0 0 0 1.6931 0.344 $8,477 $1,722 B42A NERV SYS DIS W VENT SUPP +CCC 0 1 4 38 0.09 1 0 0.1053 1.9204 7.7871 0.3525 $527 $9,615 $38,990 $1,765 B42B NERV SYS DIS W VENT SUPP -CCC 0 1 1 16 0.12 1.19 0 0 0 3.7191 0.3781 $18,622 $1,893 B60A ACUTE PARA/QUAD+/-OR PR +CCC 0 0 9 89 0.1 1 0 0.2094 1.1247 10.3318 0.3167 $1,048 $5,631 $51,731 $1,586 B60B ACUTE PARA/QUAD+/-OR PR -CCC 0 0 3 32 0.1 1 0 0.1448 1.4501 4.4952 0.2837 $725 $7,261 $22,507 $1,420 B61A SPINAL CORD COND+/-OR PR +CSCC 0 0 5 45 0.18 1 0 0.4044 1.2192 6.5004 0.3317 $2,025 $6,105 $32,548 $1,661 B61B SPINAL CORD COND+/-OR PR -CSCC 0 0 1 14 0.18 0.88 0 0 0 2.0792 0.3466 $10,411 $1,735 B62Z APHERESIS 0 0 1 3 0.1 0.8 0 0 0 0.3273 0.2604 $1,639 $1,304 B63Z DMNTIA&CHRNIC DISTURB CRBRL FN 0 0 4 43 0.05 1 0 0 0.7282 2.9127 0.1835 $3,646 $14,584 $919 B64A DELIRIUM+CCC 0 0 4 39 0.08 1 0 0 0.7037 2.8148 0.2027 $3,523 $14,094 $1,015 B64B DELIRIUM-CCC 1 0 2 19 0.09 1 0.1173 0 0.7269 1.4538 0.1901 $587 $3,640 $7,279 $952 B65A CEREBRAL PALSY 0 0 1 14 0.14 1.15 0 0 0 1.3727 0.2693 $6,873 $1,348 B65B CEREBRAL PALSY +SD 0 0 1 1 0.16 1.18 0 0 0 0.3506 0 $1,755 B66A NERV SYS NEOPLASM +RADIO 0 0 4 39 0.06 1 0 0 0.9678 3.8712 0.2325 $4,846 $19,383 $1,164 B66B NERV SYS NEOPLASM -RADIO +CSCC 0 0 2 22 0.09 1.56 0 0 1.0234 2.0469 0.2217 $5,124 $10,249 $1,110 B66C NERV SYS NEOPLASM -RADIO -CSCC 1 0 1 15 0.12 1.35 0.3258 0 0 1.1798 0.2003 $1,631 $5,907 $1,003 B67A DEGNRTV NERV SYS DIS +CSCC 0 0 4 38 0.06 1.25 0 0 0.7726 3.0904 0.2144 $3,868 $15,474 $1,074 B67B DEGNRTV NERV SYS DIS -CSCC 0 0 2 19 0.07 0.92 0 0 0.7724 1.5448 0.1893 $3,867 $7,735 $948 B67C DEGNRTV NERV SYS DIS +SD 0 0 1 1 0.1 1.93 0 0 0 0.1379 0 $690 B68A MLT SCLROSIS&CEREBEL ATAXIA+CC 0 0 3 29 0.08 1 0 0 0.8277 2.483 0.2329 $4,144 $12,432 $1,166 B68B MLT SCLROSIS&CEREBEL ATAXIA-CC 1 0 1 13 0.05 1.44 0.2088 0 0 0.9224 0.2362 $1,045 $4,618 $1,183 B69A TIA & PRECEREBRAL OCCLUSN+CSCC 0 0 1 17 0.15 1 0 0 0 1.2967 0.2194 $6,493 $1,099 B69B TIA & PRECEREBRAL OCCLUSN-CSCC 0 0 1 8 0.19 1 0 0 0 0.5745 0.1998 $2,877 $1,000 B70A STROKE & OTH CEREB DIS +CCC 0 0 5 46 0.08 1 0 0 0.7346 3.6728 0.23 $3,678 $18,390 $1,152 Please note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 1/13 Long-Stay Diem $
2. National Acute Inpatient Price Weights 2014/15 National Price Weights National Base Price DRG v7.0 Description Same-Day Payment List Bundled ICU Lower Bound Upper Bound Private Adjustment Paediatric Adjustment Same Day Outlier Base Diem Inlier Long-Stay Diem Same Day $ Outlier Base $ Diem $ Inlier $ Long-Stay Diem $ B70B STROKE & OTH CEREB DIS +SCC 0 0 2 21 0.11 1 0 0 0.9597 1.9195 0.2243 $4,805 $9,611 $1,123 B70C STROKE & OTH CEREB DIS -CSCC 1 0 1 17 0.14 2 0.2758 0 0 1.3139 0.2291 $1,381 $6,579 $1,147 B70D STRKE&OTH CEREB DIS DIE/TRN<5D 0 0 1 4 0.17 1 0 0 0 0.5141 0 $2,574 B71A CRANIAL & PERIPHL NERV DSRD+CC 0 0 2 24 0.1 1.81 0 0 1.0606 2.1213 0.2338 $5,310 $10,621 $1,171 B71B CRANIAL & PERIPHL NERV DSRD-CC 0 0 1 12 0.1 2 0 0 0 0.8819 0.2221 $4,416 $1,112 B71C CRANIAL & PERIPHL NERV DSRD+SD 0 0 1 1 0.04 1.46 0 0 0 0.1529 0 $766 B72A NRVS SYS INF EX VRL MNGTS+CSCC 0 0 4 43 0.07 1.26 0 0 0.97 3.88 0.2231 $4,857 $19,427 $1,117 B72B NRVS SYS INF EX VRL MNGTS-CSCC 0 0 1 14 0.11 1.4 0 0 0 1.1129 0.2353 $5,572 $1,178 B73Z VIRAL MENINGITIS 0 0 1 10 0.1 1.15 0 0 0 0.7953 0.2239 $3,982 $1,121 B74A NONTRAUMATC STUPR & COMA +CSCC 0 0 1 17 0.11 1 0 0 0 1.3139 0.2206 $6,579 $1,105 B74B NONTRAUMATC STUPR & COMA -CSCC 0 0 1 6 0.22 1.06 0 0 0 0.4007 0.2358 $2,006 $1,181 B75Z FEBRILE CONVULSIONS 0 0 1 4 0.11 1 0 0 0 0.363 0.2536 $1,818 $1,270 B76A SEIZURES +CSCC 0 0 2 19 0.09 1.3 0 0 0.8425 1.6849 0.2263 $4,218 $8,436 $1,133 B76B SEIZURES -CSCC 0 0 1 7 0.11 1.55 0 0 0 0.5803 0.2487 $2,906 $1,245 B76C SEIZURES +SD 0 0 1 1 0.23 2 0 0 0 0.1408 0 $705 B77Z HEADACHE 1 0 1 7 0.14 1.39 0.115 0 0 0.5115 0.2259 $576 $2,561 $1,131 B78A INTRACRANIAL INJURY +CSCC 0 0 3 30 0.08 1 0 0 0.9094 2.7283 0.2346 $4,553 $13,661 $1,175 B78B INTRACRANIAL INJURY -CSCC 0 0 1 12 0.1 1.13 0 0 0 1.0449 0.2431 $5,232 $1,217 B78C INTRACRANIAL INJURIES D/T<5D 0 0 1 4 0.19 1 0 0 0 0.4514 0 $2,260 B79A SKULL FRACTURES +CSCC 0 0 1 17 0.11 1 0 0 0 1.5008 0.2091 $7,515 $1,047 B79B SKULL FRACTURES -CSCC 0 0 1 6 0.11 1.25 0 0 0 0.5395 0.2577 $2,701 $1,290 B80A OTHER HEAD INJURIES +CSCC 0 0 1 14 0.08 1 0 0 0 0.994 0.2011 $4,977 $1,007 B80B OTHER HEAD INJURIES -CSCC 1 0 1 5 0.16 0.89 0.1103 0 0 0.3426 0.2277 $552 $1,715 $1,140 B81A OTHER DSRD OF NERVOUS SYS+CSCC 0 0 3 28 0.1 1.5 0 0 0.747 2.2409 0.2084 $3,740 $11,220 $1,043 B81B OTHER DSRD OF NERVOUS SYS-CSCC 1 0 1 13 0.14 1.18 0.3819 0 0 0.9622 0.216 $1,912 $4,818 $1,082 B82A CHR UNSP PARA/QUAD+/-OR+SGFR 0 0 24 218 0.09 1 0 0.8583 0.9036 22.5456 0.2392 $4,298 $4,524 $112,886 $1,198 B82B CHR UNSP PARA/QUAD+/-PR+CCC 0 0 6 60 0.09 1 0 0 1.0292 6.1755 0.2786 $5,153 $30,921 $1,395 B82C CHR UNSP PARA/QUAD+/- PR -CCC 0 0 2 21 0.1 1.44 0 0.1051 0.9618 2.0286 0.227 $526 $4,816 $10,157 $1,137 C01Z PROC FOR PENETRATNG EYE INJURY 0 0 1 9 0.15 1.25 0 0 0 1.6585 0.3895 $8,304 $1,950 C02Z ENUCLEATIONS & ORBITAL PROCS 1 0 1 12 0.2 1.29 0.661 0 0 2.0939 0.3148 $3,310 $10,484 $1,576 C03Z RETINAL PROCEDURES 0 0 1 4 0.75 1.15 0 0 0 0.7977 0.2706 $3,994 $1,355 C04Z MAJOR CORN, SCLERAL&CONJNCT PR 0 0 1 7 0.43 1 0 0 0 1.3603 0.3021 $6,811 $1,513 C05Z DACRYOCYSTORHINOSTOMY 0 0 1 3 0.46 0.89 0 0 0 0.9408 0.3068 $4,711 $1,536 C10Z STRABISMUS PROCEDURES 0 0 1 3 0.33 1 0 0 0 0.7686 0.2509 $3,848 $1,256 C11Z EYELID PROCEDURES 1 0 1 6 0.37 1 0.5914 0 0 1.0919 0.2236 $2,961 $5,467 $1,120 C12Z OTHER CORN, SCLERAL&CONJNCT PR 0 0 1 4 0.28 1.22 0 0 0 0.6699 0.2191 $3,354 $1,097 C13Z LACRIMAL PROCEDURES 0 0 1 3 0.28 0.86 0 0 0 0.4325 0.1686 $2,166 $844 C14Z OTHER EYE PROCEDURES 0 0 1 5 0.35 1.08 0 0 0 0.514 0.174 $2,574 $871 C15Z GLAUCOMA/CX CATARACT PROCS 0 0 1 4 0.45 1.47 0 0 0 0.7835 0.2449 $3,923 $1,226 C16Z LENS PROCEDURES 0 0 1 4 0.77 1.43 0 0 0 0.5372 0.1902 $2,690 $952 C60A AC & MJR EYE INFECTN +CC 0 0 2 24 0.05 1 0 0 1.197 2.3941 0.2425 $5,993 $11,987 $1,214 C60B AC & MJR EYE INFECTN -CC 0 0 1 13 0.03 1 0 0 0 1.2571 0.2965 $6,294 $1,485 C61A NEUROLOGICAL&VASCLR EYE DIS+CC 0 0 1 15 0.13 1 0 0 0 1.3137 0.2339 $6,578 $1,171 C61B NEUROLOGICAL&VASCLR EYE DIS-CC 1 0 1 10 0.16 1.38 0.2198 0 0 0.796 0.2279 $1,101 $3,986 $1,141 C62A HYPH&MED MNGD EYE TRAUMA +CC 1 0 1 14 0.12 1 0.1265 0 0 1.0092 0.2076 $633 $5,053 $1,039 C62B HYPH&MED MANGD EYE TRMA -CC 1 0 1 6 0.11 2 0.1282 0 0 0.4288 0.2365 $642 $2,147 $1,184 C63A OTH DIS OF THE EYE W CC 1 0 1 13 0.07 1.19 0.2068 0 0 1.1809 0.2467 $1,035 $5,913 $1,235 C63B OTH DIS OF THE EYE W/O CC 1 0 1 8 0.16 1.51 0.2202 0 0 0.7089 0.2578 $1,103 $3,549 $1,291 D01Z COCHLEAR IMPLANT 0 0 1 3 0.67 1.11 0 0 0 6.8412 0.9208 $34,254 $4,610 D02A HEAD & NECK PROC +MVTT/+CSCC 0 0 4 37 0.18 1 0 1.3348 1.2104 6.1765 0.3222 $6,683 $6,060 $30,926 $1,613 D02B HEAD & NECK PROC +MALIG/+MCC 0 0 1 14 0.16 1 0 0 0 2.7685 0.4137 $13,862 $2,071 D02C HEAD & NECK PROC -MALG -CC 0 0 1 6 0.23 1 0 0 0 1.7385 0.5114 $8,705 $2,561 D03Z SURGCL RPR CLEFT LIP/PAL DIS 0 0 1 7 0.11 1.17 0 0 0 1.7044 0.4134 $8,534 $2,070 D04Z MAXILLO SURGERY 1 0 1 7 0.21 1 0.8809 0 0 2.0053 0.3594 $4,411 $10,041 $1,800 D05Z PAROTID GLAND PROCS 0 0 1 7 0.16 1 0 0 0 2.3616 0.415 $11,825 $2,078 D06Z SINUS &CMPLX MDDL EAR PR 0 0 1 4 0.27 1 0 0 0 1.2469 0.4198 $6,243 $2,102 D10Z NASAL PROCEDURES 0 0 1 3 0.27 0.8 0 0 0 0.9614 0.363 $4,814 $1,818 D11Z TONSILLECTOMY, ADENOIDECTOMY 0 0 1 3 0.19 0.89 0 0 0 0.7058 0.3427 $3,534 $1,716 D12A OTH EAR,NOSE,MTH & THRT PR +CC 0 0 1 13 0.12 1.26 0 0 0 1.7357 0.3026 $8,691 $1,515 D12B OTH EAR,NOSE,MTH & THRT PR -CC 1 0 1 5 0.21 1 0.5515 0 0 1.1722 0.2981 $2,761 $5,869 $1,493 D13Z MYRINGOTOMY +TUBE INSERTION 0 0 1 3 0.36 1 0 0 0 0.3839 0.136 $1,922 $681 Please note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 2/13
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National Acute Inpatient Price Weights 2014/15 National Price Weights National Base Price DRG v7.0 Description Same-Day Payment List Bundled ICU Lower Bound Upper Bound Private Adjustment Paediatric Adjustment Same Day Outlier Base Diem Inlier Long-Stay Diem Same Day $ Outlier Base $ Diem $ Inlier $ Long-Stay Diem $ D14A MOUTH & SALIVRY GLAND PROC +CC 0 0 1 10 0.13 1 0 0 0 1.5904 0.3233 $7,963 $1,619 D14B MOUTH & SALIVRY GLAND PROC -CC 0 0 1 4 0.14 0.89 0 0 0 0.8244 0.2622 $4,128 $1,313 D15Z MASTOID PROCEDURES 0 0 1 6 0.3 0.93 0 0 0 2.1076 0.5363 $10,553 $2,685 D40Z DENTAL EXTRACT & RESTORATIONS 0 0 1 3 0.15 1 0 0 0 0.651 0.1825 $3,260 $914 D60A EAR NOSE MOUTH&THROAT MAL+CSCC 0 0 2 26 0.07 1 0 0.1158 1.4144 2.9447 0.2658 $580 $7,082 $14,744 $1,331 D60B EAR NOSE MOUTH&THROAT MAL-CSCC 0 0 1 7 0.08 1.26 0 0 0 0.8834 0.2188 $4,423 $1,096 D60C EAR NOSE MOUTH&THROAT MAL +SD 0 0 1 1 0.2 1 0 0 0 0.4124 0 $2,065 D61A DYSEQUILIBRIUM +CC 0 0 1 13 0.12 1 0 0 0 0.9294 0.1961 $4,654 $982 D61B DYSEQUILIBRIUM -CC 0 0 1 7 0.15 1.49 0 0 0 0.478 0.2022 $2,393 $1,012 D61C DYSEQUILIBRIUM +SD 0 0 1 1 0.23 1 0 0 0 0.098 0 $491 D62A EPISTAXIS 0 0 1 7 0.09 1.49 0 0 0 0.5142 0.2254 $2,575 $1,129 D62B EPISTAXIS +SD 0 0 1 1 0.12 2 0 0 0 0.1301 0 $651 D63A OTITIS MEDIA AND URI +CC 0 0 1 10 0.08 1.11 0 0 0 0.8504 0.246 $4,258 $1,232 D63B OTITIS MEDIA AND URI -CC 0 0 1 5 0.09 1.29 0 0 0 0.4349 0.2449 $2,178 $1,226 D63C OTITIS MEDIA AND URI +SD 0 0 1 1 0.19 1.29 0 0 0 0.1345 0 $673 D64Z LARYNGOTRACHEITIS&EPIGLOTTITIS 0 0 1 4 0.09 0.92 0 0 0 0.298 0.2156 $1,492 $1,080 D65Z NASAL TRAUMA & DEFORMITY 0 0 1 4 0.19 0.86 0 0 0 0.362 0.1459 $1,813 $731 D66A OTH EAR,NOSE,MOUTH&THRT DX +CC 0 0 1 15 0.09 1.25 0 0 0 1.2105 0.2303 $6,061 $1,153 D66B OTH EAR,NOSE,MOUTH&THRT DX -CC 0 0 1 6 0.1 1 0 0 0 0.5532 0.2109 $2,770 $1,056 D66C OTH EAR,NOSE,MOUTH&THRT DX +SD 0 0 1 1 0.25 1.11 0 0 0 0.2654 0 $1,329 D67A ORAL & DENTAL DISORDERS 0 0 1 8 0.08 1.24 0 0 0 0.6989 0.2477 $3,499 $1,240 D67B ORAL & DENTAL DISORDERS +SD 0 0 1 1 0.21 1.37 0 0 0 0.2104 0 $1,053 E01A MAJOR CHEST PROCEDURE +CCC 0 0 4 43 0.17 1.06 0 0.6677 1.24 5.6278 0.2707 $3,343 $6,209 $28,178 $1,355 E01B MAJOR CHEST PROCEDURE -CCC 0 0 2 22 0.19 1.11 0 0.3853 1.4717 3.3286 0.2665 $1,929 $7,369 $16,666 $1,334 E02A OTHER RESPIRATRY SYS OR PR+CCC 0 0 4 42 0.17 1.48 0 0.4088 1.0896 4.7672 0.2568 $2,047 $5,456 $23,869 $1,286 E02B OTH RESPIRATRY SYS OR PR+SMCC 1 0 1 14 0.17 0.88 0.593 0 0 2.1073 0.2798 $2,969 $10,551 $1,401 E02C OTHER RESPIRATY SYS OR PR -CC 0 0 1 4 0.2 0.89 0 0 0 0.8815 0.3097 $4,414 $1,551 E40A RESP DIS W VENT SUPP 0 1 4 37 0.11 0.94 0 0.0622 1.8792 7.5789 0.4323 $311 $9,409 $37,948 $2,165 E40B RESP DX W VENT SUPP D/T<5D 0 1 1 4 0.12 1 0 0 0 3.1681 0 $15,863 E41A RESP SYS DX +NON-INVS VENT+CCC 0 0 4 37 0.09 1.42 0 0.0277 1.1306 4.55 0.2603 $139 $5,661 $22,782 $1,303 E41B RESP SYS DX +NON-INVS VENT-CCC 0 0 2 23 0.08 1 0 0.0574 1.4383 2.934 0.2796 $287 $7,202 $14,691 $1,400 E42A BRONCHOSCOPY +CCC 0 0 5 49 0.09 1.12 0 0.3796 0.8973 4.8659 0.2505 $1,901 $4,493 $24,364 $1,254 E42B BRONCHOSCOPY -CCC 0 0 2 21 0.13 1.33 0 0.3475 0.9489 2.2453 0.1992 $1,740 $4,751 $11,242 $997 E42C BRONCHOSCOPY +SD 0 0 1 1 0.26 1.34 0 0 0 0.4007 0 $2,006 E60A CYSTIC FIBROSIS +CSCC 0 0 4 38 0.03 1.19 0 0 1.0096 4.0384 0.2629 $5,055 $20,220 $1,316 E60B CYSTIC FIBROSIS -CSCC 0 0 3 29 0.04 1.25 0 0 1.023 3.0691 0.2233 $5,122 $15,367 $1,118 E61A PULMONARY EMBOLISM +CCC 0 0 3 31 0.12 1 0 0 0.913 2.739 0.2138 $4,571 $13,714 $1,070 E61B PULMONARY EMBOLISM -CCC 1 0 2 18 0.15 1 0.223635 0 0.55386 1.10772 0.138125 $1,120 $2,773 $5,546 $692 E62A RESPIRATRY INFECTN/INFLAMM+CCC 0 0 3 28 0.09 1.59 0 0 0.7581 2.2742 0.2271 $3,796 $11,387 $1,137 E62B RESPIRATRY INFECTN/INFLAM+SMCC 0 0 1 16 0.1 1.31 0 0 0 1.1896 0.2238 $5,956 $1,121 E62C RESPIRATORY INFECTN/INFLAMM-CC 1 0 1 10 0.11 1 0.1196 0 0 0.7649 0.2166 $599 $3,830 $1,085 E63Z SLEEP APNOEA 0 0 1 4 0.14 1.13 0 0 0 0.2986 0.1272 $1,495 $637 E64A PULMONRY OEDEMA &RESP FAIL 0 0 2 20 0.1 1 0 0 0.9053 1.8107 0.2217 $4,533 $9,066 $1,110 E64B PULMNRY OEDMA &RESP FL D/T<5D 0 0 1 4 0.1 1 0 0 0 0.4763 0 $2,385 E65A CHRNIC OBSTRCT AIRWAY DIS +CCC 0 0 2 26 0.09 1 0 0 0.9605 1.921 0.2119 $4,809 $9,618 $1,061 E65B CHRNIC OBSTRCT AIRWAY DIS -CCC 0 0 1 14 0.09 2 0 0 0 0.9727 0.2075 $4,870 $1,039 E66A MAJOR CHEST TRAUMA +CCC 0 0 3 35 0.1 1 0 0 0.9569 2.8708 0.2031 $4,791 $14,374 $1,017 E66B MJR CHEST TRMA +SMCC 0 0 1 15 0.12 1 0 0 0 1.161 0.2099 $5,813 $1,051 E66C MAJOR CHEST TRAUMA -CC 0 0 1 8 0.12 1 0 0 0 0.5721 0.2161 $2,865 $1,082 E67A RESPIRATRY SIGNS & SYMPTM 0 0 1 13 0.15 1 0 0 0 1.0557 0.2249 $5,286 $1,126 E67B RESPIRTRY SIGNS & SYMPTM <2D 1 0 1 1 0.24 0.8 0.2044 0 0 0.2766 0 $1,023 $1,385 E68A PNEUMOTHORAX +CSCC 0 0 2 20 0.09 1 0 0 0.9301 1.8601 0.2412 $4,657 $9,314 $1,208 E68B PNEUMOTHORAX -CSCC 0 0 1 9 0.11 0.94 0 0 0 0.7945 0.242 $3,978 $1,212 E69A BRONCHITIS & ASTHMA +CC 0 0 1 11 0.09 1 0 0 0 0.8712 0.2071 $4,362 $1,037 E69B BRNCHTS&ASTHMA -CC 1 0 1 6 0.08 0.88 0.1209 0 0 0.4869 0.2236 $605 $2,438 $1,120 E70A WHOOPNG CGH &ACTE BRNCHIO +CC 0 0 1 12 0.05 1 0 0 0 1.4207 0.3477 $7,113 $1,741 E70B WHOOPNG CGH &ACTE BRNCHIO -CC 0 0 1 7 0.05 0.92 0 0 0 0.7038 0.3312 $3,524 $1,658 E71A RESPIRATORY NEOPLASMS +CCC 0 0 3 29 0.09 1 0 0 0.8526 2.5579 0.2216 $4,269 $12,807 $1,110 E71B RESPIRATORY NEOPLASMS -CCC 0 0 1 16 0.11 1.2 0 0 0 1.2731 0.2253 $6,374 $1,128 E71C RESPIRATORY NEOPLASMS +SD 0 0 1 1 0.24 1.91 0 0 0 0.2845 0 $1,424 E72Z RESP PROBS FROM NEONATL PERIOD 0 0 1 11 0.1 0.87 0 0 0 0.7881 0.3843 $3,946 $1,924 Please note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 3/13
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National Acute Inpatient Price Weights 2014/15 National Price Weights National Base Price DRG v7.0 Description Same-Day Payment List Bundled ICU Lower Bound Upper Bound Private Adjustment Paediatric Adjustment Same Day Outlier Base Diem Inlier Long-Stay Diem Same Day $ Outlier Base $ Diem $ Inlier $ Long-Stay Diem $ E73A PLEURAL EFFUSION +CCC 0 0 3 30 0.1 1 0 0 0.8575 2.5724 0.2247 $4,294 $12,880 $1,125 E73B PLEURAL EFFUSION +SMCC 1 0 2 19 0.13 1 0.2361 0 0.7478 1.4957 0.2047 $1,182 $3,744 $7,489 $1,025 E73C PLEURAL EFFUSION -CC 1 0 1 12 0.17 1 0.2108 0 0 0.8941 0.2015 $1,055 $4,477 $1,009 E74A INTERSTITAL LUNG DIS +CCC 0 0 3 31 0.13 1 0 0 0.7639 2.2917 0.2156 $3,825 $11,475 $1,080 E74B INTERSTITIAL LUNG DIS +SMCC 0 0 2 19 0.1 1 0 0 0.7874 1.5747 0.2244 $3,943 $7,885 $1,124 E74C INTERSTITIAL LUNG DIS -CC 1 0 1 15 0.1 0.94 0.2902 0 0 1.0876 0.1891 $1,453 $5,446 $947 E75A OTHER RESP SYS DIS +CC 1 0 1 16 0.1 1.38 0.1444 0 0 1.2783 0.2264 $723 $6,400 $1,134 E75B OTHER RESP SYS DIS -CC 1 0 1 8 0.11 0.95 0.1275 0 0 0.5952 0.2219 $638 $2,980 $1,111 E76A RESPIRATORY TUBERCULOSIS +CC 0 0 8 80 0.1 1 0 0 0.6962 5.5693 0.1876 $3,486 $27,885 $939 E76B RESPIRATORY TUBERCULOSIS -CC 0 0 1 14 0.1 1 0 0 0 0.6479 0.2176 $3,244 $1,090 F01A IMPLNTN/REPLCMNT AICD TTL+CCC 0 0 3 34 0.62 1 0 3.3408 2.295 10.2259 0.3232 $16,727 $11,491 $51,201 $1,618 F01B IMPLNTN/REPLCMNT AICD TTL-CCC 1 0 1 11 1 1 3.463 0 0 5.642 0.2975 $17,339 $28,249 $1,490 F02Z OTHER AICD PROCEDURES 0 0 1 12 0.38 1 0 0 0 2.3207 0.2949 $11,620 $1,477 F03A CRDC VALV PR+PMP+INV INVES+CCC 0 1 7 66 0.27 1 0 5.2778 1.2331 13.9096 0.3834 $26,426 $6,174 $69,645 $1,920 F03B CRDC VALV PR+PMP+INV INVES-CCC 0 1 3 33 0.26 1 0 3.6976 1.6415 8.6222 0.3505 $18,514 $8,219 $43,171 $1,755 F04A CRD VLV PR+PMP-INV INVES +CCC 0 1 4 39 0.23 1 0 4.1715 1.5161 10.2358 0.4098 $20,887 $7,591 $51,251 $2,052 F04B CRD VLV PR+PMP-INV INVES -CCC 0 1 2 24 0.24 1 0 2.6482 2.4147 7.4776 0.4056 $13,260 $12,090 $37,440 $2,031 F05A CRNRY BYPSS+INV INVES +CCC 0 1 6 55 0.21 1 0 2.5595 1.3929 10.9168 0.3696 $12,815 $6,974 $54,660 $1,851 F05B CRNRY BYPSS+INV INVES -CCC 0 1 4 39 0.21 1 0 2.4181 1.5277 8.5289 0.3221 $12,107 $7,649 $42,704 $1,613 F06A CRNRY BYPSS-INV INVS +CCC 0 1 3 33 0.22 1 0 2.4868 1.8003 7.8876 0.4012 $12,451 $9,014 $39,493 $2,009 F06B CRNRY BYPSS-INV INVS -CCC 0 1 2 23 0.22 1 0 2.0803 2.0631 6.2064 0.3294 $10,416 $10,330 $31,075 $1,649 F07A OTHER CARDTHOR/VASC PR+PMP+CCC 0 1 4 37 0.2 1.22 0 2.8241 1.6467 9.4109 0.4188 $14,140 $8,245 $47,120 $2,097 F07B OTHER CARDTHOR/VASC PR+PMP-CCC 0 1 2 21 0.32 1 0 2.0348 2.3527 6.7403 0.513 $10,188 $11,780 $33,749 $2,569 F08A MJR RECONSTRC VASC PR-PUMP+CCC 0 0 5 45 0.2 1 0 2.2334 1.064 7.5533 0.2821 $11,183 $5,327 $37,819 $1,412 F08B MJR RECONSTRC VASC PR-PUMP-CCC 0 0 2 19 0.47 1 0 1.3932 1.5474 4.4879 0.2655 $6,976 $7,748 $22,471 $1,329 F09A OTH CARDIOTHOR PR-PMP+CCC 0 0 3 28 0.21 1.37 0 1.1839 1.2934 5.064 0.3114 $5,928 $6,476 $25,355 $1,559 F09B OTH CARDIOTHOR PR-PMP -CCC 0 0 1 12 0.31 1.63 0 0 0 2.5994 0.3097 $13,015 $1,551 F09C OTH CARDIOTHOR PR-PMP +D/T<5D 0 0 1 4 0.25 1 0 0 0 1.8927 0 $9,477 F10A INTERVENTN CORONARY PR+AMI+CCC 0 0 2 25 0.3 1 0 1.0034 1.3531 3.7096 0.2727 $5,024 $6,775 $18,574 $1,365 F10B INTERVENTN CORONARY PR+AMI-CCC 0 0 1 10 0.39 1 0 0 0 2.148 0.292 $10,755 $1,462 F11A AMPUTN CIRC SYS-UP LMB&TOE+CCC 0 0 9 88 0.1 1 0 1.1223 0.9879 10.0135 0.2735 $5,619 $4,946 $50,138 $1,369 F11B AMPUTN CIRC SYS-UP LMB&TOE-CCC 0 0 5 46 0.1 1 0 0.7938 0.9757 5.6722 0.2854 $3,975 $4,885 $28,401 $1,429 F12A IMPLANT/REPLCE PM,TOT SYS +CCC 0 0 3 31 0.52 1 0 1.5232 1.0937 4.8044 0.2662 $7,627 $5,476 $24,056 $1,333 F12B IMPLANT/REPLCE PM,TOT SYS -CCC 1 0 1 11 0.71 1 1.4403 0 0 2.641 0.2432 $7,212 $13,223 $1,218 F13A UP LIMB&TOE AMP CIRC DIS +CSCC 0 0 5 52 0.11 1 0 0.4419 1.1446 6.1647 0.2714 $2,213 $5,731 $30,867 $1,359 F13B UP LIMB&TOE AMP CIRC DIS -CSCC 0 0 2 21 0.11 1 0 0.3931 0.9602 2.3135 0.2333 $1,968 $4,808 $11,584 $1,168 F14A VASC PR-MJR RECONSTRC-PUMP+CCC 0 0 3 32 0.2 1 0 0.5888 1.2906 4.4606 0.2649 $2,948 $6,462 $22,334 $1,326 F14B VASC PR-MJR RECONSTR-PUMP+SMCC 1 0 1 14 0.26 1.63 0.8141 0 0 2.314 0.2765 $4,076 $11,586 $1,384 F14C VASC PR-MJR RECONSTR-PUMP-CC 1 0 1 7 0.4 1.39 0.8187 0 0 1.6325 0.2566 $4,099 $8,174 $1,285 F15A INTER CORONARY PR-AMI+STN+CSCC 0 0 1 11 0.4 1 0 0 0 2.4944 0.2728 $12,489 $1,366 F15B INTER CORONRY PR-AMI+STNT-CSCC 0 0 1 6 0.6 1 0 0 0 1.7011 0.2022 $8,517 $1,012 F16A INTERVN CORONARY PR-AMI-STN+CC 0 0 1 11 0.32 1 0 0 0 1.9955 0.2816 $9,991 $1,410 F16B INTERV CORONARY PR-AMI-STNT-CC 0 0 1 5 0.37 1 0 0 0 1.3607 0.2535 $6,813 $1,269 F17Z INSERT/REPLACE PM GENERATOR 0 0 1 5 0.93 1 0 0 0 1.5496 0.2716 $7,759 $1,360 F18A OTHER PACEMAKER PROCS +CC 0 0 3 27 0.4 1 0 0.5459 0.8426 3.0736 0.2055 $2,733 $4,219 $15,390 $1,029 F18B OTHER PACEMAKER PROCS -CC 0 0 1 7 0.4 1 0 0 0 1.2632 0.2574 $6,325 $1,289 F19A TRNS-VSCLR PERC CRDC >=80Y/+CC 0 0 2 20 0.19 1 0 1.0268 1.4596 3.9459 0.2574 $5,141 $7,308 $19,757 $1,289 F19B TRNS-VSCLR PERC CRDC <80Y -CC 0 0 1 4 0.53 0.92 0 0 0 2.3155 0.294 $11,594 $1,472 F20Z VEIN LIGATION & STRIPPING 0 0 1 4 0.23 0.8 0 0 0 0.9656 0.3073 $4,835 $1,539 F21A OTH CIRC SYS OR PR +CCC 0 0 5 48 0.12 1 0 0.6093 0.9178 5.1984 0.2238 $3,051 $4,595 $26,028 $1,121 F21B OTH CIRC SYS OR PR -CCC 1 0 1 16 0.14 1 0.8505 0 0 1.9741 0.2002 $4,258 $9,884 $1,002 F40A CIRC DIS +VENT SUPP 0 1 4 41 0.12 1 0 0.1243 1.9823 8.0535 0.3784 $622 $9,925 $40,324 $1,895 F40B CIRC DIS+ VENT SUPP D/T<5D 0 1 1 4 0.13 1 0 0 0 2.9851 0 $14,946 F41A CRC DSRD+AMI+INVA INV PR+CSCC 0 0 2 23 0.15 1 0 0.2501 1.2466 2.7432 0.2496 $1,252 $6,242 $13,735 $1,250 F41B CRC DSRD+AMI+INVA INV PR-CSCC 1 0 1 13 0.18 1 0.5994 0 0 1.5689 0.2387 $3,001 $7,855 $1,195 F42A CRC DSRD-AMI+IC IN PR +CSCC 0 0 2 22 0.16 1 0 0.3713 1.1407 2.6527 0.243 $1,859 $5,711 $13,282 $1,217 F42B CRC DSRD-AMI+IC IN PR -CSCC 0 0 1 9 0.3 1.32 0 0 0 1.2853 0.1886 $6,435 $944 F42C CRC DSRD-AMI+IC IN PR +SD 0 0 1 1 0.35 1.93 0 0 0 0.5704 0 $2,856 F43Z CIRC DIS W NIV 0 0 3 34 0.1 1 0 0.012 1.3208 3.9743 0.2544 $60 $6,613 $19,899 $1,274 F60A CRC DSRD+AMI-INVA INV 0 0 1 17 0.11 1 0 0 0 1.4822 0.2318 $7,421 $1,161 F60B CRC DSRD+AMI-INVA INV D/T <5D 1 0 1 4 0.19 1 0.2248 0 0 0.7323 0 $1,126 $3,667 Please note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 4/13
2. National Acute Inpatient Price Weights 2014/15 National Price Weights National Base Price DRG v7.0 Description Same-Day Payment List Bundled ICU Lower Bound Upper Bound Private Adjustment Paediatric Adjustment Same Day Outlier Base Diem Inlier Long-Stay Diem Same Day $ Outlier Base $ Diem $ Inlier $ Long-Stay Diem $ F61A INFECTIVE ENDOCARDITIS +CCC 0 0 8 72 0.11 1 0 0 0.9044 7.2353 0.2235 $4,528 $36,227 $1,119 F61B INFECTIVE ENDOCARDITIS -CCC 0 0 4 37 0.13 1 0 0 0.7839 3.1356 0.1532 $3,925 $15,700 $767 F62A HEART FAILURE & SHOCK +CCC 0 0 3 30 0.09 1 0 0 0.8194 2.4583 0.2244 $4,103 $12,309 $1,124 F62B HEART FAILURE & SHOCK -CCC 0 0 1 15 0.1 1 0 0 0 1.1084 0.213 $5,550 $1,066 F62C HEART FAILURE & SHOCK D/T <5D 0 0 1 4 0.15 1 0 0 0 0.4253 0 $2,129 F63A VENOUS THROMBOSIS +CSCC 0 0 2 24 0.11 1 0 0 0.9397 1.8793 0.2057 $4,705 $9,410 $1,030 F63B VENOUS THROMBOSIS -CSCC 1 0 1 18 0.13 1 0.126565 0 0 0.708305 0.094435 $634 $3,546 $473 F64A SKN ULCERS CIRC DISORD +CSCC 0 0 4 39 0.07 1 0 0 0.7199 2.8797 0.2146 $3,605 $14,419 $1,075 F64B SKN ULCERS CIRC DISORD -CSCC 1 0 2 25 0.11 1 0.2044 0 0.8019 1.6039 0.1678 $1,023 $4,015 $8,031 $840 F65A PERIPHERAL VASCULAR DSRD +CSCC 0 0 2 21 0.12 1 0 0 0.9539 1.9077 0.2297 $4,776 $9,552 $1,150 F65B PERIPHERAL VASCULAR DSRD -CSCC 1 0 1 10 0.16 0.93 0.3259 0 0 0.9166 0.1918 $1,632 $4,589 $960 F66A CORONARY ATHEROSCLEROSIS +CSCC 0 0 1 14 0.14 1 0 0 0 1.1037 0.224 $5,526 $1,122 F66B CORONARY ATHEROSCLEROSIS -CSCC 1 0 1 6 0.19 1 0.1498 0 0 0.4673 0.202 $750 $2,340 $1,011 F67A HYPERTENSION +CSCC 0 0 1 17 0.11 1 0 0 0 1.2693 0.2163 $6,355 $1,083 F67B HYPERTENSION -CSCC 1 0 1 9 0.14 1.66 0.1202 0 0 0.5825 0.2071 $602 $2,917 $1,037 F68Z CONGENITAL HEART DISEASE 0 0 1 6 0.18 1.23 0 0 0 0.4746 0.2196 $2,376 $1,100 F69A VALVULAR DISORDERS +CSCC 0 0 2 19 0.11 1 0 0 0.8288 1.6575 0.2106 $4,150 $8,299 $1,054 F69B VALVULAR DISORDERS -CSCC 1 0 1 7 0.19 1.78 0.1896 0 0 0.4905 0.2168 $949 $2,456 $1,086 F72A UNSTABLE ANGINA +CSCC 0 0 1 14 0.12 1 0 0 0 1.1143 0.2194 $5,579 $1,099 F72B UNSTABLE ANGINA -CSCC 1 0 1 7 0.18 1 0.1182 0 0 0.5752 0.229 $592 $2,880 $1,147 F73A SYNCOPE & COLLAPSE +CSCC 0 0 1 17 0.1 1 0 0 0 1.2427 0.2114 $6,222 $1,058 F73B SYNCOPE & COLLAPSE -CSCC 0 0 1 7 0.16 1.31 0 0 0 0.503 0.197 $2,519 $986 F73C SYNCOPE & COLLAPSE +SD 0 0 1 1 0.3 1 0 0 0 0.1362 0 $682 F74A CHEST PAIN 0 0 1 10 0.18 1 0 0 0 0.7984 0.1986 $3,998 $994 F74B CHEST PAIN <2D 0 0 1 1 0.24 1.52 0 0 0 0.1784 0 $893 F75A OTHER CIRCULATORY DIS +CCC 0 0 3 30 0.1 1.93 0 0 0.9419 2.8258 0.2429 $4,716 $14,149 $1,216 F75B OTH CIRCULATORY DIS +SMCC 0 0 1 13 0.12 1.89 0 0 0 1.1265 0.232 $5,640 $1,162 F75C OTH CIRCULATORY DIS -CC 1 0 1 8 0.16 1.66 0.2657 0 0 0.7032 0.2254 $1,330 $3,521 $1,129 F76A ARRHY, CARD & COND DISDR +CSCC 0 0 2 18 0.11 1 0 0 0.8014 1.6028 0.2105 $4,013 $8,025 $1,054 F76B ARRHY, CARD & COND DISDR -CSCC 0 0 1 8 0.17 1.93 0 0 0 0.6062 0.1727 $3,035 $865 F76C ARRHY, CARD & COND DISDR +SD 0 0 1 1 0.19 1.19 0 0 0 0.1849 0 $926 G01A RECTAL RESECTION +CCC 0 0 5 53 0.22 1 0 1.5857 1.0996 7.0836 0.2759 $7,940 $5,506 $35,468 $1,381 G01B RECTAL RESECTION -CCC 0 0 2 27 0.26 1 0 1.5194 1.4441 4.4076 0.2446 $7,608 $7,231 $22,069 $1,225 G02A MJR SMALL & LARGE BOWEL PR+CCC 0 0 5 51 0.18 1.32 0 1.2045 1.0513 6.4611 0.2928 $6,031 $5,264 $32,351 $1,466 G02B MJR SMALL & LARGE BOWEL PR-CCC 0 0 2 22 0.19 1 0 0.6367 1.3558 3.3482 0.297 $3,188 $6,788 $16,764 $1,487 G03A STOMCH,OESPH&DUODNL PR+MAL/CCC 0 0 4 41 0.16 1.12 0 1.1837 1.4072 6.8124 0.3325 $5,927 $7,046 $34,110 $1,665 G03B STMCH,OESPHGL&DDNL PR-MAL+SMCC 0 0 2 21 0.17 1.18 0 0.9019 1.1128 3.1275 0.3056 $4,516 $5,572 $15,659 $1,530 G03C STMCH,OESPHGL&DDNL PR-MAL-CC 0 0 1 11 0.16 1.14 0 0 0 2.1542 0.2938 $10,786 $1,471 G04A PERITONEAL ADHESOLYSIS +CCC 0 0 5 46 0.12 1 0 0.9628 0.93 5.6128 0.2943 $4,821 $4,657 $28,103 $1,474 G04B PRTNL ADHLY +SMCC 0 0 2 24 0.15 1.14 0 0.7902 1.1638 3.1178 0.286 $3,957 $5,827 $15,611 $1,432 G04C PERITONEAL ADHESOLYSIS -CC 0 0 1 12 0.15 1.15 0 0 0 1.8212 0.2795 $9,119 $1,399 G05A MNR SMALL&LARGE BOWEL PR +CCC 0 0 4 43 0.14 1 0 0.7721 0.8974 4.3617 0.2686 $3,866 $4,493 $21,839 $1,345 G05B MNR SMALL&LARGE BOWEL PR +SMCC 0 0 2 21 0.14 1.12 0 0.6003 1.0341 2.6686 0.2749 $3,006 $5,178 $13,362 $1,376 G05C MNR SMALL & LARGE BOWEL PR -CC 0 0 1 12 0.17 0.8 0 0 0 1.8097 0.3392 $9,061 $1,698 G06Z PYLOROMYOTOMY PROCEDURE 0 0 1 11 0.09 0.87 0 0 0 1.8751 0.295 $9,389 $1,477 G07A APPENDCTMY +MALIG/PERITON/CSCC 0 0 1 15 0.12 1.29 0 0 0 1.8448 0.2925 $9,237 $1,465 G07B APPENDCTMY -MALIG-PERITON-CSCC 0 0 1 7 0.14 1.17 0 0 0 1.1949 0.2522 $5,983 $1,263 G10A HERNIA PROCEDURES +CC 0 0 1 15 0.16 0.8 0 0 0 2.1903 0.2698 $10,967 $1,351 G10B HERNIA PROCEDURES -CC 0 0 1 4 0.24 0.8 0 0 0 0.9989 0.3046 $5,001 $1,525 G11Z ANAL & STOMAL PROCEDURES 1 0 1 7 0.16 1.34 0.4737 0 0 0.9261 0.1935 $2,372 $4,637 $969 G12A OTH DIGEST SYS OR PR+CCC 0 0 4 44 0.14 1 0 0.4828 1.1546 5.1014 0.272 $2,417 $5,781 $25,543 $1,362 G12B OTH DIGEST SYS OR PR+SMCC 0 0 1 17 0.15 1.16 0 0 0 2.1348 0.2427 $10,689 $1,215 G12C OTH DIGEST SYS OR PR-CC 1 0 1 13 0.17 1.84 0.6369 0 0 1.5983 0.2233 $3,189 $8,003 $1,118 G46A COMPLEX GASTROSCOPY+CCC 0 0 4 39 0.12 1 0 0.2786 0.9297 3.9976 0.25 $1,395 $4,655 $20,016 $1,252 G46B COMPLEX GASTROSCOPY-CCC 0 0 1 14 0.15 1.5 0 0 0 1.4107 0.2276 $7,063 $1,140 G46C COMPLEX GASTROSCOPY,SD 0 0 1 1 0.42 1.57 0 0 0 0.3656 0 $1,831 G47A OTH GASTROSCOPY +CCC 0 0 3 32 0.11 1 0 0.19 0.8858 2.8473 0.2358 $951 $4,435 $14,256 $1,181 G47B OTH GASTROSCOPY -CCC 0 0 1 10 0.16 1.14 0 0 0 0.9748 0.2141 $4,881 $1,072 G47C OTH GASTROSCOPY, SD 0 0 1 1 0.29 1.44 0 0 0 0.1355 0 $678 G48A COLONOSCOPY +CSCC 0 0 3 28 0.09 1 0 0.2047 0.8053 2.6207 0.2295 $1,025 $4,032 $13,122 $1,149 G48B COLONOSCOPY - CSCC 0 0 1 10 0.15 1.6 0 0 0 1.0193 0.1978 $5,104 $990 Please note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 5/13
2. National Acute Inpatient Price Weights 2014/15 Same-Day Payment List National Price Weights Outlier Base Diem Inlier Long-Stay Diem Outlier Base $ National Base Price Diem $ Inlier $ Bundled Lower Upper Private Paediatric Same Day DRG v7.0 Description ICU Bound Bound Adjustment Adjustment Same Day $ G48C COLONOSCOPY, SD 0 0 1 1 0.42 1.47 0 0 0 0.3244 0 $1,624 G60A DIGESTIVE MALIGNANCY + CCC 0 0 3 28 0.1 1 0 0 0.8023 2.4069 0.2219 $4,017 $12,051 $1,111 G60B DIGESTIVE MALIGNANCY - CCC 1 0 1 14 0.11 2 0.2807 0 0 0.8797 0.2083 $1,405 $4,405 $1,043 G61A GI HAEMORRHAGE +CSCC 0 0 1 15 0.11 1 0 0 0 1.1211 0.2198 $5,613 $1,101 G61B GI HAEMORRHAGE - CSCC 1 0 1 8 0.13 1.14 0.1365 0 0 0.544 0.1961 $683 $2,724 $982 G64A INFLAMMATORY BOWEL DISEASE +CC 1 0 2 19 0.08 1.6 0.2126 0 0.7651 1.5301 0.2362 $1,064 $3,831 $7,661 $1,183 G64B INFLAMMATORY BOWEL DISEASE-CC 1 0 1 11 0.06 1.45 0.2728 0 0 0.8267 0.2312 $1,366 $4,139 $1,158 G65A GI OBSTRUCTION + CSCC 0 0 2 19 0.1 1 0 0 0.7989 1.5978 0.2326 $4,000 $8,000 $1,165 G65B GI OBSTRUCTION - CSCC 0 0 1 9 0.12 0.91 0 0 0 0.6856 0.2196 $3,433 $1,100 G66A ABDMNL PAIN/MESENT ADENTS, O/N 0 0 1 6 0.15 1.12 0 0 0 0.4517 0.2142 $2,262 $1,072 G66B ABDMNL PAIN/MESENT ADENTS, SD 0 0 1 1 0.29 1.38 0 0 0 0.1118 0 $560 G67A OESPHS, GASTR +CSCC 0 0 1 16 0.09 1.18 0 0 0 1.2455 0.2266 $6,236 $1,135 G67B OESPHS, GASTR -CSCC 1 0 1 6 0.12 1.19 0.096 0 0 0.4801 0.2031 $481 $2,404 $1,017 G70A OTHER DIGESTIVE SYS DIAG +CSCC 0 0 2 18 0.1 1.62 0 0 0.7393 1.4786 0.2164 $3,702 $7,403 $1,084 G70B OTHER DIGESTIVE SYS DIAG -CSCC 0 0 1 8 0.12 1.37 0 0 0 0.5777 0.2071 $2,893 $1,037 G70C OTHER DIGESTIVE SYS DIAG -SD 0 0 1 1 0.21 1.24 0 0 0 0.1566 0 $784 H01A PANCREAS, LIVER & SHUNT PR+CCC 0 1 5 49 0.2 1 0 0.8338 1.53 8.4835 0.3272 $4,175 $7,661 $42,477 $1,638 H01B PANCREAS, LIVER &SHUNT PR-CCC 0 0 2 19 0.21 1 0 0.3049 1.8666 4.0382 0.3839 $1,527 $9,346 $20,219 $1,922 H02A MJR BILIARY TRACT PR +CCC 0 0 5 53 0.16 1 0 0.8222 1.0726 6.1854 0.2503 $4,117 $5,371 $30,970 $1,253 H02B MJR BILIARY TRACT PR -CCC 0 0 2 21 0.2 1.54 0 0.4922 1.3611 3.2145 0.2642 $2,464 $6,815 $16,095 $1,323 H05A HEPATOBILIARY DIAGNTIC PR +CCC 0 0 4 42 0.19 1 0 0.9382 1.0778 5.2493 0.2389 $4,698 $5,397 $26,283 $1,196 H05B HEPATOBILIARY DIAGNTIC PR -CCC 0 0 1 11 0.24 1 0 0 0 1.3683 0.2927 $6,851 $1,466 H06A OTH HEPTOBILRY & PANCRS PR+CCC 0 0 5 47 0.16 1 0 0.1422 1.084 5.5624 0.266 $712 $5,428 $27,851 $1,332 H06B OTH HEPTOBILRY &PANCRS PR-CCC 0 0 1 11 0.33 1 0 0 0 1.3886 0.2036 $6,953 $1,019 H07A OPEN CHOLECYSTECTOMY+CDE/+CCC 0 0 4 39 0.16 1 0 1.1685 0.9961 5.1527 0.2604 $5,851 $4,987 $25,800 $1,304 H07B OPEN CHOLECYSTECTOMY-CDE-CCC 0 0 1 17 0.16 1 0 0 0 2.6897 0.2733 $13,467 $1,368 H08A LAP CHOLECYSTECTMY+CDE/+CSCC 0 0 2 18 0.19 1 0 0.8574 0.9562 2.7698 0.2489 $4,293 $4,788 $13,868 $1,246 H08B LAP CHOLECYSTECTMY-CDE-CSCC 0 0 1 6 0.21 1.16 0 0 0 1.4596 0.2292 $7,308 $1,148 H40A ENDO PR BLEED OES VARICES +CCC 0 0 3 30 0.12 1 0 0.2172 0.9884 3.1825 0.304 $1,088 $4,949 $15,935 $1,522 H40B ENDO PR BLEED OES VARICES -CCC 0 0 1 14 0.08 1 0 0 0 1.4896 0.3155 $7,458 $1,580 H43A ERCP PROCEDURE +CSCC 0 0 3 30 0.15 1 0 0.3304 0.9587 3.2065 0.2453 $1,654 $4,800 $16,055 $1,228 H43B ERCP PROCEDURE -CSCC 0 0 1 13 0.25 1 0 0 0 1.3276 0.2227 $6,647 $1,115 H43C ERCP PROCEDURE, SAMEDAY 0 0 1 1 0.36 1 0 0 0 0.4502 0 $2,254 H60A CIRRHOSIS & ALC HEPATITIS +CCC 0 0 3 32 0.1 1 0 0 1.0021 3.0062 0.2419 $5,018 $15,052 $1,211 H60B CIRRHOSIS & ALC HEPATITIS -CCC 0 0 1 15 0.11 1 0 0 0 1.2414 0.218 $6,216 $1,092 H60C CIRRHOSIS & ALC HEPATITIS, SD 0 0 1 1 0.19 1 0 0 0 0.2732 0 $1,368 H61A MALG HEPATOBILIARY SYS PAN+CCC 0 0 3 28 0.11 1 0 0 0.8631 2.5893 0.2158 $4,322 $12,965 $1,081 H61B MALG HEPATOBILIAY SYS PANC-CCC 0 0 1 15 0.12 1.18 0 0 0 1.227 0.2206 $6,144 $1,105 H61C MALG HEPATOBILIAY SYS PANC, SD 0 0 1 1 0.27 1.42 0 0 0 0.3161 0 $1,583 H62A DISORDERS PANCREAS-MALIG+CSCC 0 0 2 22 0.12 1 0 0 1.0089 2.0178 0.2513 $5,052 $10,103 $1,258 H62B DISORDERS PANCREAS-MALIG-CSCC 1 0 1 11 0.13 1.77 0.246 0 0 0.8051 0.2205 $1,232 $4,031 $1,104 H63A DSRD LVR-MAL,CIRR,ALC HEP+CCC 0 0 3 29 0.08 1 0 0 0.935 2.8051 0.2329 $4,682 $14,045 $1,166 H63B DSRD LVR-MAL,CIRR,ALC HEP-CCC 0 0 1 13 0.13 1.29 0 0 0 1.1123 0.2191 $5,569 $1,097 H63C DSRD LVR-MAL,CIRR,ALC HEP, SD 0 0 1 1 0.22 1.49 0 0 0 0.2704 0 $1,354 H64A DISORDERS OF BILIARY TRACT +CC 0 0 2 18 0.12 1.59 0 0 0.7906 1.5812 0.2288 $3,959 $7,917 $1,146 H64B DISORDERS OF BILIARY TRACT -CC 0 0 1 8 0.14 2 0 0 0 0.6227 0.2096 $3,118 $1,049 H64C DISORDERS OF BILIARY TRACT, SD 0 0 1 1 0.29 1 0 0 0 0.1308 0 $655 I01A BL/MLT MJ JT PR LWR EXT+RV/CCC 0 0 9 86 0.29 1 0 3.7444 0.936 12.1683 0.2451 $18,748 $4,687 $60,927 $1,227 I01B BL/MLT MJ JT PR LWR EXT-RV-CCC 0 0 2 23 0.29 1 0 3.6886 1.103 5.8946 0.3128 $18,469 $5,523 $29,514 $1,566 I02A MVTT/SKIN GRAFT+CSCC-HAND 0 0 9 88 0.22 1 0 1.8288 1.1362 12.0541 0.2808 $9,157 $5,689 $60,355 $1,406 I02B SKIN GRAFT -CSCC -HAND 0 0 2 25 0.19 0.9 0 0.6393 1.6678 3.9749 0.258 $3,201 $8,351 $19,902 $1,292 I03A HIP REPLACEMENT + CCC 0 0 4 42 0.34 1 0 2.2713 0.7895 5.4294 0.2373 $11,372 $3,953 $27,185 $1,188 I03B HIP REPLACEMENT - CCC 0 0 2 21 0.45 1 0 2.1391 1.0232 4.1855 0.1935 $10,710 $5,123 $20,957 $969 I04A KNEE REPLACEMT +CSCC 0 0 3 27 0.41 1 0 2.4888 0.8333 4.9886 0.2427 $12,461 $4,172 $24,978 $1,215 I04B KNEE REPLACEMT -CSCC 0 0 1 18 0.45 1 0 0 0 4.0454 0.22 $20,255 $1,102 I05A OTH JNT REPLACEMENT +CSCC 0 0 3 34 0.45 1 0 2.5484 0.9645 5.4418 0.2231 $12,760 $4,829 $27,247 $1,117 I05B OTH JNT REPLACEMENT -CSCC 0 0 1 12 0.47 1 0 0 0 3.6851 0.259 $18,451 $1,297 I06Z SPINAL FUSION +DEFORMITY 0 0 2 26 0.49 0.92 0 0.844 5.0466 10.9371 0.6035 $4,226 $25,268 $54,762 $3,022 I07Z AMPUTATION 0 0 8 73 0.29 1 0 0.8647 0.828 7.4887 0.2496 $4,330 $4,146 $37,496 $1,250 I08A OTHER HIP & FEMUR PROC +CCC 0 0 5 49 0.24 1.23 0 1.0496 0.8086 5.0925 0.2317 $5,255 $4,049 $25,498 $1,160 I08B OTHER HIP & FEMUR PR -CCC 0 0 2 25 0.26 1 0 0.8347 1.1774 3.1895 0.2217 $4,179 $5,895 $15,970 $1,110 Please note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 6/13 Long-Stay Diem $
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National Acute Inpatient Price Weights 2014/15 National Price Weights National Base Price DRG v7.0 Description Same-Day Payment List Bundled ICU Lower Bound Upper Bound Private Adjustment Paediatric Adjustment Same Day Outlier Base Diem Inlier Long-Stay Diem Same Day $ Outlier Base $ Diem $ Inlier $ Long-Stay Diem $ I09A SPINAL FUSION +CCC 0 0 5 51 0.33 1 0 4.0032 1.2366 10.1861 0.3235 $20,044 $6,192 $51,002 $1,620 I09B SPINAL FUSION -CCC 0 0 2 20 0.42 1.07 0 3.1214 1.3889 5.8993 0.3464 $15,629 $6,954 $29,538 $1,734 I10A OTHER BACK & NECK PROCS +CSCC 0 0 3 32 0.16 1 0 1.0941 1.1274 4.4763 0.2784 $5,478 $5,645 $22,413 $1,394 I10B OTHER BACK & NECK PROCS -CSCC 0 0 1 12 0.26 1 0 0 0 2.2668 0.2589 $11,350 $1,296 I11Z LIMB LENGTHENING PROCEDURES 0 0 1 14 0.29 1.34 0 0 0 2.7741 0.3645 $13,890 $1,825 I12A INFC/INFM BONE/JNT+MISC PR+CCC 0 0 8 74 0.13 1 0 0.479 0.7842 6.7528 0.2193 $2,398 $3,926 $33,811 $1,098 I12B INFC/INFM BNE/JNT+MISC PR+SMCC 0 0 4 42 0.11 1.26 0 0.5507 0.8509 3.9542 0.1642 $2,757 $4,260 $19,799 $822 I12C INFC/INFM BNE/JNT+MISC PR-CC 0 0 2 19 0.11 1.26 0 0.4953 0.8367 2.1688 0.1733 $2,480 $4,189 $10,859 $868 I13A HUMER,TIBIA,FIBUL,ANKL PR+CC 0 0 3 33 0.26 1 0 1.0442 1.0541 4.2064 0.2352 $5,228 $5,278 $21,061 $1,178 I13B HUM,TIB,FIB,ANKL PR-CC >=17 0 0 1 12 0.28 1 0 0 0 2.1162 0.2661 $10,596 $1,332 I13C HUM,TIB,FIB,ANKL PR-CC <17 0 0 1 5 0.23 1 0 0 0 1.2802 0.273 $6,410 $1,367 I15Z CRANIO-FACIAL SURGERY 0 0 1 17 0.21 1.5 0 0 0 3.036 0.2969 $15,201 $1,487 I16Z OTHER SHOULDER PROCEDURES 0 0 1 4 0.26 1 0 0 0 1.4847 0.4118 $7,434 $2,062 I17A MAXILLO-FACIAL SURGERY +CC 0 0 1 13 0.25 1 0 0 0 2.3853 0.3081 $11,943 $1,543 I17B MAXILLO-FACIAL SURGERY -CC 0 0 1 5 0.3 1 0 0 0 1.5873 0.3434 $7,948 $1,719 I18Z OTHER KNEE PROCEDURES 1 0 1 8 0.24 1.07 0.6455 0 0 1.3131 0.2052 $3,232 $6,575 $1,027 I19A OTHER ELBOW, FOREARM PROCS +CC 0 0 2 18 0.27 1 0 1.1194 0.8326 2.7846 0.232 $5,605 $4,169 $13,942 $1,162 I19B OTHER ELBOW, FOREARM PROCS -CC 0 0 1 6 0.37 0.87 0 0 0 1.5551 0.2557 $7,786 $1,280 I20Z OTHER FOOT PROCEDURES 1 0 1 8 0.2 1.07 0.6863 0 0 1.5089 0.2513 $3,436 $7,555 $1,258 I21Z LOC EX, REM INT FIX DEV HP&FMR 0 0 1 7 0.09 0.89 0 0 0 1.0744 0.3163 $5,380 $1,584 I23Z LOC EX,REM INT FIX-HP&FMR 1 0 1 6 0.16 1 0.5066 0 0 1.23 0.258 $2,537 $6,159 $1,292 I24Z ARTHROSCOPY 0 0 1 5 0.16 1.35 0 0 0 0.8164 0.2385 $4,088 $1,194 I25A BNE,JNT DXTIC PR INC BIOPSY+CC 0 0 3 33 0.13 1 0 0.1434 1.3236 4.1143 0.2245 $718 $6,627 $20,600 $1,124 I25B BNE,JNT DXTIC PR INC BIOPSY-CC 1 0 1 16 0.13 1.13 0.5634 0 0 1.7865 0.2138 $2,821 $8,945 $1,070 I27A SOFT TISSUE PROCEDURES +CSCC 0 0 3 35 0.11 0.84 0 0.5586 1.2204 4.2197 0.235 $2,797 $6,111 $21,128 $1,177 I27B SOFT TISSUE PROCEDURES -CSCC 0 0 1 8 0.14 1.1 0 0 0 1.3353 0.2331 $6,686 $1,167 I27C SOFT TISSUE PROCEDURES +SD 0 0 1 1 0.26 1 0 0 0 0.6005 0 $3,007 I28A OTH MUSCULOSKELETAL PR+CC 0 0 3 31 0.17 1.34 0 0.6602 0.8962 3.3489 0.2048 $3,306 $4,487 $16,768 $1,025 I28B OTH MUSCULOSKELETAL PR-CC 1 0 1 7 0.26 1.11 0.6452 0 0 1.4575 0.2358 $3,231 $7,298 $1,181 I29Z KNEE RECONSTRUCTION/REVISION 0 0 1 4 0.34 1 0 0 0 1.6779 0.4453 $8,401 $2,230 I30Z HAND PROCEDURES 1 0 1 6 0.2 1 0.6675 0 0 1.1918 0.305 $3,342 $5,967 $1,527 I31A REV HIP +CCC / INFC/INFLM PROS 0 0 7 64 0.32 1 0 3.2161 0.8599 9.2352 0.223 $16,103 $4,306 $46,241 $1,117 I31B REV HIP -CCC -INFC/INFLM PROS 0 0 2 26 0.45 1 0 2.607 1.3482 5.3033 0.2052 $13,053 $6,750 $26,554 $1,027 I32A REV KNEE+CCC / INFC/INFLM PROS 0 0 6 58 0.35 1 0 3.5867 0.7553 8.1186 0.1865 $17,959 $3,782 $40,650 $934 I32B REV KNEE -CCC -INFC/INFLM PROS 0 0 2 20 0.35 1 0 2.3443 1.3266 4.9974 0.2439 $11,738 $6,642 $25,022 $1,221 I40Z INFUSIONS +SD 0 0 1 1 0.07 1.21 0 0 0 0.2059 0 $1,031 I60Z FEMORAL SHAFT FRACTURES 0 0 3 27 0.05 1.22 0 0.1971 0.903 2.9062 0.251 $987 $4,521 $14,551 $1,257 I61A DISTAL FEMORAL FRACTURES +CC 0 0 3 35 0.08 1 0 0 0.9241 2.7722 0.2023 $4,627 $13,880 $1,013 I61B DISTAL FEMORAL FRACTURES -CC 0 0 1 15 0.1 1.23 0 0 0 1.1363 0.2027 $5,689 $1,015 I63A SPR,STR&DSLC HIP,PELV&THIGH+CC 0 0 1 17 0.09 1 0 0 0 1.3916 0.2132 $6,968 $1,067 I63B SPR,STR&DSLC HIP,PELV&THIGH-CC 0 0 1 6 0.15 1 0 0 0 0.5174 0.2041 $2,591 $1,022 I64A OSTEOMYELITIS +CSCC 0 0 5 52 0.11 1 0 0 0.7818 3.9091 0.1552 $3,914 $19,573 $777 I64B OSTEOMYELITIS -CSCC 0 0 3 34 0.07 1.2 0 0 0.7847 2.3541 0.1149 $3,929 $11,787 $575 I65A MUSCSKEL MALIG NEO +CCC/+RADIO 0 0 3 34 0.1 1.85 0 0 1.0856 3.2569 0.2351 $5,436 $16,307 $1,177 I65B MUSCSKEL MALIG NEO -CCC -RADIO 0 0 1 15 0.09 1.27 0 0 0 1.4357 0.206 $7,189 $1,031 I66A INFLAM MUSCULO DSR +CSCC 0 0 3 34 0.11 1 0 0 1.0748 3.2243 0.2585 $5,382 $16,144 $1,294 I66B INFLAM MUSCULO DSR -CSCC 0 0 1 14 0.11 1 0 0 0 1.1134 0.2265 $5,575 $1,134 I67A SEPTIC ARTHRITIS +CSCC 0 0 5 48 0.1 1 0 0 0.8636 4.3182 0.1899 $4,324 $21,621 $951 I67B SEPTIC ARTHRITIS -CSCC 0 0 2 25 0.15 1 0 0 0.7909 1.5817 0.1253 $3,960 $7,920 $627 I68A NON-SURG SPINAL DISORDERS +CC 0 0 2 26 0.09 1.39 0 0 0.9933 1.9865 0.2078 $4,973 $9,946 $1,040 I68B NON-SURG SPINAL DISORDERS -CC 0 0 1 11 0.1 1.33 0 0 0 0.7078 0.2109 $3,544 $1,056 I69A BONE DISEASES AND ARTHROP+CSCC 0 0 2 26 0.1 1 0 0 0.9431 1.8862 0.2086 $4,722 $9,444 $1,044 I69B BONE DISEASES AND ARTHROP-CSCC 0 0 1 13 0.13 1.47 0 0 0 0.8148 0.1815 $4,080 $909 I71A OTH MUSCTENDIN DISRD +CSCC 0 0 2 22 0.09 1 0 0 0.8646 1.7291 0.1993 $4,329 $8,658 $998 I71B OTH MUSCTENDIN DISRD -CSCC 0 0 1 9 0.12 1.41 0 0 0 0.6117 0.1974 $3,063 $988 I72A SPEC MUSCTEND DISRD +CSCC 0 0 3 27 0.12 1 0 0 0.7429 2.2287 0.2108 $3,720 $11,159 $1,055 I72B SPEC MUSCTEND DISRD -CSCC 0 0 1 12 0.1 1 0 0 0 0.752 0.175 $3,765 $876 I73A AFTCARE MUSCSK IMPL +CSCC 0 0 4 39 0.08 1 0 0 0.697 2.7878 0.1633 $3,490 $13,959 $818 I73B AFTCARE MUSCSK IMPL -CSCC 0 0 2 21 0.11 0.82 0 0 0.6337 1.2674 0.0997 $3,173 $6,346 $499 I74A INJ FOREARM,WRIST,HAND,FT +CC 0 0 1 18 0.11 1 0 0 0 1.1906 0.1913 $5,961 $958 I74B INJ FOREARM,WRIST,HAND,FT -CC 0 0 1 4 0.23 1.21 0 0 0 0.4931 0.1771 $2,469 $887 Please note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 7/13
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National Acute Inpatient Price Weights 2014/15 National Price Weights National Base Price DRG v7.0 Description Same-Day Payment List Bundled ICU Lower Bound Upper Bound Private Adjustment Paediatric Adjustment Same Day Outlier Base Diem Inlier Long-Stay Diem Same Day $ Outlier Base $ Diem $ Inlier $ Long-Stay Diem $ I75A INJ SH,ARM,ELB,KN,LEG,ANKL +CC 0 0 2 26 0.09 1 0 0 0.9598 1.9196 0.1925 $4,806 $9,611 $964 I75B INJ SH,ARM,ELB,KN,LEG,ANKL -CC 0 0 1 8 0.14 1.21 0 0 0 0.5937 0.1942 $2,973 $972 I76A OTH MUSCULOSKELETAL DSRD +CSCC 0 0 2 24 0.11 1 0 0 0.9593 1.9187 0.195 $4,803 $9,607 $976 I76B OTH MUSCULOSKELETAL DSRD -CSCC 0 0 1 9 0.11 1.39 0 0 0 0.67 0.191 $3,355 $956 I77A FRACTURE OF PELVIS +CSCC 0 0 3 35 0.09 1 0 0 0.837 2.5109 0.197 $4,191 $12,572 $986 I77B FRACTURE OF PELVIS -CSCC 0 0 1 16 0.1 1 0 0 0 1.1007 0.1892 $5,511 $947 I78A FRACTURE NECK OF FEMUR +CSCC 0 0 3 29 0.1 1 0 0 0.7332 2.1997 0.184 $3,671 $11,014 $921 I78B FRACTURE NECK OF FEMUR -CSCC 0 0 1 17 0.19 1 0 0 0 1.0784 0.1937 $5,400 $970 I79A PATHOLOGICAL FRACTURE +CCC 0 0 5 49 0.08 1 0 0 0.7694 3.8471 0.2367 $3,852 $19,262 $1,185 I79B PATHOLOGICAL FRACTURE -CCC 0 0 2 22 0.09 1 0 0 0.8922 1.7844 0.1983 $4,467 $8,934 $993 I80Z FEM FRACT TRANS <2D 1 0 1 1 0.29 1 0.1196 0 0 0.2763 0 $599 $1,383 I81Z INJURIES +SD 0 0 1 1 0.41 2 0 0 0 0.1567 0 $785 I82Z OTHER +SD 0 0 1 1 0.15 1.99 0 0 0 0.1872 0 $937 J01A MICRVS TSS TRNSF SKN/BRST+CSCC 0 0 5 53 0.29 1 0 3.7495 1.0953 9.226 0.3062 $18,774 $5,484 $46,195 $1,533 J01B MICRVS TSS TRNSF SKN/BRST-CSCC 0 0 2 26 0.29 1 0 2.1071 1.7218 5.5507 0.3432 $10,550 $8,621 $27,792 $1,718 J06A MAJOR PROC FOR MAL BREAST DIS 0 0 1 9 0.27 1 0 0 0 1.7531 0.2073 $8,778 $1,038 J06B MAJOR PROC FOR NON-MAL BR DIS 0 0 1 7 0.19 1 0 0 0 1.7017 0.2808 $8,520 $1,406 J07A MINOR PROC FOR MAL BREAST DIS 0 0 1 4 0.28 1 0 0 0 0.8299 0.3247 $4,155 $1,626 J07B MINOR PROC FOR NON-MAL BR DIS 0 0 1 3 0.22 1 0 0 0 0.6539 0.2278 $3,274 $1,141 J08A OTH SKN GRF&/DBRDMNT PR +CC 0 0 3 31 0.12 1.1 0 0.4927 0.9743 3.4155 0.2238 $2,467 $4,878 $17,101 $1,121 J08B OTH SKN GRF&/DBRDMNT PR -CC 0 0 1 10 0.15 1.07 0 0 0 1.4172 0.2006 $7,096 $1,004 J08C OTH SKN GRF&/DBRDMNT PR, SD 0 0 1 1 0.29 0.94 0 0 0 0.6267 0 $3,138 J09Z PERIANAL & PILONIDAL PR 0 0 1 7 0.14 1.4 0 0 0 0.7899 0.1188 $3,955 $595 J10Z SKN,SUBC TIS & BRST PLASTIC PR 1 0 1 7 0.27 0.9 0.5892 0 0 1.3509 0.2118 $2,950 $6,764 $1,060 J11Z OTHER SKIN, SUBC TIS & BRST PR 1 0 1 10 0.2 1 0.423 0 0 1.147 0.1759 $2,118 $5,743 $881 J12A L LMB PR +ULCR/CELS+CCC 0 0 8 75 0.08 1 0 0.2713 0.7161 6.0003 0.2398 $1,358 $3,586 $30,044 $1,201 J12B L LMB PR+ULCR/CELS-CCC-GRAFT 0 0 4 38 0.08 1 0 0.4108 0.8467 3.7975 0.2138 $2,057 $4,239 $19,014 $1,070 J12C L LMB PR+ULCR/CELS-CCC-GRAFT 0 0 2 26 0.12 1 0 0.2951 0.9909 2.2769 0.197 $1,478 $4,961 $11,400 $986 J13A L LMB PR-ULC/CEL+CCC/(GFT+SCC) 0 0 3 34 0.1 1 0 0.5001 1.0783 3.7349 0.2444 $2,504 $5,399 $18,701 $1,224 J13B L LMB PR-ULC/CEL-CCC-(GFT+SCC) 1 0 1 15 0.16 1 0.578 0 0 1.6444 0.2193 $2,894 $8,234 $1,098 J14Z MAJOR BREAST RECONSTRUCTIONS 0 0 2 23 0.19 1 0 1.1467 2.024 5.1948 0.3189 $5,742 $10,134 $26,010 $1,597 J60A SKIN ULCERS +CCC 0 0 5 45 0.08 1 0 0 0.6601 3.3007 0.2186 $3,305 $16,527 $1,095 J60B SKIN ULCERS -CCC 0 0 2 25 0.08 1 0 0 0.728 1.456 0.1625 $3,645 $7,290 $814 J60C SKIN ULCERS, SAMEDAY 0 0 1 1 0.2 1 0 0 0 0.1812 0 $907 J62A MALIGNANT BREAST DIS, O/N 0 0 2 21 0.08 1 0 0 0.8861 1.7722 0.2142 $4,437 $8,873 $1,072 J62B MALIGNANT BREAST DISORDERS, SD 0 0 1 1 0.08 1 0 0 0 0.1754 0 $878 J63A NON-MALIGNANT BREAST DIS 0 0 1 10 0.11 1 0 0 0 0.7628 0.1773 $3,819 $888 J63B NON-MALIGNANT BREAST DIS, SD 0 0 1 1 0.13 1 0 0 0 0.2087 0 $1,045 J64A CELLULITIS +CSCC 0 0 2 25 0.09 1 0 0 0.9751 1.9502 0.2131 $4,882 $9,765 $1,067 J64B CELLULITIS -CSCC 1 0 1 12 0.08 1.17 0.12784 0 0 0.652715 0.126055 $640 $3,268 $631 J65A TRAUMA TO SKN,SUB TIS&BST+CSCC 0 0 2 19 0.1 1 0 0 0.7757 1.5513 0.1929 $3,884 $7,767 $966 J65B TRAUMA TO SKN,SUB TIS&BST-CSCC 0 0 1 7 0.12 1.25 0 0 0 0.4651 0.1975 $2,329 $989 J65C TRAUMA TO SKN,SUB TIS&BST +SD 0 0 1 1 0.24 1.25 0 0 0 0.1374 0 $688 J67A MINOR SKIN DISORDERS 0 0 1 10 0.08 1.14 0 0 0 0.7633 0.2221 $3,822 $1,112 J67B MINOR SKIN DISORDERS, SAMEDAY 0 0 1 1 0.22 0.8 0 0 0 0.2486 0 $1,245 J68A MAJOR SKIN DISORDERS +CSCC 0 0 2 26 0.1 1.14 0 0 1.0806 2.1612 0.2237 $5,411 $10,821 $1,120 J68B MAJOR SKIN DISORDERS -CSCC 0 0 1 12 0.06 1.28 0 0 0 0.9256 0.2156 $4,634 $1,080 J68C MAJOR SKIN DISORDERS, SAMEDAY 0 0 1 1 0.03 0.8 0 0 0 0.1766 0 $884 J69A SKIN MALIGNANCY +CCC 0 0 4 38 0.13 1 0 0 0.8105 3.2419 0.2344 $4,058 $16,232 $1,174 J69B SKIN MALIGNANCY -CCC 0 0 2 20 0.13 1 0 0 0.8242 1.6484 0.1869 $4,127 $8,254 $936 J69C SKIN MALIGNANCY, SAMEDAY 0 0 1 1 0.13 1 0 0 0 0.2181 0 $1,092 K01A OR PR DIABETIC COMPLICATNS+CCC 0 0 8 78 0.09 1 0 0.3849 0.889 7.4967 0.2584 $1,927 $4,451 $37,536 $1,294 K01B OR PR DIABETIC COMPLICATNS-CCC 0 0 4 39 0.11 1 0 0.2991 0.8223 3.5884 0.2159 $1,498 $4,117 $17,967 $1,081 K02A PITUITARY PROCEDURES +CC 0 0 3 31 0.36 1 0 1.416 1.3442 5.4487 0.3753 $7,090 $6,730 $27,282 $1,879 K02B PITUITARY PROCEDURES -CC 0 0 1 16 0.36 1 0 0 0 3.4921 0.291 $17,485 $1,457 K03Z ADRENAL PROCEDURES 0 0 2 20 0.14 1 0 1.1389 1.2939 3.7267 0.3842 $5,702 $6,479 $18,660 $1,924 K05A PARATHYROID PROCEDURES +CSCC 0 0 2 21 0.25 1 0 0.831 1.1582 3.1474 0.2452 $4,161 $5,799 $15,759 $1,228 K05B PARATHYROID PROCEDURES -CSCC 0 0 1 5 0.28 1 0 0 0 1.371 0.317 $6,865 $1,587 K06A THYROID PROCEDURES +CSCC 0 0 1 15 0.16 1 0 0 0 3.0109 0.321 $15,076 $1,607 K06B THYROID PROCEDURES -CSCC 0 0 1 6 0.22 1 0 0 0 1.7371 0.3611 $8,698 $1,808 K08Z THYROGLOSSAL PROCEDURES 0 0 1 4 0.18 0.84 0 0 0 1.2957 0.3928 $6,488 $1,967 Please note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 8/13
2. National Acute Inpatient Price Weights 2014/15 National Price Weights National Base Price DRG v7.0 Description Same-Day Payment List Bundled ICU Lower Bound Upper Bound Private Adjustment Paediatric Adjustment Same Day Outlier Base Diem Inlier Long-Stay Diem Same Day $ Outlier Base $ Diem $ Inlier $ Long-Stay Diem $ K09A OTH ENDCRN, NUTR& META PR +CCC 0 0 5 49 0.28 1 0 0.3635 1.0773 5.7502 0.2414 $1,820 $5,394 $28,791 $1,209 K09B OTH ENDCRN, NUTR& META PR+SMCC 0 0 2 22 0.28 1 0 0.3196 1.3581 3.0358 0.2486 $1,600 $6,800 $15,200 $1,245 K09C OTH ENDCRN, NUTR & META PR -CC 0 0 1 9 0.28 1.48 0 0 0 1.2929 0.3136 $6,474 $1,570 K10A REV & OPEN BARIAT PROCS W CC 0 0 2 25 0.18 1 0 1.9395 1.2064 4.3522 0.2904 $9,711 $6,040 $21,791 $1,454 K10B REV & OPEN BARIAT PROCS W/O CC 0 0 1 11 0.18 1 0 0 0 2.7854 0.4553 $13,946 $2,280 K11A MAJ LAP BARIATRIC PROCS W CC 0 0 1 11 0.18 1 0 0 0 2.6864 0.3133 $13,451 $1,569 K11B MAJ LAP BARIATRIC PROCS W/O CC 0 0 1 5 0.18 1 0 0 0 1.8956 0.2715 $9,491 $1,359 K12Z OTHER BARIATRIC PROCS 0 0 1 6 0.18 1 0 0 0 2.0452 0.2707 $10,240 $1,355 K13Z PLAS OR PROC - END,NUT,MET DIS 0 0 1 12 0.18 1 0 0 0 1.8634 0.2655 $9,330 $1,329 K40A ENDO/INVEST PROC +CCC 0 0 7 64 0.16 1 0 0.1777 0.8299 5.9869 0.235 $890 $4,155 $29,976 $1,177 K40B ENDO/INVEST PROC -CCC 0 0 2 20 0.12 1.15 0 0.2166 0.9163 2.0492 0.2324 $1,085 $4,588 $10,260 $1,164 K40C ENDO/INVEST PROC +SD 0 0 1 1 0.34 1.2 0 0 0 0.3388 0 $1,696 K60A DIABETES +CSCC 0 0 2 23 0.08 1.89 0 0 1.0009 2.0019 0.2121 $5,012 $10,024 $1,062 K60B DIABETES -CSCC 0 0 1 12 0.12 1.74 0 0 0 0.914 0.1947 $4,576 $975 K60C DIABETES +SD 0 0 1 1 1 1.08 0 0 0 0.2115 0 $1,059 K61Z SEVERE NUTRITIONAL DISTURBANCE 0 0 4 36 0.06 1 0 0 0.9072 3.629 0.2422 $4,542 $18,170 $1,213 K62A MISC METABOLIC DISORDERS +CSCC 0 0 2 19 0.1 1.85 0 0 0.8101 1.6201 0.225 $4,056 $8,112 $1,127 K62B MISC METABOLIC DISORDERS -CSCC 0 0 1 10 0.09 1.6 0 0 0 0.7214 0.2365 $3,612 $1,184 K62C MISC METABOLIC DISORDERS SDAY 0 0 1 1 0.08 1.9 0 0 0 0.1663 0 $833 K63A INBORN ERR OF METAB +CSCC 0 0 2 22 0.05 1.82 0 0 1.0864 2.1728 0.2098 $5,440 $10,879 $1,050 K63B INBORN ERR OF METAB -CSCC 0 0 1 4 0.04 1.69 0 0 0 0.2836 0.1737 $1,420 $870 K64A ENDOCRINE DISORDERS +CSCC 0 0 2 24 0.08 1.49 0 0 1.0557 2.1113 0.2115 $5,286 $10,571 $1,059 K64B ENDOCRINE DISORDERS -CSCC 0 0 1 9 0.07 1.35 0 0 0 1.0771 0.21 $5,393 $1,051 K64C ENDOCRINE DISORDERS +SD 0 0 1 1 0.11 1.33 0 0 0 0.2524 0 $1,264 L02A OP INS PERI CATH DIALYSIS+CSCC 0 0 3 36 0.11 1 0 0.5816 1.2882 4.4462 0.269 $2,912 $6,450 $22,262 $1,347 L02B OP INS PERI CATH DIALYSIS-CSCC 0 0 1 6 0.08 1 0 0 0 1.0706 0.3051 $5,360 $1,528 L03A KDNY,URT&MJR BLDR PR NPSM +CCC 0 0 5 46 0.2 1 0 1.7803 1.001 6.7855 0.3198 $8,914 $5,012 $33,975 $1,601 L03B KDNY,URT&MJR BLDR PR NPSM +SCC 0 0 2 26 0.19 1 0 1.3595 1.5765 4.5126 0.367 $6,807 $7,894 $22,595 $1,838 L03C KDNY,URT&MJR BLDR PR NPSM-CSCC 0 0 1 15 0.22 1 0 0 0 2.8969 0.4105 $14,505 $2,055 L04A KDY,URT&MJR BLDR PR N-NPM+CCC 0 0 4 42 0.14 1 0 0.6722 1.1249 5.1719 0.2942 $3,366 $5,632 $25,896 $1,473 L04B KDY,URT&MJR BLDR PR N-NPM-CCC 0 0 1 10 0.18 1.37 0 0 0 1.8401 0.304 $9,213 $1,522 L04C KDY,URT&MJR BLDR PR N-NPM +SD 0 0 1 1 0.34 0.8 0 0 0 0.767 0 $3,840 L05A TRANURETH PROSTATECTOMY +CSCC 0 0 3 33 0.2 1 0 0.5095 0.9258 3.287 0.2309 $2,551 $4,635 $16,458 $1,156 L05B TRANURETH PROSTATECTOMY -CSCC 0 0 1 9 0.2 1 0 0 0 1.2896 0.2319 $6,457 $1,161 L06A MINOR BLADDER PROCEDURES+CSCC 0 0 2 26 0.15 1 0 0.4155 1.3841 3.1837 0.2731 $2,080 $6,930 $15,941 $1,367 L06B MINOR BLADDER PROCEDURES -CSCC 1 0 1 8 0.15 1.3 0.4612 0 0 1.2102 0.2398 $2,309 $6,059 $1,201 L07A TRANSURETHRAL PROCS +CC 0 0 1 14 0.16 1 0 0 0 1.5981 0.2535 $8,002 $1,269 L07B TRANSURETHRAL PROCS -CC 0 0 1 4 0.29 1 0 0 0 0.734 0.2639 $3,675 $1,321 L08A URETHRAL PROCEDURES +CC 1 0 1 13 0.14 1 0.5912 0 0 1.7218 0.2748 $2,960 $8,621 $1,376 L08B URETHRAL PROCEDURES -CC 1 0 1 6 0.18 1 0.4847 0 0 1.081 0.2881 $2,427 $5,413 $1,443 L09A OTH KIDNY & URNRY TRACT PR+CCC 0 0 5 53 0.12 1 0 0.7164 1.0905 6.1688 0.28 $3,587 $5,460 $30,887 $1,402 L09B OTH KIDNY & URNRY TRACT PR+SCC 0 0 1 14 0.14 1 0 0 0 1.988 0.2598 $9,954 $1,301 L09C OTH KIDNY & URNRY TRCT PR-CSCC 1 0 1 7 0.2 0.8 0.7493 0 0 1.5051 0.2233 $3,752 $7,536 $1,118 L40Z URETEROSCOPY 0 0 1 6 0.27 1 0 0 0 0.8178 0.2396 $4,095 $1,200 L41Z CYSTOURETHROSCOPY, SAMEDAY 0 0 1 1 0.24 1.57 0 0 0 0.2516 0 $1,260 L42Z ESW LITHOTRIPSY+URINARY STONES 0 0 1 3 0.36 1 0 0 0 0.7427 0.1982 $3,719 $992 L60A RENAL FAILURE +CCC 0 0 3 34 0.1 1 0 0 1.0561 3.1682 0.259 $5,288 $15,863 $1,297 L60B RENAL FAILURE +SCC 0 0 1 18 0.12 1 0 0 0 1.5125 0.2434 $7,573 $1,219 L60C RENAL FAILURE -CSCC 1 0 1 12 0.12 1.25 0.1987 0 0 0.955 0.2221 $995 $4,782 $1,112 L61Z HAEMODIALYSIS 0 0 1 3 0.04 2 0 0 0 0.1066 0.0853 $534 $427 L62A KDNY&UNRY TRCT NEOPLASMS +CSCC 0 0 2 22 0.09 1.18 0 0 1.0767 2.1534 0.2165 $5,391 $10,782 $1,084 L62B KDNY&UNRY TRCT NEOPLASMS -CSCC 0 0 1 7 0.16 1.61 0 0 0 0.5731 0.2523 $2,870 $1,263 L63A KDNY & UNRY TRCT INF +CSCC 0 0 2 23 0.09 1 0 0 0.8642 1.7284 0.2106 $4,327 $8,654 $1,054 L63B KDNY & UNRY TRCT INF -CSCC 1 0 1 10 0.1 1.18 0.103 0 0 0.7034 0.1984 $516 $3,522 $993 L64A URINARY STONES & OBSTR+CSCC 0 0 1 14 0.14 1 0 0 0 1.4262 0.2473 $7,141 $1,238 L64B URINARY STONES & OBSTR-CSCC 0 0 1 5 0.24 1.87 0 0 0 0.5523 0.2584 $2,765 $1,294 L64C URINARY STONES & OBSTR +SD 0 0 1 1 0.54 1 0 0 0 0.1298 0 $650 L65A KDNY & UNRY TR SGNS&SYMPS+CSCC 0 0 1 18 0.09 1 0 0 0 1.3504 0.2272 $6,761 $1,138 L65B KDNY & UNRY TR SGNS&SYMPS-CSCC 1 0 1 8 0.11 1.44 0.1374 0 0 0.5946 0.1931 $688 $2,977 $967 L66Z URETHRAL STRICTURE 0 0 1 5 0.14 0.8 0 0 0 0.5807 0.2376 $2,908 $1,190 L67A OTH KIDNY & URNRY TRCT DX+CSCC 0 0 2 20 0.09 1.43 0 0 0.9211 1.8421 0.2326 $4,612 $9,223 $1,165 Please note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 9/13
2. National Acute Inpatient Price Weights 2014/15 National Price Weights National Base Price DRG v7.0 Description Same-Day Payment List Bundled ICU Lower Bound Upper Bound Private Adjustment Paediatric Adjustment Same Day Outlier Base Diem Inlier Long-Stay Diem Same Day $ Outlier Base $ Diem $ Inlier $ Long-Stay Diem $ L67B OTH KIDNY & URNRY TRCT DX-CSCC 0 0 1 8 0.09 1.58 0 0 0 0.7641 0.2272 $3,826 $1,138 L67C OTH KIDNY & URNRY TRCT DX +SD 0 0 1 1 0.15 1.98 0 0 0 0.1642 0 $822 L68Z PERITONEAL DIALYSIS 0 0 1 3 0.02 1.52 0 0 0 0.1886 0.1507 $944 $755 M01A MAJOR MALE PELVIC PROCS +CSCC 0 0 2 20 0.17 1 0 2.2684 0.9832 4.2349 0.3124 $11,358 $4,923 $21,204 $1,564 M01B MAJOR MALE PELVIC PROCS -CSCC 0 0 1 11 0.17 1 0 0 0 3.2885 0.1548 $16,466 $775 M02A TRANSURETHRAL PROSTECTOMY+CSCC 0 0 2 20 0.12 1 0 0.5797 0.9302 2.4401 0.2419 $2,903 $4,658 $12,218 $1,211 M02B TRANSURETHRAL PROSTECTOMY-CSCC 0 0 1 8 0.2 1 0 0 0 1.3739 0.226 $6,879 $1,132 M03Z PENIS PROCEDURES 0 0 1 5 0.19 1 0 0 0 0.9275 0.2755 $4,644 $1,379 M04Z TESTES PROCEDURES 0 0 1 4 0.2 0.8 0 0 0 0.8018 0.2683 $4,015 $1,343 M05Z CIRCUMCISION 0 0 1 3 0.13 0.86 0 0 0 0.5734 0.1908 $2,871 $955 M06A OTH MALE REPROD SYS OR PR +CC 0 0 1 17 0.14 1 0 0 0 2.3495 0.2762 $11,764 $1,383 M06B OTH MALE REPROD SYS OR PR -CC 1 0 1 6 0.28 1 0.4975 0 0 1.5254 0.25 $2,491 $7,638 $1,252 M40Z CYSTOURETHROSCOPY +SD 0 0 1 1 0.42 1 0 0 0 0.2561 0 $1,282 M60A MALE REPR SYS MALIG +CSCC 0 0 2 23 0.08 1 0 0 1.0362 2.0725 0.2239 $5,188 $10,377 $1,121 M60B MALE REPR SYS MALIG -CSCC 1 0 1 12 0.23 1.38 0.3153 0 0 0.9677 0.1618 $1,579 $4,845 $810 M61A BENIGN PROSTATIC HYPERTR+CC 0 0 1 14 0.16 1 0 0 0 1.0696 0.2059 $5,355 $1,031 M61B BENIGN PROSTATIC HYPERTR-CC 0 0 1 4 0.16 1 0 0 0 0.3312 0.1977 $1,658 $990 M62A INFLAMMATION MALE REPRD SYS+CC 1 0 1 15 0.1 1 0.1554 0 0 1.077 0.1943 $778 $5,393 $973 M62B INFLAM MALE REPRD SYS -CC 1 0 1 8 0.11 1.2 0.1753 0 0 0.5561 0.1598 $878 $2,784 $800 M63Z MALE STERILISATION PROCS 0 0 1 3 0.31 1 0 0 0 0.4042 0.1444 $2,024 $723 M64Z OTHER MALE REPROD SYS DIS 0 0 1 4 0.12 1 0 0 0 0.3521 0.171 $1,763 $856 N01A PELVIC EVISC & RAD VLVMY +CSCC 0 0 3 33 0.2 1 0 1.2266 1.3814 5.3706 0.3355 $6,142 $6,917 $26,891 $1,680 N01B PELVIC EVISC & RAD VLVMY -CSCC 0 0 1 16 0.2 1 0 0 0 2.7916 0.2333 $13,978 $1,168 N04A HYSTERECTOMY FOR NON-MALG+CSCC 0 0 1 16 0.2 1 0 0 0 2.8218 0.3125 $14,129 $1,565 N04B HYSTERECTOMY FOR NON-MALG-CSCC 0 0 1 10 0.19 1 0 0 0 1.9522 0.2637 $9,775 $1,320 N05A OOPH&COM FAL TUBE PR NMAL+CSCC 0 0 1 17 0.18 1 0 0 0 2.6209 0.3074 $13,123 $1,539 N05B OOPH&COM FAL TUBE PR NMAL-CSCC 0 0 1 7 0.19 1 0 0 0 1.593 0.289 $7,976 $1,447 N06Z FEM REP SYS RECONSTRCT PROC 0 0 1 7 0.27 1 0 0 0 1.4361 0.317 $7,191 $1,587 N07A OTH UTERS & ADNEXA PR N MAL 0 0 1 6 0.19 1.23 0 0 0 1.4323 0.2601 $7,172 $1,302 N07B OTH UTRS & ADNEXA PR N MAL +SD 0 0 1 1 0.19 1 0 0 0 0.6195 0 $3,102 N08Z ENDOS & LAPAR PR, FEM REPR SYS 1 0 1 6 0.21 1.16 0.7037 0 0 1.2642 0.2295 $3,523 $6,330 $1,149 N09Z OTH VAGINA, CERVIX &VULVA PROC 0 0 1 3 0.19 1.26 0 0 0 0.5201 0.1798 $2,604 $900 N10Z DXC CURETTGE, DXC HYSTEROSCOPY 0 0 1 3 0.21 1 0 0 0 0.4785 0.1462 $2,396 $732 N11Z OTH FEMALE REPRODUCTIVE SYS PR 1 0 2 23 0.11 1 0.2986 0.4701 1.2289 2.9278 0.2727 $1,495 $2,354 $6,153 $14,659 $1,365 N12A UTRS & ADNX PR FOR MAL +CCC 0 0 2 27 0.25 1 0 1.3119 1.5752 4.4622 0.3385 $6,569 $7,887 $22,342 $1,695 N12B UTRS & ADNX PR FOR MAL -CCC 0 0 1 13 0.19 1 0 0 0 2.371 0.3264 $11,872 $1,634 N60A FEM REPROD SYS MALIG +CCC 0 0 2 27 0.09 1 0 0 1.3445 2.6891 0.2416 $6,732 $13,464 $1,210 N60B FEM REPROD SYS MALIG -CCC 0 0 1 9 0.07 1.36 0 0 0 0.8087 0.2506 $4,049 $1,255 N61Z FEMALE REPROD SYST INFECTIONS 0 0 1 7 0.1 1.28 0 0 0 0.5152 0.2358 $2,580 $1,181 N62Z MNSTRL & OTH FEM REPR DIS 0 0 1 4 0.14 1.44 0 0 0 0.2946 0.1733 $1,475 $868 O01A CAESAREAN DELIVERY +CCC 0 0 3 28 0.14 1 0 0.6668 1.005 3.6818 0.2463 $3,339 $5,032 $18,435 $1,233 O01B CAESAREAN DELIVERY +SCC 0 0 1 17 0.18 1 0 0 0 2.5268 0.277 $12,652 $1,387 O01C CAESAREAN DELIVERY -CSCC 0 0 1 12 0.19 1 0 0 0 2.0354 0.2974 $10,191 $1,489 O02A VAGINAL DELIVERY +OR PR +CSCC 0 0 1 13 0.12 1 0 0 0 2.2367 0.3505 $11,199 $1,755 O02B VAGINAL DELIVERY +OR PR -CSCC 0 0 1 10 0.13 1 0 0 0 1.5831 0.3364 $7,927 $1,684 O03A ECTOPIC PREGNANCY +CC 0 0 1 8 0.16 1 0 0 0 1.4538 0.2857 $7,279 $1,430 O03B ECTOPIC PREGNANCY -CC 0 0 1 5 0.15 1 0 0 0 0.9801 0.2886 $4,907 $1,445 O04A POSTPARTUM&POST ABORTN+OR+CSCC 0 0 1 16 0.18 1 0 0 0 2.2101 0.3103 $11,066 $1,554 O04B POSTPARTUM&POST ABORTN+OR-CSCC 0 0 1 8 0.21 1 0 0 0 1.0645 0.2343 $5,330 $1,173 O04C POSTPARTUM&POST ABORTN +OR +SD 0 0 1 1 0.18 1 0 0 0 0.5054 0 $2,531 O05Z ABORTION+ OR PROC 0 0 1 3 0.25 1 0 0 0 0.4397 0.18 $2,202 $901 O60A VAGINAL DELIVERY +CSCC 0 0 1 15 0.17 1 0 0 0 1.9394 0.2672 $9,711 $1,338 O60B VAGINAL DELIVERY -CSCC 0 0 1 9 0.19 1 0 0 0 1.303 0.3126 $6,524 $1,565 O60C VAGINAL DELIVERY, UNCOMP 0 0 1 7 0.2 1 0 0 0 0.9674 0.3188 $4,844 $1,596 O61Z POSTPARTUM & POST ABORTN-OR PR 1 0 1 9 0.09 1 0.1296 0 0 0.6423 0.2067 $649 $3,216 $1,035 O63Z ABORTION-OR PROC 0 0 1 4 0.23 1 0 0 0 0.2846 0.1966 $1,425 $984 O66A ANTENATAL&OTH OBS ADM +CSCC 0 0 1 12 0.07 1 0 0 0 0.8772 0.1864 $4,392 $933 O66B ANTENATAL&OTH OBS ADM -CSCC 0 0 1 6 0.08 1 0 0 0 0.4684 0.2114 $2,345 $1,058 O66C ANTENATAL&OTH OBS ADM +SD 0 0 1 1 0.09 1 0 0 0 0.1177 0 $589 P01Z NEO +OR, DIED/TR 5D 0 1 1 4 0.11 1 0 0 0 1.5023 0 $7,522 P02Z NEO,CARDIOTHORACIC/VASCULAR PR 0 1 10 95 0.11 1 0 2.8856 2.2144 25.0295 0.6631 $14,448 $11,088 $125,323 $3,320 Please note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 10/13
2. National Acute Inpatient Price Weights 2014/15 National Price Weights National Base Price DRG v7.0 Description Same-Day Payment List Bundled ICU Lower Bound Upper Bound Private Adjustment Paediatric Adjustment Same Day Outlier Base Diem Inlier Long-Stay Diem Same Day $ Outlier Base $ Diem $ Inlier $ Long-Stay Diem $ P03A NEO,ADMWT 1000-1499G+OR+MMP 0 1 18 164 0.11 1 0 0.0742 1.3404 24.2008 0.4038 $372 $6,711 $121,173 $2,022 P03B NEO,ADMWT 1000-1499G+OR-MMP 0 1 14 126 0.1 1 0 0.098 1.3325 18.7525 0.3921 $491 $6,672 $93,894 $1,963 P04A NEO,ADMWT 1500-1999G+OR+MMP 0 1 12 111 0.09 1 0 0.088 1.242 14.9921 0.3392 $441 $6,219 $75,065 $1,698 P04B NEO,ADMWT 1500-1999G+OR-MMP 0 1 9 85 0.09 1 0 0.0275 1.0988 9.9172 0.2581 $138 $5,502 $49,655 $1,292 P05A NEO,ADMWT 2000-2499G+OR+MMP 0 1 11 108 0.16 1 0 0.3343 1.4782 16.595 0.3978 $1,674 $7,401 $83,091 $1,992 P05B NEO,ADMWT 2000-2499G+OR-MMP 0 1 6 62 0.16 1 0 0.3197 1.4999 9.3191 0.4252 $1,601 $7,510 $46,661 $2,129 P06A NEO,ADMWT >=2500G+OR PR+MMP 0 1 9 90 0.13 1 0 0.308 1.6571 15.2217 0.484 $1,542 $8,297 $76,215 $2,423 P06B NEO,ADMWT >=2500G+OR PR-MMP 0 1 4 38 0.13 1 0 0.4167 1.6067 6.8437 0.4187 $2,086 $8,045 $34,266 $2,096 P07Z NEONATE, ADMWT <750G +OR 0 1 39 358 0.11 1 0 0.4536 1.7527 68.8077 0.45 $2,271 $8,776 $344,520 $2,253 P08Z NEONATE, ADMWT 750-999G +OR 0 1 32 297 0.11 1 0 0.3648 1.4435 46.5568 0.383 $1,827 $7,228 $233,110 $1,918 P60A NEO -OR, DIED/TR <5D 0 1 1 4 0.15 1 0 0 0 0.9078 0 $4,545 P60B NEO -OR, DIED/TR +SD 0 1 1 1 0.15 1 0 0 0 0.216 0 $1,082 P61Z NEONATE, ADMWT <750G -OR 0 1 25 232 0.1 1 0 0 1.9634 49.0853 0.4633 $9,831 $245,770 $2,320 P62Z NEONATE, ADMWT 750-999G -OR 0 1 21 193 0.09 1 0 0 1.6258 34.1418 0.4237 $8,140 $170,948 $2,121 P63A NEO,ADMWT 1000-1249G-OR+PRE 0 1 11 105 0.07 1 0 0 1.0899 11.9891 0.2862 $5,457 $60,029 $1,433 P63B NEO,ADMWT 1000-1249G-OR-PRE 0 1 5 49 0.07 1 0 0 1.5108 7.554 0.2843 $7,565 $37,823 $1,423 P64A NEO,ADMWT 1250-1499G-OR+PRE 0 1 9 87 0.08 1 0 0 0.995 8.9553 0.2617 $4,982 $44,839 $1,310 P64B NEO,ADMWT 1250-1499G-OR-PRE 0 1 7 70 0.08 1 0 0 1.0315 7.2208 0.2352 $5,165 $36,155 $1,178 P65A NEO,ADMWT 1500-1999G-OR+MMP 0 1 8 74 0.08 1 0 0 0.9005 7.2042 0.2633 $4,509 $36,071 $1,318 P65B NEO,ADMWT 1500-1999G-OR+MJP 0 1 6 63 0.07 1 0 0 1.0137 6.082 0.2515 $5,076 $30,453 $1,259 P65C NEO,ADMWT 1500-1999G-OR+OTP 0 1 6 56 0.11 1 0 0 0.8254 4.9522 0.2281 $4,133 $24,796 $1,142 P65D NEO,ADMWT 1500-1999G-OR-PRB 0 1 5 48 0.06 1 0 0 0.8152 4.0762 0.2373 $4,082 $20,410 $1,188 P66A NEO,ADMWT 2000-2499G-OR+MMP 0 1 5 51 0.11 1 0 0 0.9958 4.9791 0.2365 $4,986 $24,930 $1,184 P66B NEO,ADMWT 2000-2499G-OR+MJP 0 1 4 42 0.09 1 0 0 0.9967 3.9867 0.26 $4,990 $19,961 $1,302 P66C NEO,ADMWT 2000-2499G-OR+OTP 0 1 3 33 0.12 1 0 0 0.9521 2.8564 0.2344 $4,767 $14,302 $1,174 P66D NEO,ADMWT 2000-2499G-OR-PRB 0 1 1 14 0.12 1 0 0 0 1.0611 0.1951 $5,313 $977 P67A NEO,ADMWT >=2500G-OR+PRE+MMP 0 1 4 43 0.12 1 0 0 1.1072 4.4288 0.2529 $5,544 $22,175 $1,266 P67B NEO,ADMWT >=2500G-OR+PRE+MJP 0 1 3 32 0.11 1 0 0 1.0716 3.2149 0.2414 $5,366 $16,097 $1,209 P67C NEO,ADMWT >=2500G-OR+PRE+OTP 0 1 2 24 0.12 1 0 0 1.1532 2.3064 0.2374 $5,774 $11,548 $1,189 P67D NEO,ADMWT >=2500G-OR+PRE-PRB 0 1 1 11 0.12 1 0 0 0 1.0107 0.2253 $5,061 $1,128 P68A NEO,ADMWT >=2500G-OR-PRE+MMP 0 1 3 28 0.14 1 0 0 1.0738 3.2215 0.3045 $5,377 $16,130 $1,525 P68B NEO,ADMWT >=2500G-OR-PRE+MJP 0 1 1 17 0.12 1 0 0 0 1.5779 0.2741 $7,901 $1,372 P68C NEO,ADMWT >=2500G-OR-PRE+OTP 0 1 1 10 0.11 1 0 0 0 0.9653 0.2583 $4,833 $1,293 P68D NEO,ADMWT >=2500G-OR-PRE-PRB 0 1 1 7 0.12 1 0 0 0 0.5995 0.1999 $3,002 $1,001 Q01A SPLENECTOMY +CSCC 0 0 3 28 0.18 1 0 1.2382 1.0075 4.2605 0.3026 $6,200 $5,045 $21,332 $1,515 Q01B SPLENECTOMY -CSCC 0 0 1 14 0.18 1 0 0 0 2.6375 0.2571 $13,206 $1,287 Q02A BLD&IMM SYS DIS +OTH OR +CSCC 0 0 4 41 0.18 1.31 0 0.3544 1.2155 5.2164 0.2998 $1,774 $6,086 $26,119 $1,501 Q02B BLD&IMM SYS DIS +OTH OR -CSCC 1 0 1 10 0.21 1.05 0.5758 0 0 1.5514 0.1975 $2,883 $7,768 $989 Q60A RETICLENDO&IMNTY DIS+CSCC 0 0 2 23 0.09 1.3 0 0 1.1738 2.3476 0.3073 $5,877 $11,754 $1,539 Q60B RETICLENDO&IMNTY DIS-CSCC 0 0 1 11 0.09 1.27 0 0 0 0.9499 0.2455 $4,756 $1,229 Q60C RETICLENDO&IMNTY DIS +SD 0 0 1 1 0.1 1.23 0 0 0 0.1547 0 $775 Q61A RED BLOOD CELL DISDERS + CSCC 0 0 2 19 0.12 1.57 0 0 0.7744 1.5488 0.2152 $3,877 $7,755 $1,078 Q61B RED BLOOD CELL DISDERS -CSCC 0 0 1 7 0.15 1.71 0 0 0 0.5787 0.2191 $2,898 $1,097 Q61C RED BLOOD CELL DISDERS +SD 0 0 1 1 0.13 1.37 0 0 0 0.2015 0 $1,009 Q62A COAGULATION DISORDERS 0 0 1 13 0.12 0.91 0 0 0 0.9211 0.2164 $4,612 $1,084 Q62B COAGULATION DISORDERS +SD 0 0 1 1 0.11 0.92 0 0 0 0.2048 0 $1,025 R01A LYMPHMA&LEUKMA+MJR OR PR +CSCC 0 0 7 68 0.19 1 0 0.9652 1.3258 10.2457 0.336 $4,833 $6,638 $51,300 $1,682 R01B LYMPHMA&LEUKMA+MJR OR PR -CSCC 0 0 1 18 0.31 1 0 0 0 2.5323 0.3601 $12,679 $1,803 R02A OTH NPLSTC DSRD+MJR OR PR+CCC 0 0 5 53 0.18 1 0 1.4134 1.1347 7.0867 0.2607 $7,077 $5,681 $35,483 $1,305 R02B OTH NPLSTC DSRD+MJR OR PR+SMCC 0 0 2 25 0.21 1 0 1.0515 1.3743 3.8 0.1927 $5,265 $6,881 $19,027 $965 R02C OTH NPLSTC DSRD+MJR OR PR-CC 0 0 1 14 0.18 1 0 0 0 2.4272 0.2511 $12,153 $1,257 R03A LYMPHMA LEUKMA+OTH OR PR +CSCC 0 0 7 63 0.16 1.59 0 0.5341 1.0025 7.5518 0.3096 $2,674 $5,020 $37,812 $1,550 R03B LYMPHMA LEUKMA+OTH OR PR -CSCC 0 0 1 14 0.18 1.76 0 0 0 2.0043 0.2571 $10,036 $1,287 R03C LYMPHMA LEUKMA+OTH OR PR +SD 0 0 1 1 0.25 1 0 0 0 0.6887 0 $3,448 R04A OTH NPLSTC DSRD+OTH OR PR+CC 0 0 2 18 0.16 1 0 0.2863 1.2485 2.7834 0.2124 $1,434 $6,251 $13,936 $1,063 R04B OTH NPLSTC DSRD+OTH OR PR-CC 1 0 1 11 0.24 1.12 0.6782 0 0 1.8224 0.2771 $3,396 $9,125 $1,387 R60A ACUTE LEUKAEMIA +CCC 0 0 7 69 0.12 1.13 0 0 1.3212 9.2482 0.3451 $6,615 $46,306 $1,728 R60B ACUTE LEUKAEMIA -CCC 0 0 2 19 0.1 1 0 0 1.1445 2.289 0.3162 $5,731 $11,461 $1,583 R60C ACUTE LEUKAEMIA +SD 0 0 1 1 0.17 1.69 0 0 0 0.266 0 $1,332 R61A LYMPHMA &N-ACUTE LEUKAEMIA+CCC 0 0 5 51 0.11 1 0 0 1.1062 5.5311 0.2916 $5,539 $27,694 $1,460 R61B LYMPHMA &N-ACUTE LEUKAEMIA-CCC 0 0 1 15 0.1 1.23 0 0 0 1.6277 0.2643 $8,150 $1,323 Please note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 11/13
2. National Acute Inpatient Price Weights 2014/15 Same-Day Payment List National Price Weights Outlier Base Diem Inlier Long-Stay Diem Outlier Base $ National Base Price Diem $ Inlier $ Bundled Lower Upper Private Paediatric Same Day DRG v7.0 Description ICU Bound Bound Adjustment Adjustment Same Day $ R61C LYMPHMA / N-A LEUKAEMIA +SD 0 0 1 1 0.16 1.47 0 0 0 0.2337 0 $1,170 R62A OTHER NEOPLASTIC DIS+CC 1 0 2 23 0.11 1.71 0.2969 0 1.0003 2.0006 0.2175 $1,487 $5,009 $10,017 $1,089 R62B OTHER NEOPLASTIC DISORDERS-CC 0 0 1 4 0.1 0.95 0 0 0 0.4192 0.2436 $2,099 $1,220 R63Z CHEMOTHERAPY 0 0 1 3 0.1 1 0 0 0 0.1834 0.1466 $918 $734 S65A HIV +CCC 0 0 5 54 0.1 1 0 0 1.4847 7.4234 0.3128 $7,434 $37,169 $1,566 S65B HIV +SCC 0 0 3 30 0.1 1 0 0 1.1098 3.3294 0.3105 $5,557 $16,670 $1,555 S65C HIV -CSCC 0 0 1 17 0.1 1 0 0 0 2.0479 0.3138 $10,254 $1,571 S65D HIV +SD 0 0 1 1 0.1 1 0 0 0 0.2634 0 $1,319 T01A OR PROC INFECT& PARAS DIS+CCC 0 0 8 74 0.14 1.45 0 0.5535 0.9599 8.2324 0.2648 $2,771 $4,806 $41,220 $1,326 T01B OR PROC INFECT& PARAS DIS+SMCC 0 0 3 33 0.11 1 0 0.3537 1.0176 3.4065 0.2227 $1,771 $5,095 $17,056 $1,115 T01C OR PROC INFECT & PARAS DIS -CC 0 0 2 22 0.13 1.13 0 0.3369 0.8229 1.9826 0.1737 $1,687 $4,120 $9,927 $870 T40Z INFECT&PARAS DIS+VENT SUPPORT 0 1 3 35 0.17 1 0 0.0472 2.4819 7.493 0.3585 $236 $12,427 $37,517 $1,795 T60A SEPTICAEMIA +CCC 0 0 3 31 0.11 1.71 0 0 1.013 3.0389 0.2308 $5,072 $15,216 $1,156 T60B SEPTICAEMIA -CCC 0 0 1 17 0.12 1.37 0 0 0 1.3606 0.2146 $6,813 $1,075 T61A POSTOP & POSTTRAUM INFECT+CSCC 0 0 2 24 0.09 1.05 0 0 0.9731 1.9461 0.1911 $4,872 $9,744 $957 T61B POSTOP & POSTTRAUM INFECT-CSCC 0 0 1 13 0.08 1.18 0 0 0 0.7856 0.1558 $3,933 $780 T62A FEVER OF UNKNOWN ORIGIN +CC 0 0 1 14 0.12 1.09 0 0 0 1.1607 0.2434 $5,812 $1,219 T62B FEVER OF UNKNOWN ORIGIN -CC 0 0 1 7 0.12 1.08 0 0 0 0.5247 0.2453 $2,627 $1,228 T63A VIRAL ILLNESS +CC 1 0 1 12 0.08 0.91 0.1394 0 0 1.0084 0.2713 $698 $5,049 $1,358 T63B VIRAL ILLNESS -CC 1 0 1 6 0.1 1 0.1055 0 0 0.4829 0.2604 $528 $2,418 $1,304 T64A OTH INFECTOUS&PARSTIC DIS +CCC 0 0 4 42 0.07 1 0 0 1.1154 4.4615 0.25 $5,585 $22,339 $1,252 T64B OTH INFECTOUS&PARSTIC DIS+SMCC 0 0 2 22 0.09 1.21 0 0 0.9082 1.8163 0.1838 $4,547 $9,094 $920 T64C OTH INFECTOUS & PARSTIC DIS-CC 1 0 1 14 0.11 0.93 0.244 0 0 0.9747 0.1835 $1,222 $4,880 $919 U40Z MENTAL HEALTH TREAT+ECT +SD 0 0 1 1 0.06 1 0 0 0 0.3012 0 $1,508 U60Z MENTAL HEALTH TREAT -ECT +SD 0 0 1 1 0.07 2 0 0 0 0.105 0 $526 U61A SCHIZOPHRENIA DISODERS INVOL 0 0 20 46 0.01 1 0 0 0.3325 6.6493 0.1776 $1,665 $33,293 $889 U61B SCHIZOPHRENIA DISRDRS 0 0 11 27 0.01 1 0 0 0.3723 4.0949 0.1777 $1,864 $20,503 $890 U62A PAR&ACUTE PSYCH DSRD+CSCC/MHLS 0 0 14 32 0.02 1 0 0 0.3458 4.841 0.1867 $1,731 $24,239 $935 U62B PAR&ACUTE PSYCH DSRD-CSCC-MHLS 0 0 6 15 0.03 2 0 0 0.435 2.6101 0.1923 $2,178 $13,069 $963 U63A MAJOR AFF DIS AGE>69 +CSCC 0 0 19 44 0.02 1 0 0 0.4009 7.6169 0.2047 $2,007 $38,138 $1,025 U63B MAJOR AFF DIS AGE<70 -CSCC 0 0 10 23 0.01 2 0 0 0.3974 3.9738 0.1996 $1,990 $19,897 $999 U64Z OTH AFFECT & SOMATOFORM DSRD 0 0 5 12 0.02 1.7 0 0 0.4104 2.0518 0.1894 $2,055 $10,273 $948 U65Z ANXIETY DISORDERS 0 0 3 8 0.05 1.83 0 0 0.4667 1.4002 0.2099 $2,337 $7,011 $1,051 U66Z EATING & OBSESSV-COMPULSV DSRD 0 0 13 30 0.03 1.24 0 0 0.4479 5.8233 0.2293 $2,243 $29,157 $1,148 U67Z PERSONLTY DSRD&ACUTE REACTIONS 0 0 3 9 0.02 2 0 0 0.496 1.488 0.1985 $2,483 $7,450 $994 U68Z CHILDHOOD MENTAL DISORDERS 0 0 5 13 0.02 1.47 0 0 0.6711 3.3554 0.2566 $3,360 $16,800 $1,285 V60A ALCOHOL INTOX & WITHDRWL +CC 0 0 2 6 0.11 1 0 0 0.455 0.9099 0.1897 $2,278 $4,556 $950 V60B ALCOHOL INTOX & WITHDRWL -CC 0 0 1 4 0.07 0.91 0 0 0 0.4027 0.2302 $2,016 $1,153 V61Z DRUG INTOXICTN & WITHDRAWAL 0 0 4 11 0.05 1 0 0 0.4631 1.8522 0.2058 $2,319 $9,274 $1,030 V62Z ALCOHOL USE & DEPENDENCE 0 0 3 9 0.03 1 0 0 0.4782 1.4347 0.2032 $2,394 $7,184 $1,017 V63Z OPIOID USE & DEPENDENCE 0 0 3 8 0.05 1 0 0 0.3947 1.184 0.1699 $1,976 $5,928 $851 V64Z OTHER DRUG USE & DEPEND 0 0 3 8 0.05 1 0 0 0.3752 1.1255 0.1631 $1,879 $5,635 $817 V65Z ALCOHOL DISORDERS +SD 0 0 1 1 0.05 1.84 0 0 0 0.1283 0 $642 V66Z DRUG DISORDERS +SD 0 0 1 1 0.05 1 0 0 0 0.1191 0 $596 W01A TRACHE MULT SIG TRAUMA 0 1 16 146 0.15 1 0 2.7376 2.6432 45.0287 0.5688 $13,707 $13,235 $225,459 $2,848 W01B VENT/CRAN MT -TRAC+VNT>96/+CCC 0 1 8 79 0.15 1.05 0 1.4962 2.3273 20.1147 0.4868 $7,491 $11,653 $100,714 $2,437 W01C VENT/CRAN MT -TRAC -VNT>96-CCC 0 1 5 47 0.15 1 0 1.0206 1.9227 10.6343 0.4462 $5,110 $9,627 $53,246 $2,234 W02A HIP,FEMR&LOW LIMB PR MT+CSCC 0 0 6 61 0.22 1 0 2.0345 1.0474 8.3186 0.3258 $10,187 $5,244 $41,651 $1,631 W02B HIP,FEMR&LOW LIMB PR MT -CSCC 0 0 3 35 0.22 1 0 1.1968 1.4776 5.6295 0.3522 $5,992 $7,398 $28,187 $1,763 W03Z ABDOMINAL PR MULT SIG TRAUMA 0 0 3 35 0.15 1 0 1.0709 1.4303 5.3617 0.3811 $5,362 $7,162 $26,846 $1,908 W04A MULT TRAUMA W OTH OR PR +CSCC 0 0 6 62 0.15 1 0 1.2721 1.2283 8.6417 0.3013 $6,369 $6,150 $43,269 $1,509 W04B MULT TRAUMA W OTH OR PR -CSCC 0 0 3 33 0.15 1 0 0.894 1.3613 4.978 0.3356 $4,476 $6,816 $24,925 $1,680 W60Z MULTIPLE TRAUMA, DIED/TRANSF<5 0 0 1 4 0.1 1 0 0 0 1.3435 0 $6,727 W61A MULTIPLE TRAUMA-SIGNIF PR+CSCC 0 0 4 44 0.1 1 0 0.3765 0.8497 3.7754 0.2222 $1,885 $4,254 $18,903 $1,113 W61B MULTIPLE TRAUMA-SIGNIF PR-CSCC 0 0 2 20 0.11 1.36 0 0 0.9355 1.871 0.2219 $4,684 $9,368 $1,111 X02A MVTT/SKIN GFT+CSCC INJUR HAND 0 0 1 14 0.21 1 0 0 0 2.2441 0.4532 $11,236 $2,269 X02B SKIN GRAFT INJURIES HAND -CSCC 0 0 1 5 0.25 1 0 0 0 0.7901 0.4542 $3,956 $2,274 X04A OTHER PR INJ LWR LMB +CSCC 0 0 3 30 0.18 1 0 0.3485 1.0857 3.6055 0.253 $1,745 $5,436 $18,053 $1,267 X04B OTHER PR INJ LOWR LIMB -CSCC 1 0 1 7 0.14 0.91 0.495 0 0 1.0965 0.2719 $2,478 $5,490 $1,361 X05A OTH PR FOR INJ TO HAND +CC 0 0 1 13 0.09 1 0 0 0 1.6333 0.3033 $8,178 $1,519 X05B OTH PR FOR INJ TO HAND -CC 0 0 1 4 0.19 0.86 0 0 0 0.7146 0.3391 $3,578 $1,698 Please note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 12/13 Long-Stay Diem $
2. National Acute Inpatient Price Weights 2014/15 National Price Weights National Base Price DRG v7.0 Description Same-Day Payment List Bundled ICU Lower Bound Upper Bound Private Adjustment Paediatric Adjustment Same Day Outlier Base Diem Inlier Long-Stay Diem Same Day $ Outlier Base $ Diem $ Inlier $ Long-Stay Diem $ X06A OTHER PR OTHER INJURIES +CSCC 0 0 2 26 0.16 0.94 0 0.3756 1.2115 2.7986 0.2397 $1,881 $6,066 $14,013 $1,200 X06B OTHER PR OTHER INJURIES -CSCC 0 0 1 7 0.13 0.88 0 0 0 0.9392 0.2697 $4,703 $1,350 X07A SK GRAFT INJ-HAND+MIC TT/+CSCC 0 0 5 48 0.09 1 0 0.8209 0.9415 5.5286 0.2574 $4,110 $4,714 $27,682 $1,289 X07B SK GRAFT INJ-HAND-MIC TT-CSCC 0 0 2 20 0.08 1.26 0 0.4003 0.9861 2.3725 0.2374 $2,004 $4,937 $11,879 $1,189 X40Z INJ,POIS,TOX EFF DRUG W VENT 0 1 2 23 0.11 1 0 0.0869 2.1212 4.3292 0.305 $435 $10,621 $21,676 $1,527 X60A INJURIES +CSCC 0 0 2 19 0.1 1 0 0 0.7055 1.4111 0.1821 $3,532 $7,065 $912 X60B INJURIES -CSCC 1 0 1 7 0.13 1.34 0.1332 0 0 0.4624 0.1745 $667 $2,315 $874 X61Z ALLERGIC REACTIONS 0 0 1 4 0.13 0.86 0 0 0 0.2103 0.1452 $1,053 $727 X62A POISNG/TOXC EFF DRUGS +CSCC 0 0 1 15 0.09 1.15 0 0 0 1.1419 0.2148 $5,717 $1,076 X62B POISNG/TOXC EFF DRUGS -CSCC 1 0 1 7 0.08 1.25 0.1056 0 0 0.5061 0.2088 $529 $2,534 $1,045 X63A SEQUELAE OF TREATMNT+CSCC 1 0 2 21 0.12 1.41 0.2248 0 0.836 1.6721 0.2134 $1,126 $4,186 $8,372 $1,068 X63B SEQUELAE OF TREATMNT-CSCC 1 0 1 9 0.1 1 0.183 0 0 0.6582 0.1819 $916 $3,296 $911 X64A OTH INJ, POIS & TOX EFF +CSCC 1 0 2 19 0.1 1 0.1961 0 0.7754 1.5508 0.1797 $982 $3,882 $7,765 $900 X64B OTH INJ, POIS &TOX EFF DX-CSCC 1 0 1 5 0.09 1.13 0.1324 0 0 0.4055 0.2001 $663 $2,030 $1,002 Y01Z VNT>96/TRACH / OR PR SEV BURN 0 1 18 164 0.06 1 0 1.3263 2.1605 40.2161 0.7819 $6,641 $10,818 $201,362 $3,915 Y02A SKIN GRAFT OTHER BURNS +CSCC 0 0 5 47 0.05 1.05 0 0.4138 1.3875 7.3514 0.3941 $2,072 $6,947 $36,808 $1,973 Y02B SKIN GR OTH BRNS -CSCC +EMERG 0 0 2 23 0.05 1.11 0 0.3351 1.7191 3.7733 0.356 $1,678 $8,608 $18,893 $1,782 Y02C SKIN GR OTH BRNS -CSCC -EMERG 0 0 1 9 0.06 0.88 0 0 0 1.3379 0.4174 $6,699 $2,090 Y03Z OTHER OR PROCS FOR OTHER BURNS 0 0 1 14 0.07 0.94 0 0 0 1.6951 0.3568 $8,487 $1,786 Y60Z BURNS,TRANS OTH ACUT CARE <5D 0 0 1 4 0.03 1 0 0 0 0.3916 0 $1,961 Y61Z SEVERE BURNS 0 0 1 10 0.03 0.88 0 0 0 0.9029 0.3035 $4,521 $1,520 Y62A OTHER BURNS +CC 0 0 2 19 0.03 1.5 0 0 0.8197 1.6393 0.2278 $4,104 $8,208 $1,141 Y62B OTHER BURNS -CC 0 0 1 8 0.02 1.38 0 0 0 0.5791 0.2606 $2,900 $1,305 Y62C OTHER BURNS +SD 0 0 1 1 0.03 1.11 0 0 0 0.1502 0 $752 Z01A OTH CNT HLTH SRV +OR PROC 0 0 1 12 0.26 1 0 0 0 1.5021 0.2176 $7,521 $1,090 Z01B OTH CNT HLTH SRV +OR PROC +SD 0 0 1 1 0.46 1.07 0 0 0 0.4768 0 $2,387 Z40Z OTH CNT HLTH SRV +ENDO +SD 0 0 1 1 0.36 1.29 0 0 0 0.2532 0 $1,268 Z60Z REHABILITATION 0 0 6 55 0.03 1 0 0 0.54 3.2403 0.1692 $2,704 $16,224 $847 Z61A SIGNS AND SYMPTOMS 0 0 1 13 0.12 1 0 0 0 0.8647 0.2082 $4,330 $1,042 Z61B SIGNS AND SYMPTOMS +SD 0 0 1 1 0.19 0.85 0 0 0 0.1944 0 $973 Z63A OTH FU SURG/MED CARE +CCC 0 0 3 32 0.08 1 0 0 0.8274 2.4821 0.2046 $4,143 $12,428 $1,024 Z63B OTH FU SURG/MED CARE -CCC 0 0 1 16 0.12 1.18 0 0 0 0.8306 0.158 $4,159 $791 Z64A OTH FACTOR INFL HEALTH STATUS 0 0 1 18 0.17 1.58 0 0 0 0.7595 0.1671 $3,803 $837 Z64B OTH FCTR INFL HEALTH STATUS+SD 0 0 1 1 0.39 0.8 0 0 0 0.2286 0 $1,145 Z65Z CNGNTL & PRB ARISING FRM NNT 0 0 1 12 0.2 1.22 0 0 0 0.9016 0.281 $4,514 $1,407 Z66Z SLEEP DISORDERS 0 0 1 8 0.08 1.79 0 0 0 0.3153 0.083 $1,579 $416 Please note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 13/13
Appendix 3 Mental health per diem rates for designated wards 2014 2015-70 -
3. Mental Health Price Weights 2014/15 Designated Ward DU_TYPE WAU Qld Base Price Acquired Brain Injury AABI 0.2091 $978 Adolescent Acute Inpatient YACUTE 0.5342 $2,498 Adolescent Extended Treatment Service YETREH 0.2295 $1,073 Adult Acute AACUTE 0.3329 $1,557 Assessment PSYASS 0.1531 $716 Child Acute Inpatient CACUTE 0.4762 $2,227 Community Care Unit COMMCU 0.1282 $599 Day Program PSYDAY 0.0907 $424 Dual Diagnosis (MH and Intellectual Disability) DMHIDB 0.1547 $723 Extended Treatment and Rehabilitation AETREH 0.1634 $764 High Security Inpatient Service SECINP 0.2813 $1,315 Non Mental Health Intellectual Disability NMHIDB 0.1410 $659 Older Persons Acute PSYGER 0.1982 $927 Older Persons Extended Treatment GETREH 0.2295 $1,073 Secure Mental Health Rehabilitation Unit SECREH 0.3547 $1,659 Please note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 1/1
Appendix 4 Sub and non-acute patient admitted AN-SNAP v3.0 2014 2015-72 -
4. AN-SNAP Price Weights 2014/15 Price Weight Qld Base Price National Base Price Lower Upper Inlier Per Diem Diem Inlier Per AN-SNAP v 3#0 Episode Type Description Bound Bound Same Day Episode Inlier Per Diem Diem Same Day $ Episode $ $ $ Same Day$ Episode$ Diem$ Diem$ 3-101 Overnight Palliative Care Palliative care, admit for assessment onl 1 3 0.4185 0.1367 0.0713 $1,957 $639 $333 $2,095 $684 $357 3-102 Overnight Palliative Care Stable phase, RUG-ADL 4 1 15 0.1909 0.4530 0.1367 0.1909 $893 $2,118 $639 $893 $956 $2,268 $684 $956 3-103 Overnight Palliative Care Stable phase, RUG-ADL 5-17 3 17 0.8502 0.1367 0.2205 $3,976 $639 $1,031 $4,257 $684 $1,104 3-104 Overnight Palliative Care Stable phase, RUG-ADL 18 1 15 0.2602 1.1391 0.1367 0.2602 $1,217 $5,326 $639 $1,217 $1,303 $5,703 $684 $1,303 3-105 Overnight Palliative Care Unstable phase, RUG-ADL 4-17 1 14 0.7335 0.1367 0.2283 $3,430 $639 $1,068 $3,673 $684 $1,143 3-106 Overnight Palliative Care Unstable phase, RUG-ADL 18 1 10 0.7834 0.1367 0.3172 $3,663 $639 $1,483 $3,922 $684 $1,588 3-107 Overnight Palliative Care Deteriorating phase, RUG-ADL 4-14 1 14 0.7141 0.1367 0.2305 $3,339 $639 $1,078 $3,575 $684 $1,154 3-108 Overnight Palliative Care Deteriorating phase, RUG-ADL 15-18, age <=52 1 13 0.9978 0.1367 0.2789 $4,666 $639 $1,304 $4,996 $684 $1,396 3-109 Overnight Palliative Care Deteriorating phase, RUG-ADL 15-18, age >=53 1 11 0.8057 0.1367 0.3250 $3,767 $639 $1,520 $4,034 $684 $1,627 3-110 Overnight Palliative Care Terminal phase, RUG-ADL 4-16 1 9 0.6642 0.1367 0.3382 $3,106 $639 $1,581 $3,326 $684 $1,693 3-111 Overnight Palliative Care Terminal phase, RUG-ADL 17-18 1 8 0.5613 0.1367 0.4320 $2,625 $639 $2,020 $2,810 $684 $2,163 3-112 Overnight Palliative Care Bereavement phase 0.3041 $1,422 $1,523 3-151 All ambulatory Palliative Care Medical only 0.2036 $952 $1,019 3-152 All ambulatory Palliative Care Therapies only 0.2036 $952 $1,019 3-153 All ambulatory Palliative Care Stable phase, multidisciplinary 0.2036 $952 $1,019 3-154 All ambulatory Palliative Care Stable phase, nursing only, Palliative Care Problem Severity Score (PCPSS) <=6, RUG-ADL 4, ag 0.2036 $952 $1,019 3-155 All ambulatory Palliative Care Stable phase, nursing only, PCPSS <=6, RUG-ADL 4, age<=66 0.2036 $952 $1,019 3-156 All ambulatory Palliative Care Stable phase, nursing only, PCPSS <=6, RUG-ADL 5-18 0.2036 $952 $1,019 3-157 All ambulatory Palliative Care Stable phase, nursing only, PCPSS >=7 0.2036 $952 $1,019 3-158 All ambulatory Palliative Care Unstable phase, multidisciplinary, RUG-ADL 4, PCPSS <=7 0.2036 $952 $1,019 3-159 All ambulatory Palliative Care Unstable phase, multidisciplinary, RUG-ADL 4, PCPSS >=8 0.2036 $952 $1,019 3-160 All ambulatory Palliative Care Unstable phase, multidisciplinary, RUG-ADL 5-18 0.2036 $952 $1,019 3-161 All ambulatory Palliative Care Unstable phase, nursing only, RUG-ADL <=14, age>=60 0.2036 $952 $1,019 3-162 All ambulatory Palliative Care Unstable phase, nursing only, RUG-ADL <=14, age<=59 0.2036 $952 $1,019 3-163 All ambulatory Palliative Care Unstable phase, nursing only, RUG-ADL >=15 0.2036 $952 $1,019 3-164 All ambulatory Palliative Care Deteriorating phase, multidisciplinary, PCPSS <=6 0.2036 $952 $1,019 3-165 All ambulatory Palliative Care Deteriorating phase, multidisciplinary, PCPSS >=7, RUG<=10 0.2036 $952 $1,019 3-166 All ambulatory Palliative Care Deteriorating phase, multidisciplinary, PCPSS >=7, RUG>=11 0.2036 $952 $1,019 3-167 All ambulatory Palliative Care Deteriorating phase, nursing only, RUG-ADL 4 0.2036 $952 $1,019 3-168 All ambulatory Palliative Care Deteriorating phase, nursing only, RUG-ADL 5-18 0.2036 $952 $1,019 3-169 All ambulatory Palliative Care Terminal phase, multidisciplinary 0.2036 $952 $1,019 3-170 All ambulatory Palliative Care Terminal phase, nursing only 0.2036 $952 $1,019 3-171 All ambulatory Palliative Care Bereavement phase, age >=45 0.2036 $952 $1,019 3-172 All ambulatory Palliative Care Bereavement phase, age <=44 0.2036 $952 $1,019 3-201 Overnight Rehabilitation Rehabilitation, admit for assessment only 1 3 0.4185 0.1367 0.0713 $1,957 $639 $333 $2,095 $684 $357 3-202 Overnight Rehabilitation Brain, Neurological, Spinal & Major Multiple Trauma, FIM motor 13 44 69 10.5656 0.1367 0.3231 $49,405 $639 $1,511 $52,902 $684 $1,618 3-203 Overnight Rehabilitation All other impairments, FIM motor 13 12 37 2.8849 0.1367 0.2518 $13,490 $639 $1,177 $14,445 $684 $1,261 3-204 Overnight Rehabilitation Stroke, FIM motor 63-91, FIM cognition 20-35 6 29 1.0330 0.1367 0.1970 $4,830 $639 $921 $5,172 $684 $986 3-205 Overnight Rehabilitation Stroke, FIM motor 63-91, FIM cognition 5-19 8 33 1.7894 0.1367 0.2225 $8,367 $639 $1,040 $8,960 $684 $1,114 3-206 Overnight Rehabilitation Stroke, FIM motor 47-62, FIM cognition 16-35 13 38 1.3090 0.1367 0.1860 $6,121 $639 $870 $6,554 $684 $931 3-207 Overnight Rehabilitation Stroke, FIM motor 47-62, FIM cognition 5-15 13 38 1.8135 0.1367 0.2041 $8,480 $639 $954 $9,080 $684 $1,022 3-208 Overnight Rehabilitation Stroke, FIM motor 14-46, age>=75 16 41 2.0115 0.1367 0.2060 $9,406 $639 $963 $10,072 $684 $1,031 3-209 Overnight Rehabilitation Stroke, FIM motor 14-46, age<=74 28 53 3.0377 0.1367 0.2102 $14,204 $639 $983 $15,210 $684 $1,052 3-210 Overnight Rehabilitation Brain Dysfunction, FIM motor 56-91, FIM cognition 32-35 6 26 1.0668 0.1367 0.2160 $4,988 $639 $1,010 $5,341 $684 $1,082 3-211 Overnight Rehabilitation Brain Dysfunction, FIM motor 56-91, FIM cognition 24-31 6 29 1.5098 0.1367 0.2299 $7,060 $639 $1,075 $7,560 $684 $1,151 3-212 Overnight Rehabilitation Brain Dysfunction, FIM motor 56-91, FIM cognition 20-23 6 31 1.6920 0.1367 0.2218 $7,912 $639 $1,037 $8,472 $684 $1,111 3-213 Overnight Rehabilitation Brain Dysfunction, FIM motor 56-91, FIM cognition 5-19 12 37 1.4228 0.1367 0.1922 $6,653 $639 $899 $7,124 $684 $962 3-214 Overnight Rehabilitation Brain Dysfunction, FIM motor 24-55 19 44 2.5896 0.1367 0.2154 $12,109 $639 $1,007 $12,966 $684 $1,079 3-215 Overnight Rehabilitation Brain Dysfunction, FIM motor 14-23 48 73 5.8604 0.1367 0.2325 $27,403 $639 $1,087 $29,343 $684 $1,164 3-216 Overnight Rehabilitation Neurological, FIM motor 63-91 6 28 0.5807 0.1367 0.1725 $2,715 $639 $807 $2,908 $684 $864 3-217 Overnight Rehabilitation Neurological, FIM motor 49-62 7 32 1.2883 0.1367 0.2009 $6,024 $639 $939 $6,451 $684 $1,006 3-218 Overnight Rehabilitation Neurological, FIM motor 18-48 12 37 1.9499 0.1367 0.2128 $9,118 $639 $995 $9,763 $684 $1,065 3-219 Overnight Rehabilitation Neurological, FIM motor 14-17 9 34 3.3330 0.1367 0.2882 $15,585 $639 $1,348 $16,688 $684 $1,443 3-220 Overnight Rehabilitation Spinal Cord Dysfunction, FIM motor 81-91 6 24 0.4581 0.1367 0.1735 $2,142 $639 $811 $2,294 $684 $869 3-221 Overnight Rehabilitation Spinal Cord Dysfunction, FIM motor 47-80 13 38 1.7835 0.1367 0.2057 $8,340 $639 $962 $8,930 $684 $1,030 3-222 Overnight Rehabilitation Spinal Cord Dysfunction, FIM motor 14-46, age>=33 31 56 5.2891 0.1367 0.2550 $24,732 $639 $1,192 $26,483 $684 $1,277 3-223 Overnight Rehabilitation Spinal Cord Dysfunction, FIM motor 14-46, age<=32 39 64 6.1183 0.1367 0.2544 $28,609 $639 $1,190 $30,634 $684 $1,274 3-224 Overnight Rehabilitation Amputation of limb, FIM motor 72-91 10 35 0.4581 0.1367 0.1567 $2,142 $639 $733 $2,294 $684 $785 3-225 Overnight Rehabilitation Amputation of limb, FIM motor 14-71 17 42 1.6755 0.1367 0.1915 $7,835 $639 $895 $8,389 $684 $959 3-226 Overnight Rehabilitation Pain Syndromes 6 27 0.5091 0.1367 0.1718 $2,381 $639 $803 $2,549 $684 $860 3-227 Overnight Rehabilitation Orthopaedic conditions, fractures, FIM motor 58-91 6 29 0.5104 0.1367 0.1660 $2,387 $639 $776 $2,556 $684 $831 3-228 Overnight Rehabilitation Orthopaedic conditions, fractures, FIM motor 48-57 10 35 1.1133 0.1367 0.1838 $5,206 $639 $859 $5,574 $684 $920 3-229 Overnight Rehabilitation Orthopaedic conditions, fractures, FIM motor 14-47, FIM cognition 19-35 14 39 1.5230 0.1367 0.1925 $7,122 $639 $900 $7,626 $684 $964 3-230 Overnight Rehabilitation Orthopaedic conditions, fractures, FIM motor 14-47, FIM cognition 5-18 8 33 1.3151 0.1367 0.1973 $6,149 $639 $923 $6,585 $684 $988 3-231 Overnight Rehabilitation Orthopaedic conditions, replacement, FIM motor 72-91 6 25 0.3343 0.1367 0.1625 $1,563 $639 $760 $1,674 $684 $814 3-232 Overnight Rehabilitation Orthopaedic conditions, replacement, FIM motor 49-71 6 30 0.7680 0.1367 0.1793 $3,591 $639 $838 $3,845 $684 $898 3-233 Overnight Rehabilitation Orthopaedic conditions, replacement, FIM motor 14-48 10 35 1.5079 0.1367 0.1999 $7,051 $639 $935 $7,550 $684 $1,001 3-234 Overnight Rehabilitation Orthopaedic conditions, all other, FIM motor 68-91 6 27 0.3637 0.1367 0.1609 $1,701 $639 $752 $1,821 $684 $806 3-235 Overnight Rehabilitation Orthopaedic conditions, all other, FIM motor 53-67 7 32 0.5800 0.1367 0.1654 $2,712 $639 $773 $2,904 $684 $828 3-236 Overnight Rehabilitation Orthopaedic conditions, all other, FIM motor 14-52 13 38 1.4482 0.1367 0.1915 $6,772 $639 $895 $7,251 $684 $959 3-237 Overnight Rehabilitation Cardiac 6 31 0.8931 0.1367 0.1851 $4,176 $639 $866 $4,472 $684 $927 3-238 Overnight Rehabilitation Major Multiple Trauma, FIM total 101-126 6 25 1.4769 0.1367 0.2505 $6,906 $639 $1,171 $7,395 $684 $1,254 3-239 Overnight Rehabilitation Major Multiple Trauma, FIM total 74-100 or Burns 9 34 2.0998 0.1367 0.2302 $9,819 $639 $1,076 $10,514 $684 $1,153 3-240 Overnight Rehabilitation Major Multiple Trauma, FIM total 44-73 12 37 1.8545 0.1367 0.2099 $8,672 $639 $981 $9,285 $684 $1,051 3-241 Overnight Rehabilitation Major Multiple Trauma, FIM total 19-43 52 77 6.4207 0.1367 0.2347 $30,023 $639 $1,097 $32,148 $684 $1,175 3-242 Overnight Rehabilitation All other impairments, FIM motor 67-91 6 27 0.4485 0.1367 0.1664 $2,097 $639 $778 $2,246 $684 $833 3-243 Overnight Rehabilitation All other impairments, FIM motor 53-66 6 29 0.8698 0.1367 0.1867 $4,067 $639 $873 $4,355 $684 $935 3-244 Overnight Rehabilitation All other impairments, FIM motor 25-52 7 32 1.2577 0.1367 0.1989 $5,881 $639 $930 $6,297 $684 $996 3-245 Overnight Rehabilitation All other impairments, FIM motor 14-24 14 39 1.6062 0.1367 0.1954 $7,511 $639 $914 $8,042 $684 $978 3-251 Same Day Rehabilitation Brain, Major Multiple Trauma & Pulmonary 0.1062 $497 $532 3-252 Same Day Rehabilitation Burns, Cardiac, Pain, Spine, & Neurologica 0.1006 $470 $504 3-253 Same Day Rehabilitation All other impairments 0.0965 $451 $483 3-254 Outpatient & Community Rehabilitation Outpatient and community rehabilitation, medical assessment onl 3-255 Outpatient & Community Rehabilitation Outpatient and community rehabilitation, multidisciplinary assessmen 3-256 Outpatient & Community Rehabilitation Outpatient and community rehabilitation, medical treatment only 3-257 Outpatient & Community Rehabilitation Amputation 3-258 Outpatient & Community Rehabilitation Brain Injury and Major Multiple Trauma 3-259 Outpatient & Community Rehabilitation Spinal Injury 3-260 Outpatient & Community Rehabilitation Stroke and Development Disability, sole practitione 3-261 Outpatient & Community Rehabilitation Stroke and Development Disability, multidisciplinary, FIM motor <=8 3-262 Outpatient & Community Rehabilitation Stroke and Development Disability, multidisciplinary, FIM motor >=8 3-263 Outpatient & Community Rehabilitation All other impairments, sole practitione 3-264 Outpatient & Community Rehabilitation All other impairments, multidisciplinary, FIM motor <=80 3-265 Outpatient & Community Rehabilitation All other impairments, multidisciplinary, FIM motor >=81 Please note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 1/2
4. AN-SNAP Price Weights 2014/15 Price Weight Qld Base Price National Base Price Lower Upper Inlier Per Diem Diem Inlier Per AN-SNAP v 3#0 Episode Type Description Bound Bound Same Day Episode Inlier Per Diem Diem Same Day $ Episode $ $ $ Same Day$ Episode$ Diem$ Diem$ 3-301 Overnight Psychogeriatric Psychogeriatric, admit for assessment only 1 3 0.4185 0.1367 0.0713 $1,957 $639 $333 $2,095 $684 $357 3-302 Overnight Psychogeriatric HoNOS 65+ Overactive behaviour 3,4 0.2347 $1,097 $1,175 3-303 Overnight Psychogeriatric HoNOS 65+ Overactive behaviour 1,2 HoNOS 65+ ADL 4 0.2421 $1,132 $1,212 3-304 Overnight Psychogeriatric HoNOS 65+ Overactive behaviour 1,2 HoNOS 65+ ADL 0-3 0.2041 $954 $1,022 3-305 Overnight Psychogeriatric HoNOS 65+ Overactive behaviour 0 HoNOS 65+ total>=18 0.2118 $990 $1,060 3-306 Overnight Psychogeriatric HoNOS 65+ Overactive behaviour 0 HoNOS 65+ total<=17 0.1809 $846 $906 3-307 Overnight Psychogeriatric Long term care 0.1141 $534 $571 3-351 Outpatient Psychogeriatric Outpatient psychogeriatric assessment only 3-352 Community Psychogeriatric Assessment Only 3-353 All ambulatory Psychogeriatric Treatment, Focus of Care=acute 0.0706 $330 $353 3-354 All ambulatory Psychogeriatric Treatment, Focus of Care=not acute, HoNOS 65+ total <=8 0.0706 $330 $353 3-355 All ambulatory Psychogeriatric Treatment, Focus of Care=not acute, HoNOS 65+ total 9-13 0.0706 $330 $353 3-356 All ambulatory Psychogeriatric Treatment, Focus of Care=not acute, HoNOS 65+ total >=14, HoNOS 65+ Overactive 0,1 0.0706 $330 $353 3-357 All ambulatory Psychogeriatric Treatment, Focus of Care=not acute, HoNOS 65+ total >=14, HoNOS 65+ Overactive 2,3,4 0.0706 $330 $353 3-401 Overnight GEM GEM admit for assessment only 1 3 0.4185 0.1367 0.0713 $1,957 $639 $333 $2,095 $684 $357 3-402 Overnight GEM FIM cognition <=15, FIM motor 13-43 0.1938 $906 $970 3-403 Overnight GEM FIM cognition <=15, FIM motor 44-91, age>=84 0.1635 $765 $819 3-404 Overnight GEM FIM cognition <=15, FIM motor 44-91, age<=83 0.1573 $736 $788 3-405 Overnight GEM FIM cognition 16-35, FIM motor 13-50 0.1822 $852 $912 3-406 Overnight GEM FIM cognition 16-35, FIM motor 51-77 0.1557 $728 $780 3-407 Overnight GEM FIM cognition 16-35, FIM motor 78-91 0.1402 $656 $702 3-451 Same Day GEM Same day GEM, assessment Only 0.0842 $394 $422 3-452 Outpatients & Community GEM Outpatient and community GEM, medical assessment only 3-453 Outpatients & Community GEM Outpatient and community GEM, multidisciplinary assessmen 3-454 Same Day GEM All same day admitted GEM 0.0842 $394 $422 3-455 Outpatients & Community GEM FIM motor <=40 3-456 Outpatients & Community GEM FIM motor 41-56 3-457 Outpatients & Community GEM FIM motor>=57, sole practitioner 3-458 Outpatients & Community GEM FIM motor>=57, multidisciplinary 3-501 Overnight Maintenance Respite, RUG-ADL 15-18 0.1822 $852 $912 3-502 Overnight Maintenance Respite, RUG-ADL 5-14 0.1567 $733 $785 3-503 Overnight Maintenance Respite, RUG-ADL 4 0.1251 $585 $626 3-504 Overnight Maintenance Nursing Home Type, RUG-ADL 11-18 0.1644 $769 $823 3-505 Overnight Maintenance Nursing Home Type, RUG-ADL 4-10 0.1454 $680 $728 3-506 Overnight Maintenance Convalescent care 0.1570 $734 $786 3-507 Overnight Maintenance Other maintenance, RUG-ADL 14-18 0.1751 $819 $877 3-508 Overnight Maintenance Other maintenance, RUG-ADL 4-13 0.1670 $781 $836 3-509 Overnight Maintenance Long term care, RUG-ADL 17-18 0.1067 $499 $534 3-510 Overnight Maintenance Long term care, RUG-ADL 10-16 0.0974 $455 $488 3-511 Overnight Maintenance Long term care, RUG-ADL 4-9 0.0713 $333 $357 3-551 All ambulatory Maintenance Medical only 0.0618 $289 $309 3-552 All ambulatory Maintenance Ambulatory maintenance, nursing assessment only 0.0618 $289 $309 3-553 All ambulatory Maintenance Ambulatory maintenance, psychosocial assessmen 0.0618 $289 $309 3-554 All ambulatory Maintenance Ambulatory maintenance, physical therapy assessmen 0.0618 $289 $309 3-555 Same Day & Community Maintenance Same day and community maintenance, multidisciplinary 0.0618 $289 $309 3-556 Outpatient Maintenance Outpatient maintenance, multidisciplinary assessmen 3-557 All ambulatory Maintenance Maintenance and support, nursing, age>=37, RUG-ADL>=5 0.0618 $289 $309 3-558 All ambulatory Maintenance Maintenance and support, nursing, age>=37, RUG-ADL 4 0.0618 $289 $309 3-559 All ambulatory Maintenance Maintenance and support, nursing, age<=36, RUG-ADL>=5 0.0618 $289 $309 3-560 All ambulatory Maintenance Maintenance and support, nursing, age<=36, RUG-ADL 4 0.0618 $289 $309 3-561 All ambulatory Maintenance Maintenance and support, physical therapy, RUG-ADL>=6 0.0618 $289 $309 3-562 All ambulatory Maintenance Maintenance and support, physical therapy, RUG-ADL 4,5 0.0618 $289 $309 3-563 Community Maintenance Community maintenance and support, multidisciplinary, age>=27, RUG-ADL 4-11 3-564 All ambulatory Maintenance Maintenance and support, multidisciplinary, age>=27, RUG-ADL>=12 0.0618 $289 $309 3-565 Outpatient Maintenance Outpatient maintenance and support, multidisciplinary, age>=27, RUG-ADL 4-11 3-566 All ambulatory Maintenance Maintenance and support, multidisciplinary,<=26 yrs 0.0618 $289 $309 Please note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 2/2
Appendix 5 Non sub and non-acute care type per diem rates 2014 2015-75 -
5. Non-SNAP Price Weights 2014/15 Qld Base Price National Base Price Episode ID Episode Type Overnight Per Diem Same Day Per Diem Overnight Same Day Sameday Accommondation Overnight Accommodation 9 GERIATRIC EVAL & MANAGEMENT 0.1402 0.0842 $656 $394 $702 $422 10 PSYCHOGERIATRIC 0.1809 0.0706 $846 $330 $906 $353 11 MAINTENANCE 0.1251 0.0618 $585 $289 $626 $309 20 REHAB NEW CARE TYPE 0.1567 0.0955 $733 $447 $785 $478 30 PALLIATIVE NEW CARE TYPE 0.1909 0.1909 $893 $893 $956 $956 Please note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 1/1
Appendix 6 Tier 2 non-admitted services v3.0 2014 2015-77 -
6. Outpatient Tier 2 Price Weights 2014/15 Qld Price Weight Qld Base Price National Tier 2 Clinic Description QWAU New QWAU Review QWAU Telephone New Review Telephone NWAU Base Price 10.01 Hyperbaric Medicine 0.2026 0.2026 $947 $947 0.1899 $951 10.02 Interventional Imaging 0.4007 0.4007 $1,874 $1,874 0.4007 $2,006 10.03 Minor Surgical 0.0630 0.0630 $295 $295 0.0584 $292 10.04 Dental 0.0619 0.0619 $289 $289 0.0579 $290 10.05 Angioplasty/Angiography 0.3022 0.3022 $1,413 $1,413 0.2833 $1,418 10.06 Endoscopy - Gastrointestinal 0.1448 0.1448 $677 $677 0.1355 $678 10.07 Endoscopy- Urological/Gynaecological 0.0524 0.0524 $245 $245 0.0486 $243 10.08 Endoscopy- Orthopaedic 0.0539 0.0539 $252 $252 0.0531 $266 10.09 Endoscopy - Respiratory/ENT 0.0643 0.0643 $301 $301 0.0599 $300 10.10 Renal Dialysis - Hospital Delivered 0.0880 0.0880 $411 $411 0.0774 $388 10.11 Chemotherapy - Treatment 0.0793 0.0793 $371 $371 0.0614 $307 10.12 Radiotherapy - Treatment 0.0626 0.0626 $293 $293 0.0626 $313 10.13 Minor Medical Procedures 0.1380 0.1380 $645 $645 0.1262 $632 10.14 Pain Management Interventions 0.0396 0.0396 $185 $185 0.0387 $194 10.15 Renal Dialysis - Haemodialysis - Home Delivered 0.0880 0.0880 $411 $411 0.0774 $388 10.16 Renal Dialysis - Peritoneal Dialysis - Home Delivered 0.0377 0.0377 $176 $176 0.0332 $166 10.17 Total Parenteral Nutrition - Home Delivered 0 10.18 Enteral Nutrition - Home Delivered 0 10.19 Ventilation - Home Delivered 0 10.20 Radiation Oncology - Simulation and Planning 0.2087 0.2087 $976 $976 0.2087 $1,045 20.01 Transplants 0.0684 0.1341 0.0122 $320 $627 $57 0.0935 $468 20.02 Anaesthetics 0.0557 0.0664 0.0122 $260 $310 $57 0.0519 $260 20.03 Pain Management 0.0786 0.0914 0.0122 $368 $427 $57 0.0795 $398 20.04 Developmental Disabilities 0.1158 0.0697 0.0122 $541 $326 $57 0.0779 $390 20.05 General Medicine 0.0538 0.0408 0.0122 $252 $191 $57 0.0422 $211 20.06 General Practice and Primary Care 0 20.07 General Surgery 0.0842 0.0635 0.0122 $394 $297 $57 0.0641 $321 20.08 Genetics 0.0904 0.0325 0.0122 $423 $152 $57 0.0807 $404 20.09 Geriatric Medicine 0.1116 0.0480 0.0122 $522 $224 $57 0.0641 $321 20.10 Haematology 0.1127 0.0998 0.0122 $527 $467 $57 0.076 $381 20.11 Paediatric Medicine 0.0767 0.0533 0.0122 $359 $249 $57 0.054 $270 20.12 Paediatric Surgery 0.0586 0.0714 0.0122 $274 $334 $57 0.061 $305 20.13 Palliative Care 0.1320 0.0720 0.0122 $617 $337 $57 0.0803 $402 20.14 Epilepsy 0.0469 0.0574 0.0122 $219 $268 $57 0.0512 $256 20.15 Neurology 0.1047 0.0758 0.0122 $490 $354 $57 0.0721 $361 20.16 Neurosurgery 0.0651 0.0777 0.0122 $304 $363 $57 0.0686 $343 20.17 Ophthalmology 0.0766 0.0631 0.0122 $358 $295 $57 0.0593 $297 20.18 Ear, Nose and Throat (ENT) 0.0759 0.0405 0.0122 $355 $189 $57 0.048 $240 20.19 Respiratory 0.1225 0.0743 0.0122 $573 $347 $57 0.0749 $375 20.20 Respiratory - Cystic Fibrosis 0.2416 0.2354 0.0122 $1,130 $1,101 $57 0.2074 $1,038 20.21 Anti coagulant Screening and Management 0.0713 0.0713 0.0122 $333 $333 $57 0.0652 $326 Please note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 1/4
6. Outpatient Tier 2 Price Weights 2014/15 Qld Price Weight Qld Base Price National Tier 2 Clinic Description QWAU New QWAU Review QWAU Telephone New Review Telephone NWAU Base Price 20.22 Cardiology 0.0986 0.0562 0.0122 $461 $263 $57 0.0652 $326 20.23 Cardiothoracic 0.1076 0.1360 0.0122 $503 $636 $57 0.1046 $524 20.24 Vascular Surgery 0.1340 0.1032 0.0122 $627 $483 $57 0.102 $511 20.25 Gastroenterology 0.1250 0.1016 0.0122 $585 $475 $57 0.0848 $425 20.26 Hepatobiliary 0.1624 0.1166 0.0122 $759 $545 $57 0.1095 $548 20.27 Craniofacial 0.0693 0.0360 0.0122 $324 $168 $57 0.0458 $229 20.28 Metabolic Bone 0.0594 0.0594 0.0122 $278 $278 $57 0.0493 $247 20.29 Orthopaedics 0.0685 0.0479 0.0122 $320 $224 $57 0.05 $250 20.30 Rheumatology 0.1262 0.0672 0.0122 $590 $314 $57 0.0667 $334 20.31 Spinal 0.1122 0.1122 0.0122 $525 $525 $57 0.1047 $524 20.32 Breast 0.1373 0.0983 0.0122 $642 $460 $57 0.0957 $479 20.33 Dermatology 0.0939 0.0572 0.0122 $439 $267 $57 0.0553 $277 20.34 Endocrinology 0.0380 0.0785 0.0122 $178 $367 $57 0.0621 $311 20.35 Nephrology 0.1479 0.1380 0.0122 $692 $645 $57 0.1118 $560 20.36 Urology 0.0890 0.0451 0.0122 $416 $211 $57 0.0513 $257 20.37 Assisted Reproductive Technology 0.0712 0.0712 0.0122 $333 $333 $57 0.0695 $348 20.38 Gynaecology 0.0828 0.0460 0.0122 $387 $215 $57 0.054 $270 20.39 Gynaecology Oncology 0.0992 0.0870 0.0122 $464 $407 $57 0.0834 $418 20.40 Obstetrics 0.0791 0.0611 0.0122 $370 $286 $57 0.0591 $296 20.41 Immunology 0.1108 0.0969 0.0122 $518 $453 $57 0.0872 $437 20.42 Medical Oncology (Consultation) 0.0656 0.1603 0.0122 $307 $750 $57 0.1295 $648 20.43 Radiation therapy - consultation 0.0687 0.0404 0.0122 $321 $189 $57 0.041 $205 20.44 Infectious Diseases 0.0808 0.0856 0.0122 $378 $400 $57 0.0491 $246 20.45 Psychiatry 0.1202 0.0475 0.0122 $562 $222 $57 0.0514 $257 20.46 Plastic and Reconstructive Surgery 0.1006 0.0378 0.0122 $470 $177 $57 0.0476 $238 20.47 Rehabilitation 0.0932 0.0617 0.0122 $436 $289 $57 0.0589 $295 20.48 Multidisciplinary Burns Clinic 0.0818 0.0907 0.0122 $382 $424 $57 0.0835 $418 20.49 Geriatric Evaluation and Management (GEM) 0.0688 0.0688 0.0122 $322 $322 $57 0.0641 $321 20.50 Psychogeriatric 0.0923 0.0772 0.0122 $432 $361 $57 0.0786 $394 20.51 Sleep Disorders 0.0283 0.0548 0.0122 $132 $256 $57 0.0456 $228 20.52 Addiction Medicine 0.0458 0.0458 0.0122 $214 $214 $57 0.0422 $211 30.01 General Imaging 0 30.02 Medical Resonance Imaging (MRI) 0 30.03 Computerised Tomography (CT) 0 30.04 Nuclear Medicine 0 30.05 Pathology (Microbiology, Haematology, Biochemistry) 0 30.06 Positron Emission Tomography (PET) 0 30.07 Mammography Screening 0 30.08 Clinical Measurement 0.0359 0.0359 $168 $168 0 40.01 Aboriginal and Torres Strait Islander Health Clinic 0.0263 0.0262 0.0111 $123 $123 $52 0.0239 $120 40.02 Aged Care Assessment 0 Please note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 2/4
6. Outpatient Tier 2 Price Weights 2014/15 Qld Price Weight Qld Base Price National Tier 2 Clinic Description QWAU New QWAU Review QWAU Telephone New Review Telephone NWAU Base Price 40.03 Aids and Appliances 0.0780 0.0490 0.0111 $365 $229 $52 0.0539 $270 40.04 Clinical Pharmacy 0.1521 0.2142 0.0111 $711 $1,002 $52 0.1771 $887 40.05 Hydrotherapy 0.0528 0.0528 0.0111 $247 $247 $52 0.0495 $248 40.06 Occupational Therapy 0.0305 0.0302 0.0111 $143 $141 $52 0.0271 $136 40.07 Pre-Admission and Pre-Anaesthesia 0.1541 0.2068 0.0111 $721 $967 $52 0.1051 $526 40.08 Primary Health Care 0 40.09 Physiotherapy 0.0278 0.0486 0.0111 $130 $227 $52 0.039 $195 40.10 Sexual Health 0.0433 0.0433 0.0111 $202 $202 $52 0.0404 $202 40.11 Social Work 0.0346 0.0965 0.0111 $162 $451 $52 0.0506 $253 40.12 Rehabilitation 0.1918 0.0186 0.0111 $897 $87 $52 0.0468 $234 40.13 Wound Management 0.0517 0.0652 0.0111 $242 $305 $52 0.0575 $288 40.14 Neuropsychology 0.1726 0.1726 0.0111 $807 $807 $52 0.1505 $754 40.15 Optometry 0.0266 0.0087 0.0111 $124 $41 $52 0.0111 $56 40.16 Orthoptics 0.0146 0.0141 0.0111 $68 $66 $52 0.0133 $67 40.17 Audiology 0.0447 0.0731 0.0111 $209 $342 $52 0.0515 $258 40.18 Speech Pathology 0.0446 0.0560 0.0111 $209 $262 $52 0.0465 $233 40.21 Cardiac Rehabilitation 0.1401 0.0947 0.0111 $655 $443 $52 0.0815 $408 40.22 Stomal Therapy 0.1275 0.1422 0.0111 $596 $665 $52 0.0906 $454 40.23 Nutrition/Dietetics 0.0670 0.0604 0.0111 $313 $282 $52 0.0525 $263 40.24 Orthotics 0.0379 0.0655 0.0111 $177 $306 $52 0.0486 $243 40.25 Podiatry 0.0593 0.0534 0.0111 $277 $250 $52 0.0503 $252 40.27 Family Planning 0 40.28 Midwifery and Maternity 0.0443 0.0625 0.0111 $207 $292 $52 0.0485 $243 40.29 Psychology 0.0402 0.0340 0.0111 $188 $159 $52 0.0302 $151 40.30 Alcohol and Other Drugs 0.0859 0.0340 0.0111 $402 $159 $52 0.0362 $181 40.31 Burns 0.0410 0.0410 0.0111 $192 $192 $52 0.0376 $188 40.32 Continence 0.0815 0.0252 0.0111 $381 $118 $52 0.0323 $162 40.33 General Counselling 0 40.34 Specialist Mental Health 0 40.35 Palliative Care 0.1689 0.1689 0.0111 $790 $790 $52 0.0707 $354 40.36 Geriatric Evaluation and Management (GEM) 0.0750 0.0750 0.0111 $351 $351 $52 0.066 $330 40.37 Psychogeriatric 0.0255 0.0255 0.0111 $119 $119 $52 0.0239 $120 40.38 Infectious Diseases 0.0630 0.0630 0.0111 $295 $295 $52 0.0543 $272 40.39 Neurology 0.0997 0.0997 0.0111 $466 $466 $52 0.051 $255 40.40 Respiratory 0.0416 0.0416 0.0111 $195 $195 $52 0.0337 $169 40.41 Gastroenterology 0.0941 0.0941 0.0111 $440 $440 $52 0.0576 $288 40.42 Circulatory 0.1036 0.1036 0.0111 $484 $484 $52 0.0759 $380 40.43 Hepatobiliary 0.0767 0.0767 0.0111 $359 $359 $52 0.0543 $272 40.44 Orthopaedics 0.0538 0.0538 0.0111 $252 $252 $52 0.05 $250 40.45 Dermatology 0.0579 0.0579 0.0111 $271 $271 $52 0.0543 $272 40.46 Endocrinology 0.0639 0.0639 0.0111 $299 $299 $52 0.0489 $245 Please note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 3/4
6. Outpatient Tier 2 Price Weights 2014/15 Qld Price Weight Qld Base Price National Tier 2 Clinic Description QWAU New QWAU Review QWAU Telephone New Review Telephone NWAU Base Price 40.47 Nephrology 0.0952 0.0952 0.0111 $445 $445 $52 0.0535 $268 40.48 Haematology and Immunology 0.0715 0.0715 0.0111 $334 $334 $52 0.0491 $246 40.49 Gynaecology 0.0752 0.0752 0.0111 $352 $352 $52 0.0656 $328 40.50 Urology 0.0907 0.0907 0.0111 $424 $424 $52 0.0529 $265 40.51 Breast 0.1010 0.1010 0.0111 $472 $472 $52 0.0754 $378 40.52 Oncology 0.0547 0.0547 0.0111 $256 $256 $52 0.0357 $179 40.53 General Medicine 0.0607 0.0607 0.0111 $284 $284 $52 0.054 $270 40.54 General Surgery 0.0592 0.0592 0.0111 $277 $277 $52 0.0466 $233 40.55 Paediatrics 0.0596 0.0596 0.0111 $279 $279 $52 0.0438 $219 40.56 Falls Prevention 0.0203 0.0203 0.0111 $95 $95 $52 0.019 $95 40.57 Memory and Cognition 0.0579 0.0579 0.0111 $271 $271 $52 0.0543 $272 40.58 Hospital Avoidance Programs 0.0484 0.0484 0.0111 $226 $226 $52 0.0453 $227 40.59 Post Acute Care 0.0579 0.0579 0.0111 $271 $271 $52 0.0543 $272 40.60 Pulmonary Rehabilitation 0.0875 0.0875 0.0111 $409 $409 $52 0.0815 $408 Please note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 4/4
Appendix 7 Emergency departments URG v1.4.2 2014 2015-82 -
7. Emergency Department URG Price Weights 2014/15 URG v1.4 Description Price Weights Qld Price National Price 3 Adm_T1_Injury 0.4334 $2,027 $2,170 4 Adm_T1_Poisoning/Toxic effects of drugs 0.3202 $1,497 $1,603 5 Adm_T1_Respiratory system illness 0.3164 $1,479 $1,584 6 Adm_T1_Circulatory system and Endocrine, nutritional and metabolic illness 0.3001 $1,403 $1,503 7 Adm_T1_All other MDB groups 0.3473 $1,624 $1,739 9 Adm_T2_Poisoning 0.2344 $1,096 $1,174 10 Adm_T2_Injury 0.2803 $1,311 $1,403 11 Adm_T2_Gastrointestinal system and Digestive system illness 0.2811 $1,314 $1,407 12 Adm_T2_Respiratory system illness 0.2507 $1,172 $1,255 14 Adm_T2_Neurological illness 0.2888 $1,350 $1,446 15 Adm_T2_Toxic effects of drugs 0.2327 $1,088 $1,165 16 Adm_T2_Circulatory system and Endocrine, nutritional and metabolic illness 0.2311 $1,081 $1,157 17 Adm_T2_All other MDB groups 0.2130 $996 $1,066 19 Adm_T3_Blood/Immune system illness & system infection/parasites 0.2312 $1,081 $1,158 20 Adm_T3_Injury 0.2066 $966 $1,034 21 Adm_T3_Neurological illness 0.2414 $1,129 $1,209 22 Adm_T3_Obstetric/Gynaecological illness 0.0985 $461 $493 23 Adm_T3_Digestive system illness 0.2290 $1,071 $1,147 24 Adm_T3_Circulatory system illness and endocrine, nutritional and metabolic illness 0.2132 $997 $1,067 25 Adm_T3_Poisoning/Toxic effects of drugs 0.1919 $897 $961 26 Adm_T3_Urological illness 0.2242 $1,048 $1,123 27 Adm_T3_Respiratory system illness 0.2216 $1,036 $1,110 29 Adm_T3_All other MDB groups 0.2055 $961 $1,029 30 Adm_T4_Poisoning/Toxic effects of drugs 0.1495 $699 $749 31 Adm_T4_Respiratory system illness 0.1921 $898 $962 32 Adm_T4_Gastrointestinal system and Digestive system illness 0.1959 $916 $981 33 Adm_T4_All other MDB groups 0.1765 $825 $884 34 Adm_T4_Injury 0.1590 $743 $796 35 Adm_T4_Social problem/other presentation 0.1601 $749 $802 37 Adm_T5_All other MDB groups 1 0.1050 $491 $526 38 Dead on Arrival w any Triage w any MDB 0.0525 $245 $263 39 N-A_T1_All MDB groups 0.3099 $1,449 $1,552 40 N-A_T2_Toxic effects of drugs 0.2070 $968 $1,036 43 N-A_T2_Circulatory system / Endocrine, nutritional and metabolic diseases 0.1944 $909 $973 44 N-A_T2_Injury 0.1788 $836 $895 45 N-A_T2_Poisoning 0.1951 $912 $977 46 N-A_T2_All other MDB groups 0.1519 $710 $761 48 N-A_T3_Circulatory system and Endocrine, nutritional and metabolic illness 0.1464 $685 $733 50 N-A_T3_Injury 0.1249 $584 $625 51 N-A_T3_Genitourinary illness 0.1451 $678 $727 52 N-A_T3_Gastrointestinal system and Digestive system illness 0.1397 $653 $699 53 N-A_T3_Neurological illness 0.1507 $705 $755 55 N-A_T3_Respiratory system illness 0.1198 $560 $600 56 N-A_T3_Musculoskeletal/connective tissue illness 0.1297 $606 $649 57 N-A_T3_All other MDB groups 0.1094 $512 $548 58 N-A_T4_Injury 0.0771 $361 $386 60 N-A_T4_Urological system illness 0.0995 $465 $498 61 N-A_T4_Circulatory system / Endocrine, nutritional and metabolic illness 0.1042 $487 $522 62 N-A_T4_Gastrointestinal system and Digestive system illness 0.0971 $454 $486 63 N-A_T4_Musculoskeletal/connective tissue illness 0.0876 $410 $439 65 N-A_T4_Illness of the ENT 0.0652 $305 $326 66 N-A_T4_Illness of the Eyes 0.0573 $268 $287 67 N-A_T4_Other presentation block 0.0776 $363 $389 68 N-A_T4_All other MDB groups 0.0844 $395 $423 69 N-A_T5_Poisoning/Toxic effects of drugs 0.0597 $279 $299 70 N-A_T5_Injury 0.0514 $240 $257 71 N-A_T5_Other presentation block 0.0457 $214 $229 72 N-A_T5_All other MDB groups 0.0597 $279 $299 Please note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 1/2
7. Emergency Department URG Price Weights 2014/15 URG v1.4 Description Price Weights Qld Price National Price 73 Did Not Wait $160 74 Transfer presentation_1, 2 0.2205 $1,031 $1,104 75 Died in emergency department_triage 1 0.2482 $1,161 $1,243 76 Adm_Return visit, planned w any Triage 0.1251 $585 $626 77 N-A Return visit, planned Triage 1, 2 0.1626 $760 $814 78 N-A Return visit, planned Triage 3-5 0.0580 $271 $290 79 Adm_T1_Psychiatric illness 0.3349 $1,566 $1,677 80 Adm_T2_System infection/parasites 0.2798 $1,308 $1,401 81 Adm_T2_Urological system illness 0.2674 $1,250 $1,339 82 Adm_T2_Psychiatric illness 0.2611 $1,221 $1,307 83 Adm_T3_Illness of eyes, ear, nose, throat 0.1710 $800 $856 84 Adm_T3_Hepatobiliary system illness 0.2419 $1,131 $1,211 85 Adm_T3_Psychiatric illness 0.2017 $943 $1,010 86 Adm_T4_Circulatory system illness and Endocrine, nutritional and metabolic illness 0.1879 $879 $941 87 Adm_T4_Illness of eyes, ear nose and throat 0.1430 $669 $716 88 Adm_T4_Blood/immune system illness/system infection/parasites 0.1895 $886 $949 89 Adm_T4_Gynaecological and Male reproductive system illness 0.1570 $734 $786 90 Adm_T4_Psychiatric illness 0.1663 $778 $833 91 Adm_T5_All other MDB groups 2 0.1553 $726 $778 92 Adm_T5_Injury 0.1224 $572 $613 93 Adm_T5_Gastrointestinal system and Digestive system illness 0.1704 $797 $853 94 Adm_T5_Psychiatric illness 0.1282 $599 $642 95 N-A_T2_Respiratory system illness 0.1798 $841 $900 96 N-A_T2_Urological system illness 0.1965 $919 $984 97 N-A_T2_Gastrointestinal system and Digestive system illness 0.1834 $858 $918 98 N-A_T2_Neurological illness 0.2046 $957 $1,024 99 N-A_T2_Blood/immune system illness/system infection/parasites 0.1767 $826 $885 100 N-A_T2_Psychiatric illness 0.1842 $861 $922 101 N-A_T3_Poisoning 0.1420 $664 $711 102 N-A_T3_Toxic effects of drugs 0.1517 $709 $760 103 N-A_T3_Illness of eyes 0.0853 $399 $427 104 N-A_T3_Blood/immune system illness/system infection/parasites 0.1132 $529 $567 105 N-A_T3_Psychiatric illness 0.1334 $624 $668 106 N-A_T4_Poisoning 0.0787 $368 $394 107 N-A_T4_Toxic effects of drugs 0.1031 $482 $516 108 N-A_T4_Respiratory system illness 0.0809 $378 $405 109 N-A_T4_Blood/Immune system illness/system infection/parasites 0.0754 $353 $378 110 N-A_T4_Obstetric and Newborn/Neonate 0.0748 $350 $375 111 N-A_T4_Gynecological/Male reproductive system illness 0.0908 $425 $455 112 N-A_T4_Psychiatric illness 0.0915 $428 $458 113 N-A_T5_Circulatory system illness/endocrine, nutritional and metabolic diseases 0.0721 $337 $361 114 N-A_T5_Gastrointestinal system and Digestive system illness 0.0665 $311 $333 115 N-A_T5_Illness of the eyes, ear, nose and throat 0.0418 $195 $209 116 N-A_T5_Illness of the skin, subcutaneous tissue, breast/musculoskeletal/connective tissue illness 0.0536 $251 $268 117 N-A_T5_Blood/immune system illness/system infection/parasites 0.0560 $262 $280 118 N-A_T5_Obstetric illness/newborn/neonate 0.0501 $234 $251 119 N-A_T5_Genitourinary system illness 0.0639 $299 $320 120 N-A_T5_Psychiatric illness 0.0622 $291 $311 121 Transfer presentation_3 0.1855 $867 $929 122 Transfer presentation_4 0.1347 $630 $674 123 Transfer presentation_5 0.0963 $450 $482 124 Died in emergency department_triage 2-5 0.1937 $906 $970 125 Left at own risk_1, 2 0.1611 $753 $807 126 Left at own risk_3 0.1038 $485 $520 127 Left at own risk_4 0.0708 $331 $354 128 Left at own risk_5 0.0564 $264 $282 Please note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 2/2
Appendix 8 Emergency services UDG v 1.3 2014 2015-85 -
8. Emergency Department UDG Price Weights 2014/15 UDG v1.3 Description Price Weights Qld Base Price National Base Price 1 Adm_T1 0.3511 $1,642 $1,758 2 Adm_T2 0.2493 $1,166 $1,248 3 Adm_T3 0.2156 $1,008 $1,080 4 Adm_T4 0.1775 $830 $889 5 Adm_T5 0.1381 $646 $691 6 N-A_T1 0.3084 $1,442 $1,544 7 N-A_T2 0.1819 $851 $911 8 N-A_T3 0.1285 $601 $643 9 N-A_T4 0.0814 $381 $408 10 N-A_T5 0.0519 $243 $260 11 Did Not Wait $160 12 Dead on Arrival w any Triage w any MDB 0.0525 $245 $263 13 Transfer presentation 0.1829 $855 $916 14 Died in emergency department 0.2218 $1,037 $1,111 15 Adm_Return visit, planned w any Triage 0.1251 $585 $626 16 N-A Return visit, planned Triage 1, 2, 3 0.1081 $505 $541 17 N-A Return visit, planned Triage 4,5 0.0560 $262 $280 Please note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 1/1
Appendix 9 Adjustments 2014 2015-87 -
9. Adjustments ICU (Critical Care) facilities eligible to receive adjustments Level 3 ICU Hourly Rate WAU DRG has bundled ICU = 0 (no) 4% DRG has bundled ICU = 1 (yes) 0% Indigenous Adjustment Column1 Indigenous Adjustment 4% SNAP Indigenous Adjustment 17% Radiotherapy Adjustment Acute & SNAP Column1 With specified ICD 10 AM 8th edition radiotherapy procedure code 24% Remoteness Acute & SNAP Column1 Outer Regional 7% Remote 15% Very Remote 21% Paediatric SNAP Column1 <= 16 years 196% Specialist Psychiatric Age Adjustment Column1 <= 17 years 40% <=17 years in specialist Children's hospital 30% 65 84years 5% >=85 years 9% Please note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 1/1
Appendix 10 Intensive care units eligible to receive adjustments Gold Coast Hospital The Prince Charles Hospital Royal Brisbane and Women s Hospital Princess Alexandra Hospital The Townsville Hospital Cairns Base Hospital Royal Children s Hospital Mater Children s Hospital Mater Adult Hospital Nambour General Hospital Ipswich Hospital new in 2014 2015 Redcliffe Hospital new in 2014 2015 Logan Hospital new in 2014 2015 Bundaberg Hospital new in 2014 2015 Toowoomba Hospital new in 2014 2015 Rockhampton Base Hospital new in 2014 2015 Mackay Base Hospital new in 2014 2015 2014 2015-91 -
Appendix 11 Radiotherapy procedure codes eligible for adjustments Procedure Code Description 15000-00 Radiation treatment, superficial, 1 field 15003-00 Radiation treatment, superficial, >= 2 fields 15100-00 Radiation treatment, orthovoltage, 1 field 15103-00 Radiation treatment, orthovoltage, >= 2 fields 15224-00 Radiation treatment, megavoltage, 1 field, single modality linear accelerator 15239-00 Radiation treatment, megavoltage, >= 2 fields, single modality linear accelerator 15254-00 Radiation treatment, megavoltage, 1 field, dual modality linear accelerator 15269-00 Radiation treatment, megavoltage, >= 2 fields, dual modality linear accelerator 15600-00 Stereotactic radiation treatment, single dose 15600-01 Stereotactic radiation treatment, fractionated 15600-02 Hemi body irradiation 15600-03 Total body irradiation 15600-04 Total skin irradiation 15303-00 Brachytherapy, intrauterine, low dose rate 15304-00 Brachytherapy, intrauterine, high dose rate 15311-00 Brachytherapy, intravaginal, low dose rate 15312-00 Brachytherapy, intravaginal, high dose rate 15319-00 Brachytherapy, combined intrauterine and intravaginal, low dose rate 15320-00 Brachytherapy, combined intrauterine and intravaginal, high dose rate 90764-00 Brachytherapy, intracavitary, low dose rate 90764-01 Brachytherapy, intracavitary, high dose rate 15327-00 Brachytherapy with implantation of removable single plane, low dose rate 15327-01 Brachytherapy with implantation of removable single plane, pulsed dose rate 15327-02 Brachytherapy with implantation of removable multiple planes or volume implant, low dose rate 15327-03 Brachytherapy with implantation of removable multiple planes or volume implant, pulsed dose rate 15327-04 Brachytherapy with implantation of permanent implant, < 10 sources 15327-05 Brachytherapy with implantation of permanent implant, >= 10 sources 15327-06 Brachytherapy with implantation of removable single plane, high dose rate 15327-07 Brachytherapy with implantation of removable multiple planes or volume implant, high dose rate 15338-00 Brachytherapy, prostate 15360-00 Brachytherapy, intravascular 15339-00 Removal of sealed radioactive source 15012-00 Brachytherapy, eye 90766-00 Brachytherapy using surface applicators, other sites 16003-00 Administration of a therapeutic dose of Yttrium 90 2014 2015-92 -
Procedure Code Description 16009-00 Administration of a therapeutic dose of Iodine 131 16012-00 Administration of a therapeutic dose of Phosphorous 32 16015-00 Administration of a therapeutic dose of Strontium 89 16018-00 Administration of a therapeutic dose of 153 SM-Lexidronan 90960-00 Administration of a therapeutic dose of other unsealed radioisotope 15342-00 Construction and application of radioactive surface mould 15351-00 Construction and application of eye applicator 90765-00 Construction and fitting of immobilisation device, simple 90765-01 Construction and fitting of immobilisation device, intermediate 90765-02 Construction and fitting of immobilisation device, complex 90765-03 Construction and fitting of customised blocks 90765-04 Construction and fitting of treatment accessories 15500-00 Radiation field setting using simulator, simple 15503-00 Radiation field setting using simulator, intermediate 15506-00 Radiation field setting using simulator, complex 15506-01 Radiation field setting using dedicated CT scanner 15506-02 Radiation field setting for intensity modulated radiation therapy [IMRT] 15509-00 Radiation field setting using diagnostic x-ray unit 15550-00 Radiation field setting for three dimensional conformal radiation therapy [3DCRT] 15518-00 Dosimetry by CT interfacing computer, simple 15521-00 Dosimetry by CT interfacing computer, intermediate 15524-00 Dosimetry by CT interfacing computer, complex 15524-01 Dosimetry by CT interfacing computer for intensity mod radiation therapy [IMRT] 15527-00 Dosimetry by non-ct interfacing computer, simple 15530-00 Dosimetry by non-ct interfacing computer, intermediate 15533-00 Dosimetry by non-ct interfacing computer, complex 15536-00 Brachytherapy planning, simple 15536-01 Brachytherapy planning, intermediate 15536-02 Brachytherapy planning, complex 15539-00 Brachytherapy planning, prostate 15541-00 Brachytherapy planning, intravascular 15556-00 Dosimetry by CT interf computer for 3dim conformal rad therapy [3DCRT] 15556-01 Dosimetry by non-ct interfcomputer for 3 dim conformal rad therapy [3DCRT] 2014 2015-93 -
Appendix 12 *Excluding Mater Health Services 2014 2015 site specific grants HHS Site specific grant Total Cairns and Hinterland Children's Health Queensland Darling Downs Gold Coast Metro North Limited Indication Medication Scheme $355,633 HHS Total $355,633 Statewide Paediatric Epilepsy Service $179,031 Cochlear Implants - Bilateral $338,871 Paediatric Retrieval Service $459,735 Haemophilia Centre $550,815 Paediatric Retrieval Service $667,600 ECMO - Extracorporeal Membrane Oxygenation $837,437 Cystic Fibrosis $872,380 Cerebral Palsy Service $3,418,298 Statewide Children Services $3,717,000 Blood Clotting factors $5,219,864 PICU $7,380,000 Qld Paediatric Cardiac Service $8,081,477 HHS Total $31,722,509 Lithotripsy (inhouse) $84,800 HHS Total $84,800 Limited Indication Medication Scheme $418,745 Neonatal Intensive Care Units $459,767 Neurocoil Insertions $719,268 HHS Total $1,597,780 Paediatric and adolescent gynaecology $150,035 Lithotripsy (inhouse) $212,274 Lutate Therapy Treatment $375,686 Hyperbaric Services - Inpatients Only $457,929 ECMO - Extracorporeal Membrane Oxygenation $646,331 Nuclear Medicine (Cyclon Lab) $746,163 Bronchiectasis $798,749 Centre for Gynaecological Oncology $836,465 Neonatal Retrieval Service $866,089 Haemophilia Centre $894,891 Limited Indication Medication Scheme $936,937 Percutaneous Valve Replacement $1,006,500 Neurocoil Insertions $1,212,480 Maternal Fetal Medicine $1,807,793 Adult Congenital Service - Inpatient / Outpatient $1,878,280 Stents $1,987,231 PET Service $2,102,124 2014 2015-94 -
HHS Site specific grant Total Major Trauma Unit $2,278,906 Cardiac Ablations $2,524,481 Cystic Fibrosis $4,198,558 Genetic Health Queensland $5,214,400 Organ Transplant patients - Inpatients Only $5,295,813 Neurosurgery Unit $6,011,434 Neonatal Intensive Care Units $7,624,457 Blood Clotting factors $9,573,764 HHS Total $59,637,771 Deep Brain Stimulation Services $203,922 Oesophagectomy $479,016 Cardiac Ablations $500,665 Limited Indication Medication Scheme $502,948 Radical Peritonectomy Service $609,667 Base of Skull Surgery $873,440 Neurocoil Insertions $1,058,351 Metro South Respiratory Ventilation Unit - PAH $1,622,943 Brain Injury Rehabilitation - Inpatients Only $1,784,722 Stents $1,842,107 PET Service $1,955,204 Neurosurgery Unit $4,110,611 Qld Spinal Cord Injury $4,301,110 Major Trauma Unit $4,317,408 Organ Transplant patients - Inpatients Only $4,954,370 HHS Total $29,116,483 Cardiac Ablations $253,858 Neonatal Retrieval Service $377,363 Limited Indication Medication Scheme $795,785 Townsville Maternal Fetal Medicine $1,602,740 PET Service $1,659,969 Neonatal Intensive Care Units $2,154,732 Hyperbaric Services - Inpatients Only $2,173,782 HHS Total $9,018,229 Statewide Total $131,533,205 2014 2015-95 -
Appendix 13 2014 2015 clinical education and training grants Facility name Grant value Atherton Hospital $398,851 Bundaberg Base Hospital $4,945,536 Caboolture Hospital $4,346,333 Cairns Hospital $14,183,283 Caloundra Hospital $1,406,214 Gladstone Hospital $1,032,009 Gold Coast University Hospital $27,295,494 Gympie Hospital $389,358 Hervey Bay Hospital $4,141,935 Innisfail Hospital $654,023 Ipswich Hospital $8,650,894 Kingaroy Hospital $526,030 Logan Hospital $11,889,918 Mackay Base Hospital $6,878,255 Mareeba Hospital $496,473 Maryborough Hospital $804,336 Mater Adult Hospital $6,859,762 Mater Children s Hospital $5,999,862 Mater Mothers Hospital $2,524,434 Mount Isa Hospital $1,685,260 Nambour General Hospital $12,254,252 Princess Alexandra Hospital $30,190,526 Proserpine Hospital $428,838 Queen Elizabeth II Jubilee Hospital $4,616,218 Redcliffe Hospital $7,414,117 Redland Hospital $3,247,442 Robina Hospital $1,368,074 Rockhampton Hospital $7,780,765 Royal Brisbane & Women's Hospital $32,634,193 Royal Children's Hospital $6,641,705 The Prince Charles Hospital $13,109,584 The Townsville Hospital $19,250,791 Toowoomba Hospital $7,578,539 Warwick Hospital $401,537 2014 2015-96 -
Appendix 14 (excludes mental health specialist hospitals) Hospital Block funded hospitals Service Grouping ASGS Region Alpha Hospital Group B Very remote Augathella Hospital Group C Very remote Ayr Hospital Group G Outer regional Babinda Hospital Group F Outer regional Bamaga Hospital Group D Very remote Baralaba Hospital Group A Outer regional Barcaldine Hospital Group E Very remote Beaudesert Hospital Group G Inner regional Biggenden Hospital Group C Outer regional Biloela Hospital Group F Outer regional Blackall Hospital Group C Very remote Blackwater Hospital Group D Outer regional Boonah Hospital Group F Inner regional Bowen Hospital Group F Outer regional Capricorn Coast Hospital Group G Inner regional Charleville Hospital Group F Very remote Charters Towers Hospital Group F Outer regional Charters Towers Rehabilitation Unit Group F Outer regional Cherbourg Hospital Group F Outer regional Childers Hospital Group D Inner regional Chinchilla Hospital Group F Outer regional Clermont Hospital Group D Remote Cloncurry Hospital Group E Remote Collinsville Hospital Group C Remote Cooktown Hospital Group F Remote Cunnamulla Hospital Group D Very remote Dalby Hospital Group G Inner regional Dirranbandi Hospital Group B Very remote Doomadgee Hospital Group D Very remote Dysart Hospital Group D Outer regional Eidsvold Hospital Group B Outer regional Ellen Barron Family Centre Group F Major cities Emerald Hospital Group G Outer regional Esk Hospital Group E Inner regional Gatton Hospital Group E Inner regional Gayndah Hospital Group C Outer regional Gin Gin Hospital Group D Outer regional 2014 2015-97 -
Hospital Service Grouping ASGS Region Goondiwindi Hospital Group G Outer regional Gordonvale Hospital Group D Outer regional Herberton Hospital Group F Outer regional Home Hill Hospital Group C Outer regional Hughenden Hospital Group C Very remote Ingham Hospital Group F Outer regional Inglewood Hospital Group C Outer regional Injune Hospital Group C Very remote Jandowae Hospital Group C Outer regional Joyce Palmer Health Service Group F Remote Julia Creek Hospital Group B Very remote Kilcoy Hospital Group D Inner regional Laidley Hospital Group F Inner regional Longreach Hospital Group F Very remote Maleny Hospital Group F Inner regional Miles Hospital Group D Outer regional Millmerran Hospital Group D Inner regional Mitchell Hospital Group C Very remote Monto Hospital Group C Outer regional Moranbah Hospital Group E Outer regional Mornington Island Hospital Group D Very remote Mossman Hospital Group F Outer regional Mount Morgan Hospital Group E Inner regional Moura Hospital Group C Outer regional Mundubbera Hospital Group C Outer regional Mungindi Hospital Group C Remote Murgon Hospital Group E Outer regional Nanango Hospital Group D Inner regional Normanton Hospital Group C Very remote Oakey Hospital Group C Inner regional Quilpie Hospital Group C Very remote Richmond Hospital Group C Very Remote Roma Hospital Group G Outer regional Sarina Hospital Group E Outer regional Springsure Hospital Group C Remote St George Hospital Group F Remote Stanthorpe Hospital Group F Outer regional Surat Hospital Group C Remote Tara Hospital Group D Outer regional Taroom Hospital Group C Remote 2014 2015-98 -
Hospital Service Grouping ASGS Region Texas Hospital Group B Outer regional Theodore Hospital Group B Outer regional Thursday Island Hospital Group G Very remote Tully Hospital Group F Outer regional Weipa Hospital Group F Very remote Winton Hospital Group C Very remote Wondai Hospital Group B Outer regional Woorabinda Hospital Group C Remote Wynnum Hospital Group G Major cities 2014 2015-99 -
Appendix 15 Activity based funding and non-activity based funding budgeted services Service type Description Service examples ABF (List not exhaustive for each service type) ABF activity delivered by ABF facilities (unless specifically excluded below as non-abf e.g. deprec., patient travel) ABF equivalent activity provided by an Outsourced provider ABF equivalent activity in block funded public facilities Aged care assessment Queensland Health facilities: all activities undertaken by ABF facilities within Queensland Health. Note: the only HHS expenses to be excluded are those specifically identified below as being non-abf (e.g. deprec, research, screening programs etc. ) Private facilities: services provided by contract with a private provider that otherwise would equal ABF activity if delivered in an ABF facility e.g. Noosa Hospital contracted services. Non-ABF Hospital services provided by an outsourced provider that otherwise would equal ABF activity if delivered in an ABF facility e.g. Noosa Hospital contracted services. From 2014 2015, outsourced public activity (ABF equivalent) is considered an ABF expense. ABF equivalent hospital services provided in small facilities i.e. IHPA in and out of scope facilities. This includes: specialist mental health psychiatric hospitals facilities previously defined as community service obligations (CSOs) Services provided under the Commonwealth Aged care # ABF facilities within Queensland Health this will include all operational costs associated with the functioning of the facility: inpatient and outpatient services clinical support HITH staff development/training education non- clinical support service hotel services (e.g. cleaning, catering and wardspersons) business management (incl. finance, HR, media staff, etc.) facility and grounds management and maintenance including (as overheads) any appropriate share of HHS management costs. * Activity (public) outsourced to private providers e.g. Noosa Hospital. Category unavailable for 2014 2015. The Park Baillie Henderson Kirwan Rehabilitation Unit 86 small Rural hospitals 2014 2015-100 -
Service type Description Service examples (List not exhaustive for each service type) program assessment program. Alcohol, tobacco and other drugs Care co-ordination Services targeted at the treatment of substance abuse and misuse. Services principally targeted to the co-ordination of care services not specified in other services. Includes contractual arrangements for the provision of interim care. Child and youth Services provided principally for a child or a young person under 18 years of age. While the service may be provided to a parent or guardian, the primary focus is on the health and development of the child or young person. Chronic disease Commercial businesses and activities Excludes oral health services (refer to oral health category) and mental health services to clients under 18 years (refer to community mental health child and youth). Services targeted at early identification and management of people with chronic disease. Costs associated with the operation of commercial businesses and activities that are off-set by revenue sources external to the HHS. Includes: user pays activities (e.g. canteen, cafeterias, car parking etc.) costs recovered either from outside entities or other HHSs for recovery of salaries or consumables. Excludes: HHS expenses offset by internal re-distribution practices. Opioid treatment program Needle and syringe program Counselling Residential rehabilitation and detox Police diversion Consultation and liaison Liaison services, including: Indigenous liaison officers Community hospital interface program (CHIP) interim care and post-acute services Community clinic services Child development assessment Treatment Rehabilitation Hearing screening Child protection services Parenting support programs School based health nurses Cafeterias and canteens Recoveries of staff or clinical support (e.g. equipment hire or supplies) Carparks All trust accounts Foundation costs Commonwealth home and Services provided under the HACC program.these services are Nursing personal care 2014 2015-101 -
Service type Description Service examples (List not exhaustive for each service type) community care (HACC) program provided under the contractual arrangement with the Commonwealth principally for people 65 years and older (50 years and older for people from an Aboriginal and Torres Strait Island background). It includes direct service delivery and purchased services from a non-government provider. Domestic assistance Respite Allied health Communicable diseases Community allied health Community care programs (Department of Communities, Child Safety and Disbility Services funded) Community mental health adult and older persons Surveillance, screening and treatment of communicable diseases/infectious diseases. Allied Health services for people 18 years and older provided in the community or in a clinic setting. Excludes Tier 2 clinics which are aligned to primary healthcare. Services provided under the State Government community care program. These services are provided under a contractual arrangement with the Department of Communities Child Safety and Disability services. It includes direct service delivery and purchased services from a non-government provider. (excludes mental health services). Specialised mental health care provided in the community by community and hospital based community/ambulatory care services for people aged 18 years and older. Includes immunisations relevant for this service. Physiotherapy Audiology Exercise physiology Psychology Occupational therapy Dietetics and nutrition Podiatry Orthotics and prosthetics Social work Speech pathology Services provided primarily to persons under 65 years or 50 years and younger for people from an Aboriginal and Torres Strait Island background. Multidisciplinary community care services Acute care services Community forensic outreach services Services providing assessment, diagnosis, treatment, rehabilitation and care of non-admitted patients, including but not limited to case management, crisis assessment and treatment services Mobile intensive rehabilitation treatment teams 2014 2015-102 -
Service type Description Service examples (List not exhaustive for each service type) Community mental health child and youth Community palliative care Community rehabilitation Consumer information services (statewide) Specialised mental healthcare provided in the community by community and hospital based community/ambulatory care services for people under the age of 18 years of age. Palliative care services provided in the community. Includes consultation and liaison services, care services purchased through non-government providers, palliative care equipment hire services. Rehabilitation services for people over the age of 18 years often following a hospital event includes specialist rehabilitation programs. These services will tend to include involvement of multidisciplinary teams. These services may be delivered by a HHS for the whole state. Services aimed at providing clinical advice and general information to the public. Services may be delivered by registered nurses, allied health professionals and/or administration officers. The services will often be supplemented with online access options for consumers and are generally primary or preventative health orientated. Older persons psychiatric teams Mobile assessment and treatment services Outreach and consultation liaison. Includes forensic and prison services Multidisciplinary child and youth mental health services Adolescent day programs services providing assessment, treatment, rehabilitation or care of nonadmitted inpatients, including but not confined to crisis assessment and treatment services, mobile assessment and treatment services Child and youth forensic outreach services Cardiac and respiratory General, including community rehabilitation Heart failure Acquired brain injury Transitional rehabilitation Spinal outreach program 13 HEALTH (13 43 25 84) Quitline (13 7848) Child health information line Queensland poisons information centre Environmental health Public health initiatives to safeguard the community from potential harm or illness caused by exposure to environmental hazards or harmful practices. Food safety Water and waste Health risk assessment of environmental hazards 2014 2015-103 -
Service type Description Service examples (List not exhaustive for each service type) Home care packages Services provided under the Commonwealth Home care package program formerly known as community aged care packages and extended aged care at home packages. Includes community care services provided as part of an MPHS. Disability residential care services Non-admitted residential services targeted specifically for people under the age of 65 years typically with a physical, mental or cognitive disability. Maternal health Services provided principally for women up to six weeks after birth. Postnatal care (including home visits under the mums and bubs election commitment) Offender health services Oral health Health services specifically targeted at offenders. Oral health services provided to eligible children and adults via community and school-based mobile and fixed public dental clinics, including health promotion and disease prevention activities. Universal postnatal contact service (mums and bubs) General dental services Emergency dental services Specialist dental services Preventative health services Services targeted at the broader population to improve health. Includes services with a statewide or HHS area focus. Excludes small group or individual services and services required to be provided under a NPA or legislation. Primary healthcare Research Residential aged care Screening programs General practitioner type services, including services to Medicare ineligible clients. Services targeted at establishing or examining a body of knowledge or practice includes education specific services. Costs associated with the operation of state government operated residential aged care facilities (excludes multi-purpose health services) Specific screening service programs (excludes opportunistic screening services, mental health, child and youth). Refugee health Indigenous services Primary care clinics (out of scope Tier 2 clinics) Breast Bowel 2014 2015-104 -
Service type Description Service examples (List not exhaustive for each service type) Sexual health Services targeted specifically at sexual health. Sexual assault services Statewide functions Transition care Women s and men s health Depreciation Home and community medical aids and appliances Costs associated with specifically negotiated Statewide non-abf functions. Any costs aligned to this category will require endorsement by the department. Services provided under the Commonwealth/State funded Transition care program. Health services targeted to women or men for specific gender related health issues. As defined by the general ledger account codes for depreciation As defined by the general ledger account codes for medical aids and appliances. Aids and appliances refers to equipment provided by health services to people on a temporary or permanent basis to: (a) assist with their discharge from hospital, and/or (b) prevent readmission to hospital, and/or (c) support treatment or rehabilitation in the home or community setting, and/or (d) assist with managing a permanent health condition or disability Complex sexually transmissible infections Non-stable HIV Post-exposure prophylaxis Viral based services, including Hepatitis C treatment Cunningham Centre Queensland Centre for Mental Health Research Queensland Centre for Mental Health Learning Queensland Cancer Control Analysis Team Clinical networks chairs Organ/tissue donor retrievals Includes costs of direct service provision as well as any contractual arrangements. Family planning Breast health, gynaecological care, female genital mutilation and gynaecological oncology in outpatient clinics. Specific services may include early pregnancy clinic, fertility and reproductive endocrinology, urogynaecology sexual health and menopausal health Advice re. vasectomy, male infertility, penile and testicular problems, sexual function and dysfunction, sexual health and the prostate Spinal-cord injury response Queensland artificial limb service (QALS) Spectacle supply scheme Aids and appliances include, infusion pumps and long term ongoing requirements include wheelchairs, wheeled walkers, continence products, oxygen, artificial limbs etc. Cystic fibrosis program Excludes palliative care equipment hire (refer to palliative care). 2014 2015-105 -
Service type Description Service examples (List not exhaustive for each service type) in the home environment in order to avoid hospitalisation or admission to residential aged care. Interstate patients Patient transport Aids and appliances may be supplied ad-hoc or where the condition is permanent and stabilised. As defined by the general ledger account codes for interstate patients. HHS payments to other jurisdictions (states) for services provided to Queensland residents. As defined by the General Ledger Account codes for patient travel i.e. cost of patient accommodation and transport to services provided by a Hospital and Health Service. Aeromedical services, including fixed wing Hospital based ambulance services Queensland Ambulance Service Administration of patient transport subsidy scheme 2014 2015-106 -
Abbreviations ABF ACH ACS ADL AIS ALOS AN-SNAP ANZICS AR-DRG CCC CCU CEO COAG CSO DQT DNW DOMSAC DRG DSS DVA ED EDIS ES FIM HBCIS HHS HITH HoNOS ICD Activity based funding Australian Classification of Health Interventions Australian Coding Standard Activity of Daily Living Access Improvement Service Average Length of Stay Australian National Subacute and Non Acute Patient Classification Australian and New Zealand Intensive Care Society Australian Refined Diagnosis Related Groups Corporate Clinic Code Coronary Care Unit Chief Executive Officer Council of Australian Governments Community Service Obligation Data Quality Team Did Not Wait Directors of Medical Services Advisory Committee Diagnosis Related Group Data Set Specification Department of Veterans Affairs Emergency Department Emergency Department Information System Emergency Services Functional Improvement Measure Hospital Based Clinical Information System Hospital and Health Service Hospital in the Home Health of the National Outcome Scales International Classification of Diseases 2014 2015-107 -
ICU IHPA LOS MAC MBS MDB MDC MVA NABF NEC NEP NHCDC NHRA NICU NoF NSW NWAU OSR PHEC PICU QABF QHAPDC QIP Qld QWAU REDIS RUG SCN SEP SNAP SPP SSG Intensive Care Unit Independent Hospital Pricing Authority Length of Stay Monthly Activity Collection Medical Benefit Scheme Major Diagnostic Block (used in Urgency Related Groups URGs) Major Diagnostic Category Motor Vehicle Accident National Activity Based Funding National Efficient Cost National Efficient Price National Hospital Cost Data Collection National Health Reform Agreement Neonatal Intensive Care Unit Neck of Femur New South Wales National Weighted Activity Unit (applicable nationally) Own Source Revenue Public Hospital Establishments Collection Paediatric Intensive Care Unit Queensland Activity Based Funding Queensland Health Admitted Patient Data Collection Quality Improvement Payment Queensland Queensland Weighted Activity Unit Rural Emergency Department Information System Resource Utilisation Groups Special Care Nursery State Efficient Price Sub and Non-Acute Patient Special Purpose Payments Site Specific Grants 2014 2015-108 -
TTR UDG UoW URG WAU Teaching Training Research Urgency Disposition Groups University of Wollongong Urgency Related Groups Weighted Activity Unit (used in Queensland Health) 2014 2015-109 -
References and resources Qld ABF Intranet site http://qheps.health.qld.gov.au/abf/ Monthly Activity Collection Manual http://qheps.health.qld.gov.au/hsu/manuals.htm Queensland Health Admitted Patient Data Collection Manual http://qheps.health.qld.gov.au/hsu/manuals.htm Service Agreements National Health Reform Agreement http://www.publichospitalfunding.gov.au/national-health-reform/agreement IHPA Independent Hospital Pricing Authority (IHPA) http://www.ihpa.gov.au/internet/ihpa/publishing.nsf National Health Performance Authority (NHPA) http://www.nhpa.gov.au/internet/nhpa/publishing.nsf National Classification systems (AR-DRG, URG, UDG, Tier 2, AN-SNAP) IHPA Site http://www.ihpa.gov.au/internet/ihpa/publishing.nsf/content/classifications National Efficient Price (NEP) and National Efficient Cost (NEC) http://www.ihpa.gov.au/internet/ihpa/publishing.nsf/content/pricing-lp Tier 2 Non-admitted Services Definitions Manual 2013 2014 V2.0 http://www.ihpa.gov.au/internet/ihpa/publishing.nsf/content/non-admitted-care Tier 2 Non-Admitted Services Compendium 2014-2015 http://www.health.qld.gov.au/system-governance/health-system/managing/agreementsdeeds/default.asp http://www.ihpa.gov.au/internet/ihpa/publishing.nsf/content/tier2-nonadmitted-services-compendium-2014%e2%80%932015-html 2014 2015-110 -