At Risk DRGs

FMQAI Statewide problematic DRG's (based on data mining)
  • 478 - Other Vascular Procedures w/Complication/Co-morbidity
  • 143 – Chest Pain
  • 182 – Esophagitis, Gastroenteritis and Misc. Disorder
  • 125 – Circulatory Disorders Except AMI …
  • 001 – Craniotomy Age>17 except for Trauma
  • 315 – Other Kidney and Urinary Tract or Procedure
  • 120 – Other circulatory system or procedure
  • 296 – Nutritional and Misc. Metabolic Disorders …
  • 320 – Kidney and Urinary Tract Infections age >17
  • 079/089 -Simple vs Complex Pneumonia
  • 16 – Other Permanent Cardiac Pacemeaker Implant or PTCA with Coronary Artery Stent Implant
  • 316 – Renal failure
  • 243 – Medical Back Problems
  • 294 – Diabetes Age >35
    Professionals/Providers
    Case Review
    Home Health
    Hospital
    Nursing Home
    Physician Practice
    Pharmacy QIOSC
    Hospital Payment Monitoring Program (HPMP)
    HOP QDRP
    8th Statement of Work Archives
    9th Statement of Work