APR-DRG Weights and ALOS for Acute Services

October 1, 2015 Update for ICD-10

Effective for discharges on or after October 1, 2015, version 33 of the 3M All Patient Refined Diagnosis Related Groups (APR-DRG) will be utilized for Medicaid, Workers Compensation and No-Fault. Since there are no changes to the APR-DRGs in v33 as compared to v31 and v32, the APR-DRG weights and outlier thresholds that were effective July 1, 2014 will remain in effect for the payment of these claims. Please refer to "Final APR-DRG Weights effective July 1, 2014 (version 31)" for the weights and outlier thresholds utilized effective October 1, 2015.

In addition, since the grouping is developed by 3M using clinical logic, if a claim does not group to an APR-DRG as the provider expects it to group, the provider will need to contact 3M to discuss the grouping logic. If 3M does determine, based on their clinical review, that the grouping should be revised, the Department is requesting the provider submit an email to hospffsunit@health.ny.gov informing the Department about the grouping logic discussion with 3M and the outcome for informational purposes.