Most Frequent Diagnoses and Procedures for DRGs, by Insurance Status

Below is a summary of HCUP-3 Research Note 4 (AHCPR Pub. No. 97-0006), which is available from the AHCPR Publications Clearinghouse. Call toll free 800-358-9295.

Overview

This publication contains information on the most frequent diagnoses and procedures for the top 50 diagnosis-related groups (DRGs) in 1992. It helps to answer questions such as "What diagnoses appear for the top ranking DRGs?" and "What procedures are performed for these DRGs?" The five most common principal diagnoses and the five most commonly performed principal procedures are listed for each DRG. Resource use (mean and median charges and length of stay), along with estimates of standard errors, are given for each DRG-diagnosis and DRG-procedure combination. Results are provided for all patients combined and for three insurance-status groups: the privately insured, Medicaid, and self-pay patients.

Source of Data

The statistics given in this report are based on data on hospital inpatient stays from the 1992 Nationwide Inpatient Sample (NIS), a component of AHCPR's Healthcare Cost and Utilization Project (HCUP-3). The NIS is designed to approximate a 20-percent sample of U.S. community hospitals and contains records for all stays in the sampled hospitals. The 1992 NIS includes hospitals in 11 States.

Highlights

Examples of findings from this publication include:

• The top 10 DRGs overall are: normal newborn, vaginal delivery, heart failure, psychoses, cesarean section, neonate with significant problems, angina pectoris, specific cerebrovascular disorders, pneumonia, and hip/knee replacement. They comprise nearly 30 percent of all hospital discharges.
• Except for procedures related to childbirth, Major joint and limb reattachment procedures of the lower extremity (DRG 209) is the most common major surgical DRG.
• Resource use (length of stay and total charges) can vary considerably within a DRG, depending on the types of procedures performed. For example, the fourth most frequent DRG overall is DRG 430, Psychoses. Patients who receive electroshock therapy have mean total charges of $21,051—more than twice as high as charges for patients with no procedure ($9,100) or individual psychotherapy ($9,869).

How Can This Information Be Used?

A variety of studies can use the information in this publication. Medical professionals can compare their own practices to a nationwide sample. Third-party payers and managed care organizations can use this information as a starting point for examining the impact of payment policies and insurance status on practice patterns. Numerous topics warranting additional study by health services researchers can be identified, including the following:

• Examine the top 10 DRGs (which comprise nearly 30 percent of all hospital discharges) or the top 15 (which comprise over one-third of the total). Understanding these DRGs can provide insight into a significant proportion of discharges in all insurance-status groups.
• Investigate differences in the most common DRGs according to patients' insurance status.
• Examine the variety of diagnoses that fall under a particular DRG.
• Compare and contrast resource use among the top five diagnoses for each DRG to discern particularly resource-intensive applications of each DRG that can be targeted for further investigation. Some DRGs comprise diverse conditions with different resource use.
• Compare and contrast resource use among the top five procedures for each DRG to reveal the differences in costs for various treatments.

More Diagnosis-Procedure Information

Diagnosis and Procedure Combinations in Hospital Inpatient Data contains information on the most frequent combinations of diagnoses and procedures for inpatients in U.S. community hospitals. The analysis is based on data from the 1992 NIS.

For More Information About the NIS

Contact:

Agency for Health Care Policy and Research
Healthcare Cost and Utilization Project
540 Gaither Road, Suite 5000
Rockville, MD 20850
Phone: 866-290-HCUP (4287), toll-free
E-mail: hcup@ahrq.gov

Current as of November 1998

Internet Citation:

Most Frequent Diagnoses and Procedures for DRGs, by Insurance Status. Abstract of Research Note 4, Healthcare Cost and Utilization Project (HCUP-3). Agency for Health Care Policy and Research, Rockville, MD. http://www.hcup-us.ahrq.gov/reports/natstats/rn4.htm

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