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DHBNZ - NZHIS

WIES8C Methodology

and

Casemix Purchase Unit Allocation

Recommended for the

2003/2004 Financial Year

Frozen Specification for implementation on NMDS

This version: 12 March 2003, based on the 2002/2003 document

Authors: The DHBNZ SFG Cost Weights Project Group

1 Table of Contents

1 PREAMBLE...... 4

2 CHANGES EFFECTED IN THIS VERSION...... 4

3 INTRODUCTION...... 5

3.1 BACKGROUND...... 5 3.2 CHANGES FROM THE WIES8B VERSION FOR THE 2002/2003 FY...... 6 3.2.1 Propagation of the current exclusion framework...... 6 3.3 AREAS FOR CHANGE IN THE FUTURE...... 6 3.3.1 Exclusion rule Post Natal Early Intervention...... 6 3.3.2 Neonatal CPAP...... 6 3.3.3 Other possible exclusions...... 6 3.3.4 Maternity/Obstetrics Purchasing...... 6 4 WIES8C CALCULATION...... 8

4.1 DERIVED VARIABLES REQUIRED IN CALCULATION...... 8 4.1.1 Length of Stay...... 8 4.1.2 Reallocated DRG...... 8 4.2 DRG REALLOCATIONS...... 8 4.2.1 AR-DRG A04, Bone Marrow Transplants...... 9 4.2.2 Adjustment for Peritoneal Dialysis...... 9 4.2.3 Adjustment of medical AR-DRGs with radiotherapy...... 9 4.2.4 All other AR-DRGs...... 9 4.3 ADJUSTED MECHANICAL DAYS...... 9 4.3.1 DRGs excluded from mechanical ventilation days...... 10 4.3.2 Calculation of mechanical ventilation days from hours...... 10 4.4 GENERAL CALCULATION...... 10 4.4.1 Calculating WIES8C...... 12 4.4.2 Copayment for Mechanical Ventilation...... 12 4.4.3 Base WIES...... 13 4.4.4 Final WIES weight...... 16 5 PURCHASE UNIT ALLOCATION...... 17

5.1 DERIVED VARIABLES REQUIRED IN ALLOCATION...... 17 5.1.1 Patient’s Age...... 17 5.1.2 Length of Stay...... 17 5.2 EXCLUSIONS FROM CASEMIX PURCHASING...... 17 5.2.1 Neonatal Inpatient Casemix...... 17 5.2.2 Non - Medical/Surgical Events...... 18 5.2.3 Maternity Inpatient Casemix...... 18 5.2.4 Amniocentesis...... 19 5.2.5 Chorion Villis Sampling...... 19 5.2.6 Rhesus Isoimmunisation...... 19 5.2.7 Breast feeding / Lactation...... 19 5.2.8 Birth weight...... 20 5.2.9 Non Base Funding Purchases...... 20 5.2.10 Designated Hospital Casemix Revenue...... 20 5.2.11 Non-Treated Patients...... 22 5.2.12 Error DRGs...... 23 5.2.13 Some Transplants...... 23 5.2.14 Some Spinal Injuries...... 23 5.2.15 Surgical Termination of Pregnancy...... 23 5.2.16 Renal and Peritoneal Dialysis...... 23 5.2.17 Sameday Chemotherapy & Radiotherapy...... 23 5.2.18 Sleep Apnoea...... 23

2 5.2.19 Lithotripsy...... 24 5.2.20 Colposcopies...... 24 5.2.21 Cystoscopies...... 24 5.2.22 ERCPs...... 25 5.2.23 Colonoscopies...... 25 5.2.24 Gastroscopies...... 26 5.2.25 Bronchoscopies...... 27 5.2.26 Day Case Blood Transfusions...... 27 5.3 MAPPING OF HEALTH SERVICE SPECIALITY CODES TO CASEMIX PUS...... 27 APPENDICES...... 30

5.4 SPREADSHEET CONTAINING 03/04 FY DRG WEIGHTS AND ASSOCIATED VARIABLES FOR CALCULATING WIES8C...... 30 5.5 SAS CODE FOR DERIVATION OF WIES8C...... 51

3 4 1 Preamble Since publication of the last version of this document, DHBs have continued to make developmental progress and the Ministry of Health (MoH) has pulled back from any formal involvement in pricing while maintaining an interest in benchmarks for prices and service provision. DHBs coordinate activities of particular sector-wide interest through DHBNZ.

DHBNZ has formed the Service Framework Group (SFG) which has developed a work program that recognises the NZ Health Strategy and the new funding environment. There is a Cost Weights project group operating as part of SFG, which will undertake work similar to that of its predecessor groups, namely pricing and cost weights for casemix purchasing, including the maintenance of this document jointly with the New Zealand Health Information Service (NZHIS).

In turn, NZHIS and DHBs maintain contact with the National Data Policy Group (NDPG) who may also provide commentary on the content of future versions of this document.

2 Changes effected in this version This version includes the following changes: o Addition of a new purchaser code (20) for overseas residents who meet the eligibility criteria for publicly funded health services (includes students from and country with a valid visa and patients from countries with reciprocal agreements). Events with these purchaser codes are included in casemix;

o A modification to the definition of discharge type DA to include “discharges to an acute facility where the patient is being transferred within 5 days of admission and has a principal diagnosis of stroke or the discharge is directly due to the need for immediate treatment at a neonatal facility, or a specialist burns unit, or a multiple trauma unit”;

o Addition of the mobile surgical bus to the lists of agencies and of facilities which generate purchaser units. Hence these will not count as casemix purchases for any DHB;

o Modifications to allow casemix funding for maternity events, arising from the report of the SFG Maternity project group; and

o Reallocation of very low birthweights, ie under 400g, to 400g so that these events will then fall into a casemix funded DRG.

Some effort has been made to streamline the new version, in part by removing historical references. Those interested in maintaining a history of casemix purchasing in New Zealand should maintain a library of successive editions of this document.

5 3 Introduction This report specifies the final version of the 2003/2004 Financial Year1 (03/04 FY) WIES8C methodology for casemix purchasing recommended for use by DHBNZ. It is the same as the document for the 02/03 and is again based on the DRG schedule, AR-DRG 4.2. The cost weights used in the 02/03 FY will continue to be used on AR- DRG 4.2, but will now apply to maternity events as outlined in section 5.3 of this document. The current cost weights applied to AR-DRG 4.2 and based on this set of rules will be referred to as WIES8C. This is the recommended framework to be used in New Zealand from 1 July 2003.

The intent of this document is to specify the casemix methodology used by DHBs so that case weighted discharges can be calculated for all National Minimum Data Set (NMDS) events by NZHIS. Further variables are also required to identify casemix purchased Purchase Units (PUs), case complexity (for future costing work) and the costweight version used. A secondary purpose of this document is to provide a definitive explanation of casemix purchasing for use throughout the health sector. As such, additional information beyond that required by NZHIS for implementation on the NMDS is provided both as a background and to identify areas that may be subject to revision for future funding arrangements.

This specification is described as much as possible in plain English. There are, however, references to lists of International Classifications of Diseases (ICD-10-AM edition 2), Diagnostic Related Groupings (DRGs2) and other lists of coded variables from the Data Dictionary for the NMDS. Such lists, including logical conjunctions of different sets of variables, are provided to exactly identify what is included (or excluded) in the English definition.

Note that the terms Hospital and Health Service (HHS) and DHB provider arm will be used interchangeably throughout this document.

3.1 Background DHBs have inherited former HFA and MoH funding arrangements in the guise of a funding package, which takes the form of a service level agreement between a DHB and its provider arm from the 02/03 FY. Effectively, DHBs purchase a range of inpatient events (principally Medical/Surgical events) from their provider arms. This document extends the existing casemix methodology, known as Weighted Inlier Equivalent Separations (WIES), Version 8 with Amendments for New Zealand (WIES8C). DHBs are required to construct a price volume schedule. The casemix PUs appearing in this schedule will consist of casemix events contracted for via Purchase Units (PUs) derived from a mapping of Health Service Speciality codes. See 5.3.

1 Financial Years run from 1 July through to 30 June of the following calendar year and are abbreviated by stringing together the last two digits of the portions of calendar years in question, i.e. 98/99, 99/00, 00/01 represent the 3 consecutive financial years from 1 July 1998 through 30 June 2001. 2 Two slightly different DRG versions are in use within the methodology. The DRG version currently in use within the NZ health sector is AR-DRG version 4.2 and all DRG tests on NMDS events refer to this version. However, for the purposes of applying costweights, some AR-DRGs are not clinically homogeneous and in these cases an AR-DRG may be reallocated to a different ‘WIES’ DRG. The WIES DRGs contain all the AR-DRGs as well as two additional DRG codes (not used in AR-DRG) for the purpose of applying the appropriate costweights to NMDS events.

6 3.2 Changes from the WIES8B version for the 2002/2003 FY Following is a list of the changes made to the exclusion rules . the addition of the Mobile Surgical Bus to both the agency and facility list – the code is 8656. See 5.2.10; . the addition of a new purchaser code (20) for overseas residents who meet the eligibility criteria for publicly funded health services; . modifications to allow for casemix funding for maternity events. See 5.2.3 – 5.2.7; . Re-allocation of very low birth weights, those under 400g, to 400g so that some casemix funding will be obtained for previously ungroupable events. See 5.2.8.

3.2.1 Propagation of the current exclusion framework This document continues the framework developed over the last two years, but updates that documentation for the introduction of a maternity casemix purchase framework. The intent of the Cost Weights project group in making these changes has been to preserve the current intent of the exclusion rules, with the addition of maternity cases. Hence all existing exclusions from casemix remain. Any significant alteration to these exclusions needs to be considered formally in a future project.

3.3 Areas for change in the future

3.3.1 Exclusion rule Post Natal Early Intervention A Health Speciality code to identify Post Natal Early Intervention cases was approved by the (NDPG) for implementation from 1 July 2000. The new health speciality code, P50, is excluded from casemix Purchase Unit allocation; see 5.2.2.

3.3.2 Neonatal CPAP A field recording this variable was introduced to the NMDS from 1 July 2001 and HHSs are required to submit CPAP hours for neonates. For the 02/03 and 03/04 FY this field will not be used for calculations that make adjustments to the costweight for an event. It will, however, form the basis of a future study of CPAP utilisation and whether or not any supplementary payment is required for the use of CPAP for neonates.

3.3.3 Other possible exclusions Subject to changes on the NMDS, it may be possible to identify additional cases that require exclusion from casemix Purchase Unit allocation, eg. CAPD & MUDS.

3.3.4 Maternity/Obstetrics Purchasing The SFG Maternity project has recommended the introduction of a casemix framework for that service, and this framework will be trialed by some DHBs in 03/04. This revision includes a set of exclusion rules for the new Maternity framework that will be reviewed for effectiveness next year. In addition, the NDPG has noted some discrepancies in discharge practices between DHBs that may also be reviewed at that time or possibly during the next review of cost weights and the coding classification in use.

7 Note that in the body of this document Pregnancy and Childbirth is used rather than Maternity/Obstetric.

3.3.5

8 4 WIES8C calculation The following section describes the derived variables required, the DRG reallocation tests applied (AR-DRG => WIES DRG), the Mechanical Ventilation calculation, the matching of events with appropriate costweights and the WIES8C case weight calculation. In what follows the phrases case weight, cost weight, and costweight may be used interchangeably.

4.1 Derived variables required in calculation The following derived variables are used in the WIES8C calculation.

4.1.1 Length of Stay The Length of Stay (LOS) calculation used in the methodology is specific for use within the WIES8C calculation. This is because it has a maximum and minimum applied to it, as well as having any Event Leave Days subtracted. A maximum of 365 days applies as the methodology is used for calculating the costweight associated with a particular year. A minimum of 1 day is applied to deal with the few cases where Event Leave Days are equal to the difference between the admission and discharge dates (Note: this does not affect the LOS comparison with low boundary points as the WIES DRG boundary points are integer and the tests for whether an event is same or one day use date tests rather than the LOS). Hence, the calculated LOS equals the difference in integer days between the discharge and admission dates, minus any Event Leave Days. Further, this is set to 365 if the LOS is greater 365 or is set to 1 if the LOS=0.

4.1.2 Reallocated DRG As in previous years a number of adjustments are to be made to the original AR-DRG 4.2 grouping by utilising the WIES DRG field, prior to the calculation of WIES8C. Most of the former AN-DRG 3 adjustments applied in earlier versions of WIES, namely Cerebral Infarction, Neonates, Transvascular Percutaneous Cardiac Intervention (Stents) and Chemotherapy, are no longer required as the modification has been included within AR-DRG 4.2. However, WIES DRGs are still required for Peritoneal Dialysis (an exclusion in New Zealand), Radiotherapy (in Victoria) and Bone Marrow Transplants.

Details of the DRG splits prior to the case weight calculation are given below. These events, however, should not have the original AR-DRG overwritten (Note: the SAS code creates a new variable, DRG_NZ, to hold the WIES DRG appropriate for the case weight calculation). The WIES DRGs contain all the AR-DRGs as well as additional DRG codes (not used in AR-DRG) for the purpose of applying the appropriate costweights to NMDS events.

4.2 DRG Reallocations The following are the tests for the allocation of AR-DRGs to WIES DRGs for the purposes of the WIES8Ccase weight calculation. Note that with the introduction of AR- DRG 4.2 and improvements in the coding system, Victoria now only uses two DRG splits.

9 4.2.1 AR-DRG A04, Bone Marrow Transplants Bone Marrow Transplants have their AR-DRG 4.2 reallocated from A04Z to WIES DRG A04A if certain procedures were performed or to WIES DRG A04B if they were not. These are tested for by checking:

IF AR-DRG is equal to A04Z AND Any recorded procedure codes fall in the range: ICD-10-AM 2nd Edition Bone Marrow, any procedure in the range (13706-00, 13706-06,13706-09,13706-10). THEN DRG is reallocated to WIES DRG A04A. ELSE IF AR-DRG is equal to A04Z AND No recorded procedure falls in the above range THEN DRG is reallocated to WIES DRG A04B.

NB: 13706-00 and 13706-09 map to the ICD-10-AM 1st edition procedure code 13706-00 and 13706-06 and 13706-10 map to the ICD-10-AM 1st edition procedure code 13706-06.

4.2.2 Adjustment for Peritoneal Dialysis In recognition of cost differences between peritoneal and haemodialysis, episodes with a principal diagnosis of peritoneal dialysis (ICD-10-AM code Z49.2) are to be assigned a WIES DRG of L61Y. Note, however, that both dialysis DRGs are casemix exclusions in New Zealand; see 5.2.10 below.

4.2.3 Adjustment of medical AR-DRGs with radiotherapy3 Records with medical DRGs where radiotherapy (Z51.0) has been provided are mapped to AR-DRG R64Z (Radiotherapy). Medical DRGs are those where the number part of the DRG is greater than 60 (the format of a DRG is AnnA).

4.2.4 All other AR-DRGs All other AR-DRGs not reallocated in the above tests are given the same DRG number, ie. the WIES DRG is set to the same value as the AR-DRG.

4.3 Adjusted Mechanical Days The WIES8Ccalculation includes a component for Adjusted Mechanical Ventilation Days used to calculate the mechanical ventilation (MV) copayment. However, not all events are eligible for this component and a range of DRGs have their adjusted MV days set to zero.

4.3.1 DRGs excluded from mechanical ventilation days Each of the following AR-DRGs has their event’s Adjusted Mechanical Ventilation Days set to zero and are ineligible for a MV copayment.

3 This adjustment was added on 3 August 2001 by NZHIS. The adjustment was already in the SAS program but had been omitted from this documentation.

10 (A01Z, A02Z, A03Z, A04A, A04B, A05Z, A40Z, F02Z, F40Z, L61Y, P01Z, P02Z, P03Z, P04Z, P05Z, P60A, P60B, P61Z, P62Z, P63Z, P64Z, P65A, P65B, P65C, P65D, P66A, P66B, P66C, P66D, P67A, P67B, P67C, P67D, W01Z, 960Z, 961Z).

4.3.2 Calculation of mechanical ventilation days from hours For other AR-DRGs than above, Adjusted Mechanical Ventilation Days is calculated in the following way: If hours of ventilation are less than 6 then Adjusted Mechanical Ventilation Days is set to zero. If hours of ventilation are 6 or more then Adjusted Mechanical Ventilation Days are calculated by adding 12 hours to the hours reported, dividing the result by 24 and rounding (i.e. gives integer days, effectively rounded up).

4.4 General Calculation For the WIES8C calculation, each NMDS event is initially matched by its allocated WIES DRG to the file containing the WIES DRG costweights and other associated variables.

WIES DRGs are flagged as Sameday, Oneday or other DRGs in this file by the SOflag (Same Day/One Day WIES DRG Flag), and each has some slightly different tests. The methodology is the same as that used for the 01/02 FY, though slightly different from what has been used in the three years prior to 01/02. The development of the weight schedule has followed the same pattern as before, though the calculation has now been presented in an easier format. It uses per diem rates for both high and low outliers, inlier weight, a one day weight, and a same day weight which is usually equal to half the one day weight.

The base WIES score for sameday episodes (inlier and low outlier), one-day episodes (inlier and low outliers), and multiday inliers can be read directly from the WIES8 weights table using the appropriate column and row (WIES DRG4). The base WIES score for multiday low outliers can be calculated by multiplying the per diem weight given in the WIES8 weights table by the patient’s length of stay. The base WIES score for high outliers is obtained by multiplying the number of high outlier days by the high outlier per diem weight (from the WIES8 weights table and adding the multiday inlier weight (from table)). Technical details are provided in the following sections.

An event’s LOS is generally compared with the WIES DRG’s low and high LOS boundary points to determine an intermediate variable (IES) and which particular costweight should be applied to it. In the following sections, shortened variable names from the WIES DRG weights file are used. Note that in the following table VIC-DRG4 is synonymous with DRG_NZ and WIES DRG.

Variable Label Description (Column Heading) Victorian DRG VIC- Victorian modification to AR-DRG4.2. DRG4 Same day medical Sdmt VIC-DRG4s marked with a “Y” are classed as same day medical

11 Variable Label Description (Column Heading) target target VIC-DRG4s. VIC-DRG4s marked with “N” are not classed as same day medical target VIC-DRG4s. WIES for same day patients allocated to same day medical target VIC-DRG4s are calculated normally but the total WIES associated with same day patients in these VIC-DRG4s cannot exceed specified levels (usually 6.5% of total WIES). Excess same day medical target WIES are not funded. Mechanical Mv_elig This describes the way mechanical ventilation severity co-payments ventilation are made for the VIC-DRG4. Options are :- D: funded provided at least six hours of ventilation is provided. Patients attract a daily rate of 0.7729 WIES E: patients with a reported ICD-10-AM procedure code of 13382-02 are funded an additional 3.1323 WIES 4: funded for each day of mechanical ventilation after 4 days. Patients attract a daily rate of 0.7729 WIES. I: ineligible for mechanical ventilation co-payments Other co-payments Copay Some groups of patients attract additional funds in recognition of their (Only in Victoria, not higher costs. Options are:- in New Zealand) Thal: a co-payment of 0.2648 WIES is made to patients with a reported ICD-10-AM thalessaemia diagnosis code of D56.x or D57.2 (Note: These do not have to be principal diagnoses)

Low inlier boundary Lb The low length of stay boundary for inliers. Patients with a length of stay of less than the low boundary are classed as low outliers. For most VIC-DRG4s the low boundary has been set at a third of the estimated average length of stay for the VIC-DRG4. Boundaries are truncated to the whole number. High inlier boundary Hb The high length of stay boundary for inliers. Patients with a length of stay greater than the high boundary are classed as high outliers. For most VIC-DRG4s the high boundary has been set at three times the estimated average length of stay for the VIC-DRG4. Boundaries are rounded to the nearest whole number. Inlier average length i_alos The average length of stay (days) for inliers. of stay VIC-DRG4 Sd_od Flag for designated sameday (S) or one day (O) VIC-DRG4s designation Same day weight Sd The same day weight is used to allocate WIES to episodes where patients are admitted and separated on the same day. Depending upon the VIC-DRG4, same day patients may be either low outliers or inliers:- Designated Same day VIC-DRG4s The same day weight is based on the costs of same day patients. Non-Same Day VIC-DRG4s with a low boundary of zero days The same day weight is set at the multiday inlier weight. Non-Same Day VIC-DRG4s with a low boundary of 1 day The same day weight is set at half the multiday inlier weight Non-Same Day VIC-DRG4s with a low boundary of 2 days or more (low outliers) The same day weight is set at half of the multiday inlier weight divided by the low boundary (0.5´md_in ¸ lb) One day weight Od The one day weight is used to allocate WIES to episodes where patients have a length of stay of one but who were not separated on the same day as they were admitted. Depending upon the VIC- DRG4, one day patients may be either low outliers or inliers:- Designated Same day VIC-DRG4s The one day weight is based on the costs of all inliers excluding same day patients. If the patient is an inlier they attract the full multiday inlier weight. If the patient is a low outlier they attract the low outlier per diem weight.

12 Variable Label Description (Column Heading) Designated One day VIC-DRG4s The one day weight is based on the costs of patients with a length of stay of one day. Non-Same/One Day VIC-DRG4s with a low boundary of 1 day or less The one day weight is set at the multiday inlier weight. Non-Same/One Day VIC-DRG4s with a low boundary of 2 day or more (low outliers) The one day weight is set at the low outlier per diem weight. Low outlier multiday Lo_pd The low outlier multiday per diem weight is used to allocate WIES to per diem weight low outliers who have a length of stay of at least two days. Not all VIC-DRG4s have low outliers. No weight is reported in these cases. For most VIC-DRG4s the weight is derived as: md_in ¸ lb The WIES value is calculated by multiplying the low outlier multiday per diem weight by the patient’s length of stay. Inlier multiday weight md_in The inlier multiday weight is used to allocate WIES to inliers who have a length of stay of at least two days. For designated VIC-DRG4s, same day/one day patients are excluded when deriving the inlier multiday weight.

4.4.1 Calculating WIES8C To calculate the WIES weight allocated to a patient you need to:-  Calculate the WIES co-payment for MV(see box 1)  Calculate the base WIES allocation using the WIES DRG4 and the patient’s length of stay adjusted for mechanical ventilation per diem. This can be done using the appropriate weights from the WIES8C weights table.  Add the base WIES payment and co-payment (see box 3). The steps are described in detail below with technical specifications provided in the boxes.

4.4.2 Copayment for Mechanical Ventilation For 02/03 there is one co-payment, namely for mechanical ventilation. Technical specifications for mechanical ventilation co-payments are given in box 1.

To be eligible for a mechanical ventilation co-payment the patient must have had at least six hours of continuous mechanical ventilation and have been allocated to a WIES DRG4 that is eligible for a mechanical ventilation co-payment. WIES DRG4s are classed as either:

 Eligible for daily co-payments of 0.7729 WIES (mv_elig =“D” in the WIES8Cweights table);  Eligible for an episode WIES co-payment 3.1323 when the ICD-10-AM procedure code 13882-02 is present (mv_elig = “E” in the WIES8C weights table);  Eligible for daily co-payments at 0.7729 WIES for ventilated days in excess of four days (96 hours) mechanical ventilation (mv_elig = “4” in the WIES8C weights table); or  Ineligible for co-payments (mv_elig = “I” in the WIES8C weights table).

13 Box 1: Calculating Mechanical Ventilation Co-payments

Select mv_elig case “D” then if (hours on mechanical ventilation is greater than or equal to 6 )4 then Adjmvday = round((hours mechanical ventilation +12)/24) else adjmvday = 0 mv_copay = adjmvday ´ 0.7729 go to box 2b

case “E” then adjmvday = 0 If any procedure of 13882-02 mv_copay = 3.1323 else mv_copay = 0 go to box 2b

case “4” then if (hours on mechanical ventilation > 96) then adjmvday = round((hours mechanical ventilation +12)/24) - 4 else adjmvday = 0 mv_copay = adjmvday ´ 0.7729 go to box 2b otherwise do adjmvday = 0 mv_copay = 0 go to box 2b

Base WIES payments for high outliers are reduced when a patient receives daily mechanical ventilation co-payments. To make this reduction you will need to remember the number of days receiving mechanical ventilation co-payments (“adjmvday” in the technical specifications).

In 99/00 Victoria provided a hip revision copayment, however, this is no longer required as these are separately identified in AR-DRG 4.2 (I03A, I03B).

4.4.3 Base WIES To calculate a patient's base WIES you need to determine:  The patient’s WIES DRG4.  The patient’s length of stay (LOS).  The patient’s length of stay category (LOS_cat: “S”= same day, “O”= one day, “M”= multiday).  The number of mechanical ventilation co-payment days (“adjmvday” see box 2a).  The patient’s inlier status (“I”= inlier, “L”= low outlier, “H”= high outlier).

The patient’s length of stay and length of stay category are derived from the admission date, separation date and leave days. A maximum length of stay of one year (365 days) is used. This ensures that WIES are not allocated to extreme stays that are likely to represent non-acute care. Technical specifications are given in Box 2a.

4 This was changed to greater than or equal to 6 on 1 October 2001.

14 Box 2a: Determining Length of Stay Category and Maximum Length of Stay

Sameday='Y' if admission date = separation date Else sameday='N'

If (sameday = ‘Y’) then LOS_cat = “S” go to step/box 2b else if (sameday = ‘N’) and (LOS less than or equal to 15) then LOS_cat = “O” go to step/box 2b else LOS = min(LOS,365) LOS_cat = “M“ go to step/box 2b

The patient’s inlier status is determined by comparing the patient’s length of stay with the inlier boundaries for the WIES DRG4 to which the patient is allocated. The low inlier and the high inlier boundaries are given in the WIES8C weights table.

A patient is classified as an inlier when their length of stay is greater than or equal to the low inlier boundary and less than or equal to the sum of the high inlier boundary plus any mechanical ventilation co-payment days. Patients with a length of stay less than the low inlier boundary are classified as low outliers.

Patients with a length of stay greater than the sum of the high inlier boundary and mechanical ventilation co-payment days are classified as high outliers. Technical specifications are given in box 2b.

5 This was changed on 10 October 2001. It was less than one.

15 Box 2b: Calculate Inlier Status

If LOS < LB then Inlier = “L” go to box 2c else if LOS > (HB + adjmvday) then Inlier = “H” go to box 2c else Inlier = “I” go to box 2c

Separate columns occur in the WIES8C weights table for episodes which are  same day  one day  multiday low outliers  multiday inliers  high outliers.

The base WIES score for sameday episodes (inlier and low outlier), one day episodes (inlier and low outliers), and multiday inliers can be read directly from the WIES8C weights table using the appropriate column and row (WIES DRG4). The base WIES score for multiday low outliers can be calculated by multiplying the per diem weight given in the WIES8B weights table by the patient’s length of stay. The base WIES score for high outliers is obtained by multiplying the number of high outlier days by the high outlier per diem weight (from the WIES8C weights table and adding the multiday inlier weight (from table)). Technical details are provided in box 2c.

Box 2c: Calculate Base WIES

Select Inlier case “L” do select LOS_cat case “S” do base_WIES = sd IES = base_WIES ¸ md_in go to box 3 case “O” do base_WIES = od IES = base_WIES ¸ md_in go to box 3 case “M” do base_WIES = LOS ´ lo_pd IES = base_WIES ¸ md_in go to box 3 case “I” do IES=1 select LOS_cat case “S” do base_WIES = sd go to box 3 case “O” do base_WIES = od

16 go to box 3 case “M” do base_WIES = md_in go to box 3 case “H” do high_days = max(0, LOS - hb - adjmvday) base_WIES = Md_in + high_days ´ ho_pd IES = base_WIES ¸ Md_in go to box 3

High outlier days are days stayed in excess of the high outlier boundary plus any mechanical co-payment ventilation days (“adjmvdays” - see boxes 1 and 2b). Inlier Equivalent Separations (IES) can be calculated by dividing the base WIES by the multiday inlier weight.

4.4.4 Final WIES weight The WIES score is calculated by adding the base WIES and the co-payment WIES. Details are provided in box 3.

Box 3: Calculating WIES Score

WIES8C = base_WIES + mv_copay

17 5 Purchase Unit allocation The following section describes the derived variables required, the exclusion tests applied and the mappings used to allocate DHB casemix Purchase Units to NMDS events.

5.1 Derived variables required in allocation The following derived variables are required for casemix exclusion testing.

5.1.1 Patient’s Age The patient’s age is calculated in integer years as at the date of discharge.

5.1.2 Length of Stay (Note: same as section 2.1.1) The Length of Stay (LOS) calculation used in the methodology is specific for use within the WIES8C calculation. This is because it has a maximum and minimum applied to it, as well as having any Event Leave Days subtracted. A maximum of 365 days applies as the methodology is used for calculating the costweight associated with a particular year. A minimum of 1 day is applied to deal with the few cases where Event Leave Days are equal to the difference between the admission and discharge dates. (Note: this does not affect the LOS comparison with low boundary points as the DRG boundary points are integer and the tests for whether an event is same or one day use date tests rather than the LOS). Hence, the calculated LOS equals the difference in integer days between the discharge and admission dates, minus any Event Leave Days. Further, this is set to 365 if the LOS is greater 365 or is set to 1 if the LOS=0.

5.2 Exclusions from casemix purchasing The following section lists the tests that identify whether or not a particular event is purchased through the casemix methodology. It should be noted that some of the tests are order sensitive, e.g. the Medical/Surgical test assumes that the Neonatal test has already been applied. Also, an event may be excluded for more than one reason (note - the NZHIS SAS methodology uses individual exclusion flag fields to generate an overall exclusion flag {Yes/No} for each event).

5.2.1 Neonatal Inpatient Casemix This test takes the form of an inclusion rule, as this is easier to specify than the converse exclusion rule. To be potentially included in neonatal casemix volumes an event requires a Pregnancy & Childbirth Health Speciality code and must meet one of three tests (originally agreed by the 98/99 joint HFA/HHS Maternity & Neonates project) which attempt to distinguish between well new-borns and those who required additional health services:

The Health Service Speciality code is in the Pregnancy & Childbirth range (ie where the first character is “P”) but is not P50 – ie is in the range (P00, P10, P11, P20, P30, P35, P41, P42, P43) - AND (The Health Service Speciality code is in the range (P41, P42, P43) OR

18 (The AR-DRG is in the range (P02Z, P61Z, P62Z, P03Z, P63Z, P64Z, P04Z, P65A, P65B, P65C, P65D, P05Z, P66A, P66B, P66C, P06A, P06B, P67B, P67A)) OR (The AR-DRG is in the range (P60A, P01Z, P60B, P66D, P67C, P67D) AND (the third ICD diagnosis is NOT blank OR the first ICD procedure is NOT blank)))

5.2.2 Non - Medical/Surgical Events Events which have a Mental Health or DSS Health Service Speciality code, i.e. first character is “D” or “Y”, are excluded.

5.2.3 Maternity Inpatient Casemix The following table is generated from the table of Maternity facilities contained in the document Maternity Services: A Reference Document, HFA, 1999 – Appendix 9. Only the designated secondary and tertiary maternity facilities have been listed as the intent of the maternity project group was that a casemix purchase framework should only apply for service provided in these facilities.

Document Facility NMDS Facility NMDS Secondary Tertiary Name Name Facility Code Whangarei Whangarei Area 4111  Hospital North Shore North Shore 3215  Waitakere Waitakere 3216  National Women’s National Womens 3213   Middlemore Middlemore 3214   Auckland City Auckland City 3260   Waikato Hospital Waikato 5311   Rotorua Rotorua 5312  Tauranga Tauranga 4911  Whakatane Whakatane 3311  New Plymouth Taranaki Base 4711  Wanganui Wanganui 5711  Hastings Hastings 3612  Memorial Masterton Masterton 5511  Palmerston North Palmerston North 4311  Wellington Wellington 5811   Hutt Hutt 5812  Blenheim (Wairau) Wairau 3811  Nelson Nelson 3911  Christchurch Christchurch 4014   Women’s Womens Greymouth Grey Base 5911  Hospital Timaru Timaru 4411 

19 Document Facility NMDS Facility NMDS Secondary Tertiary Name Name Facility Code Dunedin Dunedin 4211   Invercargill Southland 4511 

Pregnancy and Childbirth events are those where the first character of the Health Specialty Code is P, excluding P50. They are not included if they meet the criteria in the Neonatal Casemix Inclusion Rule.

This means that well newborn babies, as opposed to ‘neonates’, will be covered by maternity inpatient casemix. In general, we expect well newborns to fall into AR-DRG P67D and be counted under the maternity inpatients casemix purchase unit W10.01.

The rules in 5.2.4 to 5.2.7 are intended only to apply to maternity cases.

5.2.4 Amniocentesis For events where the health speciality code starts with P and is not P50, and the event occurs in a facility listed in table 5.2.3, same-day amniocentesis events are excluded from casemix purchasing. These events are tested for by checking: That the admission and discharge dates are the same AND that the first procedure code is one of the following: 1660000, 1661800, or 1662100.

5.2.5 Chorion Villis Sampling For events where the health speciality code starts with P and is not P50, and the event occurs in a facility listed in table 5.2.3, same-day chorion villis sampling events are excluded from casemix purchasing. These events are tested for by checking: that the admission and discharge dates are the same AND That the first procedure code falls in the range: ICD10 Chorion Villis Sampling, first procedure in the range: (1660300).

5.2.6 Rhesus Isoimmunisation For events where the health speciality code starts with P and is not P50, and the event occurs in a facility listed in table 5.2.3, same-day rhesus isoimmunisation events are excluded from casemix purchasing. These events are tested for by checking: That the admission and discharge dates are the same AND That the primary diagnosis code falls in the range: ICD10 Rhesus Isoimmunisation: (O360, O361).

5.2.7 Breast feeding / Lactation For events where the health speciality code starts with P and is not P50, and the event occurs in a facility listed in table 5.2.3, same-day breastfeeding/lactation events are excluded from casemix purchasing. These events are tested for by checking:

20 That the admission and discharge dates are the same AND That the primary diagnosis code falls in the range: ICD10 Breastfeeding/Lactation: (O9230, O9231, O9240, O9241, O9250, O9251, O9270, O9271). 5.2.8 Birth weight In alignment with Victoria, a baby which has an admission weight between 125 and 399 grams will be assigned an admission weight of 400grams. This allows it to be grouped to a neonatal DRG rather than to the DRG for ungroupable events, 960Z, under which no funding would have been received.

5.2.9 Non Base Funding Purchases Events which are not part of an HHS’s base DHB service agreement are excluded. In the past, HFA base contract events, now base DHB service agreements, had a Purchaser code in the range (01, 02, 03, 04, 13, 20). Events with any other Purchaser code should be excluded, e.g. privates, ACC direct and Insurers, Elective, i.e. the former Waiting Times Fund (WTF), events, and any other MoH/DHB-specific non-base purchasing, etc. In addition, any Admission Types of “ZW” (indicating an ACC elective purchase) are excluded.

5.2.10 Designated Hospital Casemix Revenue A combination of a range of Agencies and Facilities has been identified as the providers through which the MoH/DHBs will monitor base casemix agreements. All other facilities, historically designated as ‘rural’, are excluded. Note that with HHS sub-contracting the list of included Facilities may require updating periodically; this assumes that the Agency will reflect the organisation that has the original DHB agreement. A list of included Agencies and Facilities is given below. Any combination of Agency & Facility that does not fall in the lists below is excluded from DHB casemix purchase agreements.

Health Agency code Agency Name 0223 Heart Surgery South Island 1011 Northland DHB 1021 Waitemata DHB 1022 Auckland DHB 1023 Counties Manukau DHB 2031 Waikato DHB 2041 East Bay Health (kept for historical analysis) 2042 Lakes DHB 2043 Western Bay Health (kept for historical analysis) 2047 Bay of Plenty DHB 2051 Tairawhiti DHB 2071 Taranaki DHB 3061 Hawke’s Bay DHB 3081 Mid Central DHB 3082 Whanganui DHB 3091 Capital & Coast DHB 3092 Hutt Valley DHB

21 Health Agency code Agency Name 3093 Wairarapa DHB 3101 Nelson-Marlborough DHB 4111 West Coast DHB 4121 Canterbury DHB 4122 Canterbury DHB (Healthlink South – for historical purposes) 4123 South Canterbury DHB 4131 Otago DHB 4141 Southland DHB 8630 Queen Elizabeth Hospital 8656 Mobile Surgical Bus

Facility code Facility name 4111 Whangarei Area Hospital 4112 Kaitaia 3211 Auckland 3212 Greenlane 3213 National Women’s 3214 Middlemore 3215 North Shore 3216 Waitakere 3239 Starship Hospital 3260 Auckland City Hospital 5011 Thames 3311 Whakatane 4911 Tauranga 3411 Gisborne 5311 Waikato 5312 Rotorua 5313 Te Kuiti 8630 Queen Elizabeth, Rotorua 5323 Tokoroa 4811 Taumarunui 5329 Taupo General 4711 Taranaki Base 4712 Hawera 3611 Napier 3612 Hastings Memorial 5711 Wanganui 4311 Palmerston North 5511 Masterton 5812 Hutt 5816 Kenepuru 5811 Wellington 3811 Wairau 3911 Nelson 4011 Christchurch 4013 Burwood

22 Facility code Facility name 4014 Christchurch Womens 3111 Ashburton 5911 Grey Base Hospital 4411 Timaru 4211 Dunedin 4511 Southland 3250 Manukau SuperClinic 3220 Pukekohe 3221 Papakura Obstetric 3240 Botany Downs Maternity Hospital 4113 Dargaville 4114 Bay of Islands 8270 Southern Cross, Hamilton 8331 Bowen 8432 Wakefield 8595 Ascot Hospital 8233 Mercy, Auckland 8422 Our Lady’s Home of Compassion 8366 St Georges 8377 Southern Cross Trust, Christchurch 8580 Oxford Day Clinic 3313 Murupara 3314 Opotiki 4212 Wakari 8507 Manor Park Hospital 8462 Boulcott Clinic 8471 Southern Cross, Wellington 5818 Paraparaumu 5819 Puketiro 5820 Te Whare O Rangituhi 5814 Porirua 8313 Aorangi, (was Mercy) 8314 Southern Cross, Palmerston North 8656 Mobile Surgical Bus 8218 Southern Cross Brightside

5.2.11 Non-Treated Patients Events where no treatment is provided are excluded. These include Boarders who may be admitted or in the case of Cancelled Operations. Boarders are tested for by checking the primary diagnosis code (only) for a set of codes: ICD10 Boarders, primary diagnosis in the range: Z763, Z764. Cancelled Operations are tested for by checking that: The primary operation/procedure code is blank AND

23 That the event is non-acute (i.e. Admission Type not in “AC”,”ZC”) AND Length of Stay is less than 2 days AND The one (or more) of the first six diagnosis codes contain the following codes: ICD10 Canc Ops, one (or more) of diagnosis 1-6 in the range: Z530, Z531, Z532, Z538, Z539.

5.2.12 Error DRGs Events coded to an Error AR-DRG are excluded. Error AR-DRGs are in the range (960Z, 961Z, 962Z, 963Z).

5.2.13 Some Transplants Some organ Transplants are excluded as they are not purchased via casemix, e.g. liver, heart and lung transplants. Excluded Transplants are in the AR-DRG range (A01Z, A02Z, A03Z, A05Z). Simultaneous pancreas/kidney transplants will be coded so as to fall under A02Z, Multiple Organ Transplants, thus excluded from casemix purchasing.

5.2.14 Some Spinal Injuries Some Spinal services are excluded as they are not purchased via casemix. Excluded Spinal services are in the Health Services Speciality code range (S50, S53).

5.2.15 Surgical Termination of Pregnancy Surgical Termination of Pregnancy (ToP) events are excluded. These are tested for by checking: The AR-DRG is equal to O40Z AND That the primary procedure/procedure codes fall in the range: ICD10 Surg ToP, primary procedure in the range: (3564300, 3564301) AND primary diagnosis in the range (O040-O049 {O04*}).

5.2.16 Renal and Peritoneal Dialysis The WIES DRGs for Renal Dialysis, L61Z, and Peritoneal Dialysis, L61Y, are excluded from casemix purchasing. Unless the associated events were previously coded to DRG3.1 572, this represents a new exclusion from casemix.

5.2.17 Sameday Chemotherapy & Radiotherapy Some sameday cases for Chemotherapy and Radiotherapy are excluded from casemix purchasing. These events are tested for by checking: That the Admission date is the same as the Discharge date AND That either of the first two diagnosis codes fall in the range: ICD10 Chem/Radio, either of the first two diagnosis in the range: (Z510, Z511, Z512).

5.2.18 Sleep Apnoea Some Sleep Apnoea events where they stay overnight for tests are excluded from casemix purchasing. These events are tested for by checking:

24 That the integer difference in days between the Discharge and Admission dates is less than 2 AND That the AR-DRG equals E63Z.

5.2.19 Lithotripsy Some sameday Lithotripsy events are excluded from casemix purchasing. These events are tested for by checking: That the Admission and Discharge dates are the same AND That the event is non-acute (i.e. Admission Type not in “AC”,”ZC”) AND That the primary procedure code falls in the following range: ICD10 Lithotripsy, first procedure in the range: (3654600). AND That the second procedure code falls in the following range: ICD10 Lithotripsy, second procedure in the range: (3654600,9250202, 9250300, blank). AND That the third procedure code is in the range: (3654600,9250202,9250300, blank).

5.2.20 Colposcopies Some sameday Colposcopy events are excluded from casemix purchasing. These events are tested for by checking: That the Admission and Discharge dates are the same AND That the event is non-acute (i.e. Admission Type not in “AC”,”ZC”) AND The patient’s age is greater than 15 years old AND That the primary procedure code falls in the following range: ICD10 Colposcopy, first procedure in the range: (3560800, 3564600, 3564700, 3560801, 3553902, 3561100, 3553904, 3563704, 3553903, 3560802, 3561400). AND That the second procedure code falls in the following range: ICD10 Colposcopy, second procedure in the range: (3560800, 3564600, 3564700, 3560801, 3553902, 3561100, 3553904, 3563704, 3553903, 3560802, 3561400,9250202, 9250300, blank). AND That the third procedure code is in (9250202, 9250300,blank).

5.2.21 Cystoscopies Some sameday Cystoscopies events are excluded from casemix purchasing. These events are tested for by checking: That the Admission and Discharge dates are the same AND That the event is non-acute (i.e. Admission Type not in “AC”,”ZC”) AND The patient’s age is greater than 15 years old AND

25 That the primary procedure code falls in the following range: ICD10 Cystoscopies, first procedure in the range: (3681201, 3681200, 3683600, 3683904, 3684503, 3683902, 3684501, 3684500, 3683900, 3684505, 3684504, 3684502, 3731801, 3731500, 3681501, 3682700). AND That the second procedure code falls in the following range: ICD10 Cystoscopies, second procedure in the range: (3681201, 3681200, 3683600, 3683904, 3684503, 3683902, 3684501, 3684500, 3683900, 3684505, 3684504, 3684502, 3731801, 3731500, 3681501, 3682700, 9250202, 9250300, blank). AND That the third procedure code is in (9250202, 9250300,blank).

5.2.22 ERCPs Some sameday ERCP (endoscopic retrograde cholangiopancreatography) events are excluded from casemix purchasing. These events are tested for by checking: That the Admission and Discharge dates are the same AND That the event is non-acute (i.e. Admission Type not in “AC”,”ZC”) AND The patient’s age is greater than 15 years old AND That the primary procedure code falls in the following range: ICD10 ERCP, first procedure in the range: (3048400, 3048401, 3048402, 3045200, 3048500, 3049100, 3045202, 3048501, 3049101, 3049400, 3045100, 3045201, 3044200). AND That the second procedure code falls in the following range: ICD10 second procedure in the range: (3048400, 3048401, 3048402, 3045200, 3048500, 3049100, 3045202, 3048501, 3049101, 3049400, 3045100, 3045201, 3044200, 3047801, 3047802, 3209000, 3208400, 3209001, 3208401, 3209300, 3208700, 9030800, 3209400, 3207500, 3207200, 3207201, 3207501, 9031200, 9031201, 3207800, 3208100, 3209900, 3210800, 9034100, 3210500, 4181600, 3047303, 3047810, 4182500, 4182200, 3047304, 3047600, 3047601, 3047806, 3047809, 3047811, 3047812, 3047602, 3047813, 3047900, 3047807, 3047603, 3047300, 3047301, 3047500, 3047501, 3047803, 3209500, 3047804, 3047305, 3047306, 3047815, 3047816, 3047817, 3047818, 9250202, 9250300, blank). AND That the third procedure code is in (9250202, 9250300,blank).

5.2.23 Colonoscopies Some sameday Colonoscopies events are excluded from casemix purchasing. These events are tested for by checking: That the Admission and Discharge dates are the same AND That the event is non-acute (i.e. Admission Type not in “AC”,”ZC”) AND The patient’s age is greater than 15 years old AND That the primary procedure code falls in the following range:

26 ICD10 Colonoscopies, first procedure in the range: (3209000, 3208400, 3209001, 3208401, 3209300, 3208700, 9030800, 3209400, 3207500, 3207200, 3207201, 3207501, 9031200, 9031201, 3207800, 3208100, 3209900, 3210800, 9034100, 3210500). AND That the second procedure code falls in the following range: ICD10 second procedure in the range: (3048400, 3048401, 3048402, 3045200, 3048500, 3049100, 3045202, 3048501, 3049101, 3049400, 3045100, 3045201, 3044200, 3047801, 3047802, 3209000, 3208400, 3209001, 3208401, 3209300, 3208700, 9030800, 3209400, 3207500, 3207200, 3207201, 3207501, 9031200, 9031201, 3207800, 3208100, 3209900, 3210800, 9034100, 3210500, 4181600, 3047303, 3047810, 4182500, 4182200, 3047304, 3047600, 3047601, 3047806, 3047809, 3047811, 3047812, 3047602, 3047813, 3047900, 3047807, 3047603, 3047300, 3047301, 3047500, 3047501, 3047803, 3209500, 3047804, 3047305, 3047306, 3047815, 3047816, 3047817, 3047818, 9250202, 9250300, blank). AND That the third procedure code is in (9250202, 9250300,blank).

5.2.24 Gastroscopies Some sameday Gastroscopies events are excluded from casemix purchasing. These events are tested for by checking: That the Admission and Discharge dates are the same AND That the event is non-acute (i.e. Admission Type not in “AC”,”ZC”) AND The patient’s age is greater than 15 years old AND That the primary procedure code falls in the following range: ICD10 Gastroscopies, first procedure in the range: (4181600, 3047303, 3047810, 4182500, 4182200, 3047304, 3047600, 3047601, 3047806, 3047809, 3047811, 3047812, 3047602, 3047813, 3047900, 3047807, 3047603, 3047300, 3047301, 3047500, 3047501, 3047803, 3209500, 3047804, 3047801, 3047802, 3047305, 3047306, 3047815, 3047816, 3047817, 3047818). AND That the second procedure code falls in the following range: ICD10 second procedure in the range: (3048400, 3048401, 3048402, 3045200, 3048500, 3049100, 3045202, 3048501, 3049101, 3049400, 3045100, 3045201, 3044200, 3047801, 3047802, 3209000, 3208400, 3209001, 3208401, 3209300, 3208700, 9030800, 3209400, 3207500, 3207200, 3207201, 3207501, 9031200, 9031201, 3207800, 3208100, 3209900, 3210800, 9034100, 3210500, 4181600, 3047303, 3047810, 4182500, 4182200, 3047304, 3047600, 3047601, 3047806, 3047809, 3047811, 3047812, 3047602, 3047813, 3047900, 3047807, 3047603, 3047300, 3047301, 3047500, 3047501, 3047803, 3209500, 3047804, 3047305, 3047306, 3047815, 3047816, 3047817, 3047818, 9250202, 9250300, blank). AND That the third procedure code is in (9250202, 9250300,blank).

27 5.2.25 Bronchoscopies Some sameday Bronchoscopies events are excluded from casemix purchasing. These events are tested for by checking: That the Admission and Discharge dates are the same AND That the event is non-acute (i.e. Admission Type not in “AC”,”ZC”) AND The patient’s age is greater than 15 years old AND That the primary procedure code falls in the following range: ICD10 Bronchoscopies, first procedure in the range: (4188901, 4189800, 4188900, 4189200, 4189801, 4176404, 4176403, 4184600, 4184900, 4185500, 4189500). AND That the second procedure code falls in the following range: ICD10 Bronchoscopies, second procedure in the range:. (4188901, 4189800, 4188900, 4189200, 4189801, 4176404, 4176403, 4184600, 4184900, 4185500, 4189500, 9250202, 9250300, blank). AND That the third procedure code is in (9250202, 9250300,blank).

5.2.26 Day Case Blood Transfusions Some sameday Blood Transfusion events are excluded from casemix purchasing. These events are tested for by checking: That the Admission and Discharge dates are the same AND That the event is non-acute (i.e. Admission Type not in “AC”,”ZC”) AND That the primary diagnosis OR the first three procedure codes fall in the range: ICD10 Blood, primary diagnosis in the range (Z513) OR {primary procedure in the range (9206000, 1370601, 1370602, 1370603) AND second procedure in the range (9206000, 1370601, 1370602, 1370603, blank) AND third procedure blank}.

5.3 Mapping of Health Service Speciality codes to casemix PUs DHB casemix Purchase Units are derived from a mapping of Health Service Speciality codes. This mapping only applies for included events, i.e. any events excluded from casemix purchasing should not be given a casemix PU code. (Note: the NZHIS SAS code gives excluded events a PU code of “EXCLU” rather than blank).

The following health service speciality codes are initially remapped to other health service speciality codes:

'M01' , 'M02' , 'M03' = 'M00' 'M06' , 'M07' = 'M05' 'M11' , 'M12' , 'M13' = 'M10' 'M16' , 'M17' , 'M18' , 'M19' = 'M15' 'M21' , 'M22' , 'M23' = 'M20' 'M26' , 'M27' , 'M28' = 'M25' 'M31' , 'M32' , 'M33' = 'M30' 'M36' , 'M37' , 'M38' = 'M35' 'M41' , 'M42' , 'M43' = 'M40'

28 'M46' , 'M47' , 'M48' = 'M45' 'M51' , 'M52' , 'M53' = 'M50' 'M56' , 'M57' , 'M58' = 'M55' 'M61' , 'M62' , 'M63' = 'M60' 'M66' , 'M67' , 'M68' = 'M65' 'M71' , 'M72' , 'M73' = 'M70' 'M76' , 'M77' , 'M78' = 'M75' 'M81' , 'M82' , 'M83' = 'M80' 'M87' , 'M88' = 'M85' 'M91' , 'M92' , 'M93' = 'M90' 'S01' , 'S02' , 'S03' = 'S00' 'S06' , 'S07' , 'S08' = 'S05' 'S11' , 'S12' , 'S13' = 'S10' 'S16' , 'S17' , 'S18' = 'S15' 'S21' , 'S22' , 'S23' = 'S20' 'S26' , 'S27' , 'S28' = 'S25' 'S31' , 'S32' , 'S33' = 'S30' 'S36' , 'S37' , 'S38' = 'S35' 'S41' , 'S42' , 'S43' = 'S40' 'S46' , 'S47' , 'S48' = 'S45' 'S51' , 'S52' , 'S53' = 'S50' 'S55' , 'S56' , 'S57' = 'S59' 'S61' , 'S62' , 'S63' = 'S60' 'S66' , 'S67' , 'S68' = 'S65' 'S71' , 'S72' , 'S73' = 'S70' 'S76' , 'S77' , 'S78' = 'S75'

And from there mapped to the following casemix purchased purchase units:

'S20' = 'D01.01' 'S50' = 'EXCLU' 'M00' , 'M05' , 'M08' , 'M85' , 'M86' , 'M89' = 'M00.01' 'M10' = 'M10.01' 'M14' = 'M10.05' 'M15' = 'M15.01' 'M20' = 'M20.01' 'M25' = 'M25.01' 'M30' = 'M30.01' 'M34' = 'M34.01' 'M40' , 'M75' = 'M40.01' 'M45' = 'M45.01' 'M49' = 'M49.01' 'M50' , 'M90' = 'M50.01' 'M54' , 'M94' = 'M54.01' 'M24' , 'M29' , 'M39' , 'M44' , 'M55' , 'M59' , 'M64' , 'M69' , 'M74' , 'M79' , 'M84' = 'M55.01' 'M60' = 'M60.01' 'M65' = 'M65.01' 'M35' , 'M70' = 'M70.01' 'M80' = 'M80.01' 'S00' , 'S05' , 'S10' = 'S00.01'

29 'S15' , 'S19' = 'S15.01' 'S25' = 'S25.01' 'S30' = 'S30.01' 'S35' = 'S35.01' 'S40' = 'S40.01' 'S45' = 'S45.01' 'S58' , 'S59' = 'S55.01' 'S24', 'S60' , 'S65' = 'S60.01' 'S70' = 'S70.01' 'S75' = 'S75.01' 'P41','P42','P43' = 'W06.03' ‘P00’,‘P10’,‘P20’,‘P30’ = ‘W10.01’ other = 'EXCLU';

Each PU code is then described: 'D01.01'='Inpatient Dental treatment (DRGs)' 'M00.01'='General Internal Medical Services - Inpatient Services (DRGs)' 'M10.01'='Cardiology - Inpatient Services (DRGs)' 'M10.05'='Specialist Paediatric Cardiac - Inpatient Services (DRGs)' 'M15.01'='Dermatology - Inpatient Services (DRGs)' 'M20.01'='Endocrinology & Diabetic - Inpatient Services (DRGs)' 'M25.01'='Gastroenterology - Inpatient Services (DRGs)' 'M30.01'='Haematology - Inpatient Services (DRGs)' 'M34.01'='Specialist Paediatric Haematology - Inpatient Services (DRGs)' 'M40.01'='Infectious Diseases (incl Venereology) - Inpatient Services (DRGs)' 'M45.01'='Neurology - Inpatient Services (DRGs)' 'M49.01'='Specialist Paediatric Neurology Inpatient Services (DRGs)' 'M50.01'='Oncology - Inpatient Services (DRGs)' 'M54.01'='Specialist Paediatric Oncology - Inpatient Services (DRGs)' 'M55.01'='Paediatric Medical - Inpatient Services (DRGs)' 'M60.01'='Renal Medicine - Inpatient Services (DRGs)' 'M65.01'='Respiratory - Inpatient Services (DRGs)' 'M70.01'='Rheumatology (incl Immunology) - Inpatient Services (DRGs)' 'M80.01'='Palliative Care - Inpatient Services (DRGs)' 'S00.01'='General Surgery - Inpatient Services (DRGs)' 'S15.01'='Cardiothoracic - Inpatient Services (DRGs)' 'S25.01'='Ear, Nose and Throat - Inpatient Services (DRGs)' 'S30.01'='Gynaecology - Inpatient Services (DRGs)' 'S35.01'='Neurosurgery - Inpatient Services (DRGs)' 'S40.01'='Ophthalmology - Inpatient Services (DRGs)' 'S45.01'='Orthopaedics - Inpatient Services (DRGs)' 'S55.01'='Paediatric Surgical Services (DRGs)' 'S60.01'='Plastic & Burns - Inpatient Services (DRGs)' 'S70.01'='Urology - Inpatient Services (DRGs)' 'S75.01'='Vascular Surgery - Inpatient Services (DRGs)' 'W06.03'='Neonatal Inpatient (DRGs)' ‘W10.01’ = Maternity Inpatient (DRGs) other ='Not a DRG casemix Purchase Unit'

30 Appendices

5.4 Spreadsheet containing 03/04 FY DRG weights and associated variables for calculating WIES8C

Variables names translation 8 character to name: SOflag {Same Day/One Day DRG Flag} Sd {Same Day Costweight} Od {One Day Costweight} Md_in {Multi day inlier weight} Ho_pd {High Outlier per diem} Lb {Low Boundary Point for LOS} Hb {High Boundary Point for LOS} I_alos {Average Inlier LOS}

31 NZ WIES 8C Schedule Victorian DRG 4.2 New Zealand Schedule Costweights Weights Mech.Vent. Same Day Inlier Boundary Average Outlier Per Diems Code DRG Description Copayment One Day Low High Inlier LOS Inlier High Low Same Day One Day DRG42 mv_elig lb HB i_alos md_in ho_pd lo_pd sd od A01Z Liver Transplant I 5 53 25.050000 22.072247 0.337610 4.414449 2.207225 4.414449 A02Z Multiple Organs Transplant I 3 35 10.500000 16.204378 0.337610 5.401459 2.700730 5.401459 A03Z Lung Transplant I 6 62 23.205882 17.354653 0.337610 2.892442 1.446221 2.892442 A04A Allogenic Bone Marrow Transplant I 23 53 35.072727 18.925606 0.337610 0.822852 0.411426 0.822852 A04B Non-allogenic Bone Marrow Transplant I 13 29 20.731183 8.656978 0.292308 0.665921 0.332961 0.665921 A05Z Heart Transplant I 4 44 17.636364 11.047944 0.337610 2.761986 1.380993 2.761986 A06Z Tracheostomy Any Age, Any Condition 4 15 35 22.928094 12.539470 0.337610 0.835965 0.417982 0.835965 A40Z ECMO W/O Cardiac Surgery I 6 16 8.625000 13.138687 0.337610 2.189781 1.094891 2.189781 A41Z Intubation Age<16 D 2 19 7.657407 4.289738 0.337610 2.144869 1.072434 2.144869 B01Z Ventricular Shunt Revis No Other OR Proc D 1 14 4.064516 1.842408 0.317304 0.000000 0.921204 1.842408 B02A Craniotomy W Catastrophic CC D 5 45 16.577713 7.834641 0.330821 1.566928 0.783464 1.566928 B02B Craniotomy W Severe or Moderate CC D 2 27 9.043764 4.507433 0.337610 2.253717 1.126858 2.253717 B02C Craniotomy W/O CC D 2 20 6.990223 3.057031 0.306131 1.528516 0.764258 1.528516 B03A Spinal Procedures W Catastroph/Severe CC D 4 36 11.351351 3.671011 0.226379 0.917753 0.458876 0.917753 B03B Spinal Procs W/O Catastrophic/Severe CC D 2 18 5.717241 2.566382 0.314219 1.283191 0.641596 1.283191 B04A Extracranial Vascular Procs W Cat/Sev CC D 1 16 6.488479 2.566768 0.276912 0.000000 1.283384 2.566768 B04B Extracranial Vascular Proc no Cat/Sev CC D 1 11 3.968481 1.893032 0.333912 0.000000 0.946516 1.893032 B05Z Carpal Tunnel Release D 0 3 1.022624 0.456285 0.312333 0.000000 0.456285 0.456285 B06A Prs CPalsy,Musc Dys,Neuropathy W C/S CC D 3 33 7.944444 3.218606 0.283597 1.072869 0.536434 1.072869 B06B Prs CPalsy,Musc Dys,Neuropathy No C/S CC D 0 5 1.441176 0.812251 0.337610 0.000000 0.812251 0.812251 B07A Periph+Cranial Nerve & Nerv Sys Procs+CC D 1 16 3.241758 1.571875 0.337610 0.000000 0.785938 1.571875 B07B Periph,Cranial & Oth Nerve Procs No CC D 0 4 1.434211 0.867507 0.337610 0.000000 0.867507 0.867507 B40Z Plasmapheresis W Neurological Disease D Same day 3 28 9.485714 1.622124 0.136806 0.540708 0.278095 0.540708 B41Z Prolonged Monitoring - Complex Epilepsy D 3 7 4.741935 1.232383 0.207912 0.410794 0.205397 0.410794 B60A Non-Ac Para/Quadriplegia WWO ORPs+Cat CC D 9 22 13.934783 3.158317 0.181320 0.350924 0.175462 0.350924 B60B N-Ac Para/Quadriplegia WWO ORP No Cat CC D 3 9 5.044586 1.522199 0.241399 0.507400 0.253700 0.507400 B61A Spinal Cord Cond W/W/O ORPs W Cat/Sev CC D 16 37 22.500000 6.151379 0.218716 0.384461 0.192231 0.384461 B61B Spinal Cord Cond W/W/O ORPs W/O C/Sev CC D 4 10 5.956522 2.085427 0.280087 0.521357 0.260678 0.521357 B62Z Admit for Apheresis D 0 3 1.001576 0.329798 0.263423 0.000000 0.329798 0.329798 B63Z Dementia+Oth Chr Disturb - Cerebral Func D 34 312 40.829787 12.799886 0.250795 0.376467 0.188234 0.376467 B64Z Delirium D 2 19 7.798496 1.267693 0.130045 0.633846 0.316923 0.633846 B65Z Cerebral Palsy D 1 10 1.375000 0.483350 0.281222 0.000000 0.241675 0.483350 B66A Nervous System Neoplasm Age>64 D 2 24 8.048276 1.781157 0.177047 0.890578 0.445289 0.890578 B66B Nervous System Neoplasm Age<65 D 1 13 3.026432 1.074401 0.284005 0.000000 0.537200 1.074401

32 NZ WIES 8C Schedule Victorian DRG 4.2 New Zealand Schedule Costweights Weights Mech.Vent. Same Day Inlier Boundary Average Outlier Per Diems Code DRG Description Copayment One Day Low High Inlier LOS Inlier High Low Same Day One Day DRG42 mv_elig lb HB i_alos md_in ho_pd lo_pd sd od B67A Degen Nervous System Disord W Cat/Sev CC D 11 99 19.878378 3.642598 0.146595 0.331145 0.165573 0.331145 B67B Degen Nervous Sys Disords W/O Cat/Sev CC D 8 74 14.553191 3.037676 0.166983 0.379709 0.189855 0.379709 B68A Mult Sclerosis & Cerebellar Ataxia W CC D 2 18 6.641975 1.506404 0.181440 0.753202 0.376601 0.753202 B68B Mult Sclerosis & Cerebellar Ataxia no CC D 0 6 2.100213 0.418639 0.159465 0.000000 0.418639 0.418639 B69A TIA & Precerebral Occlusion W Catast CC D 1 17 6.323529 1.067861 0.135097 0.000000 0.533930 1.067861 B69B TIA & Precerebral Occlusion W Severe CC D 1 11 3.731481 0.755308 0.161932 0.000000 0.377654 0.755308 B69C TIA+Precerebral Occlusion W/O Cat/Sev CC D 0 7 2.234783 0.526226 0.188377 0.000000 0.526226 0.526226 B70A Stroke W Severe/Complicating Diag/Proc D 3 30 13.235446 2.245058 0.135700 0.748353 0.374176 0.748353 B70B Stroke W Other CC D 2 19 8.119545 1.518801 0.149644 0.759401 0.379700 0.759401 B70C Stroke W/O Other CC D Same day 2 20 6.110048 1.299450 0.170139 0.649725 0.460008 0.649725 B70D Stroke, Died or Transferred < 5 days D 0 5 1.691860 0.606331 0.286705 0.000000 0.606331 0.606331 B71A Cranial & Peripheral Nerve Disorder W CC D 1 16 4.706093 1.199217 0.203858 0.000000 0.599608 1.199217 B71B Cranial & Peripheral Nerve Disords no CC D Same day 1 11 3.532258 1.111555 0.251750 0.000000 0.503466 1.111555 B72Z Nervous Sys Infect Exc Viral Meningitis D 1 16 5.991632 1.552681 0.207313 0.000000 0.776341 1.552681 B73Z Viral Meningitis D 0 7 2.414201 0.561376 0.186024 0.000000 0.561376 0.561376 B74Z Nontraumatic Stupor and Coma D 0 8 1.742188 0.483285 0.221921 0.000000 0.483285 0.483285 B75Z Febrile Convulsions D 0 4 1.323980 0.345710 0.208892 0.000000 0.345710 0.345710 B76A Seizure <3 or W Catastrophic/Severe CC D 1 9 2.732700 0.721725 0.211286 0.000000 0.360863 0.721725 B76B Seizure Age>2 W/O Catastrophic/Severe CC D Same day 0 7 2.153846 0.557535 0.207085 0.000000 0.194890 0.557535 B77Z Headache D Same day 0 6 1.908999 0.461329 0.193328 0.000000 0.192348 0.461329 B78Z Intracranial Injury D 1 12 3.523810 1.026262 0.232989 0.000000 0.513131 1.026262 B79Z Skull Fractures D 0 7 2.169355 0.655713 0.241809 0.000000 0.655713 0.655713 B80Z Other Head Injury D Same day 0 4 1.325163 0.365164 0.220449 0.000000 0.175018 0.365164 B81A Oth Disord - Nervous Sys W Cat/Sev CC D 2 19 7.128866 1.435792 0.161124 0.717896 0.358948 0.717896 B81B Oth Disords - Nervous Sys W/O Cat/Sev CC D 0 8 1.905289 0.521090 0.218797 0.000000 0.521090 0.521090 C01Z Procedures for Pentetrating Eye Injury D 0 7 2.852459 1.152052 0.282716 0.000000 1.152052 1.152052 C02Z Enucleations and Orbital Procedures D 0 6 2.008403 0.896962 0.312623 0.000000 0.896962 0.896962 C03Z Retinal Procedures D 0 5 1.592656 0.843847 0.337610 0.000000 0.843847 0.843847 C04Z Maj Corneal,Scleral & Conjunctival Procs D 0 4 1.234234 0.783584 0.337610 0.000000 0.783584 0.783584 C05Z Dacryocrystorhinostomy D 0 3 1.087121 0.764265 0.337610 0.000000 0.764265 0.764265 C06Z Complex Glaucoma Procedures D 0 5 1.379032 0.614565 0.311955 0.000000 0.614565 0.614565 C07Z Other Glaucoma Procedures D 0 3 1.193548 0.672803 0.337610 0.000000 0.672803 0.672803 C08Z Major Lens Procedures D 0 3 1.036576 0.546594 0.337610 0.000000 0.546594 0.546594 C09Z Other Lens Procedures D 0 3 1.085125 0.652878 0.337610 0.000000 0.652878 0.652878

33 NZ WIES 8C Schedule Victorian DRG 4.2 New Zealand Schedule Costweights Weights Mech.Vent. Same Day Inlier Boundary Average Outlier Per Diems Code DRG Description Copayment One Day Low High Inlier LOS Inlier High Low Same Day One Day DRG42 mv_elig lb HB i_alos md_in ho_pd lo_pd sd od C10Z Strabismus Procedures D Same day 0 3 1.034722 0.639371 0.337610 0.000000 0.471859 0.639371 C11Z Eyelid Procedures D Same day 0 5 1.424731 0.765383 0.337610 0.000000 0.442183 0.765383 C12Z Oth Corneal,Scleral & Conjunctival Procs D 0 3 1.035714 0.354000 0.239255 0.000000 0.354000 0.354000 C13Z Lacrimal Procedures D 0 3 1.035971 0.412368 0.278635 0.000000 0.412368 0.412368 C14Z Other Eye Procedures D 0 3 1.040449 0.377974 0.254296 0.000000 0.377974 0.377974 C60A Acute and Major Eye Infections Age>54 D 1 14 4.617021 0.746231 0.129301 0.000000 0.373115 0.746231 C60B Acute and Major Eye Infections Age<55 D 0 9 3.563636 0.766811 0.172141 0.000000 0.766811 0.766811 C61Z Neurological & Vascular Disorders of Eye D 0 7 2.322314 0.538385 0.185465 0.000000 0.538385 0.538385 C62Z Hyphema & Medically Mand Trauma to Eye D Same day 0 6 2.197605 0.346579 0.126166 0.000000 0.190758 0.346579 C63A Other Disorders of the Eye W CC D 0 8 2.584071 0.664857 0.205833 0.000000 0.664857 0.664857 C63B Other Disorders of the Eye W/O CC D Same day 0 7 2.493151 0.579527 0.185958 0.000000 0.279689 0.579527 D01Z Cochlear Implant D 0 6 2.122807 6.611238 0.337610 0.000000 6.611238 6.611238 D02A Head and Neck Procedures W CC D 3 27 10.640000 3.934050 0.258819 1.311350 0.655675 1.311350 D02B Head and Neck Procedures W/O CC D 0 8 2.179245 1.061748 0.337610 0.000000 1.061748 1.061748 D03Z Surgical Repair - Cleft Lip/Palate Diag D 1 10 2.358974 1.400948 0.337610 0.000000 0.700474 1.400948 D04A Maxillo Surgery W CC D 1 11 3.079365 1.504402 0.337610 0.000000 0.752201 1.504402 D04B Maxillo Surgery W/O CC D 0 7 1.765049 1.079356 0.337610 0.000000 1.079356 1.079356 D05Z Sialoadenectomy D 0 6 2.440252 1.259049 0.337610 0.000000 1.259049 1.259049 D06Z Sinus,Mastoid & Complex Middle Ear Procs D 0 4 1.248104 0.918106 0.337610 0.000000 0.918106 0.918106 D07Z Salivary Gland Procs Exc Sialoadenectomy D 0 5 1.400000 0.743126 0.337610 0.000000 0.743126 0.743126 D08Z Mouth Procedures D 0 4 1.260163 0.581501 0.323015 0.000000 0.581501 0.581501 D09Z Misc Ear, Nose, Mouth & Throat Procs D Same day 0 4 1.207735 0.843271 0.337610 0.000000 0.407458 0.843271 D10Z Rhinoplasty (W or W/O Turbinectomy) D 0 3 1.186680 0.785376 0.337610 0.000000 0.785376 0.785376 D11Z Tonsillectomy or Adenoidectomy D Same day 0 3 1.144923 0.523212 0.319889 0.000000 0.313400 0.523212 D12Z Other Ear,Nose,Mouth & Throat Procedures D 0 6 1.682500 0.717382 0.298465 0.000000 0.717382 0.717382 D13Z Myringotomy W Tube Insertion D 0 3 1.006033 0.290173 0.201903 0.000000 0.290173 0.290173 D40Z Dental Extractions and Restorations D 0 3 1.038848 0.426891 0.328741 0.000000 0.426891 0.426891 D60A Ear,Nose,Mouth,Throat Malig W Cat/Sev CC D 2 18 6.415385 1.926724 0.240263 0.963362 0.481681 0.963362 D60B Ear,Nose,Mouth,Throat Malig No Cat/SevCC D 0 8 2.284830 0.812714 0.284560 0.000000 0.812714 0.812714 D61Z Dysequilibrium D 0 7 1.773067 0.369715 0.166814 0.000000 0.369715 0.369715 D62Z Epistaxis D 0 5 1.685225 0.354396 0.168237 0.000000 0.354396 0.354396 D63A Otitis Media and URI W CC D 0 6 2.252174 0.605088 0.214935 0.000000 0.605088 0.605088 D63B Otitis Media and URI W/O CC D Same day 0 5 1.924028 0.438551 0.182347 0.000000 0.165688 0.438551 D64Z Laryngotracheitis and Epiglottitis D Same day 0 4 1.400338 0.387380 0.221306 0.000000 0.191791 0.387380

34 NZ WIES 8C Schedule Victorian DRG 4.2 New Zealand Schedule Costweights Weights Mech.Vent. Same Day Inlier Boundary Average Outlier Per Diems Code DRG Description Copayment One Day Low High Inlier LOS Inlier High Low Same Day One Day DRG42 mv_elig lb HB i_alos md_in ho_pd lo_pd sd od D65Z Nasal Trauma and Deformity D Same day 0 4 1.150538 0.390506 0.271529 0.000000 0.298151 0.390506 D66A Other Ear,Nose,Mouth & Throat Diags W CC D 0 7 2.286920 0.623126 0.217979 0.000000 0.623126 0.623126 D66B Other Ear,Nose,Mouth & Throat Diag no CC D Same day 0 5 1.735426 0.449284 0.207112 0.000000 0.289917 0.449284 D67Z Dental+Oral Dis Exc Extract/Restorations D Same day 0 6 1.949721 0.619586 0.254226 0.000000 0.246206 0.619586 E01A Major Chest Procedures W Catastrophic CC D 4 39 14.765957 5.343715 0.253326 1.335929 0.667964 1.335929 E01B Major Chest Procs W/O Catastrophic CC D 2 23 8.069328 3.085782 0.267686 1.542891 0.771445 1.542891 E02A Oth Respiratory Sys OR Procs W Catast CC D 2 25 10.727273 2.825330 0.184365 1.412665 0.706333 1.412665 E02B Oth Respiratory Sys OR Procs W Severe CC D Same day 1 18 5.732456 1.751262 0.213850 0.000000 0.352800 1.751262 E02C Oth Resp System OR Procs W/O Cat/Sev CC D Same day 1 11 2.716446 1.090321 0.280964 0.000000 0.359055 1.090321 E40Z Respiratory Sys Diag+Ventilator Support D 2 23 8.673913 4.576529 0.337610 2.288264 1.144132 2.288264 E60A Cystic Fibrosis W Catastrophic/Severe CC D 3 32 12.833811 3.369600 0.210045 1.123200 0.561600 1.123200 E60B Cystic Fibrosis W/O Catastroph/Severe CC D 2 22 9.000000 2.174733 0.193310 1.087366 0.543683 1.087366 E61A Pulmonary Embolism W Catast/Severe CC D 2 22 8.839196 1.823401 0.165029 0.911701 0.455850 0.911701 E61B Pulmonary Embolism W/O Catast/Severe CC D 1 15 5.670213 1.161654 0.163896 0.000000 0.580827 1.161654 E62A Resp Infections/Inflammations W Cat CC D 2 23 8.621552 1.728886 0.160425 0.864443 0.432222 0.864443 E62B Resp Infect/Inflammations W Sev/Mod CC D 1 15 5.078017 1.070377 0.168629 0.000000 0.535189 1.070377 E62C Respiratory Infect/Inflammations W/O CC D 0 8 3.032641 0.628771 0.165868 0.000000 0.628771 0.628771 E63Z Sleep Apnoea D One Day 1 11 3.433333 0.898097 0.209265 0.000000 0.227811 0.227811 E64Z Pulmonary Oedema and Respiratory Failure D 1 14 4.498607 1.220058 0.216966 0.000000 0.610029 1.220058 E65A Chr Obstruct Airway Disease W Cat/Sev CC D Same day 2 19 7.052314 1.297895 0.147231 0.648948 0.195688 0.648948 E65B Chr Obstruct Airway Dis No Cat/Sev CC D Same day 1 14 4.312081 0.887702 0.164691 0.000000 0.198145 0.887702 E66A Major Chest Trauma Age>69 W CC D 2 20 7.220339 1.706897 0.189121 0.853449 0.426724 0.853449 E66B Maj Chest Trauma <70+CC or >69 W/O CC D 1 13 4.333333 1.119158 0.206614 0.000000 0.559579 1.119158 E66C Major Chest Trauma Age<70 W/O CC D 0 6 1.929688 0.494018 0.204808 0.000000 0.494018 0.494018 E67A Respiratory Signs+Symptoms W Cat/Sev CC D 1 9 2.189055 0.580851 0.212275 0.000000 0.290426 0.580851 E67B Resp Signs & Symptoms<3 No Cat/Sev CC D 0 5 1.488889 0.385508 0.207139 0.000000 0.385508 0.385508 E67C Resp Signs+Symptoms>2 No Cat/Sev CC D 0 5 1.299658 0.378869 0.233212 0.000000 0.378869 0.378869 E68Z Pneumothorax D 1 12 3.818408 0.880091 0.184389 0.000000 0.440045 0.880091 E69A Bronchitis and Asthma Age>49 W CC D 1 13 4.343915 0.949917 0.174942 0.000000 0.474959 0.949917 E69B Bronchitis & Asthma <50+CC or >49 W/O CC D Same day 1 9 3.176056 0.797724 0.200934 0.000000 0.201794 0.797724 E69C Bronchitis and Asthma Age<50 W/O CC D Same day 0 5 1.810560 0.469738 0.207555 0.000000 0.174770 0.469738 E70A Whoop Cough+Ac Bronchiolitis+Cat/Sev CC D 1 13 4.791304 1.236737 0.206497 0.000000 0.618368 1.236737 E70B Whoop Cough+Ac Bronch'tis No Cat/Sev CC D 0 7 2.389878 0.581241 0.194568 0.000000 0.581241 0.581241 E71A Respiratory Neoplasms W CC D 1 15 3.735643 0.968373 0.207380 0.000000 0.484187 0.968373

35 NZ WIES 8C Schedule Victorian DRG 4.2 New Zealand Schedule Costweights Weights Mech.Vent. Same Day Inlier Boundary Average Outlier Per Diems Code DRG Description Copayment One Day Low High Inlier LOS Inlier High Low Same Day One Day DRG42 mv_elig lb HB i_alos md_in ho_pd lo_pd sd od E71B Respiratory Neoplasms W/O CC D Same day 1 13 2.495017 0.851136 0.272907 0.000000 0.247518 0.851136 E72Z Respiratory Problem from Neonatal Period D One Day 4 38 14.250000 2.990977 0.167914 0.747744 0.243241 0.243241 E73A Pleural Effusion W Catastrophic CC D 2 23 8.636364 1.665595 0.154287 0.832797 0.416399 0.832797 E73B Pleural Effusion W Severe CC D 1 14 3.686275 0.940482 0.204105 0.000000 0.470241 0.940482 E73C Pleural Effusion W/O Catast/Severe CC D 0 8 2.312925 0.608126 0.210340 0.000000 0.608126 0.608126 E74A Interstitial Lung Disease >64+Cat/Sev CC D 2 20 8.637931 1.764222 0.163393 0.882111 0.441056 0.882111 E74B I-st Lung Dis<65+C/S CC or >64 No C/S CC D 1 14 5.321429 1.274454 0.191596 0.000000 0.637227 1.274454 E74C Interstitial Lung Dis <65 W/O Cat/Sev CC D 0 6 2.108696 0.635161 0.240968 0.000000 0.635161 0.635161 E75A Other Respiratory System Diag >64 W CC D 1 14 4.339623 0.966222 0.178121 0.000000 0.483111 0.966222 E75B Oth Resp System Diag <65+CC or >64 No CC D 1 10 3.057621 0.816420 0.213609 0.000000 0.408210 0.816420 E75C Other Respiratory System Diag <65 W/O CC D 0 5 1.596112 0.413948 0.207478 0.000000 0.413948 0.413948 F01Z Implant or Replace of AICD, Total System D 2 25 5.894737 16.319527 0.337610 8.159763 4.079882 8.159763 F02Z AICD Component Implantation/Replacement I 1 9 6.000000 14.237196 0.337610 0.000000 7.118598 14.237196 F03Z Cardiac Valve Proc+Pump+Inv Card Inv Pr D 6 62 18.968254 12.653093 0.337610 2.108849 1.054424 2.108849 F04A Card Valve Pr+Pump No Inv Inv Pr+C/S CC D 3 36 9.637500 8.589399 0.337610 2.863133 1.431567 2.863133 F04B Card Val Pr+Pump No Inv Inv Pr No C/S CC D 2 26 7.145833 6.551920 0.337610 3.275960 1.637980 3.275960 F05A Coronary Bypass+Inv Card Inv Proc+Cat CC D 5 53 15.488599 10.285999 0.337610 2.057200 1.028600 2.057200 F05B Coron Bypass+Inv Card Inv Proc No Cat CC D 5 45 12.892857 8.323501 0.337610 1.664700 0.832350 1.664700 F06A Coron Bypass No Inv Card Inv Pr W C/S CC D 3 32 8.997351 7.112385 0.337610 2.370795 1.185397 2.370795 F06B Cor Bypass No Inv Card Inv Pr W/O C/S CC D 2 26 7.280374 6.158373 0.337610 3.079187 1.539593 3.079187 F07Z Oth Cardiothoracic/Vascular Procs W Pump D 3 32 8.266409 7.357597 0.337610 2.452532 1.226266 2.452532 F08A Maj Recon Vasc Procs W/O Pump W Cat CC D 4 42 15.395604 6.393378 0.290691 1.598345 0.799172 1.598345 F08B Maj Recon Vasc Procs W/O Pump W/O Cat CC D 2 22 7.498008 3.549571 0.331381 1.774786 0.887393 1.774786 F09Z Other Cardiothoracic Procedures W/O Pump D 2 21 7.429688 4.644187 0.337610 2.322094 1.161047 2.322094 F10Z Percutaneous Coronary Angioplasty W AMI D 1 16 4.861502 2.920174 0.337610 0.000000 1.460087 2.920174 F11A Amput-Circ Sys Exc Up Limb+Toe W Cat CC D 6 61 22.576471 5.378998 0.166780 0.896500 0.448250 0.896500 F11B Amput-Circ Sys Exc Up Limb+Toe No Cat CC D 5 47 16.631579 3.780400 0.159112 0.756080 0.378040 0.756080 F12Z Cardiac Pacemaker Implantation D 1 10 2.862745 4.030035 0.337610 0.000000 2.015017 4.030035 F13Z Up Limb+Toe Amputation for Circ Sys Dis D 3 32 13.467290 2.865873 0.148962 0.955291 0.477646 0.955291 F14A Vasc Procs Exc Maj Recon No Pump+Cat CC D 2 23 7.636752 2.998262 0.274827 1.499131 0.749565 1.499131 F14B Vasc Procs Exc Maj Recon No Pump+Sev CC D 1 9 2.690909 1.455913 0.337610 0.000000 0.727957 1.455913 F14C Vasc Prs Exc Maj Rec W/O Pump W/O C/S CC D 0 5 1.661504 1.113065 0.337610 0.000000 1.113065 1.113065 F15Z Percut Coron Angioplasty W/O AMI W Stent D 0 9 1.886792 2.238349 0.337610 0.000000 2.238349 2.238349 F16Z Percut Coron Angioplasty No AMI No Stent D 1 9 1.818627 1.981127 0.337610 0.000000 0.990563 1.981127

36 NZ WIES 8C Schedule Victorian DRG 4.2 New Zealand Schedule Costweights Weights Mech.Vent. Same Day Inlier Boundary Average Outlier Per Diems Code DRG Description Copayment One Day Low High Inlier LOS Inlier High Low Same Day One Day DRG42 mv_elig lb HB i_alos md_in ho_pd lo_pd sd od F17Z Cardiac Pacemaker Replacement D 0 8 1.572115 2.076087 0.337610 0.000000 2.076087 2.076087 F18Z Cardiac Pacemaker Rev Exc Device Replace D 0 8 2.355556 1.774451 0.337610 0.000000 1.774451 1.774451 F19Z Oth Trans-Vasc Percut Cardiac Intervent D 0 6 1.723214 1.525314 0.337610 0.000000 1.525314 1.525314 F20Z Vein Ligation and Stripping D 0 5 1.197229 0.764014 0.337610 0.000000 0.764014 0.764014 F21A Oth Circ Sys ORP+Cat CC or >64 No Cat CC D 3 35 13.301205 3.485183 0.183414 1.161728 0.580864 1.161728 F21B Oth Circ System OR Procs <65 W/O Cat CC D 1 18 3.320000 1.515275 0.319486 0.000000 0.757637 1.515275 F40Z Circulatory Sys Diag+Ventilator Support I 2 22 7.516129 4.387616 0.337610 2.193808 1.096904 2.193808 F41A Circ Dis W AMI W Inv Card Inv Pr+C/S CC D 3 28 8.821229 2.796550 0.253620 0.932183 0.466092 0.932183 F41B Circ Dis W AMI W Inv Car Inv Pr NoC/S CC D Same day 2 19 6.137705 2.044138 0.266437 1.022069 0.469092 1.022069 F42A Circ Dis No AMI+Inv Card Inv Pr+Cx Dx/Pr D 1 11 3.276954 1.198631 0.292621 0.000000 0.599316 1.198631 F42B Circ Dis No AMI W Card Inv No Comp Dx/Pr D Same day 1 9 1.880473 1.097072 0.337610 0.000000 0.512470 1.097072 F60A Circ Dis W AMI No Inv Card Inv Pr+C/S CC D 2 21 7.281726 1.997318 0.219433 0.998659 0.499330 0.998659 F60B Circ Dis+AMI W/O Card Inv W/O Cat/Sev CC D 1 14 4.538351 1.417682 0.249903 0.000000 0.708841 1.417682 F60C Circ Dis W AMI No Inv Card Inv Proc,Died D 1 10 2.470833 0.828570 0.268272 0.000000 0.414285 0.828570 F61Z Infective Endocarditis D 5 51 24.365385 4.541164 0.149102 0.908233 0.454116 0.908233 F62A Heart Failure & Shock W Catastrophic CC D Same day 2 26 8.936842 1.753556 0.156973 0.876778 0.294738 0.876778 F62B Heart Failure & Shock no Catastrophic CC D Same day 1 16 4.923722 1.079891 0.175459 0.000000 0.218037 1.079891 F63A Venous Thrombosis W Catastroph/Severe CC D 1 18 7.144681 1.301694 0.145753 0.000000 0.650847 1.301694 F63B Venous Thrombosis W/O Catast/Severe CC D 1 9 4.548644 0.611624 0.107570 0.000000 0.305812 0.611624 F64Z Skin Ulcers for Circulatory Disorders D 2 22 11.103448 1.936284 0.139509 0.968142 0.484071 0.968142 F65A Peripheral Vascular Disords W Cat/Sev CC D Same day 1 16 4.933884 1.240048 0.201066 0.000000 0.408976 1.240048 F65B Periph Vascular Disorders W/O Cat/Sev CC D Same day 0 7 2.249004 0.726766 0.258520 0.000000 0.465561 0.726766 F66A Coronary Atherosclerosis W CC D 1 10 2.303085 0.626056 0.217467 0.000000 0.313028 0.626056 F66B Coronary Atherosclerosis W/O CC D Same day 0 7 1.970387 0.571601 0.232076 0.000000 0.255704 0.571601 F67A Hypertension W CC D 1 11 3.452381 0.766141 0.177533 0.000000 0.383071 0.766141 F67B Hypertension W/O CC D 0 7 1.626335 0.415298 0.204287 0.000000 0.415298 0.415298 F68Z Congenital Heart Disease D 0 4 1.129534 0.411566 0.291495 0.000000 0.411566 0.411566 F69A Valvular Disorder W Catastroph/Severe CC D 1 13 3.736842 0.969619 0.207580 0.000000 0.484809 0.969619 F69B Valvular Disorders W/O Catast/Severe CC D 0 6 1.297500 0.341835 0.210766 0.000000 0.341835 0.341835 F70A Maj Arrhythmia+Cardiac Arrest+Cat/Sev CC D 1 15 4.263959 1.351067 0.253486 0.000000 0.675534 1.351067 F70B Maj Arrhythmia+Cardiac Arr No Cat/Sev CC D 0 8 2.205607 0.725317 0.263081 0.000000 0.725317 0.725317 F71A Non-Maj Arrhythmia+Conduct Dis W C/S CC D Same day 1 13 4.762250 1.221617 0.205217 0.000000 0.202502 1.221617 F71B Non-Maj Arrhythmia+Conduct Dis No C/S CC D Same day 0 7 2.404882 0.716118 0.238222 0.000000 0.237607 0.716118 F72A Unstable Angina W Catastrophic/Severe CC D 1 14 4.157943 1.117020 0.214918 0.000000 0.558510 1.117020

37 NZ WIES 8C Schedule Victorian DRG 4.2 New Zealand Schedule Costweights Weights Mech.Vent. Same Day Inlier Boundary Average Outlier Per Diems Code DRG Description Copayment One Day Low High Inlier LOS Inlier High Low Same Day One Day DRG42 mv_elig lb HB i_alos md_in ho_pd lo_pd sd od F72B Unstable Angina W/O Catastroph/Severe CC D 1 10 2.596812 0.759416 0.233953 0.000000 0.379708 0.759416 F73A Syncope & Collapse W Catast/Severe CC D 1 11 3.249467 0.695701 0.171278 0.000000 0.347851 0.695701 F73B Syncope & Collapse W/O Catast/Severe CC D Same day 0 7 2.240137 0.541507 0.193384 0.000000 0.187263 0.541507 F74Z Chest Pain D Same day 0 6 1.754348 0.541745 0.247041 0.000000 0.221373 0.541745 F75A Other Circulatory Sys Diags W Catast CC D 2 21 8.008772 2.015899 0.201369 1.007950 0.503975 1.007950 F75B Oth Circulatory System Diags W Severe CC D 1 13 4.028939 1.159023 0.230140 0.000000 0.579511 1.159023 F75C Oth Circulatory Sys Diags W/O Cat/Sev CC D 0 9 1.940950 0.711811 0.293387 0.000000 0.711811 0.711811 G01A Rectal Resection W Catastrophic CC D 5 47 15.597610 5.486083 0.246208 1.097217 0.548608 1.097217 G01B Rectal Resection W/O Catastrophic CC D 3 33 10.452471 3.608535 0.241663 1.202845 0.601423 1.202845 G02A Maj Small & Large Bowel Proc W Catast CC D 4 45 15.382594 4.996191 0.227357 1.249048 0.624524 1.249048 G02B Maj Small+Large Bowel Proc no Catast CC D 3 29 9.315714 2.991274 0.224770 0.997091 0.498546 0.997091 G03A Stomach,Oesophal,Duodenal Procs W Malig D 4 41 15.914894 5.817112 0.255860 1.454278 0.727139 1.454278 G03B Stom,Oesophal,Duodenal Pr No Mal +C/S CC D 4 38 11.748603 4.410777 0.262801 1.102694 0.551347 1.102694 G03C Stom,Oesoph,Duodenal Pr No Mal NoC/S CC D 1 14 4.590000 1.921999 0.293115 0.000000 0.960999 1.921999 G04A Peritoneal Adhesiolysis Age>49 W CC D 3 36 11.432000 3.209127 0.196500 1.069709 0.534854 1.069709 G04B Periton Adhesiolysis <50+CC or >49 no CC D 2 22 7.728000 2.193878 0.198721 1.096939 0.548470 1.096939 G04C Peritoneal Adhesiolysis Age<50 W/O CC D 1 13 3.323529 1.151135 0.242451 0.000000 0.575567 1.151135 G05A Minor Small & Large Bowel Procedures +CC D 2 26 8.240506 2.340041 0.198778 1.170020 0.585010 1.170020 G05B Minor Small & Large Bowel Procs W/O CC D 1 15 4.158824 1.296660 0.218250 0.000000 0.648330 1.296660 G06Z Pyloromyotomy Procedure D 1 12 3.901961 1.278608 0.229378 0.000000 0.639304 1.278608 G07A Appendicectomy W Catastrophic/Severe CC D 1 18 5.785185 1.712381 0.207196 0.000000 0.856190 1.712381 G07B Appendicectomy no Catastrophic/Severe CC D 0 8 2.955765 1.044951 0.247471 0.000000 1.044951 1.044951 G08Z Abdominal,Umbilical & Oth Hernia Procs>0 D 0 7 2.112847 0.868142 0.287621 0.000000 0.868142 0.868142 G09Z Inguinal & Femoral Hernia Procedures >0 D 0 4 1.351974 0.731534 0.337610 0.000000 0.731534 0.731534 G10Z Hernia Procedures Age<1 D Same day 0 5 1.344186 0.708335 0.337610 0.000000 0.398212 0.708335 G11A Anal & Stomal Procs W Catast/Severe CC D 1 10 3.008097 0.973542 0.226548 0.000000 0.486771 0.973542 G11B Anal & Stomal Procs W/O Catast/Severe CC D Same day 0 6 1.962229 0.716892 0.255742 0.000000 0.402004 0.716892 G12A Oth Dig Sys ORPs W C/S CC or W Malig D 2 25 9.005917 2.824587 0.219546 1.412293 0.706147 1.412293 G12B Oth Dig Sys ORP No C/S CC No Malignancy D 0 9 2.274510 0.887747 0.273212 0.000000 0.887747 0.887747 G40A Cplx Ther G'scopy-Maj Dig+C/S CC/Comp Pr D 2 24 7.224138 2.026336 0.224396 1.013168 0.506584 1.013168 G40B Cx Th Gas'py-Mj Dig Dis No C/S CC/Cmp Pr D 1 12 3.352941 1.108190 0.264410 0.000000 0.554095 1.108190 G41A Cmplx Ther Gastroscopy - Non-Maj Dig Dis D 1 15 4.380165 1.373199 0.250803 0.000000 0.686600 1.373199 G41B Cplx Ther Gastroscopy Non-Maj Dig Dis,SD D 0 3 1.000000 0.304214 0.243371 0.000000 0.304214 0.304214 G42A Oth Gastroscopy - Maj Digestive Disease D 1 14 4.367410 1.179433 0.216043 0.000000 0.589716 1.179433

38 NZ WIES 8C Schedule Victorian DRG 4.2 New Zealand Schedule Costweights Weights Mech.Vent. Same Day Inlier Boundary Average Outlier Per Diems Code DRG Description Copayment One Day Low High Inlier LOS Inlier High Low Same Day One Day DRG42 mv_elig lb HB i_alos md_in ho_pd lo_pd sd od G42B Oth Gastroscopy for Maj Dig Dis,Sameday D 0 3 1.000000 0.274756 0.219805 0.000000 0.274756 0.274756 G43Z Complex Therapeutic Colonoscopy D 0 7 1.391304 0.428644 0.246470 0.000000 0.428644 0.428644 G44A Oth Colonoscopy W Cat/Sev CC or Comp Pr D 2 20 6.812925 1.573287 0.184741 0.786644 0.393322 0.786644 G44B Oth Colonosc W/O Cat/Sev CC or Comp Proc D 1 11 3.328276 0.856480 0.205867 0.000000 0.428240 0.856480 G44C Other Colonoscopy, Sameday D 0 3 1.000000 0.252472 0.201978 0.000000 0.252472 0.252472 G45A Oth Gastroscopy - Non-Maj Digest Disease D 1 10 2.917248 0.864509 0.237075 0.000000 0.432254 0.864509 G45B Oth Gas'py - Non-Maj Dig Disease,Sameday D 0 3 1.000000 0.218506 0.174805 0.000000 0.218506 0.218506 G60A Digestive Malignancy W Catast/Severe CC D Same day 1 18 5.314079 1.202970 0.181099 0.000000 0.158174 1.202970 G60B Digestive Malignancy no Catast/Severe CC D Same day 1 14 2.965839 0.911511 0.245869 0.000000 0.237941 0.911511 G61A GI Haemorrh <65+Catast/Severe CC or >64 D 1 9 2.444444 0.644577 0.210953 0.000000 0.322289 0.644577 G61B GI Haemorrhage <65 W/O Catast/Severe CC D 0 5 1.454545 0.318812 0.175347 0.000000 0.318812 0.318812 G62Z Complicated Peptic Ulcer D 1 12 3.264706 0.877050 0.214917 0.000000 0.438525 0.877050 G63Z Uncomplicated Peptic Ulcer D 0 6 1.277778 0.284310 0.178003 0.000000 0.284310 0.284310 G64Z Inflammatory Bowel Disease D 1 12 3.826923 0.803807 0.168032 0.000000 0.401903 0.803807 G65A GI Obstruction W CC D 1 16 4.614815 0.946916 0.164152 0.000000 0.473458 0.946916 G65B GI Obstruction W/O CC D 1 9 2.859259 0.597048 0.167050 0.000000 0.298524 0.597048 G66A Abdominal Pain/Mesenteric Adenitis W CC D Same day 0 9 2.707531 0.649019 0.191767 0.000000 0.183715 0.649019 G66B Abdominal Pain/Mesenteric Adenitis no CC D Same day 0 5 1.668222 0.390745 0.187383 0.000000 0.169002 0.390745 G67A Oesophagitis,GE,Misc Dig Sys >9 W C/S CC D Same day 1 13 4.231707 0.935289 0.176815 0.000000 0.220079 0.935289 G67B Oesophagitis,GE,Misc Dig Sys >9 NoC/S CC D Same day 0 7 2.217586 0.502024 0.181106 0.000000 0.151494 0.502024 G68A Gastroenteritis Age<10 W CC D 0 7 2.329193 0.745522 0.256062 0.000000 0.745522 0.745522 G68B Gastroenteritis Age<10 W/O CC D 0 4 1.633978 0.442217 0.216511 0.000000 0.442217 0.442217 G69Z Oesophagitis & Misc Dig Sys Disords <10 D 0 5 1.696697 0.428965 0.202259 0.000000 0.428965 0.428965 G70A Other Digestive System Diagnoses W CC D 1 11 3.013619 0.786215 0.208710 0.000000 0.393107 0.786215 G70B Other Digestive System Diagnoses W/O CC D Same day 0 7 2.172316 0.514188 0.189360 0.000000 0.220110 0.514188 H01A Pancreas,Liver & Shunt Procs W Catast CC D 6 61 20.047619 6.839596 0.238817 1.139933 0.569966 1.139933 H01B Pancreas,Liver,Shunt Procs W Sev/Mod CC D 3 28 11.016393 3.825459 0.243076 1.275153 0.637576 1.275153 H01C Pancreas,Liver & Shunt Procedures W/O CC D 2 22 7.964286 3.109648 0.273314 1.554824 0.777412 1.554824 H02A Major Biliary Tract Procs W Malignancy D 5 46 14.531250 4.388024 0.211380 0.877605 0.438802 0.877605 H02B Maj Biliary Tr Proc W/O Malig W C/Sev CC D 4 39 13.129032 3.899944 0.207933 0.974986 0.487493 0.974986 H02C Maj Biliary Tr Procs No Malig No C/S CC D 2 21 8.333333 2.660919 0.223517 1.330460 0.665230 1.330460 H03A Cholecystectomy+Closed CDE W Cat/Sev CC D 3 35 12.704918 3.828618 0.210944 1.276206 0.638103 1.276206 H03B Cholecystectomy+Closed CDE no Cat/Sev CC D 2 23 7.587302 2.496468 0.230323 1.248234 0.624117 1.248234 H04A Cholecystectomy no Closed CDE+Cat/Sev CC D 1 18 5.861407 2.088454 0.249414 0.000000 1.044227 2.088454

39 NZ WIES 8C Schedule Victorian DRG 4.2 New Zealand Schedule Costweights Weights Mech.Vent. Same Day Inlier Boundary Average Outlier Per Diems Code DRG Description Copayment One Day Low High Inlier LOS Inlier High Low Same Day One Day DRG42 mv_elig lb HB i_alos md_in ho_pd lo_pd sd od H04B Cholecyst'my No Closed CDE No Cat/Sev CC D 0 7 2.224335 1.188597 0.337610 0.000000 1.188597 1.188597 H05A Hepatobiliary Diagnost Procs+Cat/Sev CC D 3 31 11.294118 3.438010 0.213085 1.146003 0.573002 1.146003 H05B Hepatobiliary Diag Procs W/O Cat/Sev CC D 1 11 2.688312 0.873022 0.227323 0.000000 0.436511 0.873022 H06Z Other Hepatobiliary & Pancreas OR Procs D 4 39 15.913043 4.687033 0.206178 1.171758 0.585879 1.171758 H40Z Endoscop Procs-Bleeding Oesophal Varices D 1 14 4.508475 1.555019 0.275928 0.000000 0.777509 1.555019 H41A ERCP Compx Therapeutic Proc W Cat/Sev CC D 2 23 8.837209 2.222431 0.201189 1.111216 0.555608 1.111216 H41B ERCP Compx Therapeut Proc W/O Cat/Sev CC D 1 11 3.448276 1.033821 0.239846 0.000000 0.516910 1.033821 H42A ERCP Other Therapeutic Proc W Cat/Sev CC D 2 24 7.939815 1.958832 0.197368 0.979416 0.489708 0.979416 H42B ERCP Oth Therapeutic Proc W/O Cat/Sev CC D 0 8 2.148751 0.614070 0.228624 0.000000 0.614070 0.614070 H60A Cirrhosis & Alcoholic Hepatitis W Cat CC D 3 28 10.796296 2.764584 0.204854 0.921528 0.460764 0.921528 H60B Cirrhosis+Alcoholic Hepatitis+Cat/Sev CC D 1 15 3.500000 0.998278 0.228178 0.000000 0.499139 0.998278 H60C Cirrhosis+Alcoh Hepatitis W/O Cat/Sev CC D 0 8 1.656347 0.495778 0.239456 0.000000 0.495778 0.495778 H61A Mal Hepatobiliary Sys,Pancreas>69+C/S CC D 2 23 7.795082 1.596129 0.163809 0.798064 0.399032 0.798064 H61B Mal Hepat,Panc<70+C/S CC or >69 NoC/S CC D 1 14 3.368209 0.875399 0.207920 0.000000 0.437700 0.875399 H61C Malig Hepato Sys,Pancreas <70 W/O C/S CC D 1 10 2.134615 0.720721 0.270108 0.000000 0.360360 0.720721 H62A Dis Pancreas Exc for Malig W Cat/Sev CC D 2 23 7.538860 1.724197 0.182966 0.862098 0.431049 0.862098 H62B Disorder of Pancreas Exc Malig No C/S CC D 1 12 4.007042 0.851469 0.169994 0.000000 0.425734 0.851469 H63A Dis Liver Exc Mal,Cirrhos,Al Hep+C/S CC D 2 19 7.209402 1.865600 0.207019 0.932800 0.466400 0.932800 H63B Dis Liver Exc Mal,Cirr,Al Hep No C/S CC D Same day 1 11 2.979849 0.949643 0.254951 0.000000 0.313956 0.949643 H64A Disorders of the Biliary Tract W CC D 1 14 4.069212 0.953914 0.187538 0.000000 0.476957 0.953914 H64B Disorders of the Biliary Tract W/O CC D Same day 0 8 2.698690 0.619047 0.183510 0.000000 0.179255 0.619047 I01Z Bilateral/Mult Maj Jt Procs - Low Extrem D 4 44 14.111111 5.425065 0.269117 1.356266 0.678133 1.356266 I02A M-vasc Tiss Tr/Skin Grt+C/S CC Exc Hand D 8 80 27.278351 8.456116 0.216996 1.057015 0.528507 1.057015 I02B Skin Graft W/O Cat/Sev CC,Excluding Hand D 3 30 12.126761 3.740512 0.215916 1.246837 0.623419 1.246837 I03A Hip Revision W Catastrophic or Severe CC D 4 44 16.382022 6.073397 0.259515 1.518349 0.759175 1.518349 I03B Hip Replac W C/S CC or Hip Rev No C/S CC D 3 30 11.616487 4.164651 0.250958 1.388217 0.694109 1.388217 I03C Hip Replacement W/O Catastroph/Severe CC D 2 22 8.816923 4.008569 0.318251 2.004285 1.002142 2.004285 I04A Knee Replacement & Reattach W Catast CC D 4 40 14.395062 4.661874 0.226697 1.165468 0.582734 1.165468 I04B Knee Replace & Reattach W/O Catast CC D 2 24 9.508221 3.942704 0.290264 1.971352 0.985676 1.971352 I05Z Oth Maj Joint Repl & Limb Reattach Procs D 2 18 6.605634 2.972396 0.314985 1.486198 0.743099 1.486198 I06Z Spinal Fusion W Deformity D 3 32 12.384615 5.509384 0.311400 1.836461 0.918231 1.836461 I07Z Amputation D 5 53 16.514286 4.530041 0.192017 0.906008 0.453004 0.906008 I08A Oth Hip & Femur Procs W Catast/Severe CC D 3 34 11.444915 3.374906 0.206418 1.124969 0.562484 1.124969 I08B Oth Hip & Femur Procs >54 W/O Cat/Sev CC D 2 24 9.031603 2.735199 0.211993 1.367599 0.683800 1.367599

40 NZ WIES 8C Schedule Victorian DRG 4.2 New Zealand Schedule Costweights Weights Mech.Vent. Same Day Inlier Boundary Average Outlier Per Diems Code DRG Description Copayment One Day Low High Inlier LOS Inlier High Low Same Day One Day DRG42 mv_elig lb HB i_alos md_in ho_pd lo_pd sd od I08C Oth Hip & Femur Procs <55 W/O Cat/Sev CC D 1 17 5.100264 2.134427 0.292945 0.000000 1.067214 2.134427 I09A Spinal Fusion W Catastrophic/Severe CC D 4 40 11.626667 5.258627 0.316603 1.314657 0.657328 1.314657 I09B Spinal Fusion W/O Catastrophic/Severe CC D 2 23 7.400000 3.711324 0.337610 1.855662 0.927831 1.855662 I10A Oth Back & Neck Procs W Catast/Severe CC D 3 36 10.790816 3.545335 0.229986 1.181778 0.590889 1.181778 I10B Other Back & Neck Procs no Catast/Sev CC D 2 19 6.053055 2.213891 0.256023 1.106945 0.553473 1.106945 I11Z Limb Lengthening Procedures D 3 30 6.333333 2.234011 0.246917 0.744670 0.372335 0.744670 I12A Infect/Inflam Bone,Joint+Misc Pr+Cat CC D 6 56 24.045455 4.883489 0.142166 0.813915 0.406957 0.813915 I12B Infect/Inflam Bone,Joint+Misc Pr+Sev CC D 2 27 9.788889 2.358320 0.168643 1.179160 0.589580 1.179160 I12C Infect/Inflam Bone,Jnt+Misc Pr No C/S CC D 1 13 3.060790 1.165965 0.266655 0.000000 0.582983 1.165965 I13A Humerus,Tibia, etc Procs W Cat/Sev CC D 3 31 9.986239 2.925480 0.205066 0.975160 0.487580 0.975160 I13B Humerus,Tibia etc Procs >59 No C/Sev CC D 2 19 6.419890 1.964430 0.214194 0.982215 0.491108 0.982215 I13C Humerus,Tibia etc Procs <60 No C/Sev CC D 1 11 3.471639 1.565885 0.315735 0.000000 0.782942 1.565885 I14Z Stump Revision D 1 18 4.187500 1.109570 0.185480 0.000000 0.554785 1.109570 I15Z Cranio-Facial Surgery D 1 12 4.445946 1.915445 0.301581 0.000000 0.957722 1.915445 I16Z Other Shoulder Procedures D 0 6 2.123667 1.155672 0.337610 0.000000 1.155672 1.155672 I17Z Maxillo-Facial Surgery D 1 9 2.323232 1.263084 0.337610 0.000000 0.631542 1.263084 I18Z Knee Procedures D Same day 1 10 2.197447 1.072697 0.337610 0.000000 0.525499 1.072697 I19Z Other Elbow or Forearm Procedures D 0 7 2.171464 1.069874 0.337610 0.000000 1.069874 1.069874 I20Z Foot Procedures D 0 8 2.229412 0.942548 0.295945 0.000000 0.942548 0.942548 I21Z Loc Excis & Remov Int Fix Dev Hip+Femur D 0 5 2.500000 0.817274 0.228837 0.000000 0.817274 0.817274 I22Z Major Wrist, Hand and Thumb Procedures D 0 5 1.453488 0.757021 0.337610 0.000000 0.757021 0.757021 I23Z Loc Exc+Removl Int Fix Dev Exc Hip,Femur D Same day 0 6 1.598400 0.870680 0.337610 0.000000 0.419427 0.870680 I24Z Arthroscopy D 0 4 1.073620 0.578502 0.337610 0.000000 0.578502 0.578502 I25Z Bone & Joint Diagnostic Proc incl Biopsy D 1 14 3.384615 1.085744 0.224551 0.000000 0.542872 1.085744 I26Z Other Wrist and Hand Procedures D Same day 0 5 1.460892 0.841812 0.337610 0.000000 0.493919 0.841812 I27Z Soft Tissue Procedures D Same day 1 9 2.469274 1.015302 0.287822 0.000000 0.442666 1.015302 I28A Other Connective Tissue Procedures W CC D 2 24 7.766129 2.205423 0.198786 1.102712 0.551356 1.102712 I28B Other Connective Tissue Procedures NO CC D 0 7 1.762004 0.776978 0.308674 0.000000 0.776978 0.776978 I60Z Femoral Shaft Fractures D 4 37 8.071429 2.599612 0.257661 0.649903 0.324951 0.649903 I61Z Other Femoral Fractures D 2 20 8.800000 1.682877 0.152989 0.841438 0.420719 0.841438 I62A Fracture- Pelvis+Femoral Neck+Catast CC D 3 30 13.632653 2.221255 0.130349 0.740418 0.370209 0.740418 I62B Fracture - Pelvis,Femoral Neck+Severe CC D 2 21 9.349398 1.482036 0.126813 0.741018 0.370509 0.741018 I62C Fractures-Pelvis+Fem Neck No Cat/Sev CC D 1 13 3.541935 0.764253 0.172618 0.000000 0.382126 0.764253 I63Z Sprain,Strain & Disloc- Hip,Pelvis,Thigh D 0 6 2.250000 0.557506 0.198224 0.000000 0.557506 0.557506

41 NZ WIES 8C Schedule Victorian DRG 4.2 New Zealand Schedule Costweights Weights Mech.Vent. Same Day Inlier Boundary Average Outlier Per Diems Code DRG Description Copayment One Day Low High Inlier LOS Inlier High Low Same Day One Day DRG42 mv_elig lb HB i_alos md_in ho_pd lo_pd sd od I64A Osteomyelitis (< 65 W Cat/Sev CC) or >64 D 3 30 10.531646 2.212642 0.168076 0.737547 0.368774 0.737547 I64B Osteomyelitis <65 W/O Catast/Severe CC D Same day 1 18 4.864407 1.206593 0.198436 0.000000 0.365226 1.206593 I65A Conn Tiss Malig W Pathological Frac >64 D 2 19 7.186916 1.826938 0.203363 0.913469 0.456734 0.913469 I65B Conn Tiss Malig W Pathological Frac <65 D 1 12 2.277264 0.889771 0.312575 0.000000 0.444885 0.889771 I66A Infl Musc Dis (< 65 W Cat/Sev CC) or >64 D 1 16 5.267241 1.325892 0.201379 0.000000 0.662946 1.325892 I66B Infl Musc Dis <65 W/O Cat/Sev CC D 0 9 2.150115 0.674883 0.251106 0.000000 0.674883 0.674883 I67A Septic Arthritis+Catastrophic/Severe CC D 3 31 12.142857 2.505307 0.165056 0.835102 0.417551 0.835102 I67B Septic Arthritis W/O Catast/Severe CC D 1 12 4.729167 0.862448 0.145894 0.000000 0.431224 0.862448 I68A N-Sg Neck,Back No Pain Pr/Myel<75+CC/>74 D 1 15 4.017450 0.771598 0.153649 0.000000 0.385799 0.771598 I68B N-Surg Neck,Back No Pain Pr/Myel<75 NoCC D 0 8 1.826970 0.396614 0.173671 0.000000 0.396614 0.396614 I68C Nsurg Neck,Back W Pain Man Pr/Myelogram D 0 5 1.137421 0.346220 0.243513 0.000000 0.346220 0.346220 I69A Bone Dis & Spec Arthropath >74 W C/S CC D 2 19 7.705882 1.679835 0.150671 0.725656 0.362828 0.725656 I69B Bone Dis & Spec Arthropath >74 No C/S CC D Same day 6 61 10.621212 1.679835 0.133787 0.296038 0.246455 0.296038 I69C Bone Diseases & Spec Arthropathies <75 D Same day 1 12 4.073529 0.903648 0.177467 0.000000 0.299129 0.903648 I70Z Non-Specific Arthropathies D 1 10 2.409091 0.595735 0.197829 0.000000 0.297868 0.595735 I71A Musculotendinous Disorders Age>69 W CC D 1 13 3.470199 0.656065 0.151245 0.000000 0.328032 0.656065 I71B Musculotendinous Dis <70+CC or >69 No CC D 0 7 1.769461 0.462070 0.208909 0.000000 0.462070 0.462070 I71C Musculotendinous Disorders <70 W/O CC D 0 5 1.274744 0.306802 0.192542 0.000000 0.306802 0.306802 I72A Tendonitis,Myositis,etc<80+C/S CC or >79 D 1 13 4.430380 0.814417 0.147060 0.000000 0.407209 0.814417 I72B Tendonitis,Myositis etc<80 No Cat/Sev CC D 0 6 1.695761 0.430374 0.203035 0.000000 0.430374 0.430374 I73A A-care - Conn Tissue Dis >59 W C/Sev CC D 2 24 9.080000 1.454828 0.128179 0.727414 0.363707 0.727414 I73B A-care CT Dis<60+C/S CC or >59 No C/S CC D 1 10 2.842391 0.715116 0.201272 0.000000 0.357558 0.715116 I73C A'care of Conn Tissue Dis <60 W/O C/S CC D 0 5 1.224490 0.442747 0.289261 0.000000 0.442747 0.442747 I74A Injury- Forearm,Wrist,Hand,Foot >74 W CC D 1 14 2.588235 0.742951 0.229639 0.000000 0.371476 0.742951 I74B Inj Forearm,Foot,etc <75+CC or >74 No CC D 0 6 1.334559 0.426259 0.255520 0.000000 0.426259 0.426259 I74C Injury- Forearm,Wrist,Hand,Foot<75 no CC D 0 3 1.091266 0.414349 0.303756 0.000000 0.414349 0.414349 I75A Injury-Shoulder,Arm,Leg,Ankle etc >64+CC D 2 19 8.323232 1.373569 0.132023 0.686784 0.343392 0.686784 I75B Inj Shldr,Arm,Leg,etc <65+CC or >64 NoCC D Same day 1 12 3.520505 0.788442 0.179166 0.000000 0.176048 0.788442 I75C Inj to Shoulder,Arm,Leg,etc<65 No CC D Same day 0 5 1.753561 0.563153 0.256919 0.000000 0.189590 0.563153 I76A Oth Musculoskeletal Disorders >69 W CC D 12 110 20.666667 3.876965 0.150076 0.323080 0.161540 0.323080 I76B Oth Musculoskeletal Dis <70+CC or >69 No CC D 1 14 2.235023 0.611013 0.218705 0.000000 0.305506 0.611013 I76C Oth Musculoskeletal Disorder <70 no CC D Same day 0 6 1.759825 0.672350 0.305644 0.000000 0.274456 0.672350 J01Z M-vasc Tiss Tr Skin,Subc Tiss,Breast Dis D 2 24 11.818182 4.482520 0.265503 2.241260 1.120630 2.241260 J02A LLimb+Skin Gr/Flap Rpr W Ulc/Cell+Cat CC D 8 78 34.824561 5.575106 0.112064 0.696888 0.348444 0.696888

42 NZ WIES 8C Schedule Victorian DRG 4.2 New Zealand Schedule Costweights Weights Mech.Vent. Same Day Inlier Boundary Average Outlier Per Diems Code DRG Description Copayment One Day Low High Inlier LOS Inlier High Low Same Day One Day DRG42 mv_elig lb HB i_alos md_in ho_pd lo_pd sd od J02B LLimb+Skin Gr/Flap Rpr+Ul/Cell No Cat CC D 4 37 17.250000 3.140997 0.127461 0.785249 0.392625 0.785249 J03A LLimb+Skin Gr/Flap No Ulc/Cell W C/S CC D 3 28 12.690909 2.290050 0.126314 0.763350 0.381675 0.763350 J03B LLimb+Skin Gr/Flap No Ulc/Cell No C/S CC D 1 13 5.766667 1.215240 0.147515 0.000000 0.607620 1.215240 J04A LLimb No Skin Gr/Flap W Ul/Cell W C/S CC D 3 35 14.764045 3.033949 0.143847 1.011316 0.505658 1.011316 J04B LLimb No Skin Gr/Flap W Ul/Cell NoC/S CC D 2 20 7.151515 1.768645 0.173117 0.884323 0.442161 0.884323 J05Z LLimb W ORP Not Skin Gr/Flap No Ulc/Cell D 0 7 2.200000 0.712588 0.226733 0.000000 0.712588 0.712588 J06A Major Procs- Malignant Breast Conditions D 1 12 4.657030 1.383147 0.207901 0.000000 0.691574 1.383147 J06B Maj Procs for Non-Malignant Breast Cond D 0 7 1.649510 0.815046 0.337610 0.000000 0.815046 0.815046 J07A Minor Procs- Malignant Breast Conditions D 0 5 1.482394 0.667142 0.315031 0.000000 0.667142 0.667142 J07B Min Procs for Non-Malignant Breast Cond D 0 3 1.021600 0.404820 0.277382 0.000000 0.404820 0.404820 J08A Oth Skin Graft +/ Debride Procs W C/S CC D Same day 2 20 7.023622 1.881923 0.187559 0.940962 0.643294 0.940962 J08B Oth Skin Graft +/ Debride Proc No C/S CC D Same day 1 9 2.394102 1.018483 0.297789 0.000000 0.566118 1.018483 J09Z Perianal and Pilonidal Procedures D 0 4 1.509740 0.605537 0.280761 0.000000 0.605537 0.605537 J10Z Skin,Subcut Tissue & Breast Plastic ORPs D Same day 0 7 1.783051 0.928075 0.337610 0.000000 0.496034 0.928075 J11Z Other Skin, Subcut Tissue & Breast Procs D 0 3 1.069103 0.476012 0.311671 0.000000 0.476012 0.476012 J60A Skin Ulcers Age>64 D Same day 3 28 10.633136 1.759640 0.132389 0.586547 0.431865 0.586547 J60B Skin Ulcers Age<65 D Same day 2 22 7.646341 1.407183 0.147227 0.703591 0.584340 0.703591 J61Z Severe Skin Disorders D 1 14 5.223022 1.393356 0.213418 0.000000 0.696678 1.393356 J62A Malignant Breast Disorders Age>69 W CC D 3 27 8.000000 1.711670 0.171167 0.570557 0.285278 0.570557 J62B Malig Breast Dis <70+CC or >69 No CC D 1 14 1.740909 0.547885 0.251770 0.000000 0.273943 0.547885 J62C Malignant Breast Disorders Age<70 W/O CC D 0 8 1.080000 0.333008 0.246672 0.000000 0.333008 0.333008 J63Z Non-Malignant Breast Disorders D 0 5 1.365482 0.432054 0.253129 0.000000 0.432054 0.432054 J64A Cellulitis >59 W Catastrophic/Severe CC D 2 20 7.811550 1.256676 0.128699 0.628338 0.314169 0.628338 J64B Cellulitis >59 W/O Catast/Sev CC or <60 D 0 8 3.372591 0.572183 0.135725 0.000000 0.572183 0.572183 J65A Skin Trauma, Subcut Tissue & Breast >69 D 1 11 1.805907 0.376656 0.166855 0.000000 0.188328 0.376656 J65B Skin Trauma, Subcut Tissue & Breast <70 D Same day 0 5 1.507813 0.400145 0.212305 0.000000 0.208043 0.400145 J66A Moderate Skin Disord W Catast/Severe CC D 1 14 3.941176 0.973877 0.197682 0.000000 0.486938 0.973877 J66B Moderate Skin Disord no Catast/Severe CC D Same day 1 11 3.569307 0.925383 0.207409 0.000000 0.250053 0.925383 J67A Minor Skin Disorders W CC D Same day 1 11 3.411429 0.990334 0.232239 0.000000 0.272909 0.990334 J67B Minor Skin Disorders W/O CC D Same day 0 6 2.012605 0.594285 0.236225 0.000000 0.306180 0.594285 K01Z Diabetic Foot D 6 55 20.606557 4.594457 0.156073 0.765743 0.382871 0.765743 K02Z Pituitary Procedures D 2 22 8.835821 3.237586 0.256491 1.618793 0.809397 1.618793 K03Z Adrenal Procedures D 2 27 7.647059 3.631746 0.332444 1.815873 0.907936 1.815873 K04Z Major Procedures for Obesity D 3 29 5.297872 3.097199 0.337610 1.032400 0.516200 1.032400

43 NZ WIES 8C Schedule Victorian DRG 4.2 New Zealand Schedule Costweights Weights Mech.Vent. Same Day Inlier Boundary Average Outlier Per Diems Code DRG Description Copayment One Day Low High Inlier LOS Inlier High Low Same Day One Day DRG42 mv_elig lb HB i_alos md_in ho_pd lo_pd sd od K05Z Parathyroid Procedures D 1 12 4.147059 1.719833 0.290298 0.000000 0.859917 1.719833 K06Z Thyroid Procedures D 0 8 2.987109 1.388754 0.325441 0.000000 1.388754 1.388754 K07Z Obesity Procedures D 2 22 5.318182 1.493729 0.196610 0.746864 0.373432 0.746864 K08Z Thyroglossal Procedures D 0 4 1.150943 0.680072 0.337610 0.000000 0.680072 0.680072 K09Z Oth Endocrine,Nutritional,Metabolic ORPs D 1 15 3.068493 1.299121 0.296362 0.000000 0.649560 1.299121 K40Z Endoscopic/Inv Proc for Metab Dis W/O CC D 0 6 1.493151 0.474019 0.222224 0.000000 0.474019 0.474019 K60A Diabetes W Catastrophic or Severe CC D 1 18 6.202703 1.372649 0.177039 0.000000 0.686324 1.372649 K60B Diabetes W/O Catastrophic or Severe CC D 1 10 3.053815 0.698081 0.182875 0.000000 0.349041 0.698081 K61Z Severe Nutritional Disturbance D 3 35 12.595238 2.502486 0.158948 0.834162 0.417081 0.834162 K62A Misc Metabolic Disorders W Catast CC D 2 19 8.090129 1.570122 0.155263 0.785061 0.392530 0.785061 K62B Misc Metabolic Dis +Sev CC or >74-Sev CC D 1 12 2.988728 0.771202 0.206430 0.000000 0.385601 0.771202 K62C Misc Metabolic Dis W/O Cat/Sev CC < 75 D 0 8 1.630597 0.422252 0.207165 0.000000 0.422252 0.422252 K63Z Inborn Errors of Metabolism D 0 8 1.865979 0.706477 0.302887 0.000000 0.706477 0.706477 K64A Endocrine Disorders W Catast/Severe CC D 2 21 7.485149 1.844522 0.197139 0.922261 0.461131 0.922261 K64B Endocrine Disorders W/O Catast/Severe CC D 0 7 1.908705 0.575714 0.241300 0.000000 0.575714 0.575714 L01A Kidney Transplant W Catastroph/Severe CC D 3 36 12.875000 5.909435 0.321290 1.969812 0.984906 1.969812 L01B Kidney Transplant W/O Catast/Severe CC D 2 23 8.000000 4.331780 0.337610 2.165890 1.082945 2.165890 L02Z Op'tive Insert Periton Catheter-Dialysis D 2 18 7.061224 2.253005 0.223347 1.126502 0.563251 1.126502 L03A Kidney,Ureter,Maj Blad Procs- Neo+C/S CC D 4 37 12.968504 4.659822 0.251523 1.164956 0.582478 1.164956 L03B Kidney,Ureter,Maj Blad Prs Neo No C/S CC D 2 24 8.393939 2.914865 0.243081 1.457433 0.728716 1.457433 L04A Kidny,Uret,Maj Blad Prs Non-Neo W C/S CC D 2 27 9.231132 3.067896 0.232640 1.533948 0.766974 1.533948 L04B Kidn,Uret,Maj Blad Prs Non-Neo No C/S CC D 1 12 4.508197 1.622657 0.251954 0.000000 0.811328 1.622657 L05A Transurethral Prostatectomy W Cat/Sev CC D 2 20 7.449275 1.846971 0.173558 0.923485 0.461743 0.923485 L05B Transureth Prostatectomy W/O Cat/Sev CC D 1 9 3.336134 1.023483 0.214751 0.000000 0.511742 1.023483 L06A Minor Bladder Procs W Catast/Severe CC D 1 15 4.550000 1.420575 0.218550 0.000000 0.710288 1.420575 L06B Min Bladder Procs W/O Catast/Severe CC D 0 7 2.097436 0.777928 0.259626 0.000000 0.777928 0.777928 L07A Transur Procs Exc Prostatectomy+C/Sev CC D 1 11 3.034884 0.957527 0.220855 0.000000 0.478764 0.957527 L07B Transur Proc Exc Prostatectomy No C/S CC D Same day 0 6 1.793210 0.783852 0.305985 0.000000 0.377686 0.783852 L08A Urethral Procedures W CC D 0 8 2.774194 0.803099 0.202643 0.000000 0.803099 0.803099 L08B Urethral Procedures W/O CC D 0 5 1.654088 0.602212 0.254852 0.000000 0.602212 0.602212 L09A Oth Proc- Kidney+Urinary Tr Dis W Cat CC D 3 28 10.984375 3.474426 0.221414 1.158142 0.579071 1.158142 L09B Oth Proc- Kidney+Urinary Tr Dis W Sev CC D 1 12 3.564103 1.568263 0.308011 0.000000 0.784132 1.568263 L09C Oth Procs- Kidney+Urin Tr Dis No C/S CC D 0 8 2.201835 1.182566 0.337610 0.000000 1.182566 1.182566 L40Z Ureteroscopy D Same day 0 7 2.444444 0.958538 0.313703 0.000000 0.588681 0.958538

44 NZ WIES 8C Schedule Victorian DRG 4.2 New Zealand Schedule Costweights Weights Mech.Vent. Same Day Inlier Boundary Average Outlier Per Diems Code DRG Description Copayment One Day Low High Inlier LOS Inlier High Low Same Day One Day DRG42 mv_elig lb HB i_alos md_in ho_pd lo_pd sd od L41Z Cystourethroscopy W/O CC D Same day 0 6 1.963068 0.808001 0.329281 0.000000 0.256119 0.808001 L42Z ESW Lithotripsy for Urinary Stones D 0 3 1.750000 0.758119 0.337610 0.000000 0.758119 0.758119 L60A Renal Failure W Catastrophic CC D 2 27 10.021978 2.170145 0.173231 1.085073 0.542536 1.085073 L60B Renal Failure W Sev CC or >69 W/O Sev CC D 1 16 5.192678 1.227642 0.189134 0.000000 0.613821 1.227642 L60C Renal Failure <70 W/O Catast/Severe CC D 1 9 2.119266 0.696448 0.262902 0.000000 0.348224 0.696448 L61Y Admit for peritoneal Dialysis I 0 3 1.005543 0.269662 0.214540 0.000000 0.269662 0.269662 L61Z Admit for Renal Dialysis D 0 3 1.000136 0.126510 0.101194 0.000000 0.126510 0.126510 L62A Kidney+Urinary Tract Neoplasm+Cat/Sev CC D 2 19 6.026316 1.421019 0.188642 0.710509 0.355255 0.710509 L62B Kidney+Urinary Tr Neoplasm No Cat/Sev CC D 0 8 1.600000 0.533900 0.266950 0.000000 0.533900 0.533900 L63A Kidney+Urinary Tr Infects >69 W Cat CC D 2 19 7.708155 1.261687 0.130946 0.630844 0.315422 0.630844 L63B Kidney+Urinary Tr Infect >69 W/O Cat CC D 1 12 3.075301 0.655991 0.170648 0.000000 0.327995 0.655991 L63C Kidney & Urinary Tract Infections < 70 D 0 7 2.525232 0.562230 0.178116 0.000000 0.562230 0.562230 L64Z Urinary Stones and Obstruction D Same day 0 6 1.760291 0.499857 0.227170 0.000000 0.194892 0.499857 L65A Kidney+Urinary Tr Sign+Syms W Cat/Sev CC D 1 11 3.148305 0.699830 0.177830 0.000000 0.349915 0.699830 L65B Kidney+Urinary Tr Sign+Syms W/O Cat/S CC D Same day 0 7 2.129032 0.532231 0.199990 0.000000 0.188228 0.532231 L66Z Urethral Stricture D 0 4 1.219048 0.341216 0.223923 0.000000 0.341216 0.341216 L67A Oth Kidney+Urinary Tract Diags W Cat CC D 1 17 5.767296 1.381005 0.191564 0.000000 0.690502 1.381005 L67B Oth Kidney+Urinary Tract Diags W Sev CC D 1 10 2.680556 0.714716 0.213304 0.000000 0.357358 0.714716 L67C Oth Kidney+Urinary Tr Diag No Cat/Sev CC D Same day 0 8 2.176084 0.686099 0.252233 0.000000 0.223391 0.686099 M01Z Major Male Pelvic Procedures D 1 17 8.375000 2.656777 0.222059 0.000000 1.328389 2.656777 M02A Transurethral Prostatectomy W Cat/Sev CC D 1 12 5.163823 1.432497 0.194187 0.000000 0.716248 1.432497 M02B Transureth Prostatectomy W/O Cat/Sev CC D 0 8 2.971123 1.063000 0.250444 0.000000 1.063000 1.063000 M03A Penis Procedures W CC D 1 12 3.100000 1.081525 0.244215 0.000000 0.540763 1.081525 M03B Penis Procedures W/O CC D 0 6 1.516129 0.641252 0.296068 0.000000 0.641252 0.641252 M04A Testes Procedures W CC D 0 6 2.053763 0.767595 0.261625 0.000000 0.767595 0.767595 M04B Testes Procedures W/O CC D Same day 0 4 1.297362 0.635666 0.337610 0.000000 0.369495 0.635666 M05Z Circumcision D 0 3 1.013542 0.342516 0.236558 0.000000 0.342516 0.342516 M06A Oth Male Repro System OR Procs for Malig D 1 10 2.954128 2.365601 0.337610 0.000000 1.182800 2.365601 M06B Oth Male Repro System ORPs Exc for Malig D 0 8 2.410256 0.830706 0.241258 0.000000 0.830706 0.830706 M40Z Cystourethroscopy W/O CC D 0 3 1.035294 0.288237 0.222728 0.000000 0.288237 0.288237 M60A Malignancy, Male Reprod Sys W Cat/Sev CC D 1 16 4.312500 0.989491 0.183558 0.000000 0.494745 0.989491 M60B Malig Male Repro System W/O Cat/Sev CC D Same day 2 21 4.425532 1.341869 0.242569 0.670935 0.299874 0.670935 M61A Ben Prostatic Hypertrophy W Cat/Sev CC D 1 11 3.419355 0.767009 0.179451 0.000000 0.383504 0.767009 M61B Ben Prostatic Hypertrophy W/O Cat/Sev CC D 0 4 1.260090 0.319020 0.202538 0.000000 0.319020 0.319020

45 NZ WIES 8C Schedule Victorian DRG 4.2 New Zealand Schedule Costweights Weights Mech.Vent. Same Day Inlier Boundary Average Outlier Per Diems Code DRG Description Copayment One Day Low High Inlier LOS Inlier High Low Same Day One Day DRG42 mv_elig lb HB i_alos md_in ho_pd lo_pd sd od M62A Inflammation of the Male Repro Sys W CC D 1 9 3.566667 0.713230 0.159977 0.000000 0.356615 0.713230 M62B Inflammation Male Repro Sys W/O CC D 0 5 1.816964 0.370592 0.163170 0.000000 0.370592 0.370592 M63Z Sterilisation, Male D 0 3 1.000000 0.368131 0.294505 0.000000 0.368131 0.368131 M64Z Other Male Reproductive System Diagnoses D 0 3 1.079787 0.279020 0.206722 0.000000 0.279020 0.279020 N01Z Pelvic Evisceration & Radical Vulvectomy D 3 29 9.105263 3.031533 0.233060 1.010511 0.505255 1.010511 N02A Uterine,Adnexa Proc-Ovarian/Adn Malig+CC D 3 28 9.887097 3.688880 0.261170 1.229627 0.614813 1.229627 N02B Uterine,Adnexa Proc-Ovar/Adn Malig No CC D 1 16 4.913043 1.972126 0.280984 0.000000 0.986063 1.972126 N03A Uterine,Adnexa Pr- Non-Ovar/Adn Malig+CC D 2 22 7.555556 2.596657 0.240573 1.298329 0.649164 1.298329 N03B Uterine,Adnexa Pr-Non-Ovar/Adn Mal No CC D 1 15 6.457627 2.099655 0.227600 0.000000 1.049828 2.099655 N04Z Hysterectomy for Non-Malignancy D 1 13 4.182637 1.517950 0.254042 0.000000 0.758975 1.517950 N05A Oophs,Cx Fall Tube Prs- Non-Mal W C/S CC D 2 20 6.018182 2.208735 0.256907 1.104367 0.552184 1.104367 N05B Oophs,Cx Fall Tube Prs-Non-Mal No C/S CC D Same day 1 11 3.288754 1.398455 0.297656 0.000000 0.767645 1.398455 N06Z Female Repro System Reconstructive Procs D 1 11 3.640496 1.297006 0.249390 0.000000 0.648503 1.297006 N07Z Oth Uterine & Adnexa Procs for Non-Malig D Same day 0 8 1.966897 1.007162 0.337610 0.000000 0.511341 1.007162 N08Z Endoscopic Procs for Female Repro System D Same day 0 6 1.529605 0.799954 0.337610 0.000000 0.437057 0.799954 N09Z Conistation,Vagina,Cervix & Vulva Procs D 0 3 1.050652 0.346735 0.231013 0.000000 0.346735 0.346735 N10Z Diagnostic Curettage or Hysteroscopy D 0 3 1.017609 0.334292 0.229955 0.000000 0.334292 0.334292 N11A Oth Fem Repro Sys ORP >64 or Malig or CC D 2 24 6.472222 2.056281 0.222396 1.028141 0.514070 1.028141 N11B Oth Fem Repro Sys ORP <65 No Malig No CC D 0 6 1.385214 0.645292 0.326090 0.000000 0.645292 0.645292 N60A Malig - Female Repro System W Cat/Sev CC D 1 15 3.274336 1.222493 0.298685 0.000000 0.611247 1.222493 N60B Malig Female Repro System W/O Cat/Sev CC D 0 8 1.779221 0.672304 0.302291 0.000000 0.672304 0.672304 N61Z Infections, Female Reproductive System D 0 6 2.114865 0.469631 0.177649 0.000000 0.469631 0.469631 N62A Menstrual+Oth Female Repro Sys Dis W CC D 0 6 1.503268 0.407278 0.216743 0.000000 0.407278 0.407278 N62B Menstrual+Oth Fem Repro Sys Disord No CC D Same day 0 5 1.548387 0.408379 0.210996 0.000000 0.177919 0.408379 O01A Caesarean Del W Mult Comp Diags 1+ Sev D 2 23 7.299180 1.766691 0.169428 0.883345 0.441673 0.883345 O01B Caesarean Delivery W Severe Complic Diag D 1 16 5.855681 1.258292 0.150419 0.000000 0.629146 1.258292 O01C Caesarean Delivery W Moderate Comp Diag D 1 13 5.258242 1.184213 0.157648 0.000000 0.592107 1.184213 O01D Caesarean Delivery W/O Complicating Diag D 1 12 4.902372 1.029550 0.147007 0.000000 0.514775 1.029550 O02Z Vaginal Delivery W Complicating OR Proc D 1 10 2.789474 0.744271 0.186770 0.000000 0.372135 0.744271 O03Z Ectopic Pregnancy D 0 7 1.877108 0.905020 0.337610 0.000000 0.905020 0.905020 O04Z Postpartum & Post Abortion W O.R. Proc D Same day 0 6 1.754902 0.724324 0.288920 0.000000 0.328422 0.724324 O40Z Abortion W D&C,Asp Curettage/Hysterotomy D Same day 0 4 1.189855 0.516129 0.303642 0.000000 0.196981 0.516129 O60A Vaginal Delivery W Mult Comp Diag,1+ Sev D 1 14 5.028846 0.912323 0.145134 0.000000 0.456161 0.912323 O60B Vaginal Delivery W Severe Complic Diag D 0 9 3.849242 0.503670 0.104679 0.000000 0.503670 0.503670

46 NZ WIES 8C Schedule Victorian DRG 4.2 New Zealand Schedule Costweights Weights Mech.Vent. Same Day Inlier Boundary Average Outlier Per Diems Code DRG Description Copayment One Day Low High Inlier LOS Inlier High Low Same Day One Day DRG42 mv_elig lb HB i_alos md_in ho_pd lo_pd sd od O60C Vaginal Delivery W Moderate Complic Diag D 0 8 3.576471 0.495709 0.110882 0.000000 0.495709 0.495709 O60D Vaginal Delivery no Complicating Diag D 0 6 3.035973 0.324462 0.087528 0.000000 0.324462 0.324462 O61Z Postpartum & Post Abortion W/O O.R. Proc D 0 8 2.411450 0.422202 0.140066 0.000000 0.422202 0.422202 O62Z Threatened Abortion D Same day 0 4 1.437500 0.280007 0.155830 0.000000 0.150713 0.280007 O63Z Abortion no D&C,Asp Curette/Hysterotomy D Same day 0 4 1.292929 0.512974 0.317403 0.000000 0.260839 0.512974 O64Z False Labour D 0 4 1.202591 0.208768 0.138879 0.000000 0.208768 0.208768 O65A Oth Antenatal Admission W Sev Comp Diag D Same day 0 8 2.801956 0.496664 0.141805 0.000000 0.100115 0.496664 O65B Oth Antenatal W Moderate/No Comp Diag D Same day 0 6 2.014369 0.421945 0.167574 0.000000 0.135895 0.421945 P01Z Neonate Died/Trans<5 Days W Sign OR Proc I 0 6 2.000000 1.926686 0.337610 0.000000 1.926686 1.926686 P02Z Cardiothoracic/Vascular Procs - Neonates I 12 27 16.575758 13.812593 0.337610 1.151049 0.575525 1.151049 P03Z Neonate, AdmWt 1000-1499G W Sign OR Proc I 29 66 48.263158 17.055298 0.247367 0.588114 0.294057 0.588114 P04Z Neonate, AdmWt 1500-1999G W Sign OR Proc I 19 45 29.000000 9.223332 0.222632 0.485439 0.242719 0.485439 P05Z Neonate, AdmWt 2000-2499G W Sign OR Proc I 14 33 20.500000 8.548402 0.337610 0.610600 0.305300 0.610600 P06A Neonate>2499G W Sign ORP W Mult Maj Prob E 6 59 20.938462 10.785002 0.337610 1.797500 0.898750 1.797500 P06B Neonate>2499 W Sign ORP No Mult Maj Prob E 5 12 7.574468 3.469927 0.320676 0.693985 0.346993 0.693985 P60A Neonate Died/Tr<5 W/O Sign ORP,Born Here I 0 4 1.481481 0.360805 0.243543 0.000000 0.360805 0.360805 P60B Neo Died/Tr<5 No Sign ORP, Not Born Here I 0 5 2.115538 0.967120 0.337610 0.000000 0.967120 0.967120 P61Z Neonate, AdmWt < 750 G I 38 87 68.272727 32.532786 0.337610 0.856126 0.428063 0.856126 P62Z Neonate, AdmWt 750-999 G I 36 82 58.400000 19.760876 0.337610 0.548913 0.274457 0.548913 P63Z Neonate 1000-1249G W/O Sign OR Proc I 26 60 40.023256 8.554184 0.213730 0.329007 0.164504 0.329007 P64Z Neonate 1250-1499G No Significant ORP I 22 51 31.300000 6.208198 0.198345 0.282191 0.141095 0.282191 P65A Neo 1500-1999G No Sign ORP W Mlt Maj Prb I 18 41 25.411765 5.891000 0.231822 0.327278 0.163639 0.327278 P65B Neo 1500-1999G No Sign ORP W Maj Problem I 16 37 26.084746 5.374751 0.206050 0.335922 0.167961 0.335922 P65C Neo 1500-1999G No Sign ORP W Oth Problem I 12 28 19.054945 4.226908 0.221827 0.352242 0.176121 0.352242 P65D Neo 1500-1999G No Sign ORP No Problem I 9 21 14.533333 2.208173 0.151939 0.245353 0.122676 0.245353 P66A Neo 2000-2499G No Sign ORP W Mlt Maj Prb I 10 24 16.500000 5.013963 0.243101 0.501396 0.250698 0.501396 P66B Neo 2000-2499G W/O Sign ORP W Major Prob I 9 21 13.194444 3.036556 0.253153 0.337395 0.168698 0.337395 P66C Neo 2000-2499G W/O Sign ORP W Other Prob I 6 15 9.444853 1.745077 0.184765 0.290846 0.145423 0.290846 P66D Neo 2000-2499G W/O Sign ORP W/O Problem I 1 15 4.083146 0.581776 0.142482 0.000000 0.290888 0.581776 P67A Neonate>2499 No Sign ORP W Mult Maj Prob I 2 22 7.963636 2.637559 0.331200 1.318779 0.659390 1.318779 P67B Neonate>2499G W/O Sign ORP W Maj Prob I 1 16 5.647969 1.502133 0.319152 0.000000 0.751066 1.502133 P67C Neonate>2499G W/O Sign ORP W Oth Prob I 1 13 4.652302 0.741983 0.127590 0.000000 0.370991 0.741983 P67D Neonate>2499G W/O Sign ORP W/O Problem I 0 7 2.926104 0.247808 0.087528 0.000000 0.247808 0.247808 Q01Z Splenectomy D 1 17 6.973333 2.490364 0.249989 0.000000 1.245182 2.490364

47 NZ WIES 8C Schedule Victorian DRG 4.2 New Zealand Schedule Costweights Weights Mech.Vent. Same Day Inlier Boundary Average Outlier Per Diems Code DRG Description Copayment One Day Low High Inlier LOS Inlier High Low Same Day One Day DRG42 mv_elig lb HB i_alos md_in ho_pd lo_pd sd od Q02A Oth ORP- Blood & Forming Organs W C/S CC D Same day 2 25 8.833333 3.037470 0.240705 1.518735 0.472482 1.518735 Q02B Oth ORP- Blood+Forming Organs W/O C/S CC D Same day 0 8 2.556522 1.237451 0.337610 0.000000 0.579494 1.237451 Q60A Reticuloendothelial+Immun Dis+Cat/Sev CC D Same day 1 18 6.003810 2.330528 0.310540 0.000000 0.379575 2.330528 Q60B Reticuloendothelial+Imm Dis No C/S CC D Same day 1 10 3.941772 1.300980 0.264040 0.000000 0.381302 1.300980 Q61A Red Blood Cell Disords W Catastrophic CC D Same day 1 13 4.520295 1.044914 0.184928 0.000000 0.334703 1.044914 Q61B Red Blood Cell Disorders W Severe CC D Same day 1 10 3.346667 0.911756 0.217950 0.000000 0.490314 0.911756 Q61C Red Blood Cell Disorder no Catast/Sev CC D Same day 0 7 2.262463 0.700486 0.247690 0.000000 0.473614 0.700486 Q62A Coagulation Disorders Age>69 D Same day 1 15 4.039604 1.149693 0.227684 0.000000 0.525399 1.149693 Q62B Coagulation Disorders Age<70 D Same day 0 8 2.747475 1.031079 0.300226 0.000000 0.733462 1.031079 R01A Lymphoma+Leukaemia+Major ORP+Cat/Sev CC D 5 53 16.586207 5.664523 0.239064 1.132905 0.566452 1.132905 R01B Lymphoma+Leukaemia+Maj ORP No Cat/Sev CC D 2 19 5.142857 2.269335 0.308882 1.134667 0.567334 1.134667 R02A Oth Neoplastic Dis W Maj ORPs W C/S CC D 3 31 11.746269 3.735557 0.222614 1.245186 0.622593 1.245186 R02B Oth Neoplastic Dis W Maj ORPs No C/S CC D 1 15 4.842105 1.794776 0.259462 0.000000 0.897388 1.794776 R03A Lymphoma+Leukaemia+Oth ORP+Cat/Sev CC D Same day 5 46 17.450000 6.074204 0.243664 1.214841 0.375194 1.214841 R03B Lymphoma+Leukaemia+Oth ORP No Cat/Sev CC D Same day 1 11 3.252101 1.423657 0.306436 0.000000 0.476649 1.423657 R04A Oth Neoplastic Dis W Oth ORPs W C/S CC D Same day 2 21 7.413043 2.104937 0.198765 1.052469 0.330061 1.052469 R04B Oth Neoplastic Dis W Oth ORPs No C/S CC D Same day 1 11 3.085714 1.304794 0.295995 0.000000 0.417279 1.304794 R60A Acute Leukaemia W Catastrophic CC D 12 29 22.349206 6.950021 0.248779 0.579168 0.289584 0.579168 R60B Acute Leukaemia W Severe CC D Same day 2 23 7.324675 2.930543 0.320073 1.465271 0.349862 1.465271 R60C Acute Leukaemia no Catastroph/Severe CC D Same day 1 12 3.584000 1.896098 0.337610 0.000000 0.434267 1.896098 R61A Lymphoma & Non-Ac Leukaemia W Catast CC D 3 31 10.542857 3.081920 0.233858 1.027307 0.513653 1.027307 R61B Lymphoma & Non-Ac Leukaemia no Catast CC D 1 12 3.331091 1.303202 0.312979 0.000000 0.651601 1.303202 R61C Lymphoma & Non-Acute Leukaemia, Sameday D Same day 0 3 1.000000 0.341003 0.272803 0.000000 0.341003 0.341003 R62A Other Neoplastic Disorders W CC D 1 17 3.307985 1.226736 0.296673 0.000000 0.613368 1.226736 R62B Other Neoplastic Disorders W/O CC D 1 11 1.589005 0.599351 0.301749 0.000000 0.299676 0.599351 R63Z Chemotherapy D 0 3 1.000674 0.196014 0.156706 0.000000 0.196014 0.196014 R64Z Radiotherapy D Same day 2 24 8.796628 2.634116 0.239557 1.317058 0.296514 1.317058 S60Z HIV, Sameday D 0 3 1.000000 0.536985 0.337610 0.000000 0.536985 0.536985 S61Z HIV-Related CNS Disease D 8 20 11.833333 2.827146 0.191131 0.353393 0.176697 0.353393 S62Z HIV-Related Malignancy D 1 16 6.318182 1.897107 0.240209 0.000000 0.948554 1.897107 S63A HIV-Related Infection W Catastrophic CC D 4 44 18.925926 4.750242 0.200793 1.187561 0.593780 1.187561 S63B HIV-Related Infection no Catastrophic CC D 1 16 6.575221 1.838144 0.223645 0.000000 0.919072 1.838144 S64A Other HIV W Catastrophic CC D 2 23 11.600000 2.785071 0.192074 1.392536 0.696268 1.392536 S64B Other HIV W/O Catastrophic CC D 1 12 4.582278 1.476651 0.257802 0.000000 0.738326 1.476651

48 NZ WIES 8C Schedule Victorian DRG 4.2 New Zealand Schedule Costweights Weights Mech.Vent. Same Day Inlier Boundary Average Outlier Per Diems Code DRG Description Copayment One Day Low High Inlier LOS Inlier High Low Same Day One Day DRG42 mv_elig lb HB i_alos md_in ho_pd lo_pd sd od T01A ORPs - Infect+Parasitic Disease W Cat CC D 5 47 19.548387 4.844294 0.173467 0.968859 0.484429 0.968859 T01B ORPs Infect & Parasitic Dis W Sev/Mod CC D 2 23 8.647482 2.046529 0.165663 1.023264 0.511632 1.023264 T01C ORP - Infect+Parasitic Diseases W/O CC D 1 14 2.914894 0.973404 0.233759 0.000000 0.486702 0.973404 T60A Septicaemia W Catastrophic or Severe CC D 2 21 7.784337 2.019620 0.207557 1.009810 0.504905 1.009810 T60B Septicaemia W/O Catastrophic/Severe CC D 1 11 4.120000 1.006671 0.195470 0.000000 0.503335 1.006671 T61A Post-Op,Trauma Inf+C/S CC or >54NoC/S CC D 1 13 4.495345 0.902167 0.160551 0.000000 0.451084 0.902167 T61B Postop & Post-Traum Infect <55 No C/S CC D 0 8 2.858871 0.573907 0.160597 0.000000 0.573907 0.573907 T62A Fever of Unknown Origin W CC D 1 12 3.705000 0.967989 0.209012 0.000000 0.483994 0.967989 T62B Fever of Unknown Origin W/O CC D 0 5 1.805869 0.437873 0.193978 0.000000 0.437873 0.437873 T63A Viral Illness Age>59 D 1 9 2.285714 0.533007 0.186553 0.000000 0.266504 0.533007 T63B Viral Illness Age<60 D Same day 0 5 1.902277 0.503260 0.211645 0.000000 0.181266 0.503260 T64A Oth Infect & Parasitic Dis W Cat/Sev CC D 2 18 6.837838 1.588659 0.185867 0.794330 0.397165 0.794330 T64B Oth Infect+Parasitic Dis W/O Cat/Sev CC D 0 6 2.031088 0.522932 0.205971 0.000000 0.522932 0.522932 U40Z Mental Health Treatment, Sameday, W ECT D 0 3 1.000000 0.090675 0.087528 0.000000 0.090675 0.090675 U60Z Mental Health Treatment,Sameday,W/O ECT D 0 3 1.000000 0.164147 0.131318 0.000000 0.164147 0.164147 U61A Schizophrenia Disorders+MH Legal Status D 11 101 13.000000 3.686606 0.226868 0.335146 0.167573 0.335146 U61B Schizophrenia Disord W/O MH Legal Status D 11 101 13.000000 3.686606 0.226868 0.335146 0.167573 0.335146 U62A Paranoia & Ac Psych Dis W C/S CC or MHLS D 6 54 14.000000 3.205709 0.183183 0.534285 0.267142 0.534285 U62B Paranoia,Ac Psych Dis No C/S CC No MHLS D 2 19 5.125000 0.842578 0.131524 0.421289 0.210644 0.421289 U63A Maj Aff Dis W C/S CC or >69 W/O C/S CC D 16 149 21.000000 4.653616 0.177281 0.290851 0.145425 0.290851 U63B Maj Affective Disords <70 W/O Cat/Sev CC D 2 25 4.888889 1.128756 0.184706 0.564378 0.282189 0.564378 U64Z Other Affective and Somatoform Disorders D 2 25 7.835821 1.326282 0.135407 0.663141 0.331570 0.663141 U65Z Anxiety Disorders D 0 8 2.440191 0.579879 0.190109 0.000000 0.579879 0.579879 U66Z Eating & Obsessive-Compulsive Disorders D 3 29 13.268293 2.578970 0.155497 0.859657 0.429828 0.859657 U67Z Personality Disorders & Acute Reactions D 1 9 1.752000 0.403929 0.184442 0.000000 0.201964 0.403929 U68Z Childhood Mental Disorders D 0 6 2.493506 0.608544 0.195241 0.000000 0.608544 0.608544 V60Z Alcohol Intoxication and Withdrawal D 0 5 1.176823 0.224703 0.152752 0.000000 0.224703 0.224703 V61A Drug Intoxication and Withdrawal W CC D 1 17 4.040000 0.831681 0.164689 0.000000 0.415840 0.831681 V61B Drug Intoxication and Withdrawal WO CC D 0 8 1.460000 0.283598 0.155396 0.000000 0.283598 0.283598 V62A Alcohol Use Disorder and Dependance D 1 13 4.447257 0.732993 0.131855 0.000000 0.366497 0.732993 V62B Alcohol Use Disorder & Depend'ce,Sameday D 0 3 1.000000 0.158195 0.126556 0.000000 0.158195 0.158195 V63Z Opioid Use Disorder and Dependence D 1 9 3.400000 0.535826 0.126077 0.000000 0.267913 0.535826 V64Z Other Drug Use Disorder and Dependance D 0 5 1.500000 0.274715 0.146515 0.000000 0.274715 0.274715 W01Z Ventil/Craniotomy Procs-Mult Sign Trauma I 16 38 26.000000 18.080524 0.337610 1.130033 0.565016 1.130033

49 NZ WIES 8C Schedule Victorian DRG 4.2 New Zealand Schedule Costweights Weights Mech.Vent. Same Day Inlier Boundary Average Outlier Per Diems Code DRG Description Copayment One Day Low High Inlier LOS Inlier High Low Same Day One Day DRG42 mv_elig lb HB i_alos md_in ho_pd lo_pd sd od W02Z Hip,Femur,Limb Prs Mult Sign Trauma+Imp D 5 52 15.375000 6.645145 0.302543 1.329029 0.664515 1.329029 W03Z Abdominal Procs for Mult Signif Trauma D 4 41 10.500000 4.452036 0.296802 1.113009 0.556505 1.113009 W04Z Other OR Procs for Mult Signif Trauma D 5 52 14.822222 6.582382 0.310862 1.316476 0.658238 1.316476 W60Z Mult Trauma, Died/Transferred LOS<5 Days D 0 4 1.765957 1.841939 0.337610 0.000000 1.841939 1.841939 W61Z Multiple Trauma W/O Significant Procs D 2 22 8.564706 2.514991 0.234917 1.257496 0.628748 1.257496 X01Z Microvasc Tiss Transf/ Skin Gr Inj LLimb D 3 28 12.372340 2.249405 0.127266 0.749802 0.374901 0.749802 X02Z Microvasc Tiss Tran/Skin Graft- Inj Hand D 0 7 1.772472 0.818929 0.323418 0.000000 0.818929 0.818929 X03Z Microvasc Tiss Transf/Skin Graft-Oth Inj D 2 25 9.539474 2.757104 0.202314 1.378552 0.689276 1.378552 X04A Oth Procs - Injuries - Low Limb >59/W CC D 2 21 8.166667 2.188697 0.187603 1.094349 0.547174 1.094349 X04B Oth Procs-Injuries to Low Limb <60 No CC D 0 7 2.743902 0.990555 0.252701 0.000000 0.990555 0.990555 X05Z Other Procedures for Injuries to Hand D Same day 0 5 1.494949 0.753135 0.337610 0.000000 0.403971 0.753135 X06A Oth Procs for Oth Injuries W Cat/Sev CC D 2 20 6.752577 2.241786 0.232393 1.120893 0.560446 1.120893 X06B Oth Procs for Oth Injuries no Cat/Sev CC D 0 6 1.611912 0.687783 0.298682 0.000000 0.687783 0.687783 X60A Injuries Age>64 W CC D 1 15 2.921283 0.597737 0.163692 0.000000 0.298869 0.597737 X60B Injuries Age>64 W/O CC D Same day 1 10 2.418750 0.461517 0.152647 0.000000 0.181241 0.461517 X60C Injuries Age < 65 D Same day 0 5 1.462819 0.408700 0.223514 0.000000 0.186823 0.408700 X61Z Allergic Reactions D 0 4 1.218121 0.363827 0.238943 0.000000 0.363827 0.363827 X62A Poison/Tox Eff-Drugs,Oth Subs >59 or +CC D Same day 0 7 2.231299 0.790343 0.283366 0.000000 0.215991 0.790343 X62B Poison/Tox Eff-Drugs,Oth Subs <60 No CC D Same day 0 4 1.310476 0.401501 0.245102 0.000000 0.182218 0.401501 X63A Sequelae of Treatment W Catast/Severe CC D 1 13 3.720000 1.009177 0.217027 0.000000 0.504589 1.009177 X63B Sequelae of Treat W/O Catast/Severe CC D Same day 0 7 2.304645 0.562203 0.195155 0.000000 0.221615 0.562203 X64A Oth Injury,Poison,Toxic Eff Dx>59 or +CC D Same day 1 11 2.901961 1.139763 0.314205 0.000000 0.228919 1.139763 X64B Oth Injury,Poison,Tox Eff Diag <60 No CC D Same day 0 4 1.208333 0.405254 0.268306 0.000000 0.320643 0.405254 Y01Z Severe Full Thickness Burns D 23 53 28.222222 15.098700 0.337610 0.656465 0.328233 0.656465 Y02A O Burn+Skin Gr>64 or C/S CC or Cmp Dx/Pr D 4 43 19.395833 4.800810 0.173262 1.200202 0.600101 1.200202 Y02B Oth Burn+Skin Gr<65 NoC/S CC NoCmp Dx/Pr D 2 21 8.866667 2.466325 0.194710 1.233163 0.616581 1.233163 Y03Z Other O.R. Procedures for Other Burns D 1 17 4.305556 1.218701 0.283053 0.000000 0.609350 1.218701 Y60Z Burns,Tran Oth Ac Care Facility< 5 Days D 0 4 1.164179 0.621887 0.337610 0.000000 0.621887 0.621887 Y61Z Severe Burns D 1 10 3.000000 0.766030 0.255343 0.000000 0.383015 0.766030 Y62A Oth Burns>64 or +C/S CC or +Comp Dx/Proc D 1 15 5.608696 1.016925 0.181312 0.000000 0.508463 1.016925 Y62B Oth Burns<65 No C/S CC No Comp Diag/Proc D 0 7 1.850365 0.386921 0.209105 0.000000 0.386921 0.386921 Z01A ORPs W Diags Oth Contacts W Cat/Sev CC D 1 13 2.285714 0.890526 0.272724 0.000000 0.445263 0.890526 Z01B ORPs W Diags Oth Contacts W/O Cat/Sev CC D 0 4 1.114679 0.458804 0.337610 0.000000 0.458804 0.458804 Z40Z F-Up After Completed Treat W Endoscopy D 0 3 1.008326 0.238404 0.189148 0.000000 0.238404 0.238404

50 NZ WIES 8C Schedule Victorian DRG 4.2 New Zealand Schedule Costweights Weights Mech.Vent. Same Day Inlier Boundary Average Outlier Per Diems Code DRG Description Copayment One Day Low High Inlier LOS Inlier High Low Same Day One Day DRG42 mv_elig lb HB i_alos md_in ho_pd lo_pd sd od Z60A Rehabilitation W Catastrophic/Severe CC D 6 16 10.666667 2.257240 0.169293 0.376207 0.188103 0.376207 Z60B Rehabilitation no Catastrophic/Severe CC D 6 14 9.500000 2.248247 0.189326 0.374708 0.187354 0.374708 Z60C Rehabilitation, Sameday D 0 3 1.000000 0.123319 0.098655 0.000000 0.123319 0.123319 Z61Z Signs and Symptoms D 0 7 1.823607 0.458610 0.201188 0.000000 0.458610 0.458610 Z62Z F-Up After Completed Treat W/O Endoscopy D 0 3 1.016064 0.340739 0.268281 0.000000 0.340739 0.340739 Z63A Other Aftercare W Catastrophic/Severe CC D 2 22 7.663636 1.282246 0.167316 0.641123 0.320562 0.641123 Z63B Oth Aftercare W/O Catastrophic/Severe CC D 1 10 1.909621 0.458957 0.240339 0.000000 0.229479 0.458957 Z64A Other Factors Influenc Health Status >79 D Same day 2 25 10.121951 1.458849 0.115302 0.729424 0.338932 0.729424 Z64B Other Factors Influenc Health Status <80 D Same day 1 9 2.656891 0.642604 0.193490 0.000000 0.325459 0.642604 Z65Z Mult Oth & Unspec Congenital Anomalies D 0 6 1.111111 0.391248 0.281698 0.000000 0.391248 0.391248 901Z Extensive OR Proc Unrelated to PDiag D 2 21 7.203704 2.641778 0.256707 1.320889 0.660444 1.320889 902Z Non-Extensive OR Proc Unrelated to PDiag D 2 18 6.389474 1.783868 0.195432 0.891934 0.328951 0.891934 903Z Prostatic OR Proc Unrelated to PDiag D 4 38 21.807692 4.131158 0.132605 1.032790 0.516395 1.032790 960Z Ungroupable I 0 3 1.000000 0.000000 0.000000 0.000000 0.000000 0.000000 961Z Unacceptable Principal Diagnosis I 0 6 1.000000 0.000000 0.000000 0.000000 0.000000 0.000000 962Z Unacceptable Obstetric Diag Combination D 0 8 3.000000 0.000000 0.000000 0.000000 0.000000 0.000000 963Z Neonatal Diagnosis Inconsistent W/Weight D 5 47 18.000000 0.000000 0.000000 0.000000 0.000000 0.000000

51 5.5 SAS Code for Derivation of WIES8C

NB. Before running this code a libname cwd needs to be assigned to a directory containing the NZ Schedule of Costweights as a SAS dataset.

%macro w8CICD10(indset, outdset); options nomlogic nomrecall nodetails nomerror nomprint nosymbolgen;

Proc format; value $newpu 'S20' = 'D01.01' 'S50' = 'EXCLU' 'M00' , 'M05' , 'M08' , 'M85' , 'M86' , 'M89' = 'M00.01' 'M10' = 'M10.01' 'M14' = 'M10.05' 'M15' = 'M15.01' 'M20' = 'M20.01' 'M25' = 'M25.01' 'M30' = 'M30.01' 'M34' = 'M34.01' 'M40' , 'M75' = 'M40.01' 'M45' = 'M45.01' 'M49' = 'M49.01' 'M50' , 'M90' = 'M50.01' 'M54' , 'M94' = 'M54.01' 'M24' , 'M29' , 'M39' , 'M44' , 'M55' , 'M59' , 'M64' , 'M69' , 'M74' , 'M79' , 'M84' = 'M55.01' 'M60' = 'M60.01' 'M65' = 'M65.01' 'M35' , 'M70' = 'M70.01' 'M80' = 'M80.01' 'S00' , 'S05' , 'S10' = 'S00.01' 'S15' , 'S19' = 'S15.01' 'S25' = 'S25.01' 'S30' = 'S30.01' 'S35' = 'S35.01' 'S40' = 'S40.01' 'S45' = 'S45.01' 'S58' , 'S59' = 'S55.01' 'S24', 'S60' , 'S65' = 'S60.01' 'S70' = 'S70.01' 'S75' = 'S75.01' 'P41' , 'P42' , 'P43' = 'W06.03' 'P00','P10','P20','P30' = 'W10.01' other = 'EXCLU'; value $remap 'M01' , 'M02' , 'M03' = 'M00' 'M06' , 'M07' = 'M05' 'M11' , 'M12' , 'M13' = 'M10' 'M16' , 'M17' , 'M18' , 'M19' = 'M15' 'M21' , 'M22' , 'M23' = 'M20' 'M26' , 'M27' , 'M28' = 'M25' 'M31' , 'M32' , 'M33' = 'M30' 52 'M36' , 'M37' , 'M38' = 'M35' 'M41' , 'M42' , 'M43' = 'M40' 'M46' , 'M47' , 'M48' = 'M45' 'M51' , 'M52' , 'M53' = 'M50' 'M56' , 'M57' , 'M58' = 'M55' 'M61' , 'M62' , 'M63' = 'M60' 'M66' , 'M67' , 'M68' = 'M65' 'M71' , 'M72' , 'M73' = 'M70' 'M76' , 'M77' , 'M78' = 'M75' 'M81' , 'M82' , 'M83' = 'M80' 'M87' , 'M88' = 'M85' 'M91' , 'M92' , 'M93' = 'M90' 'S01' , 'S02' , 'S03' = 'S00' 'S06' , 'S07' , 'S08' = 'S05' 'S11' , 'S12' , 'S13' = 'S10' 'S16' , 'S17' , 'S18' = 'S15' 'S21' , 'S22' , 'S23' = 'S20' 'S26' , 'S27' , 'S28' = 'S25' 'S31' , 'S32' , 'S33' = 'S30' 'S36' , 'S37' , 'S38' = 'S35' 'S41' , 'S42' , 'S43' = 'S40' 'S46' , 'S47' , 'S48' = 'S45' 'S51' , 'S52' , 'S53' = 'S50' 'S55' , 'S56' , 'S57' = 'S59' 'S61' , 'S62' , 'S63' = 'S60' 'S66' , 'S67' , 'S68' = 'S65' 'S71' , 'S72' , 'S73' = 'S70' 'S76' , 'S77' , 'S78' = 'S75 other = '???'; value $PU_name 'D01.01' = 'Inpatient Dental treatment (DRGs)' 'M00.01' = 'General Internal Medical Services - Inpatient Services (DRGs)' 'M10.01' = 'Cardiology - Inpatient Services (DRGs)' 'M10.05' = 'Specialist Paediatric Cardiac - Inpatient Services (DRGs)' 'M15.01' = 'Dermatology - Inpatient Services (DRGs)' 'M20.01' = 'Endocrinology & Diabetic - Inpatient Services (DRGs)' 'M25.01' = 'Gastroenterology - Inpatient Services (DRGs)' 'M30.01' = 'Haematology - Inpatient Services (DRGs)' 'M34.01' = 'Specialist Paediatric Haematology - Inpatient Services (DRGs)' 'M40.01' = 'Infectious Diseases (incl Venereology) - Inpatient Services (DRGs)' 'M45.01' = 'Neurology - Inpatient Services (DRGs)' 'M49.01' = 'Specialist Paediatric Neurology Inpatient Services (DRGs)' 'M50.01' = 'Oncology - Inpatient Services (DRGs)' 'M54.01' = 'Specialist Paediatric Oncology - Inpatient Services (DRGs)' 'M55.01' = 'Paediatric Medical - Inpatient Services (DRGs)' 'M60.01' = 'Renal Medicine - Inpatient Services (DRGs)' 'M65.01' = 'Respiratory - Inpatient Services (DRGs)' 'M70.01' = 'Rheumatology (incl Immunology) - Inpatient Services (DRGs)' 'M80.01' = 'Palliative Care - Inpatient Services (DRGs)' 'S00.01' = 'General Surgery - Inpatient Services (DRGs)' 'S15.01' = 'Cardiothoracic - Inpatient Services (DRGs)' 'S25.01' = 'Ear, Nose and Throat - Inpatient Services (DRGs)' 'S30.01' = 'Gynaecology - Inpatient Services (DRGs)' 'S35.01' = 'Neurosurgery - Inpatient Services (DRGs)' 'S40.01' = 'Ophthalmology - Inpatient Services (DRGs)' 'S45.01' = 'Orthopaedics - Inpatient Services (DRGs)' 'S55.01' = 'Paediatric Surgical Services (DRGs)' 'S60.01' = 'Plastic & Burns - Inpatient Services (DRGs)' 'S70.01' = 'Urology - Inpatient Services (DRGs)' 'S75.01' = 'Vascular Surgery - Inpatient Services (DRGs)' 'W10.01' = 'Maternity Inpatient (DRGs)' 'W06.03' = 'Neonatal Inpatient (DRGs)' other = 'Not a DRG casemix Purchase Unit'; value $cystos '3681201','3681200','3681501','3683600', '3683904','3684503','3683902','3684501', '3684500','3683900','3684505','3684504', '3684502','3731801','3731500','3682700' = 1 other = 0; value $notret 'Z530','Z531','Z532','Z538','Z539' = 1 other = 0; value $error '960Z', '961Z', '962Z', '963Z' = 'Y' other = 'N'; value $transp 'A01Z', 'A02Z', 'A03Z', 'A05Z' = 'Y' other = 'N';

53 value $COLPO '3560800','3564600','3564700','3560801', '3553902','3561100','3553904','3563704', '3553903','3560802','3561400' = 1 other = 0; value $ERCPa '3048400','3048401','3048402','3049400', '3045200','3048500','3049100','3045202','3045201','3044200', '3048501','3049101','3045100' = 1 other = 0; value $COLONsa '3209000','3208400','3209001','3208401', '3209300','3208700','9030800','3209400', '3207500','3207200','3207201','3207501', '9031200','9031201','3207800','3208100', '3209900','3210800','9034100','3210500' = 1 other = 0; value $GASTRa '4181600','3047303','3047810','4182500', '4182200','3047304','3047600','3047601', '3047806','3047809','3047811','3047812', '3047602','3047813','3047900','3047807', '3047603','3047300','3047301','3047500', '3047501','3047803','3209500','3047804', '3047305','3047306','3047815','3047816','3047817','3047818', '3047802','3047801' = 1 other = 0; value $op2test '3048400','3048401','3048402','3049400', '3045200','3048500','3049100','3045202','3045201','3044200', '3048501','3049101','3045100',

'3209000','3208400','3209001','3208401', '3209300','3208700','9030800','3209400', '3207500','3207200','3207201','3207501', '9031200','9031201','3207800','3208100', '3209900','3210800','9034100','3210500',

'4181600','3047303','3047810','4182500', '4182200','3047304','3047600','3047601', '3047806','3047809','3047811','3047812', '3047602','3047813','3047900','3047807', '3047603','3047300','3047301','3047500', '3047501','3047803','3209500','3047804', '3047305','3047306','3047815','3047816','3047817','3047818', '3047802','3047801','9250202','9250300',' '= 1 other = 0; value $BRON '4188901','4189800','4188900','4189200', '4189801','4176404','4176403','4184600', '4184900','4185500','4189500' = 1 other = 0; value $bone '1370600','1370606','1370609','1370610' = 1 other = 0; value $mechven '1385700','1387900','1388201' = 1 other = 0; /* Formats desage and desfac were put in in order to identify the combination of a range of Agencies and Facilities that have been identified as the providers through which the MoH and DHBs will monitor its base casemix service agreements. All other facilities (historically designated as "rural") are excluded. */ value $desage '1022','3091','4121','4111','2041', '3082','3061','4131','4122','4123', '3092','2031','2042','3081','1011', '3101','2047','1023','4141','2071', '2051','2043','3093','1021','0223', '8630','8656' = 1 other = 0; value $desfac '4111','4112','3211','3212','3213', '3214','3215','3216','3239','5011', '3311','4911','3411','5311','5312', 54 '5313','5320','5323','4811','5329', '4711','4712','3611','3612','5711', '4311','5511','5812','5816','5811', '3811','3911','4011','4013','4014', '3111','5911','4411','4211','4511', '3250','3220','3221','3240','4113', '4114','8270','8331','8432','8595', '8233','8422','8366','8377','8580', '3313','3314','4212','8507','8462', '8471','5818','5819','5820','5814', '8313','8314','8630','8656','3260' = 1 other = 0; value $matfac '4111','3215','3216','3213','3214', '5311','5312','4911','3311','4711', '5711','3612','5511','4311','5811', '5812','3811','3911','4014','5911', '4411','4211','4511','3260' = 'Y' other = 'N'; run; options missing = 0; data test(index = (drg_nz)); length NONMEDSG deshosp BOARDER CANC_OP ERR_DRG XPLANT SPINAL TERMPREG RENAL CHEM_RAD SLEEP LITHO COLPO CYSTO ERCP COLON GASTRO BRONCHO TRANSFUS base $1; set &indset;

array px {20} op01-op20; /* load up oper1-20 */ array dx {20} diag01-diag20; /* load up diag1-20 */

drg_nz = drg_42;

*-- Require change in DRG for medical DRGs with code V580--;

radio='N'; drgnumb=input(substr(drg_nz,2),2.); do i = 1 to 20; tempx = dx{i} || ' '; if substr(tempx,1,4) = 'Z510' then radio='Y'; end; if (radio = 'Y') and (drgnumb ge 60) then drg_nz = 'R64Z';

if substr(diag01,1,4) = 'Z492' then drg_nz='L61Y';

age = intck('year', dob, evendate); LOS = max(1,min(sum(evendate, -evstdate, -(evntlvd/1)), 365)) ;

*REMAP THE HEALTH SPECIALITY CODES; if not(put(hlthspec, $remap.) = '???') then hlthspec = put(hlthspec, $remap.);

*BELOW IS INCLUSION RULE FOR NEONATAL INPATIENT (CASEMIX) SERVICES; if substr(hlthspec,1,1)='P' and ((hlthspec in ('P41','P42','P43')) or (drg_nz in ('P02Z', 'P61Z', 'P62Z', 'P03Z', 'P63Z', 'P64Z', 'P04Z', 'P65A','P65B', 'P65C', 'P65D', 'P05Z', 'P66A', 'P66B', 'P66C', 'P06A','P06B', 'P67B', 'P67A')) or (drg_nz in ('P60A', 'P01Z', 'P60B', 'P66D', 'P67C', 'P67D') and (diag03 ne ' ' or op01 ne ' ') )) then NEONATE='Y'; else NEONATE='N'; if hlthspec = 'P50' then NEONATE = 'N'; * specifically exclude this code;

*BELOW IS EXCLUSION RULE FOR NON MEDICAL/SURGICAL SERVICES; *Exclude maternity only if at non tertiary/secondary facility; *Determine maternity events but continue to use nonmedsg exclusion; if (substr(hlthspec,1,1)='P' and (hlthspec ne ‘P50’) and (neonate ='N') and put(facility,$matfac.) = 'Y') then materny = ‘Y’; else if (substr(hlthspec,1,1)='P' and (hlthspec ne ‘P50’) and (neonate ='N') and put(facility,$matfac.) = 'N') then materny = ‘N’; else materny = ‘X’;

if ((substr(hlthspec,1,1) in ('D','Y')) or (materny = ‘N’)) then NONMEDSG='Y'; else NONMEDSG='N';

55 *DEFINE BASE CONTRACT PAYMENTS; If compress(purchasr) in ('01','02','03','04','13','20') then base = 'Y'; else base = 'N'; if compress(adm_typ) = 'ZW' then base = 'N';

*BELOW IS EXCLUSION RULE FOR DESIGNATED HOSPITAL PURCHASING; If (put(agency, $desage.)*put(facility, $desfac.)) then Deshosp = 'Y'; else deshosp='N';

*BELOW ARE EXCLUSION RULES FOR NON-TREATED PATIENTS; if diag01 in ('Z763','Z764') then BOARDER='Y'; else BOARDER='N';

if (put(diag01, $notret.) + put(diag02, $notret.) + put(diag03, $notret.) + put(diag04, $notret.) + put(diag05, $notret.) + put(diag06, $notret.)) and (op01=' ') and (substr(adm_typ,2,1) ne 'C') and (LOS<2) then CANC_OP='Y'; else CANC_OP='N';

*BELOW IS EXCLUSION RULE FOR ERROR DRGS; err_drg = put(drg_nz, $error.);

*BELOW IS EXCLUSION RULE FOR TRANSPLANTS (LIVER, HEART, LUNG); xplant = put(drg_nz, $transp.);

*BELOW IS EXCLUSION RULE FOR SPINAL INJURIES; if HLTHSPEC in ('S50','S53') then SPINAL='Y'; else SPINAL='N';

*BELOW IS EXCLUSION RULE FOR SURGICAL TERMINATION OF PREGNANCY; if drg_nz='O40Z' and op01 in ('3564300','3564301') and substr(diag01,1,3) = 'O04' then TERMPREG='Y'; else TERMPREG='N'; * the above diag01 code collect o04, not 004. Its been capitalised above, so dont get confused;

*BELOW IS EXCLUSION RULE FOR RENAL DIALYSIS; if drg_nz in ('L61Z','L61Y') then RENAL='Y'; else RENAL='N';

*BELOW IS EXCLUSION RULE FOR CHEMOTHERAPY/RADIOTHERAPY; if (diag01 in ('Z510', 'Z511', 'Z512') or diag02 in ('Z510', 'Z511', 'Z512')) and (evendate=evstdate) then CHEM_RAD='Y'; else CHEM_RAD='N';

*BELOW IS EXCLUSION RULE FOR SLEEP APNOEA; if drg_nz = ('E63Z') and (evendate-evstdate < 2) then SLEEP='Y'; else SLEEP='N';

*BELOW IS EXCLUSION RULE FOR LITHOTRIPSY; if op01='3654600' and op02 in (' ','3654600','9250202','9250300') and op03 in (' ','9250202','9250300') and evendate=evstdate and substr(adm_typ,2,1) ne 'C' then LITHO='Y'; else LITHO='N';

*BELOW IS EXCLUSION RULE FOR COLPOSCOPIES; if put(op01, $COLPO.)*(put(op02, $COLPO.) or op02 in (' ','9250202','9250300')) and op03 in (' ','9250202','9250300') and age>15 and substr(adm_typ,2,1) ne 'C' and evendate=evstdate then COLPO='Y'; else COLPO='N';

*BELOW IS EXCLUSION RULE FOR CYSTOSCOPIES; if put(op01, $CYSTOS.)*(put(op02, $CYSTOS.) or op02 in (' ','9250202','9250300')) and op03 in (' ','9250202','9250300') and (evendate=evstdate) and age>15 and substr(adm_typ,2,1) ne 'C' then CYSTO='Y'; else CYSTO='N';

*BELOW IS EXCLUSION RULE FOR ERCPs; if (put(op01, $ERCPa.)*put(op02, $op2test.)) and op03 in (' ','9250202','9250300') and evendate=evstdate and substr(adm_typ,2,1) ne 'C' and age>15 then ERCP='Y'; else ERCP='N';

*BELOW IS EXCLUSION RULE FOR COLONOSCOPIES; 56 if (put(op01, $COLONsa.)*put(op02, $op2test.)) and op03 in (' ','9250202','9250300') and evendate=evstdate and substr(adm_typ,2,1) ne 'C' and age>15 then COLON='Y'; else COLON='N';

*BELOW IS EXCLUSION RULE FOR GASTROSCOPIES; if (put(op01, $GASTRa.)*put(op02, $op2test.)) and op03 in (' ','9250202','9250300') and evendate=evstdate and substr(adm_typ,2,1) ne 'C' and age>15 then GASTRO='Y'; else GASTRO='N';

*BELOW IS EXCLUSION RULE FOR BRONCHOSCOPIES; if (put(op01, $bron.)*((put(op02, $bron.) or op02 in (' ','9250202','9250300')))) and op03 in (' ','9250202','9250300') and evendate=evstdate and substr(adm_typ,2,1) ne 'C' and age>15 then BRONCHO='Y'; else BRONCHO='N';

*BELOW IS EXCLUSION RULE FOR DAY CASE BLOOD TRANSFUSIONS; if (diag01='Z513' or (op01 in ('9206000','1370601','1370602','1370603') and op02 in (' ','9206000','1370601','1370602','1370603') and op03 =' ')) and evendate=evstdate and substr(adm_typ,2,1) ne 'C' then TRANSFUS='Y'; else TRANSFUS='N';

*Following 4 exclusions relate to maternity events only;

*Below is Amniocentesis exclusion; if (materny = ‘Y’ and evstdate=evendate and op01 in ('1660000','1661800','1662100')) then amnio='Y'; else amnio = 'N';

*Below is Chorio Villis Sampling exclusion;

If (materny = ‘Y’ and evstdate=evendate and op01 = '1660300') then chorio = 'Y'; Else chorio = 'N';

*Below is Rhesus Isoimmunisation exclusion;

If (materny = ‘Y’ and evstdate=evendate and substr(diag01,1,4) in ('O360',’O361’)) then rhesus = 'Y'; Else rhesus = 'N';

*Breast feeding/lactation exclusion *; if ( materny = ‘Y’ and evstdate=evendate and diag01 in ('O9230','O9231','O9240','O9241','O9250','O9251','O9270','O9271')) then bfl = 'Y'; else bfl = 'N';

*BELOW CREATES A MASTER EXCLUSION VARIABLE TO IDENTIFY ALL EXCLUDED EVENTS; if NONMEDSG='Y' or Deshosp='N' or BOARDER='Y' or CANC_OP='Y' or ERR_DRG='Y' or XPLANT='Y' or SPINAL='Y' or TERMPREG='Y' or RENAL='Y' or CHEM_RAD='Y' or SLEEP='Y' or LITHO='Y' or COLPO='Y' or CYSTO='Y' or ERCP='Y' or COLON='Y' or GASTRO='Y' or BRONCHO='Y' or TRANSFUS='Y' or base = 'N' or amnio = 'Y' or chorio = 'Y' or rhesus = 'Y' or bfl = 'Y' then EXCLU='Y'; else EXCLU='N';

*BELOW MAPS EVENTS TO CASEMIX PURCHASED UNITS OR IDENTIFIES AS CASEMIX EXCLUSIONS; if EXCLU='N' then do; if NEONATE='Y' then PU='W06.03'; else pu = put(hlthspec, $newpu.); end; else PU='EXCLU'; PU_name=put(PU,$PU_name.);

*BELOW REALLOCATES BONE MARROW TRANSPLANT AN-DRGs; if drg_nz='A04Z' then do; if (put(op01, $bone.) + put(op02, $bone.) + put(op03, $bone.) + put(op04, $bone.)+ put(op05, $bone.) + put(op06, $bone.) + put(op07, $bone.) + put(op08, $bone.)+ put(op09, $bone.) + put(op10, $bone.) + put(op11, $bone.) + put(op12, $bone.)+ put(op13, $bone.) + put(op14, $bone.) + put(op15, $bone.) + put(op16, $bone.)+ put(op17, $bone.) + put(op18, $bone.) + put(op19, $bone.) + put(op20, $bone.)) then DRG_NZ='A04A'; else DRG_NZ='A04B'; end; 57 proc sort data = cwd.wies8; by vicdrg4; data &outdset; merge test (in=wanted) cwd.wies8 (rename=(vicdrg4=drg_nz) drop =vicdesc sameday); by DRG_nz; if wanted;

*------*; *------Mechanical ventilation copayments first ------*; *------*;

if evendate < mdy(07,01,1999) then do; if drg_nz in ('A01Z', 'A02Z', 'A03Z', 'A04A', 'A04B', 'A05Z', 'A40Z', 'F02Z', 'F40Z', 'L61Y', 'P01Z', 'P02Z', 'P03Z', 'P04Z', 'P05Z', 'P60A', 'P60B', 'P61Z', 'P62Z', 'P63Z', 'P64Z', 'P65A', 'P65B', 'P65C', 'P65D', 'P66A', 'P66B', 'P66C', 'P66D', 'P67A', 'P67B', 'P67C', 'P67D', 'W01Z', '960Z', '961Z') then adjmvday=0;

else if op01='1388202' or op02='1388202' or op03='1388202' or op04='1388202' or op05='1388202' or op06='1388202' or op07='1388202' or op08='1388202' or op09='1388202' or op10='1388202' or op11='1388202' or op12='1388202' or op13='1388202' or op14='1388202' or op15='1388202' then adjmvday=5;

else if (put(op01, $mechven.) + put(op02, $mechven.) + put(op03, $mechven.) + put(op04, $mechven.)+ put(op05, $mechven.) + put(op06, $mechven.) + put(op07, $mechven.) + put(op08, $mechven.)+ put(op09, $mechven.) + put(op10, $mechven.) + put(op11, $mechven.) + put(op12, $mechven.)+ put(op13, $mechven.) + put(op14, $mechven.) + put(op15, $mechven.) ) then adjmvday=2;

else if op01='1388200' or op02='1388200' or op03='1388200' or op04='1388200' or op05='1388200' or op06='1388200' or op07='1388200' or op08='1388200' or op09='1388200' or op10='1388200' or op11='1388200' or op12='1388200' or op13='1388200' or op14='1388200' or op15='1388200' then adjmvday=1;

else adjmvday=0; end; else do; if drg_nz in ('A01Z', 'A02Z', 'A03Z', 'A04A', 'A04B', 'A05Z', 'A40Z', 'F02Z', 'F40Z', 'L61Y', 'P01Z', 'P02Z', 'P03Z', 'P04Z', 'P05Z', 'P60A', 'P60B', 'P61Z', 'P62Z', 'P63Z', 'P64Z', 'P65A', 'P65B', 'P65C', 'P65D', 'P66A', 'P66B', 'P66C', 'P66D', 'P67A', 'P67B', 'P67C', 'P67D', 'W01Z', '960Z', '961Z') then adjmvday=0; else if (HMVHRS < 6) then adjmvday=0; else adjmvday=round((HMVHRS+12)/24); end;

*------*; *------LOS category and Inlier category ------*; *------*;

** Before value of Inlier is determined need to make adjustment to adjmvday for those drgs with mv_elig = '4');

if mv_elig = '4' then adjmvday = max(0,adjmvday-4);

if (sum(evendate, -evstdate, -(evntlvd/1)) lt lb) then inlier='L'; else if (sum(evendate, -evstdate, -(evntlvd/1)) gt sum(HB, adjmvday)) then inlier='H'; else inlier='I';

if evstdate=evendate then los_cat = 'S'; else if (sum(evendate, -evstdate, -(evntlvd/1)) <= 1 ) then los_cat = 'O'; else los_cat = 'M';

array px(20) op01-op20; nmvsepn = 0;

select (mv_elig); when ('D') do; if (adjmvday > 0) then mv_copay = adjmvday *0.7729; else mv_copay = 0; end;

when ('E') do; *--- Check for neonate mechanical ventilation ---*; do i = 1 to 20; 58 if (substr(px(i),1,7) = '1388202') then nmvsepn = 1; end; if (nmvsepn = 1) then do; adjmvday= 0; mv_copay = 3.1323; end; else do; adjmvday = 0; mv_copay = 0; end; end;

when ('4') if (hmvhrs gt 96) then do; /* adjmvday= sum(adjmvday, -4); */ mv_copay = adjmvday *0.7729; end; else do; adjmvday = 0; mv_copay = 0; end; otherwise do; adjmvday = 0; mv_copay = 0; end; end;

*------*; *------Box 3c: Calculate Base WIES -----*; *------*; select (Inlier); when ('L') do; *---- Same day cases --; select (los_cat); when ('S') wies8 = sd; when ('O') wies8 = od; when ('M') wies8 = los * lo_pd; otherwise wies8 = 0; end;

if md_in gt 0 then ies= wies8 / md_in; else ies=0; high_day = 0; hiwies = 0; end;

when ('I') do; *---- Inlier calculations --; select (los_cat); when ('S') wies8 = sd; when ('O') wies8 = od; when ('M') wies8 = md_in; otherwise wies8 = 0; end;

ies= 1; high_day=0; hiwies = 0; end;

when ('H') do; *---- high outlier calculations --; high_day = max(0,sum(los,-hb,-adjmvday)); hiwies = high_day * ho_pd ; wies8 = md_in + hiwies; if md_in gt 0 then ies= wies8 / md_in; else ies=1; end;

Otherwise do; high_day=0; wies8=0; ies=0; end; end;

59 *------*; *------Box 5: Total WIES -----*; *------*; wies8c = sum(wies8, mv_copay);

* * Clean up temporary datasets * *; proc datasets library=work; delete test; run; options mlogic mrecall details merror mprint symbolgen; %mend w8CICD10;

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