Health Funding Policy and Principles 2019-20 financial year version 3.0
Contributors Special thanks go to those who contributed to the development of this document from the Department of Health (the Department) and Hospital and Health Services.
Version history
Version Date Modification 3.0 16 December 2019 Appendix 1 DRG B78C and U68B Queensland PBS weight amended to 0, Appendix 3 removed Du_Type and Designated Ward columns as no longer relevant, Appendix 8 Tier 2 Clinic 73.02 and 73.03 Queensland weights corrected, and Appendix 11 Bilateral Cochlear Implants procedure code updated. 2.0 17 October 2019 Updated National Admitted Acute prices and Tier 2 30.08 Clinical Measurement Queensland 1.0 4 October2019 Approved and published 2019-20
Queensland Health Funding Policies and Principles 2019-20 Published by the State of Queensland (Queensland Health), October 2019
This document is licensed under a Creative Commons Attribution 3.0 Australia licence. To view a copy of this licence, visit creativecommons.org/licenses/by/3.0/au © State of Queensland (Queensland Health) 2019 You are free to copy, communicate and adapt the work, as long as you attribute the State of Queensland (Queensland Health). For more information contact: Healthcare Purchasing and Funding Branch, Department of Health, GPO Box 48, Brisbane QLD 4001, email [email protected], phone 07 3708 5901. An electronic version of this document is available at www.health.qld.gov.au
Disclaimer: The content presented in this publication is distributed by the Queensland Government as an information source only. The State of Queensland makes no statements, representations or warranties about the accuracy, completeness or reliability of any information contained in this publication. The State of Queensland disclaims all responsibility and all liability (including without limitation for liability in negligence) for all expenses, losses, damages and costs you might incur as a result of the information being inaccurate or incomplete in any way, and for any reason reliance was placed on such information.
Queensland Health Funding Policy and Principles 2019-20
Contents
For ease of reading, please refer Acronyms and Glossary on page 137. Introduction ...... 1 1. Overview of Queensland public health services funding ...... 1 2. Queensland Health budget and funding sources ...... 2 2.1 State Appropriation ...... 4 2.2 Commonwealth Appropriation ...... 4 2.3 Grants and Contributions ...... 4 2.4 Own source revenue ...... 4 3. Queensland healthcare purchasing and HHS funding ...... 6 3.1 The process for determining health service purchasing and HHS funding ...... 6 3.2 Healthcare purchasing approach, funding policy and purchasing incentives ...... 7 3.3 HHS funding via service agreements ...... 10 3.4 Queensland public hospital funding models ...... 11 4. Activity based funding (ABF) model ...... 13 4.1 Overview of ABF ...... 13 4.2 National ABF model ...... 14 4.3 Queensland ABF model ...... 15 4.4 Hospitals in scope for ABF model ...... 19 4.5 Services in-scope for ABF model ...... 19 4.6 Private and ineligible patients ...... 31 4.7 ABF model adjustments ...... 32 4.8 Grants for ABF facilities ...... 33 5. Block funded facilities and services – NEC ...... 35 5.1 Block funded facilities - NEC ...... 35 5.2 Block funded services - NEC ...... 36 6. Population-based funding ...... 37 7. Other specific funding ...... 38 7.1 Community state-wide services – limited HHS delivery ...... 38 7.2 Prisoner Health services ...... 38 7.3 Third party funded health services ...... 39 7.4 Other funding ...... 39 8. Pricing for safety and quality ...... 40 8.1 Sentinel events ...... 40 8.2 Hospital Acquired Complications ...... 41 8.3 Avoidable Readmissions ...... 44 9. Data reporting for costing and funding ...... 47 9.1 Data collection ...... 47 9.2 Data reporting ...... 48 9.3 Data quality and integrity ...... 49 10. Governance ...... 53
Queensland Health Funding Policy and Principles 2019-20
10.1 Department of Health ...... 53 10.2 System Performance ...... 54 Appendices ...... 57 Appendix 1 Queensland Admitted Acute Price Weights 2019-20 (Q22) ...... 58 Appendix 2 National Admitted Acute Price Weights 2019-20 (N1920) ...... 71 Appendix 3 Mental Health Admitted (QH Standard Units) 2019-20 – Q22 Only ...... 83 Appendix 4 Queensland Subacute and Non-acute Admitted 2019-20 (Q2) ...... 86 Appendix 5 National Subacute and Non-acute Admitted 2019-20 (N1920)...... 88 Appendix 6 Paediatric SNAP Price Weights 2019-20 (N1920 and Q22) ...... 91 Appendix 7 Queensland Unscored SNAP price weights 2019-20 – Q22 Only ...... 93 Appendix 8 Non-Admitted price weights 2019-20 (N1920 and Q22) ...... 95 Appendix 9 Emergency Department price weights 2019-20 (N1920 and Q22) ...... 100 Appendix 10 Emergency Service price weights 2019-20 (N1920 and Q22) ...... 104 Appendix 11 ABF model adjustments and localisations 2019-20 ...... 106 Appendix 12 Funding adjustments for Hospital Acquired Complications 2019-20 .... 111 Appendix 13 Specified Intensive Care Units 2019-20 ...... 112 Appendix 14 Radiotherapy procedures codes eligible for adjustment ...... 113 Appendix 15 Dialysis codes eligible for adjustment ...... 115 Appendix 16 Specified Grants 2019-20 ...... 116 Appendix 17 Clinical education and training grants ...... 118 Appendix 18 HHS hospitals and facilities by funding model 2019-20...... 120 Appendix 19 2019-20 ABF and Non-ABF Service Category Definitions ...... 128 Acronyms and Glossary ...... 137 Bibliography ...... 141
Figures Figure 1 Australian Public Hospital System Funding and Payment Framework ...... 3 Figure 2 Shadow Purchasing Hierarchy 2019-20 ...... 7 Figure 3 Development of service agreements with the HHSs ...... 10 Figure 4 2019-20 HHS allocations by funding models ...... 11
Tables Table 1 Summary of healthcare purchasing incentives 2019-20 ...... 8 Table 2 ABF counting units and classifications for 2019-20 ...... 13 Table 3 Variance between the NEP and the QEP ...... 16 Table 4 Components included in the NWAU and QWAU ...... 16 Table 5 Summary of differences - National model and Queensland model 2019-20 ...... 17 Table 6 Queensland localisations applied to the ABF Model in 2019-20 ...... 18 Table 7 ADL score determinants ...... 22 Table 8 Summary of mental health funding for 2019-20 ...... 24 Table 9 BSQ funding model price per screen 2019-20 ...... 30 Table 10 State oral health funding model price per WOOS 2019-20 ...... 31 Table 11 Australian sentinel events list (version 2) 2018 ...... 40 Table 12 HAC list version 1.1 applicable for 2019-20 ...... 41 Table 13 List of avoidable hospital readmissions ...... 45 Table 14 Queensland (Statewide) activity and costing data collection ...... 47
Queensland Health Funding Policy and Principles 2019-20
Introduction
The purpose of the Queensland Health Funding Policy and Principles is to give an overview and governance of funding and purchasing of public healthcare services in Queensland. This includes the key inputs into the final budget allocations for each Hospital and Health Services (HHS), governance, operational guideline for services and facilities funded via the Activity Based Funding (ABF) model and other funding models, the relevant data and performance reporting. The guidelines reflect the Department’s role as a system manager and support the service agreement in place between the Department and each HHS.
1. Overview of Queensland public health services funding
The funding for Queensland public hospitals and healthcare services aims to provide sufficient resources for the delivery of high quality, sustainable and safe health services. This is achieved via a transparent process that allocates funding to where resources are most required. Funding decisions are guided by the principles and Department’s strategic objectives: supporting Queenslanders to be healthier: promoting and protecting the health of Queenslanders enabling safe, quality services: delivering and enabling safe, clinically effective, high quality health services (principle: provide incentives to support continuous improvement in patient safety and quality) equitable health outcomes: improving health outcomes through better access to services for Queenslanders (principle: ensure hospital resources are allocated to those activities which maximise health outcomes through allocative efficiency. principle: ensure that hospitals are funded on a comparable basis for the activity they provide, and that unavoidable differences in costs between hospitals are taken into account through equitable funds distribution) high performance: responsive, dynamic and accountable management of the department, and of funding and service performance (principle: increase the level of hospital activity for a given level of inputs through technical efficiency) dynamic policy leadership: drive service improvement and innovation through a collaborative policy cycle (provide incentives for technological and clinical innovations that lead to better health outcomes through dynamic efficiency) broad engagement with partners: harnessing the skill and knowledge of our partners engaged and productive workforce: foster a culture that is vibrant, innovative and collaborative.
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2. Queensland Health budget and funding sources
The Queensland Health operating budget is published annually in the Service Delivery Statement (Queensland Budget 2019-20). The Queensland Health budget is allocated to the Department of Health (the Department), Queensland Ambulance Service and 16 Hospital and Health Services (HHSs). The majority of the annual health budget is allocated to HHSs and other organisations such as the Mater Health Service through Service Agreements to deliver frontline hospital and health services, with the remaining balance supporting improved patient outcomes through centralised state-wide services. Queensland Health’s funding is provided from the following sources: State Government Commonwealth Government Grants and Contributions Own Source Revenue In line with the August 2011 National Health Reform Agreement (NHRA), a single National Health Funding Pool (NHFP) was established, comprising a Reserve Bank of Australia account for each state and territory that is operated by the National Health Funding Administrator1 (the Administrator), an independent statutory office holder. National Health Reform Funding comprises ABF, Block Funding, Teaching, Training and Research Funding (TTR) and Public Health Funding. All Commonwealth Funding for NHR is deposited into the State Pool Account along with the State’s contribution to activity-based public hospital funding. National Health Reform Funding is paid to HHSs in accordance with their Service Agreement, which is a formal agreement between the Department and each HHS for the provision of public health services. The Administrator has responsibility for calculating the Commonwealth contributions to states and territories and ensuring deposits into the NHFP are in line with the NHRA and that Block and TTR Funding for public hospitals and other public sector health services, flow through a separate and discrete account called the State Managed Fund (SMF). To increase transparency in the funding of health services and as required under the NHRA and Hospital and Health Boards Act 2011, separate bank accounts have been established as follows (refer also Figure 1): Commonwealth ABF is deposited into the NHFP then distributed directly to HHSs’ bank accounts. State ABF is transferred from the Department’s operating account to the NHFP and then distributed to the HHSs. Commonwealth Block Funding is deposited into the NHFP then transferred to the SMF and distributed to HHSs. Similarly, State Block Funding is transferred from the Department’s operating account to the SMF then distributed to HHSs.
1 The Australian Commission on Safety and Quality in Health Care, Independent Hospital Pricing Authority, Administrator National Health Funding Pool and National Health Funding Body were established under the National Health Reform Act 2011.
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Commonwealth TTR Funding is deposited to the NHFP, then transferred to the SMF then distributed to HHSs. Similarly, State TTR funding is transferred from the Department’s operating account to the SMF then distributed to HHSs. Commonwealth Public Health Funding is deposited to the NHFP then transferred to the Department’s operating account. Other system manager funds are paid directly to HHSs from the Department’s operating account and do not form part of the National Health Reform Funding arrangements. Figure 1 Australian Public Hospital System Funding and Payment Framework
Source: Administrator, National Health Funding Pool – National Health Reform funding flows https://www.publichospitalfunding.gov.au/public-hospital-funding/pay At the 1 April 2016 Council of Australian Governments (COAG) meeting, COAG agreed to the National Health Reform Agreement. This agreement will continue the Commonwealth funding 45 per cent of the growth of public hospital services for the three years spanning 2017-18 to 2019-20, although growth in Commonwealth public hospital funding will be capped so that it does not exceed six and a half per cent (6.5%) per year across the State. The Prime Minister and Premiers of all States and Territories signed Schedule I - Addendum to the NHRA in June 2017, which came into effect on 1 July 2017. It includes: the introduction of a data conditional payment to encourage the prompt provision of required data a six and a half per cent cap on the growth of Commonwealth National Health Reform funding the incorporation of safety and quality into hospital pricing and funding (for sentinel events, hospital acquired complications and re-admissions) reforms to primary care to reduce potentially avoidable hospital admissions better coordinated care for patients with chronic and complex disease.
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2.1 State Appropriation State appropriation is provided by the Queensland Government and received via Queensland Treasury. State appropriation funds the State’s contribution towards National Health Reform Funding (ABF, Block and TTR), in addition to other specific State funded programs to deliver public hospital and health services.
2.1.1 Depreciation Revenue Depreciation is a non-cash expense related to the change in the value of assets over time. To ensure there is no impact to the operating position of the Department and HHSs, the Department is funded State appropriation equal to its depreciation expense. As depreciation is a non-cash expense, this results in a build-up of cash. Queensland Health is able to retain a portion of the depreciation revenue (state appropriation) to fund its base capital program, with the remainder of the cash being returned to Queensland Treasury via an equity withdrawal. HHSs are provided non-cash revenue equivalent to their depreciation expense via their Service Agreement.
2.2 Commonwealth Appropriation Commonwealth appropriation is provided by the Commonwealth Government and received via Queensland Treasury. Commonwealth appropriation is provided for specific programs and excludes the Commonwealth’s contribution to National Health Reform Funding (ABF, Block, TTR and Public Health Funding).
2.3 Grants and Contributions In some instances, arrangements may be made whereby the Department or HHS receives funding from another Government Agency (including the Commonwealth Government) in exchange for the provision of services. There are often conditions attached to these funds specifying the required outputs and benefits to be delivered. This is commonly referred to as a grant or contribution.
2.4 Own source revenue Own source revenue (OSR) is revenue that is generated by the Department and HHSs through the sale of goods and services (excluding State and Commonwealth revenue). There are two main recognised forms of OSR: user charges and other revenue.
2.4.1 User charges Section G3 of the NHRA states that private patients, compensable patients and ineligible patients can be charged for public hospital services. Funding obtained via this method is referred to as OSR. The types of patients and flow of revenue is outlined in the following list.
Locally receipted OSR Private practice, other patient and non-patient revenue are generated, managed and retained by HHSs and commercial business units:
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admitted patient (also known as inpatient), non-admitted patient (also known as outpatient) and non-patient OSR Note regarding the National Disability Insurance Scheme (NDIS), HHSs may choose to seek funding from the NDIS by registering to become an NDIS service provider and delivering NDIS supports on a fee-for-service basis. This revenue may offset funding that has been identified to be quarantined by HHSs as part of their contribution to the State’s NDIS commitment, which is withdrawn at the start of the financial year. Contact [email protected] for more information on funding impacts. private admitted patients private non-admitted patients Medicare ineligible patients overseas visitors (not covered by a reciprocal health care agreement), asylum seekers workers’ compensation (including WorkCover Queensland) motor vehicle accident outside the Queensland compulsory third party scheme personal injury insurers Department of Defence Department of Veterans’ Affairs (DVA) (admitted and non-admitted) - right of private consultations and imaging) Other patient related (pharmaceutical recoveries, prosthetic recoveries).
Centrally receipted OSR (Category C) Revenue centrally negotiated by the Department is allocated to HHSs. These include: Queensland compulsory third party scheme—Motor Accident Insurance Commission (MAIC) National Injury Insurance Scheme Queensland (NIISQ) DVA, hospital admitted patient service and non-admitted public service fees, which uses National Weighted Activity Unit (NWAU) based funding model Interstate (cross border residents), which uses the NWAU-based funding model.
2.4.2 Other Revenue Revenue that is not directly related to the provision of services to patients. Non-patient revenue can include retail proceeds, Non-Government Organisations’ (NGOs) research grants, salary recoveries, or the provision of services for commercial arrangements.
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3. Queensland healthcare purchasing and HHS funding
Public health services funding in Queensland is based on the Department’s purchasing model, funding model and the service agreement negotiation process. The level of funding provided to HHSs is informed by identified priorities for investment and known/expected service developments in negotiation with the HHSs. The ABF funding model determines the price at which the Department purchases services from HHSs. The purchasing model identifies the volume of services that the Department has agreed with the HHSs to purchase and any efficiency and/or productivity adjustments applied to the ABF determination. The block funding models in the service agreement defines the health services, teaching, research and other services that are to be provided by the HHSs. It also defines the outcomes that are to be met by the HHSs and how their performance will be measured.
3.1 The process for determining health service purchasing and HHS funding Funding for each successive financial year is determined in advance to allow sufficient time for HHS planning. HHS funding consists of: the previous year’s recurrent allocations for ABF and non-ABF services; and new allocations (and deductions) for: – wage increases resulting from enterprise bargaining – non-labour escalation – funding policy2 and purchasing incentives. A number of other factors may also influence budget determinations, such as election commitments, national partnership agreements, up-front adjustments for purchasing incentives and efficiency dividends. In addition to the planned purchase of activity grouped to the care setting, the 2019-20 activity is grouped according to condition/cohort and outcomes to reflect the focus on improved health outcomes; refer Figure 2 Shadow Purchasing Hierarchy 2019-20. Activity data is translated into standard units of activity, Weighted Activity Units (WAUs), using the Generated Weighted Activity Units (GEN-WAU) system. WAUs are used for the reporting of activity and are a keystone to the setting and monitoring performance of HHSs.
2 Refer the Scope of Publicly Funded Services Policy QH-POL-336:2015 and Publicly Funded Services Guidelines
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Figure 2 Shadow Purchasing Hierarchy 2019-20
3.2 Healthcare purchasing approach, funding policy and purchasing incentives As well as defining activity targets, the 2019-20 purchasing approach is based on supporting the investment in value based healthcare and comprises a range of ‘purchasing incentives’ that apply financial levers to drive the delivery of efficient and effective care. Different to investment in activity growth, purchasing incentives target the following principal areas: improving patient safety and quality, e.g. stroke unit care improving preventative health measures, e.g. Quality Improvement Payments (QIPs) for smoking cessation and early, regular antenatal care for Indigenous women; and specific investments e.g. in high risk foot care more care closer to home, e.g. telehealth other targeted price adjustments where the decisions on investment are directly linked to a service or improving patient outcomes. Table 1 summarises the purchasing incentives applicable for 2019-20 and whether they are a service agreement amendment or ABF Model adjustment. TNote that this is a brief summary only and specific information on each initiative is detailed in the Purchasing and Non-Activity Based Funding Specification Sheets available on QHEPS and in the service agreement for each HHS available on Queensland Health website.
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Table 1 Summary of healthcare purchasing incentives 2019-20
Incentive Description Scope Application Quality Improvement Incentive payments for All HHSs (including Mater Payment (QIP) achieving targets for: Public Hospitals but – Antenatal Visits for • Indigenous women excluding Children’s Health Indigenous Women attending an antenatal Queensland) session during their first trimester, and attending at least 5 antenatal visits; and • Indigenous women stopping smoking. Quality Improvement Incentive payments for each All HHSs (including Mater Payment (QIP) Wellness Pathway Public Hospitals but – Patient Wellness completed and received by excluding Children’s Health Pathway the Health Contact Centre Queensland) for in-scope adult public hospital patients on knee, hip or shoulder elective surgery wait lists. Quality Improvement Incentive payments for All HHSs (excluding Mater Service Payment (QIP) achieving targets for Public Hospitals and - Smoking Cessation community mental health Children’s Health (Community Mental patients clinically supported Queensland) Health) onto the Smoking Cessation Amendment Agreement Clinical Pathway. High Cost Home Payment for high cost 24 All HHSs (including Mater Support Program hour home ventilated Public Hospitals) patients. Telehealth Incentive payments for Outpatients - Central West, additional outpatient activity North West, South West and volume, provision of Torres and Cape HHSs only. telehealth consultancy for Inpatients3 and Emergency
inpatients and Emergency Department, Store and Department episodes and Forward - all HHSs Store and Forward (including Mater Public assessments. Hospitals) High risk foot services Funding for achieving timely All HHSs (including Mater assessment / treatment of Public Hospitals but referred high risk foot excluding Children’s Health patients, based on data Queensland) recorded in the Measurement Analysis and Reporting System (MARS) Advance Care Payments for HHSs that All HHSs (including Mater Planning (ACP) offer admitted, non-admitted Public Hospitals) and community health patients treated in or funded by Queensland Health public facilities the opportunity to contemplate an ACP and an outcome documented.
3 Telehealth admitted/ inpatient component is removed and funded recurrently via ABF model
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Incentive Description Scope Application Sentinel Events Payment withdrawn for All HHSs (including Mater national sentinel events. Public Hospitals)
Emergency Zero QWAUs for DNWs All ABF hospitals (including Department ‘Did Not Mater Public hospitals) Wait’ (DNW) Fractured neck of Base WAU reduced All ABF hospitals and any femur timely surgical (reduced Diagnosis Related contracted care outsourced access Group or DRG price weight) from an ABF hospital for non-timely surgical treatment of fractured neck of femur. Hospital in the Home Discounted price weight for All ABF hospitals (including (HITH) specific non-complex DRGs Mater Public hospitals) and with no HITH component or any contracted care A
long stay days with a HITH outsourced from an ABF localisation funding and model BF component. hospital Out-of-scope activity Zero QWAUs for out-of- All HHSs (including Mater scope procedures of a Public hospitals) and any purely cosmetic nature, contracted care outsourced unless one of the listed from a HHS clinical exemptions are present. (Refer the Publicly Funded Services Guidelines and the 2019-20 purchasing specifications for Out-of- scope service on QHEPS).
Pre-operative elective QWAUs for long stay days All ABF hospitals and any bed days (above upper trim point less contracted care outsourced Intensive Care Unit or ICU from an ABF hospital days) reduced equivalent to pre-operative days. Smoking cessation QWAU loading equivalent to All ABF hospitals (including (inpatients) fixed price of $37.00 per in- Mater Public hospitals) scope episode of care, matching ISOH Dental Item Number D142 (Tobacco counselling).
Stroke Care 10% DRG inlier rate loading All ABF hospitals with for stroke unit care. endorsed stroke unit (including Mater Public hospitals)
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3.3 HHS funding via service agreements The Hospital and Health Boards Act 2011 stipulates that a service agreement must be in place between the Department and each HHS for the provision of public health services. The service agreement defines the health services, teaching, research and other services that are to be provided by the HHS4 and the funding to be provided to the HHS for the delivery of these services (both ABF and non-ABF services). It also defines the outcomes that are to be met by the HHS and the associated mandatory departmental activity reporting requirements which will support how its performance will be measured. The current service agreement covers the period 2019-20 to 2021-22. However, funding and purchased activity is re-negotiated annually, with further in-year variations being made through the service agreement amendment process. Further information on HHS service agreements is available on www.health.qld.gov.au. Figure 3 summarises the processes behind the development of service agreements with the HHSs. Figure 3 Development of service agreements with the HHSs
Department of Health’s Strategic Priorities
HHS Strategic Plans/ priorities ABF plus Grants: Specified and Clinical Education Planning Models, Training Growth Analysis, HHS Service Healthcare service Purchasing for Agreements delivery Performance
Non-ABF Budget
Existing Service Utilisation
Health Portfolio Budget (state and commonwealth funding)
HHS funding is provided from: the State purchasing pool that holds funding for the following purposes: – ABF for HHSs via the funding pool – Block funding via the State Managed Fund – Centrally receipted (to the Department) OSR – Department grants, and HHS locally receipted grants and HHS locally receipted OSR which HHSs have to collect directly.
4 Within HHS service agreements, Schedule 1, Hospital and Health Service Accountabilities, includes that the HHS must ensure that all facilities have undertaken a baseline self-assessment against the Clinical Services Capability Framework.
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The proportion of funding allocated for each funding service stream is depicted in Figure 4 2019-20 HHS allocations by funding models.
Figure 4 2019-20 HHS allocations by funding models
Source: 2019-20 Queensland HHS Purchasing Model Final (v1.15 June 2019), M1A. Finance and Activity Schedule
3.4 Queensland public hospital funding models There are 16 HHSs and the public health services provided by the Mater Health Services, South Brisbane, which are funded under the NHRA and Queensland Government. The Queensland ABF model is based largely on the national ABF (otherwise known as the National Efficient Price) model but includes a few modifications to reflect Queensland priorities. Note: Queensland public hospitals’ funded activity includes activity contracted to private hospitals. There are 39 public hospitals which are ABF funded. Queensland also funds the following services: oral health, breast screening, clinical education training and specified grants. Under the National Efficient Cost 2019-20 (NEC19) block funding model, there are 100 block funded hospitals and facilities in Queensland (for more detail, refer Section 5.1 Block funded facilities - NEC). Also under the NEC19 block funding model, the following services are funded: Teaching, training and research; Community Mental Health Services; Non-admitted Home Ventilation Services (as defined by Tier 2 V5.0 Non-Admitted Services class 10.19) and A17 List services not otherwise priced. Other funding models have been developed for those public health services which are outside the scope of the above NHRA ABF and Block funding models. These include population-
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based community services, specific funding arrangements for Prisoner Health services and third-party funded health services including for residential aged care and disability residential care service facilities. Refer Appendix 18 HHS hospitals and facilities by funding model 2019-20 for the detailed list of facilities and funding model applied.
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4. Activity based funding (ABF) model
4.1 Overview of ABF ABF is a method of funding hospitals, whereby they are funded based on the mix and volume of patients treated. ABF is based on three key elements: classification of patient activity (the classification system used) counting the activity (the counting unit) costing the activity (determining a cost per counting unit) which informs the price set for the services. The different types of activity funded by ABF are identified and counted in a standardised manner. Used effectively, these elements result in pricing and funding transparency of the public hospital system. Table 2 shows the activity type classification systems used and the counting units for the Queensland funding model. Table 2 ABF counting units and classifications for 2019-20
Activity type Counting unit Classification 2019-20 Information needed to classify episode Acute admitted patients Patient episode and per Australian refined International Statistical diem for short or long diagnosis related Classification of stay outliers groups classification Diseases and Related version 9.0 (AR-DRG Health Problems, 11th v9) Revision, Australian Modification (ICD-10- AM), Australian Classification of Health Interventions (ACHI) and Australian Coding Standards (ACS) for diagnosis and procedures codes Intensive care admitted Patient episode and AR-DRG v9.0 Hours in eligible ICU patients time spent in an >24,000 hrs per annum intensive care unit (ICU) with >20% continuous mechanical ventilation
Sub and non-acute If episode is classified Australian National Care type, impairment admitted patients into AN-SNAP V4.0 Subacute and Non- type (rehabilitation), class* then counting Acute Patient age, phase (for unit is patient episode classification Version palliative care), activity and per diem for short 4.0 (AN-SNAP v4) of daily living (ADL) and long stay outliers. assessment score, i.e. Remaining episodes are Resource Utilisation care type per diem Groups (RUG), (including same day) Functional Improvement *Paediatric palliative Measure (FIM), Health care remains as care of the Nation Outcome type per diem. Scales (HoNOS)
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Activity type Counting unit Classification 2019-20 Information needed to classify episode Mental Health Admitted Per diem for any Queensland Mental Care Type 12 Days in patients episode Health per diem an eligible mental health Appendix 3 Mental standard unit or Days in Health Admitted (QH ‘PY’ standard unit (the applied per diem Standard Units) 2019- reported (regardless of rate varies depending 20 – Q22 only care type) whether in a mental health standard unit or Average Mental Health other) per diem is applied when no ‘PY’ standard unit reported Emergency Department Presentation Urgency related groups Principal diagnosis, (Level 3b and above) (URG) v1.4 triage category, episode end status and visit type Emergency services Presentation Urgency disposition Triage category and (ES) - small or rural groups (UDG) v1.3 episode end status EDs – (Level 1 to 3a) Non-admitted patients Service event Tier 2 Non-Admitted Clinic type (specialty Services Classification and provider), delivery 2019-20 modality, e.g. face-to- face, telehealth, telephone
The overall funding for a service is determined using a combination of a ‘standard’ or ‘base price’ and a unit of activity that is weighted according to resource requirements, called a ‘weighted activity unit’ or WAU. The basis of the ABF calculated payment model being: Price x Weighted Activity Unit = ABF ($) The principle behind applying a weighting to each of the service activities is to reflect that the more resource intensive a procedure or treatment is, then the greater the weight. It should be noted however that the actual funding received by HHSs is negotiated through the annual service agreement process. This funding is provided at the beginning of the financial year and subject to HHS budget allocation principles for internal dissemination.
4.2 National ABF model The Independent Hospital Pricing Authority (IHPA) is required to determine on an annual basis the public hospital services that are to be funded by the Commonwealth under the NHRA and any adjustments to the NEP to reflect legitimate and unavoidable variations in the cost of delivering health care services. The scope of public hospital services eligible for Commonwealth funding under the NHRA 2011 (the ‘in-scope services’), as determined by IHPA in the Pricing Framework for Australian Public Hospital Services 2019-20, are: All admitted programs, including HITH programs and forensic mental health admitted patient services All emergency department services and Other non-admitted services that meet the criteria for inclusion on the General List of In‑scope Public Hospital Services.
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The NHRA states that ABF should be used wherever practicable. If ABF is not possible, IHPA has developed criteria to determine which public hospital services are better funded through block grants. The main criteria are: The technical requirements for applying ABF are not able to be satisfied; or There is an absence of economies of scale that means that some services would not be financially viable under ABF. The intent is, where technical requirements can be met, to move to ABF funding over time. However, other services may need to be funded using only block grants or a combination of block grants and ABF on an ongoing basis. Refer Section 5 of this document for further information on block funded services and facilities and Sections 6 and 7 for other funding models. Educational and training resources on the topic of ABF are available on IHPA’s website.
4.2.1 National Efficient Price (NEP) and National Efficient Cost (NEC) The NEP, which is a single National price based on the average cost of public hospital activity from all states and territories, is developed by IHPA and intended to provide a consistent and transparent method to determine Commonwealth growth funding to states and territories for health services provided by ABF facilities. This average price is applied to admitted services, emergency and non-admitted services. All price weights are expressed as a single unit of measure being the NWAU and guides the Commonwealth contribution for ABF services. 2019-20 NEP (NEP19) $5,134 = 1 NWAU The National Efficient Cost (NEC) determines the Commonwealth contribution to block fund those hospitals and services, which do not meet the criteria for ABF. Refer to Section 5 for more information on block-funded services. The IHPA releases annually the Pricing Framework for Australian Public Hospital Services along with NEP and NEC determinations. Further information on how the NEP is calculated is available on the IHPA website.
4.3 Queensland ABF model The Queensland ABF model uses a Queensland Efficient Price (QEP) for ABF services in Queensland. The QEP, based on the average cost to deliver a Queensland weighted activity unit (QWAU) using 2017-18 costs indexed for two years, is used to reflect the differences between the Queensland funding model and the national cost base. Examples of these differences include the application of the clinical education and training (CET) grant in the Queensland model and application of the mental health per diem rates instead of DRGs in the localised model. This is considered a fairer way to fund HHSs, as it reflects the investment in services. 2019-20 QEP (Q22) $4,847 = 1 QWAU
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Table 3 Variance between the NEP and the QEP
Component NEP19 QEP22 Phase N1920 Q22 Price $5,134 $4,847 Clinical Education & Training $36 $148 Specified Grants $0 $52 Efficiency Dividend $0 $105 Impact $5,170 $5,152
Table 4 Components included in the NWAU and QWAU
Component NWAU QWAU Labour Yes Yes Blood No Yes PBS Drugs No Yes ED Did Not Wait Yes No Private Patient No Yes Contribution MBS Contribution No Yes DVA/ MAIC/ Other No Yes
4.3.1 Difference between National and Queensland models There is no requirement for the Department to fund HHSs according to the National model, as that model is an average for the purpose of growth funding. However, the Queensland Government decided in-principle to follow the National model where appropriate but with differences according to Queensland priorities in the way that health services are managed and OSR is treated. These are outlined in Table 5 below. The unit of measure for the 2019-20 Queensland ABF model is the QWAU. For example, the QWAU includes the cost weight equivalent for Pharmaceutical Benefits Scheme (PBS) that are excluded from the NWAU. Where localisations have occurred, there will be variations between NWAUs and QWAUs.
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Table 5 Summary of differences - National model and Queensland model 2019-20
Component Calculation of National Calculation of Queensland (QWAUs) (NWAUs) Base price weights • NEP19 • QEP22 Acute Admitted • AR-DRG • AR-DRG classification v9.0 patients classification v9.0 • Localisations as per Table 1 Summary of healthcare purchasing incentives 2019-20 and Table 6 Queensland localisations applied to the ABF Model • Private patients • Private patients calculated as per public discounted to account patients to take into account the OSR or the alternative contribution funding source • PBS excluded • PBS included
Mental Health • AR-DRG • Per diem funding based on mental health Admitted patients classification v9 standard unit days for Care Type 12 • Adjustments to trim • Mental health “PY**” standard unit code is points in acute DRG required else average per diem applied model • Private patients • Private patients calculated as per public discounted to account patients to take into account the OSR for the alternative contribution funding source • PBS excluded • PBS included in the per diem rate
Subacute and Non- • AN-SNAP • AN-SNAP classification v4.0 Acute Admitted classification v4.0 • If unable to assign to an AN-SNAP V4.0 class, patients • If unable to assign to the episode is funded on care type per diem an AN-SNAP V4.0 • Private patients calculated as per public class, the episode is patients to take into account the OSR funded under the contribution DRG assignment • Private patients discounted to account for the alternative funding source • PBS excluded • PBS not applicable
Emergency • URG classification • URG classification v1.4 department v1.4 • No QWAU for DNW discharge status patients Emergency • UDG classification • UDG classification v1.3 services patients v1.3 • No QWAU for DNW discharge status
Non-admitted • Tier 2 Non-Admitted • Tier 2 Non-admitted Services classification patients Services classification v5.0 2019-20 v5.0 2019-20 • A fixed rate for telephone consults • NWAU as per Tier 2 • Tier 2 code 30.08 Clinical Measurements is in- weights for telephone scope consults
Queensland Health Funding Policy and Principles 2019-20 - 17 - Component Calculation of National Calculation of Queensland (QWAUs) (NWAUs) Non-admitted • Receiving Telehealth • Receiving Telehealth funded by clinical patients continued to specific telehealth specialty clinics • Multi-disciplinary • Multi-disciplinary clinics - no clinics – Loading loading/adjustment forty-six per cent • Private patients WAU calculated as per public • Private patients - no patients to take into account the OSR NWAU contribution • PBS excluded • PBS WAU calculated
Note: additional purchasing incentives and localisations also apply to the Queensland model (see Table 1 Summary of healthcare purchasing incentives 2019-20).
4.3.2 Queensland localisations from the National ABF model Queensland localisations include those Purchasing Incentives (PI) applied via the Queensland ABF Model (refer section 3.2) and Localisations (LCZ) from the National ABF model so that adverse impacts to Queensland can be managed and offset where possible. Refer Table 6 below for the Queensland localisations being applied in the 2019-20 ABF Model. The localisation is applied each time the specified criteria is met, except for those episodes where there is more than one applicable localisation then the highest localisation will apply (order of application is numbered, i.e. LCZ (1)). For more detailed information about 2019-20 localisations and their application, refer Appendix 11. Table 6 Queensland localisations applied to the ABF Model in 2019-20
Localisations (LCZ) Purchasing Incentives (PI) from National ABF Model applied to Qld ABF Model Bilateral Cochlear implants Emergency Department ‘Did Not Wait ‘ Cystic Fibrosis Fractured Neck of Femur timely surgical access Hospital Acquired Complications applicable to Hospital in the Home sub and non-acute care for Queensland Kidney and Liver Transplant Out-of-Scope services5 Mental Health (Care Type 12) Pre-Operative Elective Bed Days Neurosurgery Smoking Cessation (Inpatients) Neonatal Intensive Care Unit Stroke Care Spinal – acute, sub and non-acute Transplant Support Trauma
4.3.3 HHS growth funding In 2019-20, the Commonwealth Government will fund 45 per cent of ‘growth’ of activity-based services, up to a cap of 6.5 per cent growth from the 2018-19 funding base. In Queensland,
5 Refer Scope of Publicly Funded Services Policy and Guideline Publicly Funded Services on Department of Health website
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this growth funding is allocated to HHSs through specific funding allocations at the start of the financial year. Activity is measured by fund source (NWAUs) and QWAUs. In calculating growth funding amendments, the Department will compare HHS’ year-to-date actual in-scope activity by fund source with their associated WAUs to their WAU forecast at the HHS and Service Stream level: Where a HHS is below its target, funding and activity will be withdrawn at 100 per cent of the QEP. Where a HHS is below, or is deemed not likely to meet its WAU target, funding may be distributed to other HHSs. Where an HHS is above its NWAU target, additional activity may be funded at 45 per cent subject to the availability within the 6.5 per cent cap. Funding is provided on the basis that the Commonwealth government funds Efficient Growth in 2019-20 (capped at 6.5 per cent) and that HHSs submit activity data in accordance with data schedules that identify standards in relation to the quality and timeliness of data for submission to national bodies. Funding of Efficient Growth will be based on HHS data as utilised in the Department of Health’s year-end submission to the Independent Hospital Pricing Authority. For further information, please refer to the ‘Commonwealth efficient growth funding’ specification sheet available on Purchasing and non-activity based funding specifications page on QHEPS.
4.4 Hospitals in scope for ABF model For public hospitals and facilities in scope for the ABF model, refer to Appendix 18 HHS hospitals and facilities by funding model 2019-20. Private hospitals under contract to deliver health services for public patients are also in-scope but have not been listed.
4.5 Services in-scope for ABF model
4.5.1 Admitted Acute
Classification and counting unit Acute episodes of care are grouped into clinically similar and resource homogenous groups based on the principal reason for admission using the AR-DRG classification system, which includes the standards: ICD-10-AM, ACHI and ACS. AR-DRG V9.0 is the version of the classification and used for pricing from 1 July 2019 to 30 June 2020. The counting unit is ‘episodes of care for an admitted patient’.
Data collection and reporting All acute admitted patient information is collected as part of the Queensland Health Admitted Patient Data Collection (QHAPDC) which is also used for reporting of the Admitted patient care National Minimum Data Set (NMDS) 2019-20 to Australian Institute of Health and Welfare (AIHW) and to IHPA (refer the ABF data request specifications for the relevant year).
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WAU, funding and adjustments
Payment based on inlier and outlier modelling Funding for acute admitted patients is based on payment for each episode of care, which is a phase of treatment that ends when the clinical intent of care changes or the patient is formally discharged from hospital. To calculate Queensland WAUs, the PBS price weight should be included.
Payment methodology for acute admitted patients The payment model for acute admitted care is based on episodic payments plus per diem payments for outlier days, and includes adjustments for Hospital Acquired Complications (HAC), ICU, paediatric, indigenous, remote areas on both patient’s place of resident and place of treatment, radiotherapy treatment and dialysis and Queensland localisations. Refer section 4.7 ABF model adjustments for further information on adjustments available for acute admitted patients. In the AR- DRG V9.0 classification, a number of DRGs are set as same day based on the patient being admitted and discharged on the same day, i.e. the upper and lower trim points are set at one day and the word ‘Same day’ is part of the DRG name. There has been a significant reduction in the number of same day DRGs over the years, from 68 in V7.0 to 6 in V9.0. As has been the case in previous years, weighted activity units for acute admitted patients is based on: same day price weight for episodes that are day only, or short stay base price weight + short stay per diem price weight for episodes that are overnight but less than the lower boundary, or inlier price weight (for episodes within the lower and upper boundaries) + long stay per diem price weight (for episodes exceeding the upper boundary). It should be noted that all per diem calculations are based on the fractional length of stay of the patient. DRGs designated for a separate same day payment are identified in the acute admitted patients AR-DRG V9.0 schedule with a ‘1’ in the column ‘same-day payment list’, refer Appendix 1 Queensland Admitted Acute Price Weights 2019-20 (Q22).
Critical care delivered via ICUs and funding adjustments Critical care is an area that utilises significant resources in the treatment of patients, which an AR-DRG alone does not reflect. Therefore, additional funding (in the form of an adjustment) over and above the acute admitted patient payment is made where a patient is admitted to an eligible ICU, Neonatal Intensive Care Unit (NICU) or Paediatric Intensive Care Unit (PICU). For ICU (including PICU) and NICU adjustments, refer Appendix 11 ABF model adjustments and localisations 2019-20. For each hour in an eligible ICU, a QWAU loading of 0.0432 will apply. The ICU QWAU is in addition to the inlier episodic WAU and a long stay per diem WAU. For each hour in a recognised NICU, a QWAU loading of 0.0055 will apply.
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The paediatric adjustment applicable for all paediatric patients admitted to Specialised Children’s Hospitals6, incorporates PICU however PICUs located in facilities with a specified ICU also receive the ICU QWAU loading. Refer column headed ‘Paediatric Adjustment’ in Appendix 1 Queensland Admitted Acute Price Weights 2019-20 (Q22) for the adjustment for each AR-DRG.
Adjustment for Renal Dialysis patients An adjustment is available for an admitted patient with a specified ICD-10-AM 11th Edition renal dialysis code who is not assigned to the AR-DRG L61Z Haemodialysis or AR-DRG L68Z Peritoneal Dialysis. For more information, refer Section 4.7 ABF model adjustments and Appendix 11 .
4.5.2 Admitted subacute and non-acute patients Subacute care is defined by the AIHW as specialised multidisciplinary care in which the primary need for care is optimisation of the patient’s functioning and quality of life. A person’s functioning may relate to their: whole body or a body part the whole person, or the whole person in a social context impairment of a body function or structure, activity limitation and/or participation restriction. Non-acute care refers to care that provides support for patients with a severe level of impairment, activity limitation or participation restriction due to a health condition. Following assessment or treatment, the patient does not require further complex assessment or stabilisation.
Classification and counting unit Subacute and non-acute patients (SNAP) differ from patients under an acute care type in that they are classified according to their functional status, rather than their principal medical diagnosis. The AR-DRG is not a good indicator of the resource requirements for these patients. As such, the Australian National Sub and Non-acute Patient (AN-SNAP) classification version 4 is used to categorise patients into similar groupings based on their functional needs. The AN-SNAP classification consists of the following care types: rehabilitation care (includes overnight and same day classes) palliative care (overnight and same day classes) geriatric evaluation and management (GEM) (overnight and same day classes) psychogeriatric care (overnight and same day classes) maintenance care also known as non-acute care. It is important to note that a patient cannot be in an acute, mental health or subacute care type at the same time, i.e. a change in care type is a change in episode. These are mutually exclusive classification systems.
6 The Queensland Specialised Children's Hospitals in 2019-20 are the Queensland Children’s Hospital (Lady Cilento Children's Hospital was formally renamed on 9 November 2018) and The Townsville Hospital.
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Assignment to an AN-SNAP class relies on information such as care type, impairment type (for rehabilitation), age, phase (for palliative care)7 and a functional assessment score using the relevant ADL tool. The following table lists the ADL tools for assessment under each care type. Table 7 ADL score determinants
Care type ADL assessment tool Rehabilitation OR GEM FIM - using scores for motor and cognitive subscales Psychogeriatric care HoNOS Palliative care OR Maintenance care RUG
The counting unit for admitted sub and non-acute care is a combination of patient episode and number of days in care. This will vary with the AN-SNAP class assigned. For 2019-20, overnight episodes without an ADL score will be included in the QHAPDC and the activity will attract WAUs. The episode, however, cannot be assigned to an AN-SNAP class and is therefore termed ‘ungroupable’ (or unscored). In this case, the default counting unit is a care type per diem. The per diem payment for these episodes is listed in Appendix 7 Queensland Unscored SNAP price weights 2019-20 – Q22 Only. Same day episodes do not require an ADL score and will be allocated to the relevant same day AN-SNAP class for their care type.
Data collection and reporting All sub and non-acute admitted patient information is collected as part of the QHAPDC which is also used for reporting of the Admitted patient care NMDS 2019-20 and Admitted subacute and non-acute hospital care NBEDS 2019-20 to AIHW and to IHPA (refer the ABF data request specifications for the relevant year). Definitions for each of the care types are available in the QHAPDC Manual.
WAU, funding and adjustments Episodes classified into an AN-SNAP class are allocated a QWAU, including episodic with inlier and outlier per diem WAU. Specific loading adjustments are also applicable for indigenous and remote patients receiving sub and non-acute care. Price weights vary across classes depending on factors such as care type, age, type of impairment and functional capacity of the patient (refer to Appendix 4 Queensland Subacute and Non-acute Admitted 2019-20 (Q22)).
Paediatric sub and non-acute care Children under three years of age do not require an ADL assessment. For children aged three and over the RUG tool is used for paediatric palliative and maintenance care patients and the WeeFIM is used for paediatric rehabilitation patients8. Price weights, according to the AN- SNAP V4.0 classification, for paediatric rehabilitation and maintenance care patients have
7 Palliative care episode can be made up of multiple phases. Consequently, each phase is assigned to the relevant AN-SNAP palliative class. 8 GEM and Psychogeriatric care types are not applicable to paediatric patients.
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been introduced. However, the default for paediatric palliative patients remains as a per diem rate (refer to Appendix 5 National Subacute and Non-acute Admitted 2019-20 (N1920)).
4.5.3 Admitted mental health Queensland Health is a major provider of mental health services in Queensland and offers specialised clinical care in a variety of settings to a broad range of age groups.
Classification and counting unit The Australian Mental Health Care Classification Version 1.0 (AMHCC V1.0) was finalised by IHPA but data collection is best endeavours for 2019-20. IHPA intends to implement the AMHCC for pricing once comprehensive phase-level cost and activity data is available from states and territories. The current phases of care are: Acute Functional Gain Intensive Extended Consolidating Gain Assessment Only These phases are currently under review and may change in future. The Queensland counting unit for patients with a Mental Health care type 12 is the number of fractional days in care (per diem)9.
Data collection and reporting Mental health admitted patient information is collected as part of the QHAPDC which is also used for reporting of the Admitted patient care NMDS 2019-20 and the Activity based funding: Mental health care National Best Endeavours Data Set (NBEDS) 2019-20 to AIHW and to IHPA (refer the ABF data request specifications for the relevant year) . The Mental Health Activity Data Collection is the statewide collection of specialised mental health services activity and clinical outcome (including phase) data (that is, the Mental Health National Outcomes and Casemix Collection (MH-NOCC)) in Queensland. Subsets of the data, collected via Consumer Integrated Mental Health Application (CIMHA), are used to report the ABF Mental Health Care NBEDS and other nationally mandated collections.
WAU, funding and adjustments In Queensland, Mental Health is funded differently to the national model. Nationally, the NWAUs are based on the admitted acute model with a series of loadings based on age, major diagnostic category, and whether or not they had one or more psychiatric care days. The QWAU is based on the following criteria: Mental health care delivered in mental health standard units, i.e. standard units beginning with ‘PY**’ within ABF hospitals, receive a per diem price weight which varies depending on the type of unit (as per Appendix 3 Mental Health Admitted (QH Standard
9 Patients may also be classified under the AR-DRG classification if a care type 12 is not assigned. In this case, the counting unit is an admitted patient episode.
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Units) 2019-20 – Q22 Only). For example, a patient in an extended unit with code PYET, the per diem weight is 0.1675. Mental health care delivered outside a mental health standard unit, where the episode is a Care Type 12, is assigned an ‘average’ per diem Mental Health QWAU (0.2422 QWAU). Episodes receiving mental health outside of a mental health standard unit and not under Care Type 12 will be funded via the AR-DRG. Admitted mental health care delivered in the following public psychiatric facilities is block funded: – Baillie Henderson Hospital – Charters Towers Rehabilitation Unit – Kirwan Rehabilitation Unit – The Park – Centre for Mental Health All non-admitted mental health services, including community/ambulatory and community bed- based public residential mental health service facilities, will continue to be block funded in 2019-20. Refer to the table below for a summary of Mental Health funding according to acuity and/or setting. Table 8 Summary of mental health funding for 2019-20
Care Type Funding model according to patient acuity Admitted patient - outside of a With Care Type 12: the ‘average’ Mental Health per diem rate will mental health standard unit be applied (0.2422 QWAU) (ABF hospital) Without Care Type 12: AR-DRG assigned for the episode of care and funded as per other acute admitted patients (refer Appendix 1) Admitted patient - Mental With/without Care Type 12: Per diem payment depending on type of health standard unit (ABF mental health standard unit (refer Appendix 3) hospital) * Admitted patient - Designated Block funded small hospitals and specialist facilities mental health facility (public (see Section 5.1) psychiatric hospital) Specialised community bed Block funded services (see Section 5.2) based public residential mental health service facilities Specialised Block funded services (see Section 5/2) community/ambulatory mental health
* Localisation from the 2019-20 National ABF model.
Psychiatric age adjustments See section 4.7 - age adjustments for psychiatric patients in the National model are not applicable under the Queensland Model as these are managed through the application of different per diem rates.
4.5.4 Emergency care Emergency care services are delineated into seven levels depending on a range of factors, including availability of support services, staffing, physical design and location. Levels 1, 2 and 3A are referred to as emergency services (ES), and levels 3B, 4, 5 and 6 are referred to as emergency departments (ED).
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Classification and counting unit Two classification systems are used to classify emergency care for the purposes of ABF of these services: Urgency Disposition Groups and Urgency Related Groups.
Urgency Disposition Groups This classification system defines seventeen patient categories. Using the Urgency Disposition Groups classification system version 1.3 (UDG v1.3), patients are classified by the discharge status (or disposition) recorded at the end of the patient’s ED episode, i.e. admitted, non- admitted, DNW or dead on arrival, and triage type according to the Australasian triage scale. 2019-20 UDG v1.3 applies to small and medium size facilities with 1 to 3A emergency services10. In terms of Queensland ABF facilities, this only includes Kingaroy, Warwick, Dalby and Emerald.
Urgency Related Groups This classification system segments the UDG classification system further by using Major Diagnostic Blocks (MDB), which are derived from the diagnosis assigned to the ED presentation. 2019-20 Urgency Related Groups version 1.4 (URG v1.4) applies to large size facilities with levels 3B to 6 emergency care services10. This includes all Queensland ABF facilities with EDs except for Kingaroy, Warwick, Dalby and Emerald. The counting unit for emergency care is an ‘emergency department stay.’
Data collection and reporting All hospitals providing emergency care services ranging from level 1 – 6, collect and report patient level information to the Healthcare Improvement Unit (HIU) in accordance with the data set specifications of the Queensland Health Emergency Data Collection (EDC) in the service agreements. Emergency departments using iSoft's Emergency Department Information System (EDIS) have a direct feed to EDC. For those emergency departments not using EDIS, they submit a file to EDC. The minimum data requirements for reporting to the EDC are detailed on the HIU website. The EDC is used to report the Non-admitted patient emergency department care NMDS 2019-20 to AIHW and the ABF data request specifications to IHPA.
WAU, funding and adjustments Refer to Appendix 9 Emergency Department price weights 2019-20 (N1920 and Q22) and Appendix 10 Emergency Service price weights 2019-20 (N1920 and Q22) for the full list of price weights for Queensland and National. There is a national emergency care age adjustment which is applied to an Emergency Department or Emergency Service patient, with the rate of adjustment being dependent upon the person’s age: 65 to 79 years: 13% loading and Over 79 years: 20% loading. Refer Appendix 11 ABF model adjustments and localisations 2019-20. Although the emergency services levels clearly describe whether the UDG and URG classification is applicable for the facility, IHPA will use the URG classification for any facilities
10 Nationally, emergency care services provided by public hospitals are divided into seven different levels (1, 2, 3A, 3B, 4, 5 and 6) depending on a range of factors including support services, staffing, physical design and location. Levels 1, 2 and 3A are referred to as “emergency services” while levels 3B, 4, 5 and 6 are referred to as “emergency departments”.
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that submit patient level ED information. It is important that patient level data be submitted where available for all national collections as this ensures a broad range of facilities included in pricing determinations.
4.5.5 Non-admitted care
Classification and counting unit Non-admitted patients (also known as outpatients) are those that do not undergo a hospital’s formal admission process. The Tier 2 Non-admitted Services Classification (Tier 2) version 5 categorises a hospital’s non-admitted services into classes which are generally based on the nature of the service provided and the type of clinician providing the service11. IHPA has three reference documents to assist the consistent allocation of non-admitted services to a Tier 2 class. Further information on the Tier 2 non-admitted services classification is available on IHPA’s website. IHPA introduced two new classes in 2018, Multidisciplinary case conference (MDCC) – where patient not present (nursing or allied health-led 40.62 and medical-led 20.56), but only the 20.56 was shadowed in the ABF Model for the 2018-19 year as there was insufficient cost information for IHPA to model an indicative cost for 20.56. IHPA will work with jurisdictions to obtain the data to determine a shadow price for the 20.56, and in the meantime, IHPA intends to continue to shadow price the 20.56 where the patient is not present in 2019-20. IHPA is planning a national costing study to be conducted over 2019-20 to collect non- admitted (including non-admitted subacute) activity and cost data and test the shortlist of variables and potential classification hierarchies for the development of the Australian Non- Admitted Care Classification. Several Queensland hospitals plan to participate. The counting unit is ‘non-admitted patient service event’, being an interaction between one or more healthcare provider(s) with one non-admitted patient, which must contain therapeutic/clinical content and result in a dated entry in the patient's medical record. The interaction may be for assessment, examination, consultation, treatment and/or education. It is independent of the service setting, thus services provided outside of the hospital setting are included.
Data collection and reporting All non-admitted patient data is collected via the Queensland Health Non-Admitted Patient Data Collection (QHNAPDC). The QHNAPDC was established to collect the non-admitted activity at the patient-level as specified for State and Commonwealth Government reporting requirements, in particular, IHPA’s Non-admitted Patient NBEDS 2019-20. All non-admitted patient care aggregate data is collected via the Monthly Activity Collection for those facilities with only aggregate data (the MAC Clinic types specified in the Clinic Form, Diagnostic and Procedures Form, Telehealth Form and Group Forms are aligned to the Tier 2 classes to allow Queensland to meet IHPA and AIHW reporting requirements, in particular IHPA’s Non-admitted Patient Care Aggregate NBEDS 2019-20).
11 Tier 2 Non-admitted Care Services Classification, Independent Hospital pricing Authority,
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WAU, funding and adjustments The calculation of the QWAU is applied to the patient level activity as collected through the Queensland Non-Admitted Patient collection where the HHS has specified recording at that level. Limited calculation of WAU for aggregate clinics are to apply from 1 July 2019. To calculate Queensland WAUs, the PBS price weight should be included. The price weight will vary depending on the clinic. Refer Appendix 8 Non-Admitted price weights 2019-20 (N1920 and Q22), block funding (Community Mental Health) has been retained in 2019-20 for clinic 40.34 Specialist Mental Health.
4.5.6 Home delivered services Home delivered services are priced via a patient census count per calendar month. In relation to the following services, all non-admitted patient sessions performed per month are to be bundled and counted as one non-admitted patient service event per patient per calendar month regardless of the number of sessions (refer IHPA’s Tier 2 Non-Admitted Services Classification Compendium 2019-20).
Renal dialysis – home delivered Renal dialysis forms part of a long-term treatment provision to patients and is offered in a flexible manner where patients can move between treatment settings as their condition changes. Dialysis patients can be treated in a hospital setting, via walk-in centres or receive treatment at home. In-centre renal dialysis, undertaken as an admitted patient episode, will be classified and funded under the admitted acute model. Renal dialysis – home delivered, undertaken as a non-admitted service event, will be classified as Tier 2 and procedures include (mapped by the respective Corporate Clinic Code (CCC)): Renal dialysis – haemodialysis – home delivered (Tier 2 10.15) – Home - haemo - standard – Home - haemo - extended – Facility - haemo - self care Renal dialysis – peritoneal dialysis – home delivered (Tier 2 10.16) – Home - automated peritoneal dialysis (PD) – Home - continuous ambulatory peritoneal dialysis (CAPD)
Enteral Nutrition and Total Parenteral Nutrition – home delivered Enteral Nutrition and Total Parenteral Nutrition – home delivered must by performed by the patient (or the patient’s carer) in their home without a health care provider present to be eligible for reporting under this category. Nutrition can be provided either through a feeding tube (Tier 2 class 10.18 enteral nutrition – home delivered and CCC Procedure – Enteral nutrition) or, when the digestive tract cannot be used, through an intravenous tube called a catheter that is inserted directly into the veins (Tier 2 class Total parenteral nutrition – home delivered 10.17 and CCC Procedure – Total parenteral nutrition).
Ventilation – home delivered Ventilation – home delivered is ventilation which is self-administered by the patient (or the patient’s carer), who are ventilator dependent and would otherwise require hospitalisation. Procedures performed for these patients include (mapped by the respective CCC):
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Ventilation – home delivered Tier 2 class 10.19 – Home Ventilation - Bi-level positive airway pressure (BiPAP) – Home Ventilation - Continuous positive airway pressure (CPAP) – Home Ventilation - Diaphragm Pacing – Home Ventilation - Ventilation via tracheostomy – Negative pressure ventilation (iron lung)
Weighted activity unit The QWAU for the above home delivered services are based on their respective Tier 2 code (e.g. 10.15, 10.16 etc.) and associated price weight This non-admitted service, although still to be counted and classified, is block funded in 2019-20.
Prevention and Primary Care
4.5.7 BreastScreen Queensland (BSQ) services BSQ services refer to the delivery of breast screening services in Queensland under the national program BreastScreen Australia (BSA) that aims to reduce illness and deaths from breast cancer targeting women aged 50 to 74 years. Women aged 40-49 and 75 and over are also eligible to attend. In Queensland, the program is delivered through BreastScreen Queensland (BSQ) screening and assessment services, including 11 main hubs (offering screening and assessment), 21 satellite (screening only) services and 11 mobile vans (screening only) covering more than 260 locations across the State. BSQ Services are managed by 11 host HHSs and BSQ is coordinated by the Cancer Screening Unit (CSU), Prevention Division. The Commonwealth and State governments jointly fund the program. BreastScreen Australia services and the State Coordination Unit are regularly reviewed to ensure they are providing a high-quality service and are compliant with the BreastScreen Australia National Accreditation Standards (NAS) that assess: participation and client focus, clinical practice, governance and management, strategic planning and quality improvement. The BreastScreen Australia NAS, in relation to participation, is for each State Program and BSQ Service to demonstrate 70 per cent participation for the target age group of those aged 50 to 74 years. That is, 70 per cent of the total number of women in this age group will have participated in a screening program every two years. Activity targets are set in accordance with activity modelling undertaken by the Department’s Prevention Division, that reflects projected participation levels and consultation with BSQ services in the HHSs.
Counting unit HHSs delivering BSQ services are categorised into Metro and Regional groups to reflect the different cost drivers. BSQ services are counted per screen.
Data collection and reporting Breast screening data is collected by the Breast Screening Queensland Registry (BSQR), in accordance with BreastScreen Australia NAS. BSQR provides a complete screening history for women participating in the BSQ Program, as well as appointment management, clinical episode data capture and the generation of results and reminder notifications to women and their health providers.
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WAU, funding and adjustments For 2019-20, HHS allocations for BSQ services for screening activity funding continue to be nominally converted to QWAUs in the service agreements in order to align all output-based models to a common currency. The Tier 2 non-admitted services class ‘70.07 Breastscreen’ was introduced from 2016-17 as a Queensland variation for the collection of BSQ funded activity – refer Appendix 8 Non-Admitted price weights 2019-20 (N1920 and Q22). BSQ funding model is based on a price per screen for each HHS (grouped either Metro or Regional) - refer Table 10. However, BSQ incentive allocations, fixed allocations and Queensland wide hosted services are out-of-scope for the ABF Model in 2019-20: Incentive 1: loading for out-of-hours screens funded at $30 per screen in 2019-20 in the target age group 50-74. This loading is to incentivise more flexible service provision meeting the needs of the BSQ target population. Incentive 2: loading to fund increased first and second screens in the target age group 50- 74 for activity greater than the 2015-16 BSQ Service specific baseline, and funded at $90 per screen in 2019-20. This loading is to incentivise increased screening activity and a higher percentage of total screens in the target age group. Incentive 1 and Incentive 2 activity is a subset of the total screening activity. BSQ activity surplus to target will be fully funded at 100 per cent the price per screen. This includes any activity surplus to incentive volume estimates. Adjustments to funding for any activity variance (increase/decrease) will be actioned via an end of financial year activity/funding reconciliation process. Further information regarding BSQ funding is available on the Purchasing and non-activity based funding specifications on QHEPS.
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Table 9 BSQ funding model price per screen 2019-20
BSQ model group Hospital and Health Service $ price per screen Metro Gold Coast Metro North $130 Metro South Metro Sunshine Coast * $135 Regional Cairns and Hinterland Central Queensland Darling Downs Mackay $168 Townsville West Moreton Wide Bay
* Sunshine Coast HHS is transitioning to the Metro group target price over 3 years (2019-20 is the second year).
4.5.8 Oral Health Services The 2019-20 Oral Health Services (OHS) funding model continues to incentivise equitable OHS access and efficient service delivery across the State by linking the production of services (outputs) to funding. HHS targets for oral health include general oral health activity and activity associated with the Child Dental Benefits Schedule (CDBS).
Classification and counting unit Within the OHS funding model, HHSs are categorised into two groups: Metro/ Regional and Remote. This approach is based on the significant differences in cost per Weighted Occasion of Service (WOOS) event evident between the two HHS groups.
Data collection and reporting Oral health data is collected via the Information System for Oral Health, ISOH™, reported via Queensland Health Enterprise Reporting Service (QHERS).
WAU, funding and adjustments The baseline (Queensland Government-funded) service activity targets or WOOS for all HHSs have been set at the 2018-19 purchased levels. Table 10 State oral health funding model price per WOOS 2019-20 displays the grouping of HHS and price per WOOS under the OHS funding model. Since 2016-17, HHS budget allocations for oral health have been nominally converted to WAUs in the service agreements in order to align all output-based models to a common currency. The Tier 2 class (70.04 Oral Health) was introduced from 2016-17 as a Queensland variation for the collection of OHS funded activity – refer Appendix 8 Non-Admitted price weights 2019-20 (N1920 and Q22). In addition, HHSs may have access to Commonwealth OHS funding under the National Partnership Agreement (NPA) on Public Dental Services for Adults (pending signing by the Health Minister) . Dental NPA activity targets for all HHSs receiving NPA funding have been set at $55 per WOOS, based on the price per WOOS determined by the Commonwealth
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Government under the NPA. This Commonwealth funding will be allocated to HHSs on an oral health needs basis, principally determined by HHS OHS eligible populations with consideration to disease levels and demand for care. HHSs are also able to directly claim Medicare benefits for eligible children under the CDBS. CDBS activity targets (WOOS) for all HHSs have been set at 45 per cent of the activity related to CDBS and equivalent item numbers recorded during 2017-18, excluding items recorded by students. Activity claimed under CDBS will be included in the reporting of actual OHS activity. A review of performance against purchased target is undertaken through the End-of-Year Technical adjustment process. If a HHS is not meeting their purchased targets the equivalent funding will be withdrawn and reallocated to those HHSs who are over delivering against their purchased target (on a pro-rata basis if under delivery is less than over delivery). Further information regarding OHS funding is available on the Purchasing and non-activity based funding specifications on QHEPS. Table 10 State oral health funding model price per WOOS 2019-20
OHS model group Hospital and Health Service $ price per WOOS Metro/Regional Cairns and Hinterland Central Queensland Darling Downs Gold Coast Mackay Metro North $58.00 Metro South Sunshine Coast Townsville West Moreton Wide Bay Remote Central West $78.16 North West $51.46 South West $94.66 Torres and Cape $93.13
4.6 Private and ineligible patients
4.6.1 Private patients in public hospitals IHPA notes in the Pricing Framework for Australian Public Hospital Services 2019-20 that: “Public hospitals may receive revenue for delivering care from funding sources other than through the National Health Reform Agreement. For example, patients admitted to public hospitals may opt to use their private health cover or pay for their own hospital stay. The National Health Reform Agreement requires IHPA to set the price for admitted private patients in public hospitals accounting for these payments by other parties, particularly private health insurers (for prostheses and the default bed day rate) and the Medicare Benefits Schedule (MBS).” The NEP for private admitted patients is reduced to offset funding received from other Commonwealth programs (e.g. Medicare Benefits Schedule (MBS) and PBS) and patient
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charges, including prostheses and accommodation/nursing related components equivalent to the Queensland private health insurance default bed day rate or equivalent. The NWAU for private patients admitted to public hospitals is discounted in accordance with clause A41 of the NHRA. In the Queensland ABF model, QWAU includes the private patient adjustment WAU due to the recognition of the contribution of HHS Own Source Revenue in the funding and purchasing model (refer section 2.4).
4.6.2 Ineligible patients Ineligible patients are those patients who are: ineligible for a Medicare card or overseas visitors, asylum seekers not covered by a Reciprocal Health Care Agreement. In the National ABF model, there is no WAU allocated to episodes of care for ineligible patients. QWAUs are calculated as there is the expectation that fees are charged and recovered where possible, and reflects the HHS funding of these patients.
4.7 ABF model adjustments There are 13 adjustments (or loadings) in the National model. Queensland applies nine of the National ABF model adjustments. For more detail about those adjustments and application, refer Appendix 11 ABF model adjustments and localisations 2019-20. The order of application (refer Precedence of adjustments in NEP19) is: 1. Paediatric Adjustment, then For the paediatric adjustment, the level of loading varies according to the AR-DRG. Refer to the column headed paediatric adjustment in Appendix 1 Queensland Admitted Acute Price Weights 2019-20 (Q22). 2. Specialist Psychiatric Age Adjustment (not applied in Queensland QWAU) 3. Patient Residential Remoteness Area Adjustments, then 4. Indigenous Adjustment, then 5. Radiotherapy Adjustment, then For the radiotherapy adjustment, refer the relevant radiotherapy ICD-10-AM codes in Appendix 14 Radiotherapy procedures codes eligible for adjustment. 6. Dialysis Adjustment, then For the dialysis admitted patient adjustment, refer the relevant dialysis ICD-10-AM codes in Appendix 15 Dialysis codes eligible for adjustment. 7. Patient Treatment Remoteness Area Adjustments, then 8. Intensive Care Unit (ICU) Adjustment, then Refer to the Queensland ICUs in Appendix 13 Specified Intensive Care Units 2019-20. 9. Private Patient Service Adjustment (not applied in Queensland QWAU) 10. Private Patient Accommodation Adjustment (not applied in Queensland QWAU) 11. Multidisciplinary Clinic Adjustment (not applied in Queensland QWAU)
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12. Emergency Care Age Adjustment, then 13. Hospital Acquired Complications (HAC) adjustment For more detail about the HAC adjustments and application, refer Section 8.2 Hospital Acquired Complications.
4.8 Grants for ABF facilities These grants are funded from the ABF pool (and the deductions referenced in Table 3 Variance between the NEP and the QEP).
4.8.1 Specified grants Grants are provided to HHSs for costs incurred by ABF facilities for services, which could not be appropriately funded through the ABF model and are funded through a portion of the total ABF pool available for Queensland, thus reducing the calculated QEP. In general, these grants are provided where: There was classification failure in the ABF model such that an ABF hospital, when operating efficiently, could not fund the activity through ABF funding. This includes statewide and/or highly complex services, such as the Queensland Spinal Injuries Service; or The service was critical to the delivery of public hospital services but did not give rise to activity that attracted funding under the ABF model such as clinical advisory and patient management services. From 1 July 2018, the Department implemented the Specified Grant Assessment Framework For Services with Legitimate and Unavoidable Costs (available on QHEPS) to align requests and assessment with the three-year service agreement cycle commencing with the 2019-20 to 2021-22 period. For 2019-20, the Specified Grants are based on the updated applications made by HHSs during 2018-19 and approved for application in the Service Agreements 2019-20 to 2021-22. For the complete list, refer to Appendix 16 Specified Grants 2019-20.
4.8.2 Clinical education and training It is recognised that the public hospital system has a significant role in educating and training the clinical workforce. Clinical education and training (CET) funding is allocated for the mix and level of staffing employed and the number of under-graduate and post-graduate student clinical placements in the HHS. For the purposes of the funding model, CET is defined as an activity where the primary aim is to transfer clinical knowledge for ongoing professional development via a teacher or mentor to a student or candidate in a recognised program/course resulting in: either qualifications that may meet registration requirements or other admission to a specialised discipline where the right to practice in that discipline requires completion of the program or course. Due to difficulties in separating the resource time for education activity that is incurred during direct patient treatment, a notional value is determined based on methodologies applied to each of the following components of clinical education:
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salaried employees in clinical training positions under-graduate and post-graduate student scholarships and clinical placements jointly appointed clinical academics. The funding provides incentives for ABF facilities and staff to build the capacities for future health workforce and influence student decisions when choosing their future employer. Jointly appointed clinical academic positions in Queensland public facilities provide the nexus between the university sector, professional colleges and the health industry. A notional estimate of the statewide cost of this activity is allocated on a pro-rata basis according to the distribution of positions in-scope for the salaried employee component. As with specified grants, block grants for CET are funded from a portion of the total ABF pool available for Queensland that is redirected to grants. Hence, the CET grants are applicable to ABF facilities only. Refer to Appendix 17 Clinical education and training grants. These grants were calculated on the best available data at the time of model development.
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5. Block funded facilities and services – NEC
5.1 Block funded facilities - NEC IHPA provides the following block funding criteria to COAG and is typically applied for small rural public hospitals where: the technical requirements for applying ABF are not able to be satisfied there is an absence of economies of scale that mean some services would not be financially viable under ABF. IHPA has also determined ‘low volume’ thresholds that form part of the Block Funding Criteria for use in 2019-20. For more information about the National block funding criteria, refer to the National Efficient Cost Determination on IHPA’s website. Note the NEC is based on costing data from three years ago supplied for the National Public Hospital Establishment Database (NPHED) and the National Hospital Cost Data Collection (NHCDC). Hospitals and facilities in scope for block funding include small rural hospitals, standalone hospitals providing specialist mental health services12 (e.g. Psychiatric Hospitals), standalone major city hospitals providing specialist services (e.g. mothercraft, dental and dialysis) and other standalone hospitals. For 2019-20, there are 83 NEC block funded hospitals and facilities in Queensland: 76 small rural hospitals four standalone hospitals providing specialist mental health services: Baillie Henderson Hospital, The Park – Centre for Mental Health, Kirwan Rehabilitation Unit and Charters Towers Rehabilitation Unit two standalone hospitals: Roma Hospital and Thursday Island Hospital one standalone major city hospital providing specialist services: Ellen Barron Family Centre. The methodology of the 2019-20 Queensland block funded hospitals model is based on the 2017-18 expenditure reported to the NPHED, net of depreciation and other patient revenue and DVA revenue sources, indexed by 2.5 per cent per annum for two years. While Section 19(2) Health Insurance Act 1973 prohibits the payment of Medicare benefits where other government funding is provided for that service, COAG introduced the Section 19(2) Exemptions Initiative (the s19(2) Initiative) - Improving Access to Primary Care in Rural and Remote Areas Initiative in conjunction of the Better Health for All Australians Action Plan under the 2006-07 Federal Budget process. The Initiative provides for exemptions under section 19(2) of the Act to allow exempted eligible sites to claim against the MBS for non- admitted, non-referred professional services (including nursing, midwifery, allied and dental services) provided in EDs and outpatient clinic settings. The Initiative recognises that many patients in small rural and remote towns have limited access to primary health care services and that in response to a lack of private practices, many rural and remote public hospitals have employed medical officers to make traditional general practitioner services available.
12 IHPA determines the efficient cost of these hospitals in consultation with the relevant state or territory, with reference to their total inscope reported expenditure in the NPHED in 2014-15.
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The Queensland Government has a Memorandum of Understanding with the Commonwealth that allows Queensland to bill public non-admitted primary care services because the Commonwealth who is responsible for primary care services (through Medicare), acknowledges that in some rural and remote sites that have a doctor workforce shortage, the State is treating a lot of these cases through their public outpatient clinics and EDs. Schedule A(7)(a) of the NHRA allows the payment of Commonwealth funding for services that attract an MBS payment under a 19(2) Directive. The total 2019-20 allocation is calculated by adding the 2017-18 amount of other revenue back onto the State and Commonwealth allocation. This amount reflects the OSR component of the funding allocation. This methodology is applied to all block funded hospitals. However, there are exceptions for the three HHSs: Central West, South West and Torres and Cape, specific allocations have been added to the total block hospital funding to reflect the ABF QWAU allocation of oral health funding from block funded services. Further information regarding block funded hospitals in 2019-20, refer the Purchasing and non-activity based funding specifications page on QHEPS.
5.2 Block funded services - NEC In 2019-20, IHPA determined that the following services in ABF hospitals were eligible for block funding as the technical requirements for applying ABF are not able to be satisfied: Teaching, training and research (TTR) Non-admitted mental health services including: community bed-based mental health services (such as Community Care Units) and specialised community/ambulatory mental health services (including adult, older persons, forensic). From 2019-20 child and youth community mental health services (CYMHS) have been included in NEC block funding. Non-admitted Home Ventilation Services (as defined by Tier 2 V5.0 Non-Admitted Services class 10.19) A17 List services13 not otherwise priced and Other public hospital programs. IHPA determined the efficient cost of these services for 2019-20 based on the advice of states and territories. For Queensland, TTR is partially funded under the CET grant (refer section 4.8.2). Queensland block funds 12 public residential mental health service facilities (Community Care Units). Refer to Appendix 18 HHS hospitals and facilities by funding model 2019-20.
13 Under Clause A17 of the NHRA, IHPA has also determined a list of services (the ‘A17 list’), which would not normally be considered a public hospital service, but which IHPA is satisfied were provided by a particular hospital in 2010. Refer NEP19NEP19 on IHPA’s website.
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6. Population-based funding
In addition to hospital services, HHSs also provide a wide range of primary and community health and other services that are outside the scope of ABF and Block funding – NEC models and, as such, are State and/or Commonwealth-funded services. The available statewide pool for these services is determined following allocations for ABF and block funded hospitals, and other non-ABF services, such as third party and other specific funding. The following services are funded under the pooled approach for core primary and community care models: Alcohol, Tobacco and Other Drugs Community Care Programs Other Community Services Primary Health Care.
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7. Other specific funding
These are services funded through specific funding arrangements. For regional and metropolitan HHSs, the funding for 2019-20 is based on the indexed 2015-16 expenditure. For remote HHSs, the 2019-20 funding has been based on the indexed 2015-16 service agreements.
7.1 Community state-wide services – limited HHS delivery A number of community services are offered statewide by a small number of representative HHSs. For example: Consumer Information services including the Kids Help Line and Alcohol and Drug Information Service are offered by Children’s Health Queensland HHS and Metro North HHS. Disability Residential Care Services. Environmental Health services are provided by public health units in twelve HHSs14. The Home and Community Medical Aids and Appliances service is primarily facilitated through Metro South HHS and funded under the Queensland Medical Aids Subsidy Scheme (MASS).
7.2 Prisoner Health services Prisoner Health services refer to the delivery of primary health services (defined as the delivery of multi-disciplinary primary health and other ambulatory care) to prisoners in public correctional centres. Funding for specialist prisoner mental health services in both publicly and privately operated correctional centres is provided separately through block funded Mental Health programs. Dental services for publicly and privately operated prisons are funded from HHS oral health funding. A new funding methodology for prisoner health services was applied from 2019-20 to better reflect the health needs of the total prison population. This funding methodology determines the total funding pool available for distribution to HHSs by establishing a per annum funding amount per prisoner multiplied by the total forecast number of prisoners. Forecast prisoner populations were derived from the prisoner projections provided by Queensland Correctional Services, medium growth scenario for adult prisoners. The funding pool is then distributed to each relevant HHS based on its proportion of the total prison population, prisoner turnover, and with the security level of the correctional centre. An additional $13.1 million in recurrent funding is being provided from 2019-20 to relevant HHSs to fund the delivery of comprehensive primary health care services for prisoners. This additional funding has been added to HHSs existing Prisoner Health service funding to create a new funding base.
14 Cairns and Hinterland HHS, Central Queensland HHS, Darling Downs HHS, Gold Coast HHS, Mackay HHS, Metro North HHS, Metro South HHS, North West HHS, Sunshine Coast HHS, Torres and Cape York HHS, Townsville HHS and Wide Bay HHS.
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For further information regarding the prisoner health services in 2019-20, refer to the Purchasing and non-activity based funding specifications page on QHEPS.
7.3 Third party funded health services The Department has historically subsidised HHSs for the delivery of a range of ‘third party funded services’ that are the responsibility of the Commonwealth or other agencies15. These services include: Aged Care Assessment Program (ACAP) Home and Community Care (HACC) Home Care Packages Multi-purpose Health Services (MPHS) Residential Aged Care Transition Care program. The following principles will apply to the funding of these services: No State subsidy will be provided for services/programs that are the responsibility of another jurisdiction or state government agency (except for MPHS, Transitional Care and Residential Aged Care). HHSs retain the capacity to deliver these services beyond the third party funding levels but will not receive a specific funding allocation for these services from the Department. Exemptions may apply for HHSs deemed to be the provider of last resort for a particular service that is not the responsibility of Queensland Health. Funding that is provided from a third party agency to the Department to distribute to HHSs will be specified in Service Agreements and based on historical revenue from the previous year. This will be reconciled upon receipt of funding from third party agency. Funding under existing joint agreements will continue, e.g. Transition Care funding whereby the Department will fund twenty-five per cent of the total cost of the Transition Care program). Funding for Residential Aged Care and MPHS incorporates both Commonwealth funding and State contributions for Residential Aged Care and MPHS.
7.4 Other funding Patient transport and depreciation are funded by the State. Patient Travel Subsidy Scheme Depreciation Patient transport, Queensland Health Authorised Transport (QHAT), has been removed from the funding and purchasing model from 2019-20 and is managed by Queensland Ambulance Service.
15 See National Health Reform Agreement (2011) Schedule F
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8. Pricing for safety and quality
The Commonwealth has directed the IHPA, in collaboration with the Australian Commission on Safety and Quality in Health Care (the Commission), to incorporate safety and quality into the pricing and funding of public hospital services with the aim of improving health outcomes, avoiding funding unnecessary or unsafe care and decreasing avoidable demand for public hospital services for: 1. Sentinel events (effective from 2017-18) 2. Hospital Acquired Complications (effective from 2018-19) 3. Avoidable hospital readmissions (implementation to be advised).
8.1 Sentinel events Sentinel events are a subset of adverse events that result in death or serious harm to a patient and occur due to systems and process deficiencies. Sentinel events are sometimes referred to as ‘never events’ to distinguish them from other less serious (but still harmful to patients) adverse events. The Australian Sentinel Events definition is “a particular type of serious incident that is wholly preventable and has caused serious harm to or death of a patient” that must satisfy the following criteria: should not have occurred where preventative barriers are available; there is evidence the event has occurred in the past; and the event is easily recognised and clearly defined. The Commission reviewed and updated the Australian sentinel events list which was endorsed by Australian Health Ministers in December 2018. Version 2 Australian Sentinel Events list will be used for pricing in 2019-20. Queensland collects this information via RiskMan. Table 11 Australian sentinel events list (version 2) 2018
1. Surgery or other invasive procedure performed on the wrong site resulting in serious harm or death 2. Surgery or other invasive procedure performed on the wrong patient resulting in serious harm or death 3. Wrong surgical or other invasive procedure performed on a patient resulting in serious harm or death 4. Unintended retention of a foreign object in a patient after surgery or other invasive procedure resulting in serious harm or death 5. Haemolytic blood transfusion reaction resulting from ABO incompatibility resulting in serious harm or death 6. Suspected suicide of a patient in an acute psychiatric unit or acute psychiatric ward
7. Medication error resulting in serious harm or death
8. Use of physical or mechanical restraint resulting in serious harm or death
9. Discharge or release of an infant or child to an unauthorised person
10. Use of an incorrectly positioned oro- or naso- gastric tube resulting in serious harm or death
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Sentinel Funding Adjustment From 1 July 2017, a model of nil payment for sentinel events was implemented nationally, based on state-based collections of sentinel events as reportable incidents submitted to IHPA. Queensland had implemented a similar model since 2014, ‘Never Events’. For 2019-20, IHPA will apply the Australian sentinel events list version 2 (2018) to the state funding calculation with the associated NWAU value will be deducted by the Administrator of the National Health Funding Pool. Queensland will apply the same list as a purchasing localisation with QWAUs deducted through the HHS Service Agreement amendment process and the payment for that episode withdrawn. For further information regarding the Sentinels events, refer to the Purchasing and non-activity based funding specifications page on QHEPS.
8.2 Hospital Acquired Complications A hospital-acquired complication (HAC) refers to a complication for which clinical risk mitigation strategies may reduce (but not necessarily eliminate) the risk of that complication occurring. HACs result in harm to the patient as well as an additional cost to the system. The National HAC list includes 16 agreed high-priority complication groups, with HAC identification reliant on ICD codes and the condition onset flag in the admitted data collection. Table 12 HAC list version 1.1 applicable for 2019-20
Complication Group Complication Category 1. Pressure injury 1.1 Stage III ulcer 1.2 Stage IV ulcer 1.3 Unspecified decubitus ulcer and pressure area 2. Falls resulting in fracture or intracranial 2.1 Intracranial injury injury 2.2 Fractured neck of femur 2.3 Other fractures 3. Healthcare associated infection 3.1 Urinary tract infection 3.2 Surgical site infection 3.3 Pneumonia 3.4 Blood stream infection 3.5 Central line and peripheral line associated bloodstream infection 3.6 Multi-resistant organism 3.7 Infection associated with prosthetics/implantable devices 3.8 Gastrointestinal infections 4. Surgical complications requiring 4.1 Postoperative haemorrhage/ haematoma unplanned return to theatre* requiring transfusion and/or return to theatre 4.2 Surgical wound dehiscence 4.3 Anastomotic leak 4.4 Vascular graft failure 4.5 Other surgical complications requiring unplanned return to theatre
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Complication Group Complication Category 5. Unplanned intensive care unit 5.1 Unplanned intensive care unit admission admission**^ 6. Respiratory complications 6.1 Respiratory failure including acute respiratory distress syndrome requiring ventilation 6.2 Aspiration pneumonia 7. Venous thromboembolism 7.1 Pulmonary embolism 7.2 Deep vein thrombosis 8. Renal failure 8.1 Renal failure requiring haemodialysis or continuous veno-venous haemodialysis 9. Gastrointestinal bleeding 9.1 Gastrointestinal bleeding 10. Medication complications 10.1 Drug related respiratory complications/depression 10.2 Haemorrhagic disorder due to circulating anticoagulants 10.3 Hypoglycaemia 11. Delirium 11.1 Delirium 12. Persistent incontinence 12.1 Urinary incontinence 13. Malnutrition 13.1 Malnutrition 14. Cardiac complications 14.1 Heart failure and pulmonary oedema 14.2 Arrhythmias 14.3 Cardiac arrest 14.4 Acute coronary syndrome including unstable angina, STEMI and NSTEMI 15. Third and fourth degree perineal 15.1 Third and fourth degree perineal laceration laceration during delivery^ during delivery 16. Neonatal birth trauma^ 16.1 Neonatal birth trauma
Notes: * unplanned return to theatre flag not currently collected and reported ** unplanned ICU not currently collected and not reported ^ no financial HAC adjustment applies
HAC adjustment methodology Risk-adjusted funding approaches have been developed for 13 of the 16 nationally agreed HAC groups (excluding perineal lacerations, birth trauma and unplanned ICU). The NWAU/QWAU value for a hospital patient is automatically reduced where a patient suffers one or more of the designated HACs. The size of the weighted activity unit adjustment at the episodic level reflects the expected extra percentage increase in cost caused by the HAC group with the highest adjustment value, risk-adjusted for any characteristics of the patient which make him or her inherently more susceptible to a particular HAC. A HAC score for each episode is calculated for each applicable complication group and risk factor. Patient scores are then classified to three ‘complexity’ groupings (low, medium or high) for the purposes of dampening and WAU adjustments to balance complexities, risk homogeneity and sample size with each HAC group. Low complexity patients should not have HACs, so the WAU reductions for low risk episodes reflect the full incremental cost of the relevant HAC. The cost in low complexity patients is then used as a benchmark for the other two groups with WAU dampened (by risk of HAC occurring) for episodes with moderate and high complexity. If an episode contains more than one HAC group, then the maximum
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percentage adjustment is used for the WAU adjustment (regardless of HAC complexity). For the WAU adjustments, refer to Appendix 12 Funding adjustments for Hospital Acquired Complications 2019-20 (also available on IHPA’s website in the NEP Determination 2019-20 price weight tables). In summary, the value of the NWAU for any admission is reduced where a HAC occurred. The size of the reduction is based on the average incremental cost of the complication (2016-17 cost data) and the complexity of the patient in which the complication occurred.
Example 1: Falls resulting in fracture or intracranial injury – high risk The patient is an 87 year old female who was admitted to hospital via the emergency department with a principal diagnosis of stroke. The patient has a background of dementia, cirrhosis of the liver, chronic renal failure, chronic obstructive pulmonary disease and type 2 diabetes managed with insulin. The patient is an ex-drinker and smoker. The patient was treated conservatively. On the second day of her admission she fell while trying to take herself to the bathroom unsupervised, which resulted in a fractured neck of femur. A total hip replacement was performed. The patient was discharged to her residential aged care accommodation 25 days following admission. The table below breaks down the complexity and adjustment calculations for this case.
Risk factor Complexity Score HAC group base 24.593 Age (group 085-089) +14.1329 Sex (female) +0.6275 Admission status (emergency) +8.1407 Transfer status (No) 0 ICU status (yes) 3.9737 Diagnosis Related Group type (medical) 0 Major Diagnostic Category (Nervous system) 1.5966 Charlson score (07 or more) 9.4865 Total 62.5509
Complexity group High Maximum adjustment -2.5% Dampening Factor 0.1376 Final % Adjustment to base WAU -0.3%
HAC funding application The Safety and quality adjustment is calculated as part of the State’s actual NWAU during the National Health Funding Body (‘Administrator’) reconciliation process and incorporated into the Commonwealth National Health Reform funding through the Commonwealth growth calculation using back-casting to compare NWAU movements between the current year and the previous year. Following is a summary of the Administrator’s funding adjustment process which is applied at a state level:
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For ABF hospitals, safety and quality adjustments are calculated at a HHS level via the National Health Funding Pool in equal monthly amounts as part of the six-month and annual reconciliation. For Block funded hospitals, safety and quality adjustments are calculated at an aggregate state level via the NHFP to State Managed Funds (deducted from the National Efficient Cost Commonwealth growth funding) in equal monthly amounts as part of the six-month and annual reconciliation. The state financial impact under the Commonwealth model will be passed onto HHSs, given that it is HHSs who have responsibility for delivering clinical care and are therefore in the best position to influence performance. Though the national NWAU adjustment applies to acute care episodes (acute, qualified newborns and mental health), a Queensland localisation extending the HAC funding adjustments to all care types (where a QWAU is generated) is also applied. HAC adjustments are subject to back-casting to a base year (allowing for changes in price, volume, classification or costing methodologies between years) and applies for the safety component of growth funding. This back-casting means that if the level of HACs remains the same for a HHS between the two years, then the impact on the Commonwealth growth funding to the state would be minimal. For 2019-20, movements in HAC NWAU adjustments in the current year will be compared to the previous year 2018-19 in the same phase N1920. At the national level, the HAC funding adjustment will be operating within the 6.5 per cent funding cap. At a state level the same concept will be applied and the HAC adjustment will operate within the HHS funding cap. Both HHS overall NWAU HAC/growth movements as well as Key Performance Indicator HAC volume movements will be monitored as part of the HHS performance reviews with any adjustments to be transacted within the Service Agreement amendment process. A mid-year and year-end reconciliation will be undertaken comparing performance for a period against the comparative period in the baseline year with the Department having the opportunity to make financial adjustments. For more information on HACS, refer: the HAC information kit which is available on the Commission’s website the Pricing and funding for safety and quality - Risk adjustment model for Hospital Acquired Complications 2019-20 which is available on IHPA’s website.
8.3 Avoidable Readmissions As defined by the Commission, an avoidable hospital readmission occurs when a patient who has been discharged from hospital (index admission) is admitted again within a certain time interval, and the readmission: Is clinically related to the index admission, and Has the potential to be avoided through improved clinical management and/or appropriate discharge planning in the index admission. The following is the list of conditions considered to be avoidable hospital readmissions and the associated condition-specific time intervals.
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Table 13 List of avoidable hospital readmissions
Readmission Readmission Diagnosis Interval Condition days Pressure Injury Stage III ulcer 14 Stage IV ulcer 7 Unspecified decubitus ulcer and pressure area 14 Infections Urinary tract infection 7 Surgical site infection 30 Pneumonia 7 Blood stream infection 2 Central line and peripheral line associated bloodstream infection 2 Multi-resistant organism 2 Infection associated with devices, implants and grafts 90 Infection associated with prosthetics devices, implants and grafts 30 in genital tract or urinary system Infection associated with peritoneal dialysis 2 Gastrointestinal infections 28 Surgical Postoperative haemorrhage/ haematoma 28 Complications Surgical wound dehiscence 28 Anastomotic leak 28 Pain following surgery 14 Other surgical complications 28 Respiratory Respiratory failure including acute respiratory distress syndrome 21 Complications requiring ventilation Aspiration pneumonia 14 Venous Venous thromboembolism 90 thromboembolism Renal Failure Renal failure 21 Gastrointestinal Gastrointestinal bleeding 2 bleeding Medical Drug related respiratory complications/depression 2 Complications Hypoglycaemia 4 Delirium Delirium 10 Cardiac Heart failure and pulmonary oedema 30 Complications Ventricular Arrhythmias and cardiac arrest 30 Atrial tachycardia 14 Acute coronary syndrome including unstable angina, STEMI and 30 NSTEMI Other Constipation 14 Nausea and vomiting 7 The Commission is finalising the specifications for the list of avoidable hospital readmissions, that include the related codes for each condition.
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The IHPA is developing options for pricing and funding for avoidable readmissions which were included in the Consultation Paper on the Pricing Framework for Australian Public Hospital Services.
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9. Data reporting for costing and funding
9.1 Data collection Under the Hospital and Health Board Act 2011, health services are required to provide to the Chief Executive, being the Director General, performance data and other data under the service agreement. The HHS Service Agreement Schedule 4 details the Data Reporting Requirements. In particular, that the following principles guide the collection, storage, transfer and disposal of data: (a) Trustworthy – data is accurate, relevant, timely, available and secure; (b) Private – personal information is protected in accordance with the law; (c) Valued – data is a core strategic asset; (d) Managed – collection of data is actively planned, managed and compliant; and (e) Quality – data provided is complete, consistent, undergoes regular validation and is of sufficient quality to enable the purposes outlined in clause 3.2 of this Schedule 4 to be fulfilled. Principle (e) is particularly important as data reported to the department must be of sufficient quality to enable all the Department’s responsibilities detailed in clause 3.2 of Schedule 4, e.g.: fulfil legislative requirements and deliver accountabilities to the state and commonwealth governments. Service Agreement Schedule 4 Attachment A lists the full clinical and non-clinical data set specifications (refer Service agreements and deeds of amendments on www.health.qld.gov.au). These are also available on QHEPS: Data reporting requirements, and QHIK and on the internet: Statistical Services Branch Data Collections. The health system, the Department, is required to submit required data to IHPA and the Administrator of the National Health Funding Pool (the Administrator) so that they can perform the functions set out in the National Health Reform Act and National Health Reform Agreement. The following table summarises the Queensland activity and costing data collections for reporting to the National data set specifications by IHPA in collaboration with the Administrator. Refer to IHPA’s Three Year Data Plan 2018-19 to 2020-21 and the Administrator’s Data Plan 2018-19 to 2020-21. Table 14 Queensland (Statewide) activity and costing data collection
Service category System Data collection National data set & custodian specifications Acute admitted patients Hospital Based Corporate QHAPDC Admitted Patient Care including Intensive care Information System (HBCIS) SSB NMDS patients Subacute admitted HBCIS Admitted Subacute and patients Non-Acute Hospital Care NBEDS Emergency EDIS, Cerner FirstNet, or EDC Non-Admitted Patient Departments manual file submission HIU Emergency Department Care NMDS
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Service category System Data collection National data set & custodian specifications Emergency Services HBCIS, EDC Activity based funding: (small or rural EDs) EDIS, Rural EDIS (REDIS) or HIU Emergency service care MAC online form NBEDS Mental health admitted Additionally, CIMHA for QHAPDC Activity based funding: patients clinical outcome measures (above) and Mental health care Mental Health NBEDS Activity Data Collection Mental Health, Alcohol and Other Drugs Branch
Non-admitted MAC online form MAC Non-Admitted Patient 16 aggregate SSB Care Hospital Aggregate NMDS – for hospital services Non-Admitted Patient Care Local Hospital Network Aggregate NBEDS – for Local Hospital Network services Non-admitted patient NAP repository QHNAPDC17 Non-Admitted Patient SSB NBEDS Teaching and Training Collected originally as survey In development Hospital teaching, training to HHSs and being and research activities transitioned to a new system NBEDS Hospital patient costing Clinical costing system Queensland NHCDC DRS - IHPA NHCDC Healthcare Purchasing and Funding (HPF) Branch Sentinel events PRIME CI / RiskMan Sentinel events ABF Sentinel Events Patient Safety Specifications 2019-20 - and Quality IHPA Improvement National data set is being Branch developed by the ACSQHC. Refer Administrator’s Data Plan 2018-19 to 2020-21.
9.2 Data reporting The Department submits or reports the above activity to IHPA (who provides the data to the National Health Funding Body who acts for the Administrator) quarterly on a ‘year to date’
16 IHPA intends to phase out the collection of aggregate non-admitted data in 2019-20 as the reporting of patient level data improves. Refer IHPA’s Three Year Data Plan 2018-19 to 2020-21. 17 This does not apply to non-admitted specialised mental health services.
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basis, except the activity data for teaching, training and research which is on an annual basis. The patient costing data, Queensland NHCDC, is submitted annually to IHPA. Under the NHRA and the principle of data rationalisation, IHPA and the Administrator utilise cost and expenditure data through the same key collections – the NHCDC, the National Public Hospitals Establishments Database and the Public Hospitals Establishments Data Set Specification. The Administrator also requires: Service category activity estimates for each State and Territory and at an LHN level based on projected Service Agreements with LHNs. These data are required in order to calculate and provide a formal forecast of the Commonwealth funding contribution to the Commonwealth Treasurer. Disaggregated unit level activity data from States and Territories. These data are required in order to perform reconciliation based on actual levels of activity. The activity data is to be accompanied by a Statement of Assurance (refer section 9.3.1 Data quality). Commonwealth data relating to MBS and PBS services. Commonwealth advice of the annual national health reform funding amounts paid for services delivered. Funding, payments and service volumes. These data are required in order to enable monthly reporting of relevant national health reform funding transactions. The key reporting systems for Queensland funding model are: Decision Support Systems (DSS) is a business intelligence tool that provides Queensland Health users with access to statewide source system data for operational and strategic reporting, benchmarking and analytics. Amongst the many modules, are the Activity Based Funding and the Gen-WAU modules for data relating to Activity Based Funding activity and Admitted/Inpatient, Non-admitted/Outpatient and Emergency departments, including WAUs, WAU Targets, Revenue etc. System Performance Reporting (SPR) is Queensland Health’s system-wide performance reporting platform and provides insights into how our HHSs are performing now, over time, and relative to comparable facilities. SPR focuses on understanding the relationships within the system by reporting on appropriate access, safety and effectiveness, and sustainability. For more information, refer section 10.2 System Performance.
9.3 Data quality and integrity
9.3.1 Data quality management The Department and HHSs have a shared vision for information management that ‘our information is fit-for-purpose and easily shared to support good decision-making.’ There is a shared commitment to appropriate consultation and understanding that decisions are made by both the department and by HHSs, for the benefit of patients and the health of 18 Queenslanders . As well as the Data Quality Principles outlined in the Service Agreements.
18 Queensland Health (Audit, Risk & Governance Branch), 2016, A health system for Queenslanders: Charter of Responsibility, p. 4.
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the information management principles also support the vision and provide high-level guidance to staff: 1. Privacy, confidentiality and security 2. Quality and integrity 3. Managed 4. Accessible 5. Transparent 6. Valued 7. Standardised. Department oversees the following: Queensland Health's Open data strategy - lists data collected by the Department, timetables for its release and standards for data management. Information Management Strategy - Supports the Queensland Health system provide strategic information management direction, and assist customers better manage information in order to support the 2026 Vision: Information governance: – eHealth Executive Committee and subcommittees: Architecture and Standards Committee and Information Management Strategic Governance Committee (IMSGC). – Communities of practice groups and other information management networks/groups at National and State level including: Statewide Clinical Networks, Hospital and Health Services (HHS) Information Management Committees, ICT Project Committees, Statewide Health Information Management Clinical Coder Network (SHIM-CCN), Statistical Services Branch Data Quality Improvement Working Group (SSB-DQIWG). – Statewide information management advice and support via Health Informatics Services, Digital Strategy and Transformation Branch and SSB. – Clinical Governance via the State’s Clinical Advisory Committee, Statewide Data and Transformation (DaT) Committee and Local DaT Committees. Data and application custodianship – Application custodians (and data contained) – List of Data and Application Custodians approved by the IMSGC – Data collections custodians is available on https://www.health.qld.gov.au/hsu/how-to- access-data-from-ssb Policies, standards and guidelines – refer https://www.health.qld.gov.au/system- governance/policies-standards/doh-policy – Queensland Health Data Dictionary (QHDD) – Queensland Health Corporate Reference Data System (CRDS) .
9.3.2 Counting, coding and costing compliance All HHSs are required to comply with relevant counting, coding and costing standards and guidelines: Counting: – Refer Queensland (Statewide) activity and costing data collection
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Coding, refer to the Australian Consortium for Classification Development: – ICD-10-AM, ACHI and ACS Costing: – Australian Hospital Patient Costing Standards – Queensland Clinical Costing Guidelines Supplementary Notes
9.3.3 Data quality Queensland Health Data Management Policy describes the management of data in any medium and includes data capture, data cleansing, data conversion, data de-duplication, data integration, redress mechanisms, data migration, data modelling, data quality and integrity, and data transformation. Data quality and validation checks are conducted at various time-points and levels from initial data capture through to data transformation for local, State and National reporting obligations. In particular: Counting/activity validation conducted by the data custodians and the Healthcare Purchasing and Funding Branch, Healthcare Purchasing and System Performance Division for reporting to the National ABF dataset specifications (refer Table 14 Queensland (Statewide) activity and costing data collection) Costing validation: – Queensland annual NHCDC by HPF Branch and the Independent Financial Review of the NHCDC (coordinated by IHPA nationally of selected HHSs for each jurisdiction) – ABF/Non-ABF Cost centre splits by HPF Branch – MAC checks by SSB and the HPF Branch who agree on advice to HHSs for the mapping of CCC codes to the MAC – Financial and Residential Activity Collection (FRAC), the annual Queensland collection on public hospital establishments including expenditure, revenue, staffing (FTE) levels and other related hospital data, is coordinated by SSB with input by HPF Branch (used to report to the National Public Hospital Establishment Database) Clinical coding audit statewide program is coordinated by HPF Branch in line with a pre- determined Statewide Clinical Coding audit Schedule developed with HHS stakeholders. The schedule includes all participating ABF HHSs with ABF facilities over a three-year audit cycle and is conducted by qualified HHS Clinical Coder Auditors, engaged by the Department to perform coding audits on HHSs. The program will be offered to block funded facilities in future years. The overall objective of the Statewide Clinical Coding Audit Framework is to assess the validity of clinical coded data within the admitted patient dataset by: – measuring coding accuracy against the national standards and rules for clinical classification – examining how coding errors and levels of accuracy affect Diagnosis Related Group (DRG) assignment – validation of the data underpinning the patient safety and quality codes, and to assist in the assurance of DRG accuracy for the HHS as well as compliance with ethical coding practice – auditing and ensuring that correct assignment of the Hospital Acquired Complications and the associated Condition Onset Flag
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– validation of a range of administrative data relative to the determination of the DRG for example, Admission source, Subacute and Non-Acute Patient and Discharge destination – support data quality improvement in admitted patient data reporting – providing feedback and educational support to the HHS following the findings of the audit to enable the Coding Teams to improve in areas that have been identified as having incongruities in their coding practice.
Data quality statement of assurance From 1 July 2017, Clause I40 of the Addendum to the National Health Reform Agreement required that States (jurisdictions) provide IHPA with a Statement of Assurance from a senior health department official on the completeness and accuracy of approved data submissions provided under clauses B63, B95 and B97 of the Agreement. Consistent with Clause B97. Specifically, the Statement of Assurance will include commentary on: 1. steps taken to promote completeness and accuracy of activity data (for example, audit tools or programs, third-party reviews, stakeholder engagement strategies) 2. efforts applied to ensure the classification of activity was in accordance with the current year’s standards, data plans and determinations 3. variations in activity volumes and movements between activity based funding and block funding 4. other information that may be relevant to users of the data, as determined by the signing officer. IHPA will provide these jurisdictional Statements of Assurance to the Administrator for reconciliation purposes. The Queensland Department of Health also requires HHSs to provide a data quality statement of assurance regarding their activity and costing data submitted to the Department.
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10. Governance
A sound governance framework supported by clear standards and definitions and backed up with an auditing process supported by end users is pivotal to ensuring funding is transparent, reflects need and based on reliable data sources.
10.1 Department of Health The levels within the Department with roles in governance of healthcare funding include: System Leadership Team Department Leadership Team System Management Committee HHS Funding Technical Committee (as required) HHS Costing and Funding Network.
System Leadership Team (SLT) The purpose of the SLT is to support the Director-General to oversee the strategic function, capabilities and effective operation of the Queensland Health Public Health System within the purview of members. Members discharge their responsibilities as accountable officers, and provide leadership, direction and guidance to the Queensland Health system. Members include: Director-General (Chair); Deputy Director-Generals of the Corporate Services Division; Clinical Excellence Division Healthcare Purchasing and System Performance Division; Strategy, Policy and Planning Division; Chief Health Officer and DDG, Prevention Division; Chief Executive, eHealth Queensland; Chief Executive, Health Support Queensland; Commissioner, Queensland Ambulance Service; Chair, Queensland Health Board Chairs Forum; Chair, Health Service Chief Executive Forum; Chair, Queensland Clinical Senate.
Departmental Leadership Team (DLT) The DLT supports the Director-General to oversee the strategic function, capabilities and effective operation of the Department of Health within the purview of members. Members discharge their responsibilities as accountable officers, and provide leadership, direction and guidance to the Department. Members include the Director-General (Chair); DDG, Corporate Services Division; DDG, Clinical Excellence Division; DDG, Healthcare Purchasing and System Performance Division; DDG, Strategy, Policy and Planning Division; Chief Health Officer and DDG, Prevention Division; Chief Executive, eHealth Queensland; Chief Executive, Health Support Queensland and Commissioner, Queensland Ambulance Service. The DLT will not make decisions about matters that affect HHSs nor will it monitor their performance or make decisions about services to be purchased from HHSs.
System Management Committee (SMC) The SMC will replace the Healthcare Purchasing and Performance Executive Committee in 2019-20. The purpose of the SMC is to:
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support the Director-General and provide advice to the DLT on system priorities and the system manager’s response to changing health needs drive the system response to priorities and provide leadership and oversight of system performance enable consistent and collaborative decision-making and communication across the department in response to system priorities ensure the effective and equitable purchasing of clinical activity from service providers and manage the performance of those service providers to achieve whole-of-system outcomes in line with the Department of Health’s strategic priorities.
HHS Funding Committee (as required) The purpose of the HHS Funding Committee is to provide guidance and make recommendations to the Senior Director, HPF Branch, in relation to aspects of HHS funding. The committee reports to the SMC. The committee provides technical oversight and detailed input into the purchasing framework and its associated purchasing incentives, the purchasing model, implementation of the National ABF and NEC block funding models and any agreed Queensland localisations and grants, new output based funding models funding strategies to maximise own source revenue and funding within Queensland and oversight of the NHCDC and input into the annual collection for NPHED. Membership includes representatives from Metro, regional and rural HHS Chief Finance Officers and from the Department: Contracting and Performance Management Branch, Finance Branch, HIU, HPF Branch, SSB, System Performance Branch, System Planning Branch, Statewide Health Information Management Clinical Coder Network and Queensland representatives on IHPA’s committees and working groups. The committee currently has three subcommittees: HHS Costing and Funding Network Specified Grants sub-committee Statewide Health Information Management Clinical Coder Network
HHS Costing and Funding Network The purpose of the network is to provide a forum for stakeholders to discuss operational or technical HHS costing and funding issues, resolutions and to provide advice to influence the development of future national models and classifications. The network governance is through the HHS Funding Committee.
10.2 System Performance The overall management of the public sector health system is the responsibility of the Department, through the Director General (Chief Executive in the system manager role). In performing this role, the Director General is responsible for monitoring Health Service performance as per section 8 of the Hospital and Health Boards Act 2011.
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Performance management On behalf of the Department, the Contracting and Performance Management Branch (CPMB), HPSP Division, provides a central coordination point between HHSs and the Department, in particular: Commission HHSs for the public health system in Queensland; Negotiate Service Agreements with HHSs and the Mater Public Hospitals; Manages the Surgery Connect program; Provide coordination and support to performance management meetings between the Department and HHSs under the Performance Framework; Monitor HHS performance against the requirements of their Service Agreement, including key performance indicators (KPIs) and specific funded projects; and Manage the service agreement amendment processes. The framework setting out performance requirements is Delivering a high-performing health system for Queenslanders: Performance framework – refer Performance Framework on www.health.qld.gov.au. The Performance Framework provides an integrated process for performance review and assessment, within the overarching objectives of driving sustained improvement, keeping people healthy and improving access to timely, quality and patient-focused health care. It comprises: clearly stated performance requirements the roles and responsibilities of HHSs, Mater Health Services and the Department in the operation of the framework transparent monitoring and reporting processes both internally to Boards and externally to Government and national bodies clear levels of response to address performance issues governance processes through which the escalation/de-escalation of responses is determined. The Performance Framework identifies four categories of performance measures: 1. Safety and Quality Markers which together provide timely and transparent information on the safety and quality of services provided by the HHS; 2. Key Performance Indicators (KPIs) which are focused on the delivery of key strategic objectives and statewide targets. KPI performance will inform HHS performance assessments; 3. Outcome Indicators which provide information on specific activities and interventions where there is a reasonable expectation or evidence that they make a positive contribution towards improving the health status and experience of patients; and 4. Supporting Indicators which provide contextual information and enable an improved understanding of performance, facilitate benchmarking of performance across HHSs and provide intelligence on potential future areas of focus. For more detail on these performance measures, refer Schedule 3 of any Service Agreement available on Service agreements and deeds of amendments, www.health.qld.gov.au.
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Performance reporting, analytics and insights Performance is reported and monitored at a number of levels. Hospital performance is published nationally by the AIHW through the MyHospitals website. In Queensland, information on the performance of each hospital is made available to the public through the Department’s Hospital Performance website. Information on performance of Hospital and Health Service, and their hospitals, is also available through public documents such as budget papers and annual reports. Performance against State and Commonwealth government priorities is monitored by the relevant program area in the Department. The System Performance Branch, HPSP Division, prepares the performance reports on the Queensland public health system to support the Performance Framework. The reports are produced for the Minister; the Director General; HHS Executives, HHS Boards and Queensland Government central agencies. The System Performance Reporting platform, SPR, was developed for the Department and HHSs with the aim to increase transparency and empower decision makers with actionable information to improve system performance. It reports timely, validated, whole-of-system performance information on health services in Queensland; and provides insights on opportunities for improvement. SPR supports improved performance by bringing various system performance insights and relative performance to the attention of SPR users across the State, i.e. service agreement performance dashboards, insights dashboards and collaborative initiatives.
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Appendices
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Appendix 1 Queensland Admitted Acute Price Weights 2019-20 (Q22) AR-DRG v9.0
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qld‐nep‐abf‐priceweights_1920_v3.0
Back to 2019-20 Queensland Admitted Acute Price Weights (Q22) AR-DRG V9.0 See NOTES Queensland Weight (QWAU) see note 4 Queensland Price INDEX DRG CODE Description Same Day Bundled IHPA ALOS Lower Upper Paediatric Same Day Short-Stay Short-Stay Inlier Long-Stay PBS Same Day $ Short-Stay Short-Stay Inlier $ Long-Stay PBS $ Payment ICU Bound Bound Adjustment Outlier Outlier Per Outlier Per Outlier Outlier Per Outlier Per List Base Diem Diem Base $ Diem $ Diem $
801A GIs Unrelated To Principal Diagnosis, Major Complexity 0 0 20.9 8 75 146% 0.9444 0.9758 8.6896 0.2933 0.0613 $0 $4,578 $4,730 $42,118 $1,422 $297 801B GIs Unrelated To Principal Diagnosis, Intermediate Complexity 0 0 8.7 3 27 95% 0.6184 1.1336 3.9927 0.2574 0.0265 $0 $2,997 $5,495 $19,353 $1,248 $128 801C GIs Unrelated To Principal Diagnosis, Minor Complexity 0 0 2.7 1 9 100% 1.3153 0.3157 0.0148 $0 $0 $0 $6,375 $1,530 $72 960Z Ungroupable 000000%000000$0 $0 $0 $0 $0 $0 961Z Unacceptable Principal Diagnosis 000000%000000$0 $0 $0 $0 $0 $0 963Z Neonatal Diagnosis Not Consistent W Age/Weight 000000%000000$0 $0 $0 $0 $0 $0 A13A Ventilation >=336hours, Major Complexity 0 0 25.4 8 76 155% 2.3888 3.3279 28.849 0.3923 0.1630 $0 $11,579 $16,130 $139,831 $1,901 $790 A13B Ventilation >=336hours, Minor Complexity 0 0 11.8 4 40 100% 1.2601 4.3318 18.4924 0.3755 0.0951 $0 $6,108 $20,996 $89,633 $1,820 $461 A14A Ventilation >=96hours & <336hours, Major Complexity 0 0 25.7 8 77 120% 2.5838 2.0832 19.1859 0.3792 0.0636 $0 $12,524 $10,097 $92,994 $1,838 $308 A14B Ventilation >=96hours & <336hours, Intermediate Complexity 0 0 13.1 4 39 108% 0.9065 2.5425 11.0146 0.3803 0.0617 $0 $4,394 $12,323 $53,388 $1,843 $299 A14C Ventilation >=96hours & <336hours, Minor Complexity 0 0 6.7 2 20 100% 0.4125 3.213 6.8024 0.3860 0.0361 $0 $1,999 $15,573 $32,971 $1,871 $175 A15A Tracheostomy, Major Complexity 0 0 32.3 11 107 100% 4.1493 1.3622 19.1043 0.3042 0.0296 $0 $20,112 $6,603 $92,599 $1,474 $143 A15B Tracheostomy, Intermediate Complexity 0 0 19.3 6 55 100% 2.3688 1.6126 12.0185 0.3149 0.0257 $0 $11,482 $7,816 $58,254 $1,526 $125 A15C Tracheostomy, Minor Complexity 0 0 11.6 4 37 100% 0.717 1.6111 7.1457 0.3400 0.0157 $0 $3,475 $7,809 $34,635 $1,648 $76 A40Z ECMO 0 0 11.3 4 39 200% 2.2166 4.4346 19.8678 0.5636 0.0871 $0 $10,744 $21,495 $96,299 $2,732 $422 B01Z Ventricular Shunt Revision 0 0 5.6 2 21 86% 0.9176 1.2064 3.2407 0.3453 0.0897 $0 $4,448 $5,847 $15,708 $1,674 $435 B02A Cranial Procedures, Major Complexity 0 0 16.5 5 50 132% 1.6336 1.6618 9.8552 0.3227 0.0872 $0 $7,918 $8,055 $47,768 $1,564 $423 B02B Cranial Procedures, Intermediate Complexity 0 0 8 2 24 110% 1.5619 1.8699 5.2346 0.2784 0.0671 $0 $7,571 $9,063 $25,372 $1,349 $325 B02C Cranial Procedures, Minor Complexity 0 0 5.6 2 19 93% 1.3501 1.3495 3.9819 0.2419 0.0672 $0 $6,544 $6,541 $19,300 $1,172 $326 B03A Spinal Procedures, Major Complexity 0 0 15.1 5 45 100% 2.1164 1.2941 8.4078 0.3186 0.1792 $0 $10,258 $6,273 $40,753 $1,544 $869 B03B Spinal Procedures, Intermediate Complexity 0 0 6.8 2 19 100% 1.7444 1.3171 4.3398 0.2970 0.0387 $0 $8,455 $6,384 $21,035 $1,440 $188 B03C Spinal Procedures, Minor Complexity 0 0 3.2 1 10 100% 2.6935 0.2938 0.0340 $0 $0 $0 $13,055 $1,424 $165 B04A Extracranial Vascular Procedures, Major Complexity 0 0 10.9 4 43 100% 1.4907 1.1504 6.0477 0.2889 0.0444 $0 $7,225 $5,576 $29,313 $1,400 $215 B04B Extracranial Vascular Procedures, Intermediate Complexity 0 0 6.4 2 21 100% 1.2826 1.354 3.9784 0.2120 0.0122 $0 $6,217 $6,563 $19,283 $1,028 $59 B04C Extracranial Vascular Procedures, Minor Complexity 0 0 3.2 1 10 100% 2.6782 0.2695 0.0259 $0 $0 $0 $12,981 $1,306 $126 B05Z Carpal Tunnel Release 0 0 1 1 3 100% 0.43 0.1454 0.0163 $0 $0 $0 $2,084 $705 $79 B06A Procedures For Cerebral Palsy, Muscular Dystrophy And Neuropathy, Major Comp 0 0 12.7 4 38 80% 1.1564 1.3332 6.4464 0.2934 0.0428 $0 $5,605 $6,462 $31,246 $1,422 $207 B06B Procedures For Cerebral Palsy, Muscular Dystrophy And Neuropathy, Interm Comp 0 0 5.1 1 15 84% 2.5261 0.2601 0.0187 $0 $0 $0 $12,244 $1,261 $91 B06C Procedures For Cerebral Palsy, Muscular Dystrophy And Neuropathy, Minor Comp 1 0 2.2 1 8 156% 0.6761 1.4391 0.2743 0.0235 $3,277 $0 $0 $6,975 $1,330 $114 B07A Cranial Or Peripheral Nerve And Other Nervous System Procedures, Major Comp 0 0 9.5 3 28 100% 0.9219 1.0388 3.9887 0.2152 0.0496 $0 $4,468 $5,035 $19,333 $1,043 $240 B07B Cranial Or Peripheral Nerve And Other Nervous System Procedures, Minor Comp 1 0 1.9 1 6 117% 0.6665 1.2981 0.2578 0.0707 $3,231 $0 $0 $6,292 $1,250 $343 B40Z Plasmapheresis W Neurological Disease, Sameday 0 0 1 1 1 100% 0.2264 0.0012 $0 $0 $0 $1,097 $0 $6 B41A Telemetric EEG Monitoring, Major Complexity 0 0 6.6 2 22 134% 0.0102 1.0602 2.1025 0.2990 0.0282 $0 $49 $5,139 $10,191 $1,449 $137 B41B Telemetric EEG Monitoring, Minor Complexity 0 0 3.7 1 11 80% 1.6326 0.2955 0.0173 $0 $0 $0 $7,913 $1,432 $84 B42A Nervous System Disorders W Ventilator Support, Major Complexity 0 0 12.7 5 48 100% 0.0595 1.4112 7.0868 0.3025 0.0287 $0 $288 $6,840 $34,350 $1,466 $139 B42B Nervous System Disorders W Ventilator Support, Intermediate Complexity 0 0 5.4 2 18 145% 0.102 1.751 3.5875 0.3675 0.0166 $0 $494 $8,487 $17,389 $1,781 $80 B42C Nervous System Disorders W Ventilator Support, Minor Complexity 0 0 2.2 1 7 100% 1.8228 0.2795 0.1998 $0 $0 $0 $8,835 $1,355 $968 B62Z Apheresis 0 0 1 1 3 100% 0.2891 0.3308 0.1243 $0 $0 $0 $1,401 $1,603 $602 B63A Dementia And Other Chronic Disturbances Of Cerebral Function, Major Complexity 0 0 17.1 6 55 100% 0 0.6654 3.9662 0.1936 0.0259 $0 $0 $3,225 $19,224 $938 $126 B63B Dementia And Other Chronic Disturbances Of Cerebral Function, Minor Complexity 0 0 7 2 23 100% 0 0.8392 1.6688 0.1911 0.0097 $0 $0 $4,068 $8,089 $926 $47 B64A Delirium, Major Complexity 0 0 7.8 2 25 100% 0 1.0185 2.0209 0.2327 0.0161 $0 $0 $4,937 $9,795 $1,128 $78 B64B Delirium, Minor Complexity 1 0 3 1 9 100% 0.1074 0.7086 0.2235 0.0119 $521 $0 $0 $3,435 $1,083 $58 B65Z Cerebral Palsy 0 0 1.5 1 4 121% 0.432 0.3333 0.0424 $0 $0 $0 $2,094 $1,616 $206 B66A Nervous System Neoplasms, Major Complexity 0 0 10 3 30 114% 0 1.0345 3.0397 0.2479 0.0638 $0 $0 $5,014 $14,733 $1,202 $309 B66B Nervous System Neoplasms, Minor Complexity 1 0 4.4 1 15 132% 0.3578 1.2611 0.2460 0.0621 $1,734 $0 $0 $6,113 $1,192 $301 B67A Degenerative Nervous System Disorders, Major Complexity 0 0 12.4 4 40 136% 0 0.835 3.3243 0.2392 0.0159 $0 $0 $4,047 $16,113 $1,159 $77 B67B Degenerative Nervous System Disorders, Intermediate Complexity 1 0 5.2 2 19 134% 0.1894 0 0.7816 1.5094 0.2260 0.0537 $918 $0 $3,788 $7,316 $1,095 $260 B67C Degenerative Nervous System Disorders, Minor Complexity 0 0 1.1 1 4 200% 0.1888 0.1537 0.0183 $0 $0 $0 $915 $745 $89 B68A Multiple Sclerosis And Cerebellar Ataxia, Major Complexity 1 0 7.2 2 22 155% 0.3056 0 1.061 1.9161 0.2747 0.2059 $1,481 $0 $5,143 $9,287 $1,331 $998 B68B Multiple Sclerosis And Cerebellar Ataxia, Minor Complexity 0 0 1.1 1 3 169% 0.2414 0.2701 0.1345 $0 $0 $0 $1,170 $1,309 $652 B69A Tia And Precerebral Occlusion, Major Complexity 0 0 5.1 1 15 100% 1.3329 0.2371 0.0089 $0 $0 $0 $6,461 $1,149 $43 B69B Tia And Precerebral Occlusion, Minor Complexity 0 0 1.8 1 6 100% 0.4576 0.2557 0.0070 $0 $0 $0 $2,218 $1,239 $34 B70A Stroke And Other Cerebrovascular Disorders, Major Complexity 0 0 13.9 4 42 100% 0 1.0386 4.1244 0.2675 0.0300 $0 $0 $5,034 $19,991 $1,297 $145 B70B Stroke And Other Cerebrovascular Disorders, Intermediate Complexity 0 0 6.4 2 19 100% 0 0.9695 1.9077 0.2457 0.0314 $0 $0 $4,699 $9,247 $1,191 $152 B70C Stroke And Other Cerebrovascular Disorders, Minor Complexity 1 0 3.8 1 11 190% 0.2078 1.0712 0.2454 0.0162 $1,007 $0 $0 $5,192 $1,189 $79 B70D Stroke And Other Cerebrovascular Disorders, Transferred <5 Days 1 0 2.3 1 4 100% 0.2462 0.808 0.0333 $1,193 $0 $0 $3,916 $0 $161 B71A Cranial And Peripheral Nerve Disorders, Major Complexity 1 0 5.3 1 18 161% 0.1974 1.4061 0.2717 0.0172 $957 $0 $0 $6,815 $1,317 $83 B71B Cranial And Peripheral Nerve Disorders, Minor Complexity 0 0 1.1 1 3 200% 0.1634 0.1260 0.0089 $0 $0 $0 $792 $611 $43 B72A Nervous System Infection Except Viral Meningitis, Major Complexity 0 0 10.9 3 34 131% 0 1.2063 3.5765 0.2516 0.0423 $0 $0 $5,847 $17,335 $1,220 $205 B72B Nervous System Infection Except Viral Meningitis, Minor Complexity 0 0 3.2 1 10 197% 0.6062 0.2057 0.0122 $0 $0 $0 $2,938 $997 $59 B73A Viral Meningitis, Major Complexity 0 0 5.2 1 15 100% 1.3155 0.2277 0.0205 $0 $0 $0 $6,376 $1,104 $99 B73B Viral Meningitis, Minor Complexity 0 0 2.4 1 7 128% 0.6537 0.2721 0.0086 $0 $0 $0 $3,168 $1,319 $42 B74A Nontraumatic Stupor And Coma, Major Complexity 0 0 4.8 1 14 100% 1.2073 0.2540 0.0126 $0 $0 $0 $5,852 $1,231 $61 B74B Nontraumatic Stupor And Coma, Minor Complexity 0 0 1.5 1 5 173% 0.3078 0.2315 0.0010 $0 $0 $0 $1,492 $1,122 $5 B75Z Febrile Convulsions 0 0 1.2 1 4 100% 0.3215 0.2548 0.0042 $0 $0 $0 $1,558 $1,235 $20 B76A Seizures, Major Complexity 1 0 4.6 1 15 133% 0.2235 1.2741 0.2611 0.0128 $1,083 $0 $0 $6,176 $1,266 $62 B76B Seizures, Minor Complexity 1 0 1.8 1 6 180% 0.1343 0.4749 0.2764 0.0089 $651 $0 $0 $2,302 $1,340 $43 B77A Headaches, Major Complexity 1 0 3.2 1 10 134% 0.1401 0.8154 0.2447 0.0186 $679 $0 $0 $3,952 $1,186 $90 B77B Headaches, Minor Complexity 0 0 1.2 1 4 180% 0.1788 0.1303 0.0104 $0 $0 $0 $867 $632 $50 B78A Intracranial Injuries, Major Complexity 0 0 10 3 34 136% 0 0.9811 2.9285 0.2484 0.0149 $0 $0 $4,755 $14,194 $1,204 $72 B78B Intracranial Injuries, Minor Complexity 0 0 3.1 1 10 113% 0.8113 0.2596 0.0092 $0 $0 $0 $3,932 $1,258 $45 B78C Intracranial Injuries, Transferred <5 Days 0 0 1.5 1 4 100% 0.507 0.0000 $0 $0 $0 $2,457 $0 $0 B79A Skull Fractures, Major Complexity 0 0 4.9 1 16 124% 1.3039 0.2675 0.0930 $0 $0 $0 $6,320 $1,297 $451 B79B Skull Fractures, Minor Complexity 0 0 1.6 1 5 146% 0.3801 0.2660 0.0235 $0 $0 $0 $1,842 $1,289 $114
Note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 1.Qld Admitted Acute 1 of 11 qld‐nep‐abf‐priceweights_1920_v3.0
Back to 2019-20 Queensland Admitted Acute Price Weights (Q22) AR-DRG V9.0 See NOTES Queensland Weight (QWAU) see note 4 Queensland Price INDEX DRG CODE Description Same Day Bundled IHPA ALOS Lower Upper Paediatric Same Day Short-Stay Short-Stay Inlier Long-Stay PBS Same Day $ Short-Stay Short-Stay Inlier $ Long-Stay PBS $ Payment ICU Bound Bound Adjustment Outlier Outlier Per Outlier Per Outlier Outlier Per Outlier Per List Base Diem Diem Base $ Diem $ Diem $
B80A Other Head Injuries, Major Complexity 1 0 3.6 1 12 91% 0.1267 0.8158 0.2094 0.0117 $614 $0 $0 $3,954 $1,015 $57 B80B Other Head Injuries, Minor Complexity 0 0 1.1 1 3 81% 0.1422 0.1143 0.0067 $0 $0 $0 $689 $554 $32 B81A Other Disorders Of The Nervous System, Major Complexity 0 0 7.5 2 22 128% 0 1.0115 2.0082 0.2178 0.0149 $0 $0 $4,903 $9,734 $1,056 $72 B81B Other Disorders Of The Nervous System, Minor Complexity 1 0 3.5 1 11 151% 0.2629 0.7352 0.2091 0.0309 $1,274 $0 $0 $3,564 $1,014 $150 B82A Chronic & Unspec Para/Quadriplegia, Major Complexity 0 0 15.3 5 46 100% 0 0.9298 4.6319 0.2505 0.0173 $0 $0 $4,507 $22,451 $1,214 $84 B82B Chronic & Unspec Para/Quadriplegia, Intermediate Complexity 0 0 5.3 2 19 100% 0 0.8297 1.6469 0.2467 0.0125 $0 $0 $4,022 $7,983 $1,196 $61 B82C Chronic & Unspec Para/Quadriplegia, Minor Complexity 0 0 2.5 1 8 100% 0.6729 0.2553 0.0246 $0 $0 $0 $3,262 $1,237 $119 B83A Acute Paraplegia And Quadriplegia And Spinal Cord Conditions, Major Complexity 0 0 19 8 81 100% 0 0.8671 6.9084 0.2986 0.0285 $0 $0 $4,203 $33,485 $1,447 $138 B83B Acute Paraplegia And Quadriplegia And Spinal Cord Conditions, Interm Comp 0 0 6.5 2 24 100% 0 1.2147 2.3862 0.2717 0.0433 $0 $0 $5,888 $11,566 $1,317 $210 B83C Acute Paraplegia And Quadriplegia And Spinal Cord Conditions, Minor Complexity 0 0 2.9 1 10 100% 0.9643 0.2679 0.0082 $0 $0 $0 $4,674 $1,299 $40 C01A Procedures For Penetrating Eye Injury, Major Complexity 0 0 3.9 1 13 100% 2.2759 0.3771 0.0396 $0 $0 $0 $11,031 $1,828 $192 C01B Procedures For Penetrating Eye Injury, Minor Complexity 0 0 1.7 1 5 147% 1.1817 0.4150 0.0122 $0 $0 $0 $5,728 $2,012 $59 C02A Enucleations And Orbital Procedures, Major Complexity 1 0 5.2 1 17 147% 0.69 2.4764 0.3033 0.0605 $3,344 $0 $0 $12,003 $1,470 $293 C02B Enucleations And Orbital Procedures, Minor Complexity 1 0 2 1 6 105% 0.7453 1.6043 0.3244 0.0355 $3,612 $0 $0 $7,776 $1,572 $172 C03A Retinal Procedures, Major Complexity 0 0 1.4 1 4 139% 0.8631 0.2992 0.0054 $0 $0 $0 $4,183 $1,450 $26 C03B Retinal Procedures, Minor Complexity 0 0 1 1 3 200% 0.2775 0.1942 0.0385 $0 $0 $0 $1,345 $941 $187 C04A Major Corneal, Scleral And Conjunctival Procedures, Major Complexity 0 0 3.9 1 15 100% 2.0937 0.3202 0.0046 $0 $0 $0 $10,148 $1,552 $22 C04B Major Corneal, Scleral And Conjunctival Procedures, Minor Complexity 0 0 1.1 1 4 100% 1.2689 0.3240 0.0040 $0 $0 $0 $6,150 $1,570 $19 C05Z Dacryocystorhinostomy 0 0 1.1 1 3 100% 0.8968 0.3306 0.0240 $0 $0 $0 $4,347 $1,602 $116 C10Z Strabismus Procedures 0 0 1 1 3 126% 0.7642 0.2627 0.0077 $0 $0 $0 $3,704 $1,273 $37 C11Z Eyelid Procedures 1 0 1.9 1 6 115% 0.6019 0.9901 0.3531 0.0478 $2,917 $0 $0 $4,799 $1,711 $232 C12A Other Corneal, Scleral And Conjunctival Procedures, Major Complexity 0 0 4.1 1 13 100% 1.4656 0.2893 0.0098 $0 $0 $0 $7,104 $1,402 $48 C12B Other Corneal, Scleral And Conjunctival Procedures, Minor Complexity 0 0 1 1 3 136% 0.6249 0.2454 0.0069 $0 $0 $0 $3,029 $1,189 $33 C13Z Lacrimal Procedures 0 0 1.1 1 3 100% 0.4563 0.1871 0.0118 $0 $0 $0 $2,212 $907 $57 C14A Other Eye Procedures, Major Complexity 0 0 4.7 1 13 100% 1.3789 0.2456 0.0079 $0 $0 $0 $6,684 $1,190 $38 C14B Other Eye Procedures, Minor Complexity 0 0 1.1 1 3 120% 0.4376 0.2506 0.0058 $0 $0 $0 $2,121 $1,215 $28 C15Z Glaucoma And Complex Cataract Procedures 0 0 1.3 1 4 158% 0.7738 0.2606 0.0028 $0 $0 $0 $3,751 $1,263 $14 C16Z Lens Procedures 0 0 1 1 4 197% 0.5285 0.2219 0.0049 $0 $0 $0 $2,562 $1,076 $24 C60A Acute And Major Eye Infections, Major Complexity 0 0 7.2 2 22 100% 0 1.1006 2.1801 0.2727 0.0212 $0 $0 $5,335 $10,567 $1,322 $103 C60B Acute And Major Eye Infections, Minor Complexity 0 0 3 1 9 138% 0.7681 0.2834 0.0079 $0 $0 $0 $3,723 $1,374 $38 C61A Neurological And Vascular Disorders Of The Eye, Major Complexity 1 0 4.2 1 12 132% 0.3192 1.1712 0.2598 0.0361 $1,547 $0 $0 $5,677 $1,259 $175 C61B Neurological And Vascular Disorders Of The Eye, Minor Complexity 1 0 2.3 1 8 189% 0.1588 0.6363 0.2532 0.0198 $770 $0 $0 $3,084 $1,227 $96 C62A Hyphaema And Medically Managed Trauma To The Eye, Major Complexity 1 0 4.1 1 14 143% 0.1787 1.0317 0.2199 0.0076 $866 $0 $0 $5,001 $1,066 $37 C62B Hyphaema And Medically Managed Trauma To The Eye, Minor Complexity 0 0 1.2 1 4 188% 0.1853 0.1315 0.0029 $0 $0 $0 $898 $637 $14 C63A Other Disorders Of The Eye, Major Complexity 1 0 4 1 13 122% 0.3669 1.1364 0.2559 0.0120 $1,778 $0 $0 $5,508 $1,240 $58 C63B Other Disorders Of The Eye, Minor Complexity 1 0 2 1 6 189% 0.1733 0.5115 0.2471 0.0094 $840 $0 $0 $2,479 $1,198 $46 D01Z Cochlear Implant 0 0 1.2 1 3 112% 6.5265 0.9488 0.0679 $0 $0 $0 $31,634 $4,599 $329 D02A Head And Neck Procedures, Major Complexity 0 0 9.4 2 27 100% 0.9542 2.3562 5.6452 0.4111 0.0214 $0 $4,625 $11,421 $27,362 $1,993 $104 D02B Head And Neck Procedures, Minor Complexity 0 0 2 1 7 100% 1.6722 0.4790 0.0179 $0 $0 $0 $8,105 $2,322 $87 D03A Surgical Repair For Cleft Lip And Palate Disorders, Major Complexity 0 0 2.3 1 7 118% 1.8985 0.4378 0.0506 $0 $0 $0 $9,202 $2,122 $245 D03B Surgical Repair For Cleft Lip And Palate Disorders, Minor Complexity 0 0 1.6 1 5 112% 1.4092 0.4484 0.0261 $0 $0 $0 $6,830 $2,173 $127 D04A Maxillo Surgery, Major Complexity 0 0 2.5 1 8 100% 2.188 0.3964 0.0938 $0 $0 $0 $10,605 $1,921 $455 D04B Maxillo Surgery, Minor Complexity 0 0 1.5 1 5 116% 1.3659 0.4255 0.0533 $0 $0 $0 $6,621 $2,062 $258 D05Z Parotid Gland Procedures 0 0 2.4 1 7 100% 2.3644 0.4203 0.0566 $0 $0 $0 $11,460 $2,037 $274 D06Z Sinus And Complex Middle Ear Procedures 0 0 1.2 1 4 100% 1.2978 0.4492 0.0388 $0 $0 $0 $6,290 $2,177 $188 D10Z Nasal Procedures 0 0 1.1 1 3 88% 0.9699 0.3866 0.0484 $0 $0 $0 $4,701 $1,874 $235 D11Z Tonsillectomy And Adenoidectomy 0 0 1.1 1 3 113% 0.7019 0.3500 0.0091 $0 $0 $0 $3,402 $1,696 $44 D12A Other Ear, Nose, Mouth And Throat Procedures, Major Complexity 1 0 5.2 1 15 116% 0.7489 2.1539 0.2900 0.0236 $3,630 $0 $0 $10,440 $1,406 $114 D12B Other Ear, Nose, Mouth And Throat Procedures, Minor Complexity 0 0 1.3 1 4 114% 0.7861 0.2817 0.0317 $0 $0 $0 $3,810 $1,365 $154 D13Z Myringotomy W Tube Insertion 0 0 1.1 1 3 118% 0.4021 0.1479 0.0112 $0 $0 $0 $1,949 $717 $54 D14A Mouth And Salivary Gland Procedures, Major Complexity 0 0 2 1 6 111% 1.0712 0.3194 0.0341 $0 $0 $0 $5,192 $1,548 $165 D14B Mouth And Salivary Gland Procedures, Minor Complexity 0 0 1.1 1 3 112% 0.5198 0.2029 0.0235 $0 $0 $0 $2,519 $983 $114 D15Z Mastoid Procedures 0 0 1.9 1 6 100% 2.1949 0.2631 0.0470 $0 $0 $0 $10,639 $1,275 $228 D40Z Dental Extractions And Restorations 0 0 1.1 1 3 100% 0.6757 0.2013 0.0136 $0 $0 $0 $3,275 $976 $66 D60A Ear, Nose, Mouth And Throat Malignancy, Major Complexity 0 0 8.3 2 27 100% 0.1656 1.4274 3.0098 0.2872 0.0106 $0 $803 $6,919 $14,589 $1,392 $51 D60B Ear, Nose, Mouth And Throat Malignancy, Minor Complexity 1 0 2.4 1 8 146% 0.3489 0.9841 0.2174 0.0094 $1,691 $0 $0 $4,770 $1,054 $46 D61A Dysequilibrium, Major Complexity 1 0 3.6 1 12 100% 0.1223 0.879 0.2117 0.0092 $593 $0 $0 $4,261 $1,026 $45 D61B Dysequilibrium, Minor Complexity 0 0 1.3 1 4 168% 0.2303 0.1752 0.0071 $0 $0 $0 $1,116 $849 $34 D62A Epistaxis, Major Complexity 0 0 3.4 1 11 100% 0.8451 0.2449 0.0257 $0 $0 $0 $4,096 $1,187 $125 D62B Epistaxis, Minor Complexity 0 0 1.3 1 4 113% 0.2388 0.1659 0.0067 $0 $0 $0 $1,157 $804 $32 D63A Otitis Media And Upper Respiratory Infections, Major Complexity 1 0 3.1 1 9 115% 0.1561 0.8211 0.2441 0.0141 $757 $0 $0 $3,980 $1,183 $68 D63B Otitis Media And Upper Respiratory Infections, Minor Complexity 0 0 1.2 1 4 111% 0.2415 0.1939 0.0076 $0 $0 $0 $1,171 $940 $37 D64A Laryngotracheitis And Epiglottitis, Major Complexity 0 0 1.7 1 5 109% 0.5515 0.2921 0.0117 $0 $0 $0 $2,673 $1,416 $57 D64B Laryngotracheitis And Epiglottitis, Minor Complexity 0 0 1.1 1 3 80% 0.2133 0.1662 0.0028 $0 $0 $0 $1,034 $806 $14 D65A Nasal Trauma And Deformity, Major Complexity 0 0 3.3 1 10 100% 0.7202 0.2289 0.0238 $0 $0 $0 $3,491 $1,109 $115 D65B Nasal Trauma And Deformity, Minor Complexity 0 0 1.1 1 3 116% 0.2334 0.1372 0.0281 $0 $0 $0 $1,131 $665 $136 D66A Other Ear, Nose, Mouth And Throat Disorders, Major Complexity 1 0 3.8 1 12 119% 0.2816 0.9367 0.2765 0.0160 $1,365 $0 $0 $4,540 $1,340 $78 D66B Other Ear, Nose, Mouth And Throat Disorders, Minor Complexity 0 0 1.2 1 4 134% 0.2393 0.1212 0.0065 $0 $0 $0 $1,160 $587 $32 D67A Oral And Dental Disorders, Major Complexity 1 0 4 1 12 118% 0.2394 1.1169 0.2765 0.0102 $1,160 $0 $0 $5,414 $1,340 $49 D67B Oral And Dental Disorders, Minor Complexity 0 0 1.2 1 4 138% 0.2602 0.1451 0.0076 $0 $0 $0 $1,261 $703 $37 E01A Major Chest Procedures, Major Complexity 0 0 15.9 5 48 100% 1.2812 1.2263 7.3378 0.2884 0.0748 $0 $6,210 $5,944 $35,566 $1,398 $363 E01B Major Chest Procedures, Intermediate Complexity 0 0 9.1 3 30 110% 1.1725 1.1281 4.5027 0.2558 0.0541 $0 $5,683 $5,468 $21,825 $1,240 $262 E01C Major Chest Procedures, Minor Complexity 0 0 6 2 19 119% 0.5572 1.3831 3.279 0.2614 0.0444 $0 $2,701 $6,704 $15,893 $1,267 $215 E02A Other Respiratory System GIs, Major Complexity 0 0 12.1 4 37 131% 0.5946 1.0657 4.7281 0.2609 0.1294 $0 $2,882 $5,165 $22,917 $1,265 $627
Note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 1.Qld Admitted Acute 2 of 11 qld‐nep‐abf‐priceweights_1920_v3.0
Back to 2019-20 Queensland Admitted Acute Price Weights (Q22) AR-DRG V9.0 See NOTES Queensland Weight (QWAU) see note 4 Queensland Price INDEX DRG CODE Description Same Day Bundled IHPA ALOS Lower Upper Paediatric Same Day Short-Stay Short-Stay Inlier Long-Stay PBS Same Day $ Short-Stay Short-Stay Inlier $ Long-Stay PBS $ Payment ICU Bound Bound Adjustment Outlier Outlier Per Outlier Per Outlier Outlier Per Outlier Per List Base Diem Diem Base $ Diem $ Diem $
E02B Other Respiratory System GIs, Intermediate Complexity 1 0 3.1 1 9 80% 0.686 1.7685 0.2885 0.0242 $3,325 $0 $0 $8,572 $1,398 $117 E02C Other Respiratory System GIs, Minor Complexity 0 0 1.1 1 3 100% 0.7754 0.3219 0.0128 $0 $0 $0 $3,758 $1,560 $62 E03Z Lung Or Heart-Lung Transplant 0 0 20.4 10 98 100% 5.0211 1.665 21.6183 0.3195 0.0524 $0 $24,337 $8,070 $104,784 $1,549 $254 E40A Respiratory System Disorders W Ventilator Support, Major Complexity 0 0 8.4 3 29 100% 0.0254 1.6103 4.8258 0.2963 0.0306 $0 $123 $7,805 $23,391 $1,436 $148 E40B Respiratory System Disorders W Ventilator Support, Minor Complexity 0 0 4.5 1 15 82% 2.6875 0.3278 0.0163 $0 $0 $0 $13,026 $1,589 $79 E41A Respiratory System Disorders W Non-Invasive Ventilation, Major Complexity 0 0 10.6 3 35 100% 0.022 1.3765 4.1243 0.2912 0.0271 $0 $107 $6,672 $19,990 $1,411 $131 E41B Respiratory System Disorders W Non-Invasive Ventilation, Minor Complexity 0 0 5.6 2 18 80% 0 1.0686 2.1211 0.2943 0.0161 $0 $0 $5,180 $10,281 $1,426 $78 E42A Bronchoscopy, Major Complexity 0 0 12 4 38 156% 0.2221 1.0472 4.3496 0.2690 0.0615 $0 $1,077 $5,076 $21,083 $1,304 $298 E42B Bronchoscopy, Intermediate Complexity 1 0 6.2 2 19 139% 0.5477 0.3046 1.0633 2.3828 0.2422 0.0485 $2,655 $1,476 $5,154 $11,549 $1,174 $235 E42C Bronchoscopy, Minor Complexity 1 0 2.9 1 9 123% 0.4706 1.2143 0.2345 0.0367 $2,281 $0 $0 $5,886 $1,137 $178 E60A Cystic Fibrosis, Major Complexity 0 0 11.4 4 36 128% 0 1.1176 4.2453 0.2868 0.2253 $0 $0 $5,417 $20,577 $1,390 $1,092 E60B Cystic Fibrosis, Minor Complexity 0 0 6.6 2 20 125% 0 1.1802 2.2655 0.1768 0.0950 $0 $0 $5,720 $10,981 $857 $460 E61A Pulmonary Embolism, Major Complexity 0 0 6.2 2 20 100% 0 0.9083 1.7961 0.2299 0.0206 $0 $0 $4,403 $8,706 $1,114 $100 E61B Pulmonary Embolism, Minor Complexity 1 0 2.9 1 10 100% 0.1915 0.7313 0.1835 0.0158 $928 $0 $0 $3,545 $889 $77 E62A Respiratory Infections And Inflammations, Major Complexity 0 0 5.8 2 19 109% 0 0.827 1.6382 0.2415 0.0159 $0 $0 $4,008 $7,940 $1,171 $77 E62B Respiratory Infections And Inflammations, Minor Complexity 1 0 2.8 1 9 80% 0.1245 0.7332 0.2282 0.0107 $603 $0 $0 $3,554 $1,106 $52 E63A Sleep Apnoea, Major Complexity 0 0 1.7 1 5 123% 0.4895 0.2791 0.0068 $0 $0 $0 $2,373 $1,353 $33 E63B Sleep Apnoea, Minor Complexity 0 0 1.1 1 4 115% 0.3172 0.1692 0.0056 $0 $0 $0 $1,537 $820 $27 E64A Pulmonary Oedema And Respiratory Failure, Major Complexity 0 0 5.9 2 18 100% 0 0.9078 1.8062 0.2382 0.0095 $0 $0 $4,400 $8,755 $1,155 $46 E64B Pulmonary Oedema And Respiratory Failure, Minor Complexity 0 0 2.4 1 8 100% 0.5986 0.2304 0.0216 $0 $0 $0 $2,901 $1,117 $105 E65A Chronic Obstructive Airways Disease, Major Complexity 0 0 5.7 2 18 100% 0 0.7602 1.5121 0.2253 0.0084 $0 $0 $3,685 $7,329 $1,092 $41 E65B Chronic Obstructive Airways Disease, Minor Complexity 0 0 2.7 1 9 196% 0.6159 0.2189 0.0067 $0 $0 $0 $2,985 $1,061 $32 E66A Major Chest Trauma, Major Complexity 0 0 8.7 3 28 100% 0 0.8165 2.4098 0.2298 0.0396 $0 $0 $3,958 $11,680 $1,114 $192 E66B Major Chest Trauma, Intermediate Complexity 0 0 4 1 12 100% 1.0335 0.2412 0.0122 $0 $0 $0 $5,009 $1,169 $59 E66C Major Chest Trauma, Minor Complexity 0 0 1.8 1 6 100% 0.4205 0.2536 0.0072 $0 $0 $0 $2,038 $1,229 $35 E67A Respiratory Signs And Symptoms, Major Complexity 1 0 3.2 1 10 88% 0.2405 0.8539 0.2496 0.0206 $1,166 $0 $0 $4,139 $1,210 $100 E67B Respiratory Signs And Symptoms, Minor Complexity 0 0 1.2 1 4 80% 0.2329 0.1853 0.0066 $0 $0 $0 $1,129 $898 $32 E68A Pneumothorax, Major Complexity 0 0 5.3 1 18 100% 1.5204 0.2679 0.0160 $0 $0 $0 $7,369 $1,299 $78 E68B Pneumothorax, Minor Complexity 0 0 2.3 1 7 126% 0.5885 0.2668 0.0188 $0 $0 $0 $2,852 $1,293 $91 E69A Bronchitis And Asthma, Major Complexity 0 0 3.1 1 10 106% 0.8257 0.2401 0.0075 $0 $0 $0 $4,002 $1,164 $36 E69B Bronchitis And Asthma, Minor Complexity 0 0 1.4 1 4 80% 0.2988 0.2280 0.0171 $0 $0 $0 $1,448 $1,105 $83 E70A Whooping Cough And Acute Bronchiolitis, Major Complexity 0 0 2.8 1 8 108% 0.9715 0.3521 0.0032 $0 $0 $0 $4,709 $1,707 $16 E70B Whooping Cough And Acute Bronchiolitis, Minor Complexity 0 0 1.6 1 6 80% 0.5409 0.3322 0.0018 $0 $0 $0 $2,622 $1,610 $9 E71A Respiratory Neoplasms, Major Complexity 0 0 8.4 2 27 100% 0 1.2332 2.4415 0.2477 0.0249 $0 $0 $5,977 $11,834 $1,201 $121 E71B Respiratory Neoplasms, Minor Complexity 1 0 4.1 1 13 159% 0.3253 1.0728 0.2474 0.0243 $1,577 $0 $0 $5,200 $1,199 $118 E72Z Respiratory Problems Arising From Neonatal Period 0 0 1.8 1 5 87% 0.4898 0.2908 0.0065 $0 $0 $0 $2,374 $1,410 $32 E73A Pleural Effusion, Major Complexity 0 0 8.9 3 28 100% 0 0.877 2.5923 0.2302 0.0388 $0 $0 $4,251 $12,565 $1,116 $188 E73B Pleural Effusion, Intermediate Complexity 0 0 4.2 1 14 100% 1.114 0.2395 0.0196 $0 $0 $0 $5,400 $1,161 $95 E73C Pleural Effusion, Minor Complexity 1 0 2.7 1 8 100% 0.1729 0.7076 0.2134 0.0229 $838 $0 $0 $3,430 $1,034 $111 E74A Interstitial Lung Disease, Major Complexity 0 0 6.6 2 20 100% 0 0.9031 1.7899 0.2268 0.0162 $0 $0 $4,377 $8,676 $1,099 $79 E74B Interstitial Lung Disease, Minor Complexity 1 0 3.9 1 12 88% 0.2669 1.0118 0.2243 0.0281 $1,294 $0 $0 $4,904 $1,087 $136 E75A Other Respiratory System Disorders, Major Complexity 0 0 3.8 1 12 135% 0.969 0.2493 0.0156 $0 $0 $0 $4,697 $1,208 $76 E75B Other Respiratory System Disorders, Minor Complexity 1 0 1.8 1 6 81% 0.131 0.483 0.2445 0.0121 $635 $0 $0 $2,341 $1,185 $59 E76Z Respiratory Tuberculosis 0 0 15.8 4 43 100% 0 1.0354 4.1124 0.2312 0.0290 $0 $0 $5,019 $19,933 $1,121 $141 E77A Bronchiectasis, Major Complexity 0 0 7.7 2 24 200% 0 1.0504 2.0849 0.2454 0.0160 $0 $0 $5,091 $10,106 $1,189 $78 E77B Bronchiectasis, Minor Complexity 0 0 4.4 1 13 165% 0.9749 0.1922 0.0063 $0 $0 $0 $4,725 $932 $31 F01A Implantation And Replacement Of AICD, Total System, Major Complexity 0 0 10.7 3 32 100% 4.3872 1.4184 8.6111 0.3110 0.0312 $0 $21,265 $6,875 $41,738 $1,507 $151 F01B Implantation And Replacement Of AICD, Total System, Minor Complexity 1 0 2.3 1 7 100% 2.9223 4.6829 0.3203 0.0203 $14,164 $0 $0 $22,698 $1,552 $98 F02Z Other AICD Procedures 0 0 3.6 1 12 100% 2.5967 0.3412 0.0190 $0 $0 $0 $12,586 $1,654 $92 F03A Cardiac Valve Procedures W CPB Pump W Invasive Cardiac Investigation, Major Comp 0 0 22 7 67 100% 4.5768 1.2539 13.3236 0.3056 0.0304 $0 $22,184 $6,078 $64,579 $1,481 $147 F03B Cardiac Valve Procedures W CPB Pump W Invasive Cardiac Investigation, Minor Comp 0 0 11.6 4 39 100% 6.2581 0.7854 9.3755 0.1781 0.0244 $0 $30,333 $3,807 $45,443 $863 $118 F04A Cardiac Valve Procedures W CPB Pump W/O Invasive Cardiac Invest, Major Comp 0 0 17.2 5 54 116% 4.2406 1.6387 12.3747 0.3130 0.0596 $0 $20,554 $7,943 $59,980 $1,517 $289 F04B Cardiac Valve Procedures W CPB Pump W/O Invasive Cardiac Invest, Interm Comp 0 0 8.4 3 28 100% 6.0273 0.6321 7.9034 0.2551 0.0203 $0 $29,214 $3,064 $38,308 $1,236 $98 F04C Cardiac Valve Procedures W CPB Pump W/O Invasive Cardiac Invest, Minor Comp 0 0 5.8 2 19 100% 5.047 0.771 6.573 0.1657 0.0160 $0 $24,463 $3,737 $31,859 $803 $78 F05A Coronary Bypass W Invasive Cardiac Investigation, Major Complexity 0 0 15.9 6 55 100% 2.9406 1.1525 9.8264 0.3498 0.0292 $0 $14,253 $5,586 $47,629 $1,695 $142 F05B Coronary Bypass W Invasive Cardiac Investigation, Minor Complexity 0 0 11.6 4 36 100% 2.5448 1.2533 7.5335 0.2981 0.0243 $0 $12,335 $6,075 $36,515 $1,445 $118 F06A Coronary Bypass W/O Invasive Cardiac Investigation, Major Complexity 0 0 13.1 4 41 100% 3.2066 1.3686 8.6512 0.3481 0.0299 $0 $15,542 $6,634 $41,932 $1,687 $145 F06B Coronary Bypass W/O Invasive Cardiac Investigation, Intermediate Complexity 0 0 8.1 2 25 100% 2.2445 1.9514 6.1232 0.2598 0.0242 $0 $10,879 $9,458 $29,679 $1,259 $117 F06C Coronary Bypass W/O Invasive Cardiac Investigation, Minor Complexity 0 0 6.3 2 19 100% 2.1916 1.5386 5.2449 0.2388 0.0238 $0 $10,623 $7,458 $25,422 $1,157 $115 F07A Other Cardiothoracic/Vascular Procedures W CPB Pump, Major Complexity 0 0 10.9 3 35 110% 3.9967 1.8879 9.6445 0.4437 0.0159 $0 $19,372 $9,151 $46,747 $2,151 $77 F07B Other Cardiothoracic/Vascular Procedures W CPB Pump, Minor Complexity 0 0 6.1 2 19 100% 2.2473 1.7557 5.7097 0.3295 0.0491 $0 $10,893 $8,510 $27,675 $1,597 $238 F08A Major Reconstructive Vascular Procedures W/O CPB Pump, Major Complexity 0 0 17.9 6 58 100% 3.8141 1.0997 10.391 0.2675 0.0212 $0 $18,487 $5,330 $50,365 $1,297 $103 F08B Major Reconstructive Vascular Procedures W/O CPB Pump, Intermediate Complexity 0 0 8.5 2 26 100% 3.1047 1.5427 6.1689 0.2359 0.0212 $0 $15,048 $7,477 $29,901 $1,143 $103 F08C Major Reconstructive Vascular Procedures W/O CPB Pump, Minor Complexity 0 0 4.1 1 13 100% 3.8901 0.2912 0.0113 $0 $0 $0 $18,855 $1,411 $55 F09A Other Cardiothoracic Procedures W/O CPB Pump, Major Complexity 0 0 9.9 3 30 100% 1.1351 1.7154 6.2686 0.3035 0.0129 $0 $5,502 $8,315 $30,384 $1,471 $63 F09B Other Cardiothoracic Procedures W/O CPB Pump, Intermediate Complexity 0 0 5 1 17 100% 3.4527 0.3205 0.0096 $0 $0 $0 $16,735 $1,553 $47 F09C Other Cardiothoracic Procedures W/O CPB Pump, Minor Complexity 0 0 2.1 1 7 100% 1.8842 0.4136 0.0054 $0 $0 $0 $9,133 $2,005 $26 F10A Interventional Coronary Procedures, Admitted For Ami, Major Complexity 0 0 6.7 2 21 100% 0.945 1.3056 3.5374 0.3099 0.0188 $0 $4,580 $6,328 $17,146 $1,502 $91 F10B Interventional Coronary Procedures, Admitted For Ami, Minor Complexity 0 0 3.1 1 9 100% 2.0144 0.3160 0.0177 $0 $0 $0 $9,764 $1,532 $86 F11A Amputation, Except Upper Limb And Toe, For Circulatory Disorders, Major Comp 0 0 28.8 12 114 100% 1.3035 0.9523 12.7041 0.3201 0.0266 $0 $6,318 $4,616 $61,577 $1,552 $129 F11B Amputation, Except Upper Limb And Toe, For Circulatory Disorders, Minor Comp 0 0 15.5 5 50 100% 1.0021 0.9548 5.7422 0.2862 0.0342 $0 $4,857 $4,628 $27,832 $1,387 $166 F12A Implantation And Replacement Of Pacemaker, Total System, Major Complexity 0 0 7.5 2 24 100% 1.321 1.3407 3.982 0.2819 0.0204 $0 $6,403 $6,498 $19,301 $1,366 $99 F12B Implantation And Replacement Of Pacemaker, Total System, Minor Complexity 1 0 2.6 1 8 100% 1.2435 2.137 0.2612 0.0268 $6,027 $0 $0 $10,358 $1,266 $130 F13A Amputation, Upper Limb And Toe, For Circulatory Disorders, Major Complexity 0 0 16.5 5 51 100% 0.4771 1.1215 6.0685 0.2754 0.0159 $0 $2,313 $5,436 $29,414 $1,335 $77
Note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 1.Qld Admitted Acute 3 of 11 qld‐nep‐abf‐priceweights_1920_v3.0
Back to 2019-20 Queensland Admitted Acute Price Weights (Q22) AR-DRG V9.0 See NOTES Queensland Weight (QWAU) see note 4 Queensland Price INDEX DRG CODE Description Same Day Bundled IHPA ALOS Lower Upper Paediatric Same Day Short-Stay Short-Stay Inlier Long-Stay PBS Same Day $ Short-Stay Short-Stay Inlier $ Long-Stay PBS $ Payment ICU Bound Bound Adjustment Outlier Outlier Per Outlier Per Outlier Outlier Per Outlier Per List Base Diem Diem Base $ Diem $ Diem $
F13B Amputation, Upper Limb And Toe, For Circulatory Disorders, Minor Complexity 0 0 7.3 2 22 100% 0.434 1.2024 2.8271 0.2639 0.0117 $0 $2,104 $5,828 $13,703 $1,279 $57 F14A Vascular Procedures, Except Major Reconstruction, W/O CPB Pump, Major Complexity 0 0 12.4 4 40 150% 1.0077 1.2171 5.8406 0.2880 0.0356 $0 $4,884 $5,899 $28,309 $1,396 $173 F14B Vascular Procedures, Except Major Reconstruction, W/O CPB Pump, Interm Comp 0 0 3.7 1 11 117% 2.4311 0.2980 0.0170 $0 $0 $0 $11,784 $1,444 $82 F14C Vascular Procedures, Except Major Reconstruction, W/O CPB Pump, Minor Complexity 1 0 1.9 1 6 134% 1.0025 1.6492 0.2838 0.0165 $4,859 $0 $0 $7,994 $1,376 $80 F17A Insertion And Replacement Of Pacemaker Generator, Major Complexity 0 0 4.2 1 11 100% 2.5659 0.3740 0.0292 $0 $0 $0 $12,437 $1,813 $142 F17B Insertion And Replacement Of Pacemaker Generator, Minor Complexity 0 0 1.1 1 3 100% 1.2958 0.2180 0.0226 $0 $0 $0 $6,281 $1,057 $110 F18Z Other Pacemaker Procedures 0 0 3.8 1 13 100% 2.1595 0.3571 0.0279 $0 $0 $0 $10,467 $1,731 $135 F19A Trans-Vascular Percutaneous Cardiac Intervention, Major Complexity 0 0 5.6 2 19 100% 1.6541 1.586 4.8091 0.2460 0.0170 $0 $8,017 $7,687 $23,310 $1,192 $82 F19B Trans-Vascular Percutaneous Cardiac Intervention, Minor Complexity 0 0 1.5 1 5 134% 2.0746 0.2737 0.0129 $0 $0 $0 $10,056 $1,327 $63 F20Z Vein Ligation And Stripping 0 0 1.2 1 4 112% 0.9242 0.3038 0.0093 $0 $0 $0 $4,480 $1,473 $45 F21A Other Circulatory System GIs, Major Complexity 0 0 21.9 8 76 100% 0.4717 0.8755 7.4259 0.2597 0.0497 $0 $2,286 $4,244 $35,993 $1,259 $241 F21B Other Circulatory System GIs, Intermediate Complexity 0 0 9.3 3 30 100% 0.528 0.914 3.2544 0.2205 0.0154 $0 $2,559 $4,430 $15,774 $1,069 $75 F21C Other Circulatory System GIs, Minor Complexity 1 0 3.3 1 10 100% 0.8133 1.6299 0.2246 0.0248 $3,942 $0 $0 $7,900 $1,089 $120 F22Z Insertion Of Artificial Heart Device 0 0 36.4 14 132 100% 31.882 2.3375 64.1415 0.4143 0.4650 $0 $154,532 $11,330 $310,894 $2,008 $2,254 F23Z Heart Transplant 0 0 22.7 13 121 100% 4.0805 1.7736 27.0065 0.6480 0.1311 $0 $19,778 $8,597 $130,901 $3,141 $635 F24A Interventional Coronary Procs, Not Adm For Ami, Major Comp 0 0 6.6 2 19 100% 1.0574 1.2961 3.6323 0.2907 0.0173 $0 $5,125 $6,282 $17,606 $1,409 $84 F24B Interventional Coronary Procs, Not Adm For Ami, Minor Comp 0 0 1.6 1 5 170% 1.642 0.3094 0.0245 $0 $0 $0 $7,959 $1,500 $119 F40A Circulatory Disorders W Ventilator Support, Major Complexity 0 0 8.6 3 31 100% 0.095 1.8665 5.6117 0.3218 0.0827 $0 $460 $9,047 $27,200 $1,560 $401 F40B Circulatory Disorders W Ventilator Support, Minor Complexity 0 0 2.7 1 9 100% 1.8287 0.2326 0.0245 $0 $0 $0 $8,864 $1,127 $119 F41A Circulatory Disorders, Adm For Ami W Invasive Cardiac Inves Proc, Major Comp 0 0 6.8 2 21 100% 0.3355 1.1702 2.6591 0.2682 0.0168 $0 $1,626 $5,672 $12,889 $1,300 $81 F41B Circulatory Disorders, Adm For Ami W Invasive Cardiac Inves Proc, Minor Comp 1 0 3.5 1 11 100% 0.5301 1.5169 0.2497 0.0214 $2,569 $0 $0 $7,352 $1,210 $104 F42A Circulatory Disorders, Not Adm For Ami W Invasive Cardiac Inves Proc, Major Comp 0 0 5.7 1 18 118% 2.1503 0.2766 0.0169 $0 $0 $0 $10,423 $1,341 $82 F42B Circulatory Disorders, Not Adm For Ami W Invasive Cardiac Inves Proc, Minor Comp 1 0 2.6 1 8 200% 0.5422 1.1632 0.2235 0.0289 $2,628 $0 $0 $5,638 $1,083 $140 F43A Circulatory Disorders W Non-Invasive Ventilation, Major Complexity 0 0 12.8 4 45 100% 0.0545 1.2504 5.025 0.2456 0.0311 $0 $264 $6,061 $24,356 $1,190 $151 F43B Circulatory Disorders W Non-Invasive Ventilation, Minor Complexity 0 0 7.5 2 23 100% 0.0193 1.3351 2.6785 0.2575 0.0109 $0 $94 $6,471 $12,983 $1,248 $53 F60A Circulatory Disorder, Adm For Ami W/O Invas Card Inves Proc 0 0 4.7 1 14 100% 1.3382 0.2558 0.0101 $0 $0 $0 $6,486 $1,240 $49 F60B Circulatory Disorder, Adm For Ami W/O Invas Card Inves Proc, Transf <5 Days 0 0 1.5 1 4 100% 0.5501 0.0248 $0 $0 $0 $2,666 $0 $120 F61A Infective Endocarditis, Major Complexity 0 0 23.1 7 70 100% 0 1.0528 7.3276 0.2167 0.0419 $0 $0 $5,103 $35,517 $1,050 $203 F61B Infective Endocarditis, Intermediate Complexity 0 0 14.3 4 40 100% 0 1.0754 4.2715 0.1854 0.0300 $0 $0 $5,212 $20,704 $899 $145 F61C Infective Endocarditis, Minor Complexity 0 0 7.5 2 22 80% 0 0.8975 1.785 0.1107 0.0101 $0 $0 $4,350 $8,652 $537 $49 F62A Heart Failure And Shock, Major Complexity 0 0 7.8 2 25 100% 0 1.0535 2.0946 0.2415 0.0123 $0 $0 $5,106 $10,153 $1,171 $60 F62B Heart Failure And Shock, Minor Complexity 0 0 3.4 1 11 100% 0.8099 0.2256 0.0059 $0 $0 $0 $3,926 $1,093 $29 F62C Heart Failure And Shock, Transferred <5 Days 0 0 1.6 1 4 100% 0.4375 0.0068 $0 $0 $0 $2,121 $0 $33 F63A Venous Thrombosis, Major Complexity 0 0 4.9 1 15 100% 1.1996 0.2225 0.0151 $0 $0 $0 $5,814 $1,078 $73 F63B Venous Thrombosis, Minor Complexity 1 0 2.9 1 11 100% 0.1205 0.5904 0.1469 0.0095 $584 $0 $0 $2,862 $712 $46 F64A Skin Ulcers In Circulatory Disorders, Major Complexity 0 0 11.2 4 40 100% 0 0.7641 3.0449 0.2325 0.0115 $0 $0 $3,704 $14,759 $1,127 $56 F64B Skin Ulcers In Circulatory Disorders, Intermediate Complexity 0 0 5.5 1 16 100% 1.2468 0.2169 0.0070 $0 $0 $0 $6,043 $1,051 $34 F64C Skin Ulcers In Circulatory Disorders, Minor Complexity 1 0 3.7 1 12 100% 0.1807 0.8153 0.1920 0.0142 $876 $0 $0 $3,952 $931 $69 F65A Peripheral Vascular Disorders, Major Complexity 0 0 5.6 1 17 100% 1.5472 0.2514 0.0124 $0 $0 $0 $7,499 $1,219 $60 F65B Peripheral Vascular Disorders, Minor Complexity 1 0 2.7 1 9 135% 0.3002 0.7799 0.1910 0.0367 $1,455 $0 $0 $3,780 $926 $178 F66A Coronary Atherosclerosis, Major Complexity 0 0 4 1 12 100% 1.0513 0.2647 0.0307 $0 $0 $0 $5,096 $1,283 $149 F66B Coronary Atherosclerosis, Minor Complexity 0 0 1.4 1 4 100% 0.2834 0.2156 0.0043 $0 $0 $0 $1,374 $1,045 $21 F67A Hypertension, Major Complexity 1 0 4.4 1 13 167% 0.177 1.1279 0.2366 0.0072 $858 $0 $0 $5,467 $1,147 $35 F67B Hypertension, Minor Complexity 0 0 1.4 1 4 148% 0.2465 0.1843 0.0055 $0 $0 $0 $1,195 $893 $27 F68Z Congenital Heart Disease 0 0 1.9 1 5 186% 0.5296 0.2607 0.0820 $0 $0 $0 $2,567 $1,264 $397 F69A Valvular Disorders, Major Complexity 1 0 5.6 2 18 100% 0.2536 0 0.8726 1.7298 0.2413 0.0154 $1,229 $0 $4,229 $8,384 $1,170 $75 F69B Valvular Disorders, Minor Complexity 0 0 1.2 1 4 200% 0.225 0.1755 0.0061 $0 $0 $0 $1,091 $851 $30 F72A Unstable Angina, Major Complexity 1 0 3.7 1 12 100% 0.1899 1.0602 0.2407 0.0061 $920 $0 $0 $5,139 $1,167 $30 F72B Unstable Angina, Minor Complexity 1 0 1.8 1 6 100% 0.1377 0.5133 0.2500 0.0065 $667 $0 $0 $2,488 $1,212 $32 F73A Syncope And Collapse, Major Complexity 0 0 4.5 1 13 100% 1.099 0.2325 0.0128 $0 $0 $0 $5,327 $1,127 $62 F73B Syncope And Collapse, Minor Complexity 1 0 1.8 1 6 127% 0.1231 0.4403 0.2283 0.0116 $597 $0 $0 $2,134 $1,107 $56 F74A Chest Pain, Major Complexity 0 0 1.9 1 6 200% 0.4142 0.2489 0.0044 $0 $0 $0 $2,008 $1,206 $21 F74B Chest Pain, Minor Complexity 0 0 1.1 1 3 155% 0.1452 0.1124 0.0047 $0 $0 $0 $704 $545 $23 F75A Other Circulatory Disorders, Major Complexity 0 0 9.5 3 30 173% 0 1.037 3.0939 0.2443 0.0172 $0 $0 $5,026 $14,996 $1,184 $83 F75B Other Circulatory Disorders, Intermediate Complexity 1 0 4.6 1 15 176% 0.2798 1.3707 0.2506 0.0240 $1,356 $0 $0 $6,644 $1,215 $116 F75C Other Circulatory Disorders, Minor Complexity 1 0 2.4 1 8 195% 0.2339 0.6715 0.2321 0.0173 $1,134 $0 $0 $3,255 $1,125 $84 F76A Arrhythmia, Cardiac Arrest And Conduction Disorders, Major Complexity 0 0 4 1 13 197% 1.0982 0.2501 0.0098 $0 $0 $0 $5,323 $1,212 $48 F76B Arrhythmia, Cardiac Arrest And Conduction Disorders, Minor Complexity 1 0 1.9 1 6 200% 0.1777 0.4713 0.2205 0.0066 $861 $0 $0 $2,284 $1,069 $32 G01A Rectal Resection, Major Complexity 0 0 23.5 8 78 100% 2.272 1.1155 11.1668 0.3160 0.0295 $0 $11,012 $5,407 $54,125 $1,532 $143 G01B Rectal Resection, Intermediate Complexity 0 0 12.7 4 42 100% 2.1511 1.1109 6.5412 0.2754 0.0534 $0 $10,426 $5,385 $31,705 $1,335 $259 G01C Rectal Resection, Minor Complexity 0 0 7.6 2 24 100% 1.8101 1.4329 4.6513 0.2661 0.0245 $0 $8,774 $6,945 $22,545 $1,290 $119 G02A Major Small And Large Bowel Procedures, Major Complexity 0 0 21.7 8 73 145% 1.6694 1.0153 9.7289 0.3011 0.0626 $0 $8,092 $4,921 $47,156 $1,459 $303 G02B Major Small And Large Bowel Procedures, Intermediate Complexity 0 0 10 3 31 118% 1.3781 1.1711 4.8426 0.3022 0.0488 $0 $6,680 $5,676 $23,472 $1,465 $237 G02C Major Small And Large Bowel Procedures, Minor Complexity 0 0 5.4 1 17 100% 2.9515 0.3281 0.0310 $0 $0 $0 $14,306 $1,590 $150 G03A Stomach, Oesophageal And Duodenal Procedures, Major Complexity 0 0 16.3 5 51 100% 2.0283 1.384 8.9179 0.3416 0.0305 $0 $9,831 $6,708 $43,225 $1,656 $148 G03B Stomach, Oesophageal And Duodenal Procedures, Intermediate Complexity 0 0 7.2 2 24 115% 0.9772 1.6229 4.1901 0.3410 0.0329 $0 $4,736 $7,866 $20,309 $1,653 $159 G03C Stomach, Oesophageal And Duodenal Procedures, Minor Complexity 0 0 3.4 1 11 126% 2.2284 0.3069 0.0370 $0 $0 $0 $10,801 $1,488 $179 G04A Peritoneal Adhesiolysis, Major Complexity 0 0 13 4 40 154% 1.1074 1.1151 5.5407 0.3216 0.0271 $0 $5,368 $5,405 $26,856 $1,559 $131 G04B Peritoneal Adhesiolysis, Intermediate Complexity 0 0 5.8 2 18 136% 0.8241 1.0476 2.888 0.2950 0.0314 $0 $3,994 $5,078 $13,998 $1,430 $152 G04C Peritoneal Adhesiolysis, Minor Complexity 0 0 2.6 1 9 129% 1.6096 0.3220 0.0162 $0 $0 $0 $7,802 $1,561 $79 G05A Minor Small And Large Bowel Procedures, Major Complexity 0 0 10.6 3 31 117% 0.887 1.109 4.1916 0.2976 0.0224 $0 $4,299 $5,375 $20,317 $1,442 $109 G05B Minor Small And Large Bowel Procedures, Minor Complexity 0 0 3.9 1 11 80% 2.0894 0.3613 0.0208 $0 $0 $0 $10,127 $1,751 $101 G06Z Pyloromyotomy 0 0 3.1 1 11 100% 1.7452 0.3296 0.0401 $0 $0 $0 $8,459 $1,598 $194 G07A Appendicectomy, Major Complexity 0 0 4.3 1 13 136% 1.9815 0.3220 0.0721 $0 $0 $0 $9,604 $1,561 $349
Note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 1.Qld Admitted Acute 4 of 11 qld‐nep‐abf‐priceweights_1920_v3.0
Back to 2019-20 Queensland Admitted Acute Price Weights (Q22) AR-DRG V9.0 See NOTES Queensland Weight (QWAU) see note 4 Queensland Price INDEX DRG CODE Description Same Day Bundled IHPA ALOS Lower Upper Paediatric Same Day Short-Stay Short-Stay Inlier Long-Stay PBS Same Day $ Short-Stay Short-Stay Inlier $ Long-Stay PBS $ Payment ICU Bound Bound Adjustment Outlier Outlier Per Outlier Per Outlier Outlier Per Outlier Per List Base Diem Diem Base $ Diem $ Diem $
G07B Appendicectomy, Minor Complexity 0 0 2.1 1 7 123% 1.2016 0.3210 0.0556 $0 $0 $0 $5,824 $1,556 $269 G10A Hernia Procedures, Major Complexity 0 0 3.6 1 11 92% 1.9818 0.3061 0.0151 $0 $0 $0 $9,606 $1,484 $73 G10B Hernia Procedures, Minor Complexity 0 0 1.2 1 4 80% 1.0291 0.3297 0.0279 $0 $0 $0 $4,988 $1,598 $135 G11A Anal And Stomal Procedures, Major Complexity 0 0 4.5 1 14 169% 1.5094 0.2475 0.0289 $0 $0 $0 $7,316 $1,200 $140 G11B Anal And Stomal Procedures, Minor Complexity 0 0 1.4 1 4 109% 0.6539 0.2495 0.0283 $0 $0 $0 $3,169 $1,209 $137 G12A Other Digestive System GIs, Major Complexity 0 0 16.9 6 55 100% 0.5116 0.9511 6.1954 0.2684 0.0227 $0 $2,480 $4,610 $30,029 $1,301 $110 G12B Other Digestive System GIs, Intermediate Complexity 0 0 7 2 22 119% 0.5092 1.0684 2.6247 0.2446 0.0213 $0 $2,468 $5,179 $12,722 $1,186 $103 G12C Other Digestive System GIs, Minor Complexity 1 0 3.3 1 10 138% 0.7373 1.4844 0.2224 0.0326 $3,574 $0 $0 $7,195 $1,078 $158 G46A Complex Endoscopy, Major Complexity 1 0 6.6 2 21 170% 0.5085 0.2967 1.0462 2.3654 0.2897 0.0237 $2,465 $1,438 $5,071 $11,465 $1,404 $115 G46B Complex Endoscopy, Minor Complexity 0 0 1.1 1 3 193% 0.4533 0.3155 0.0133 $0 $0 $0 $2,197 $1,529 $64 G47A Gastroscopy, Major Complexity 0 0 6 2 19 159% 0.2263 0.9243 2.0513 0.2732 0.0236 $0 $1,097 $4,480 $9,943 $1,324 $114 G47B Gastroscopy, Intermediate Complexity 1 0 3 1 9 141% 0.3671 0.9964 0.2466 0.0187 $1,779 $0 $0 $4,830 $1,195 $91 G47C Gastroscopy, Minor Complexity 1 0 1.9 1 6 152% 0.2971 0.6729 0.1953 0.0303 $1,440 $0 $0 $3,262 $947 $147 G48A Colonoscopy, Major Complexity 1 0 5.9 2 18 168% 0.4134 0.2425 0.8812 1.9312 0.2469 0.0737 $2,004 $1,175 $4,271 $9,361 $1,197 $357 G48B Colonoscopy, Minor Complexity 0 0 1.1 1 3 200% 0.3752 0.1654 0.0261 $0 $0 $0 $1,819 $802 $127 G60A Digestive Malignancy, Major Complexity 0 0 7.4 2 24 100% 0 1.0897 2.1496 0.2453 0.0298 $0 $0 $5,282 $10,419 $1,189 $144 G60B Digestive Malignancy, Minor Complexity 1 0 2.9 1 10 100% 0.3285 0.7101 0.2368 0.0346 $1,592 $0 $0 $3,442 $1,148 $168 G61A Gastrointestinal Haemorrhage, Major Complexity 0 0 4 1 13 106% 0.9658 0.2368 0.0211 $0 $0 $0 $4,681 $1,148 $102 G61B Gastrointestinal Haemorrhage, Minor Complexity 1 0 2 1 6 134% 0.1158 0.4577 0.2356 0.0111 $561 $0 $0 $2,218 $1,142 $54 G64A Inflammatory Bowel Disease, Major Complexity 1 0 5 1 15 168% 0.2535 1.1992 0.2725 0.1059 $1,229 $0 $0 $5,813 $1,321 $513 G64B Inflammatory Bowel Disease, Minor Complexity 0 0 1.1 1 3 80% 0.2046 0.3319 0.2167 $0 $0 $0 $992 $1,609 $1,050 G65A Gastrointestinal Obstruction, Major Complexity 0 0 5.6 1 17 114% 1.4611 0.2665 0.0204 $0 $0 $0 $7,082 $1,292 $99 G65B Gastrointestinal Obstruction, Minor Complexity 0 0 2.5 1 8 87% 0.5955 0.2290 0.0168 $0 $0 $0 $2,886 $1,110 $81 G66A Abdominal Pain And Mesenteric Adenitis, Major Complexity 1 0 2.5 1 8 117% 0.1272 0.6003 0.2301 0.0145 $617 $0 $0 $2,910 $1,115 $70 G66B Abdominal Pain And Mesenteric Adenitis, Minor Complexity 0 0 1.2 1 4 127% 0.1956 0.1564 0.0059 $0 $0 $0 $948 $758 $29 G67A Oesophagitis And Gastroenteritis, Major Complexity 0 0 3.5 1 11 107% 0.8822 0.2572 0.0176 $0 $0 $0 $4,276 $1,247 $85 G67B Oesophagitis And Gastroenteritis, Minor Complexity 0 0 1.3 1 4 106% 0.2202 0.1718 0.0067 $0 $0 $0 $1,067 $833 $32 G70A Other Digestive System Disorders, Major Complexity 0 0 5.1 1 16 141% 1.2773 0.2614 0.0165 $0 $0 $0 $6,191 $1,267 $80 G70B Other Digestive System Disorders, Intermediate Complexity 1 0 2.8 1 9 162% 0.166 0.6743 0.2236 0.0155 $805 $0 $0 $3,268 $1,084 $75 G70C Other Digestive System Disorders, Minor Complexity 0 0 1.3 1 4 148% 0.2258 0.1758 0.0084 $0 $0 $0 $1,094 $852 $41 H01A Pancreas, Liver And Shunt Procedures, Major Complexity 0 0 19.2 6 61 100% 2.7917 1.2667 10.2804 0.3047 0.1116 $0 $13,531 $6,140 $49,829 $1,477 $541 H01B Pancreas, Liver And Shunt Procedures, Intermediate Complexity 0 0 7.3 2 26 100% 0.3799 2.2838 4.8594 0.3563 0.0882 $0 $1,841 $11,070 $23,554 $1,727 $428 H01C Pancreas, Liver And Shunt Procedures, Minor Complexity 0 0 2.7 1 9 100% 1.8345 0.4951 0.0754 $0 $0 $0 $8,892 $2,400 $365 H02A Major Biliary Tract Procedures, Major Complexity 0 0 17.3 6 60 100% 1.1794 1.1009 7.734 0.2885 0.0506 $0 $5,717 $5,336 $37,487 $1,398 $245 H02B Major Biliary Tract Procedures, Intermediate Complexity 0 0 9 3 27 100% 0.7252 1.1654 4.2046 0.2933 0.0166 $0 $3,515 $5,649 $20,380 $1,422 $80 H02C Major Biliary Tract Procedures, Minor Complexity 0 0 4.1 1 12 100% 1.7553 0.2551 0.0098 $0 $0 $0 $8,508 $1,236 $48 H05A Hepatobiliary Diagnostic Procedures, Major Complexity 0 0 9.9 3 31 100% 0.8875 1.2686 4.6166 0.2785 0.0768 $0 $4,302 $6,149 $22,377 $1,350 $372 H05B Hepatobiliary Diagnostic Procedures, Intermediate Complexity 0 0 4 1 13 100% 1.7761 0.2833 0.0630 $0 $0 $0 $8,609 $1,373 $305 H05C Hepatobiliary Diagnostic Procedures, Minor Complexity 0 0 1.4 1 4 100% 0.6623 0.3308 0.0303 $0 $0 $0 $3,210 $1,603 $147 H06A Other Hepatobiliary And Pancreas GIs, Major Complexity 0 0 20.1 13 29 100% 0.3476 0.5118 6.985 0.2321 0.0153 $0 $1,685 $2,481 $33,856 $1,125 $74 H06B Other Hepatobiliary And Pancreas GIs, Intermediate Complexity 0 0 8.5 2 25 100% 0.3861 1.3282 2.9469 0.2184 0.0955 $0 $1,871 $6,438 $14,284 $1,059 $463 H06C Other Hepatobiliary And Pancreas GIs, Minor Complexity 0 0 1.6 1 5 100% 1.2819 0.2573 0.0562 $0 $0 $0 $6,213 $1,247 $272 H07A Open Cholecystectomy, Major Complexity 0 0 13.1 5 46 100% 1.4021 0.9148 5.9556 0.2617 0.0207 $0 $6,796 $4,434 $28,867 $1,268 $100 H07B Open Cholecystectomy, Intermediate Complexity 0 0 7.5 2 23 100% 1.1904 1.307 3.7865 0.3197 0.0180 $0 $5,770 $6,335 $18,353 $1,550 $87 H07C Open Cholecystectomy, Minor Complexity 0 0 4.7 1 14 100% 2.783 0.3320 0.0083 $0 $0 $0 $13,489 $1,609 $40 H08A Laparoscopic Cholecystectomy, Major Complexity 0 0 5.8 2 18 100% 0.8367 1.0709 2.9455 0.2788 0.0329 $0 $4,055 $5,191 $14,277 $1,351 $159 H08B Laparoscopic Cholecystectomy, Minor Complexity 0 0 2 1 6 123% 1.5019 0.2803 0.0360 $0 $0 $0 $7,280 $1,359 $174 H09Z Liver Transplant 0 0 21.6 6 63 150% 5.2794 2.9362 22.6774 0.5515 0.2192 $0 $25,589 $14,232 $109,917 $2,673 $1,062 H60A Cirrhosis And Alcoholic Hepatitis, Major Complexity 0 0 11.7 3 36 100% 0 1.2595 3.7437 0.2857 0.0347 $0 $0 $6,105 $18,146 $1,385 $168 H60B Cirrhosis And Alcoholic Hepatitis, Intermediate Complexity 0 0 4.9 1 15 100% 1.368 0.2643 0.0172 $0 $0 $0 $6,631 $1,281 $83 H60C Cirrhosis And Alcoholic Hepatitis, Minor Complexity 1 0 3 1 10 100% 0.3608 0.8074 0.2184 0.0331 $1,749 $0 $0 $3,913 $1,059 $160 H61A Malignancy Of Hepatobiliary System And Pancreas, Major Complexity 0 0 8.6 2 26 100% 0.1576 1.2234 2.5609 0.2677 0.0434 $0 $764 $5,930 $12,413 $1,298 $210 H61B Malignancy Of Hepatobiliary System And Pancreas, Minor Complexity 1 0 3.7 1 11 139% 0.3809 1.0335 0.2483 0.0453 $1,846 $0 $0 $5,009 $1,204 $220 H62A Disorders Of Pancreas, Except Malignancy, Major Complexity 0 0 6.4 2 20 157% 0 0.9678 1.9161 0.2920 0.0195 $0 $0 $4,691 $9,287 $1,415 $95 H62B Disorders Of Pancreas, Except Malignancy, Minor Complexity 1 0 2.8 1 9 157% 0.2613 0.7245 0.2340 0.0128 $1,267 $0 $0 $3,512 $1,134 $62 H63A Other Disorders Of Liver, Major Complexity 0 0 7.4 2 22 136% 0 1.1253 2.0756 0.2589 0.1751 $0 $0 $5,454 $10,060 $1,255 $849 H63B Other Disorders Of Liver, Intermediate Complexity 1 0 3.5 1 11 143% 0.3052 0.884 0.2107 0.0804 $1,479 $0 $0 $4,285 $1,021 $390 H63C Other Disorders Of Liver, Minor Complexity 1 0 2.1 1 6 135% 0.3514 0.5367 0.2184 0.1407 $1,703 $0 $0 $2,601 $1,059 $682 H64A Disorders Of The Biliary Tract, Major Complexity 0 0 7.1 2 22 132% 0.1874 1.0434 2.2271 0.2575 0.0472 $0 $908 $5,057 $10,795 $1,248 $229 H64B Disorders Of The Biliary Tract, Intermediate Complexity 1 0 3.6 1 11 164% 0.3458 1.0345 0.2336 0.0222 $1,676 $0 $0 $5,014 $1,132 $108 H64C Disorders Of The Biliary Tract, Minor Complexity 1 0 2.3 1 7 139% 0.2653 0.638 0.2406 0.0245 $1,286 $0 $0 $3,092 $1,166 $119 H65A Bleeding Oesophageal Varices, Major Complexity 0 0 9.5 3 28 100% 0.396 1.2817 4.1629 0.2996 0.0781 $0 $1,919 $6,212 $20,178 $1,452 $379 H65B Bleeding Oesophageal Varices, Intermediate Complexity 0 0 4.4 1 14 100% 1.7591 0.2888 0.0883 $0 $0 $0 $8,526 $1,400 $428 H65C Bleeding Oesophageal Varices, Minor Complexity 0 0 2.3 1 8 100% 0.8403 0.3477 0.0204 $0 $0 $0 $4,073 $1,685 $99 I01A Bilateral And Multiple Major Joint Procedures Of Lower Limb, Major Complexity 0 0 24.3 8 75 100% 3.8889 0.9987 11.8461 0.2843 0.0321 $0 $18,849 $4,841 $57,418 $1,378 $156 I01B Bilateral And Multiple Major Joint Procedures Of Lower Limb, Minor Complexity 0 0 5.5 2 19 100% 3.6386 1.289 6.2034 0.2626 0.0132 $0 $17,636 $6,248 $30,068 $1,273 $64 I02A Microvascular Tissue Transfers Or Skin Grafts, Excluding Hand, Major Complexity 0 0 33.8 12 115 100% 4.3026 0.9841 16.0832 0.3125 0.0281 $0 $20,855 $4,770 $77,955 $1,515 $136 I02B Microvascular Tissue Transfers Or Skin Grafts, Excluding Hand, Intermediate Comp 0 0 17.1 5 53 100% 1.2897 1.422 8.3629 0.3362 0.0370 $0 $6,251 $6,892 $40,535 $1,630 $179 I02C Microvascular Tissue Transfers Or Skin Grafts, Excluding Hand, Minor Complexity 0 0 6 2 20 89% 0.5082 1.53 3.5504 0.3186 0.0178 $0 $2,463 $7,416 $17,209 $1,544 $86 I03A Hip Replacement For Trauma, Major Complexity 0 0 13.1 4 39 100% 1.8713 0.977 5.7559 0.2630 0.0235 $0 $9,070 $4,736 $27,899 $1,275 $114 I03B Hip Replacement For Trauma, Minor Complexity 0 0 7.4 2 25 100% 1.3809 1.2731 3.9036 0.2303 0.0236 $0 $6,693 $6,171 $18,921 $1,116 $114 I04A Knee Replacement, Major Complexity 0 0 8.4 3 30 100% 2.2511 0.9082 4.9602 0.2614 0.0156 $0 $10,911 $4,402 $24,042 $1,267 $76 I04B Knee Replacement, Minor Complexity 0 0 4.4 1 14 100% 3.7345 0.2278 0.0099 $0 $0 $0 $18,101 $1,104 $48 I05A Other Joint Replacement, Major Complexity 0 0 8.3 2 27 100% 3.0424 1.2531 5.5347 0.2609 0.0138 $0 $14,747 $6,074 $26,827 $1,265 $67
Note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 1.Qld Admitted Acute 5 of 11 qld‐nep‐abf‐priceweights_1920_v3.0
Back to 2019-20 Queensland Admitted Acute Price Weights (Q22) AR-DRG V9.0 See NOTES Queensland Weight (QWAU) see note 4 Queensland Price INDEX DRG CODE Description Same Day Bundled IHPA ALOS Lower Upper Paediatric Same Day Short-Stay Short-Stay Inlier Long-Stay PBS Same Day $ Short-Stay Short-Stay Inlier $ Long-Stay PBS $ Payment ICU Bound Bound Adjustment Outlier Outlier Per Outlier Per Outlier Outlier Per Outlier Per List Base Diem Diem Base $ Diem $ Diem $
I05B Other Joint Replacement, Minor Complexity 0 0 3.2 1 9 100% 3.8173 0.2602 0.0220 $0 $0 $0 $18,502 $1,261 $107 I06Z Spinal Fusion For Deformity 0 0 7.5 2 26 108% 3.8823 3.3147 10.487 0.5077 0.0247 $0 $18,818 $16,066 $50,830 $2,461 $120 I07Z Amputation 0 0 21.3 8 73 100% 1.016 0.863 7.8991 0.2450 0.0208 $0 $4,925 $4,183 $38,287 $1,188 $101 I08A Other Hip And Femur Procedures, Major Complexity 0 0 16.8 5 50 91% 1.5047 1.0423 6.6699 0.2479 0.0464 $0 $7,293 $5,052 $32,329 $1,202 $225 I08B Other Hip And Femur Procedures, Intermediate Complexity 0 0 9.3 3 32 100% 1.1936 0.9518 4.0227 0.2371 0.0264 $0 $5,785 $4,613 $19,498 $1,149 $128 I08C Other Hip And Femur Procedures, Minor Complexity 0 0 5.9 2 19 110% 0.9613 0.9307 2.8011 0.2268 0.0215 $0 $4,659 $4,511 $13,577 $1,099 $104 I09A Spinal Fusion, Major Complexity 0 0 16.7 6 58 100% 4.3054 1.0516 10.5177 0.3005 0.0972 $0 $20,868 $5,097 $50,979 $1,457 $471 I09B Spinal Fusion, Intermediate Complexity 0 0 7 2 23 106% 3.1349 1.6281 6.3664 0.3513 0.0247 $0 $15,195 $7,891 $30,858 $1,703 $120 I09C Spinal Fusion, Minor Complexity 0 0 4 1 13 100% 4.6109 0.4017 0.0282 $0 $0 $0 $22,349 $1,947 $137 I10A Other Back And Neck Procedures, Major Complexity 0 0 8 2 24 100% 1.5927 1.2501 4.075 0.2847 0.0178 $0 $7,720 $6,059 $19,752 $1,380 $86 I10B Other Back And Neck Procedures, Minor Complexity 0 0 2.6 1 9 100% 2.1109 0.2953 0.0081 $0 $0 $0 $10,232 $1,431 $39 I11Z Limb Lengthening Procedures 0 0 5.7 1 14 180% 3.6039 0.3858 0.0204 $0 $0 $0 $17,468 $1,870 $99 I12A Misc Musculoskeletal Procs For Infect/Inflam Of Bone/Joint, Major Complexity 0 0 21.9 15 33 109% 0.7604 0.444 7.3812 0.2146 0.0397 $0 $3,686 $2,152 $35,777 $1,040 $192 I12B Misc Musculoskeletal Procs For Infect/Inflam Of Bone/Joint, Intermediate Comp 0 0 10 3 30 90% 0.5899 0.9588 3.453 0.1938 0.0134 $0 $2,859 $4,647 $16,737 $939 $65 I12C Misc Musculoskeletal Procs For Infect/Inflam Of Bone/Joint, Minor Complexity 0 0 4.3 1 13 123% 1.4295 0.1936 0.0093 $0 $0 $0 $6,929 $938 $45 I13A Humerus, Tibia, Fibula And Ankle Procedures, Major Complexity 0 0 11 4 36 100% 1.2559 0.9311 4.9624 0.2642 0.0178 $0 $6,087 $4,513 $24,053 $1,281 $86 I13B Humerus, Tibia, Fibula And Ankle Procedures, Intermediate Complexity 0 0 4.8 1 15 92% 2.6363 0.2914 0.0150 $0 $0 $0 $12,778 $1,412 $73 I13C Humerus, Tibia, Fibula And Ankle Procedures, Minor Complexity 0 0 2.2 1 7 80% 1.6901 0.3043 0.0145 $0 $0 $0 $8,192 $1,475 $70 I15Z Cranio-Facial Surgery 0 0 4.6 1 14 155% 3.1851 0.2846 0.0077 $0 $0 $0 $15,438 $1,379 $37 I16Z Other Shoulder Procedures 0 0 1.3 1 4 100% 1.551 0.4514 0.0065 $0 $0 $0 $7,518 $2,188 $32 I17A Maxillo-Facial Surgery, Major Complexity 0 0 3.8 1 11 100% 3.1531 0.3970 0.0300 $0 $0 $0 $15,283 $1,924 $145 I17B Maxillo-Facial Surgery, Minor Complexity 0 0 1.5 1 4 100% 1.4644 0.4549 0.0128 $0 $0 $0 $7,098 $2,205 $62 I18A Other Knee Procedures, Major Complexity 1 0 3.6 1 12 107% 0.7195 1.7341 0.2298 0.0120 $3,487 $0 $0 $8,405 $1,114 $58 I18B Other Knee Procedures, Minor Complexity 0 0 1 1 3 161% 0.6964 0.2265 0.0288 $0 $0 $0 $3,375 $1,098 $140 I19A Other Elbow And Forearm Procedures, Major Complexity 0 0 5.7 2 18 100% 1.1496 0.9542 3.0282 0.2785 0.0298 $0 $5,572 $4,625 $14,678 $1,350 $144 I19B Other Elbow And Forearm Procedures, Minor Complexity 0 0 1.6 1 5 90% 1.5454 0.3074 0.0414 $0 $0 $0 $7,491 $1,490 $201 I20A Other Foot Procedures, Major Complexity 0 0 5.6 1 16 107% 2.5355 0.2458 0.0175 $0 $0 $0 $12,290 $1,191 $85 I20B Other Foot Procedures, Minor Complexity 0 0 1.5 1 5 100% 1.2897 0.2836 0.0069 $0 $0 $0 $6,251 $1,375 $33 I21A Local Excision And Removal Of Internal Fixation Devices Of Hip & Femur, Maj Comp 0 0 3.1 1 13 84% 1.7055 0.3096 0.0161 $0 $0 $0 $8,267 $1,501 $78 I21B Local Excision And Removal Of Internal Fixation Devices Of Hip & Femur, Min Comp 0 0 1.1 1 3 100% 0.9591 0.3495 0.0056 $0 $0 $0 $4,649 $1,694 $27 I23A Local Excision & Removal Of Internal Fixation Device, Except Hip & Fmr, Maj Comp 1 0 2.7 1 9 115% 0.6853 1.6923 0.2925 0.0087 $3,322 $0 $0 $8,203 $1,418 $42 I23B Local Excision & Removal Of Internal Fixation Device, Except Hip & Fmr, Min Comp 0 0 1 1 3 100% 0.5811 0.1828 0.0073 $0 $0 $0 $2,817 $886 $35 I24A Arthroscopy, Major Complexity 0 0 3.4 1 10 100% 1.5331 0.2322 0.0110 $0 $0 $0 $7,431 $1,125 $53 I24B Arthroscopy, Minor Complexity 0 0 1.1 1 3 108% 0.7436 0.2758 0.0052 $0 $0 $0 $3,604 $1,337 $25 I25A Bone And Joint Diagnostic Procedures Including Biopsy, Major Complexity 0 0 10 3 35 100% 0.3465 1.3369 4.3053 0.2546 0.0519 $0 $1,679 $6,480 $20,868 $1,234 $252 I25B Bone And Joint Diagnostic Procedures Including Biopsy, Minor Complexity 1 0 3.9 1 13 121% 0.5238 1.4429 0.2086 0.0593 $2,539 $0 $0 $6,994 $1,011 $287 I27A Soft Tissue Procedures, Major Complexity 0 0 9.7 3 29 93% 0.7076 1.1135 4.0185 0.2566 0.0297 $0 $3,430 $5,397 $19,478 $1,244 $144 I27B Soft Tissue Procedures, Minor Complexity 1 0 2.2 1 7 115% 0.6027 1.2492 0.2615 0.0298 $2,921 $0 $0 $6,055 $1,267 $144 I28A Other Musculoskeletal Procedures, Major Complexity 0 0 11.6 4 38 100% 0.9045 0.9235 4.5667 0.2469 0.0317 $0 $4,384 $4,476 $22,135 $1,197 $154 I28B Other Musculoskeletal Procedures, Intermediate Complexity 1 0 2.7 1 8 116% 1.0196 1.7691 0.2057 0.0288 $4,942 $0 $0 $8,575 $997 $140 I28C Other Musculoskeletal Procedures, Minor Complexity 1 0 1.9 1 6 110% 0.5594 1.0374 0.2563 0.0084 $2,711 $0 $0 $5,028 $1,242 $41 I29Z Knee Reconstructions, And Revisions Of Reconstructions 0 0 1.2 1 4 117% 1.7219 0.4766 0.0064 $0 $0 $0 $8,346 $2,310 $31 I30Z Hand Procedures 0 0 1.2 1 4 95% 0.83 0.2487 0.0272 $0 $0 $0 $4,023 $1,205 $132 I31A Revision Of Hip Replacement, Major Complexity 0 0 22.3 8 78 100% 2.9349 0.8718 9.8765 0.2258 0.0324 $0 $14,225 $4,226 $47,871 $1,094 $157 I31B Revision Of Hip Replacement, Intermediate Complexity 0 0 11.4 4 36 100% 3.156 0.8523 6.5495 0.1934 0.0159 $0 $15,297 $4,131 $31,745 $937 $77 I31C Revision Of Hip Replacement, Minor Complexity 0 0 6.2 2 21 100% 2.4184 1.1001 4.6073 0.1732 0.0113 $0 $11,722 $5,332 $22,332 $840 $55 I32A Revision Of Knee Replacement, Major Complexity 0 0 15.5 10 23 100% 3.4026 0.4489 7.8704 0.1847 0.0210 $0 $16,492 $2,176 $38,148 $895 $102 I32B Revision Of Knee Replacement, Minor Complexity 0 0 6.5 2 23 100% 2.4906 1.1893 4.8425 0.2236 0.0267 $0 $12,072 $5,765 $23,472 $1,084 $129 I33A Hip Replacement For Non-Trauma, Major Complexity 0 0 8.5 3 28 100% 2.6495 0.8452 5.1683 0.2480 0.0167 $0 $12,842 $4,097 $25,051 $1,202 $81 I33B Hip Replacement For Non-Trauma, Minor Complexity 0 0 4.2 1 13 100% 3.8794 0.2267 0.0166 $0 $0 $0 $18,803 $1,099 $80 I60Z Femoral Shaft Fractures 0 0 8.3 3 28 92% 0.2372 0.9758 3.1384 0.2572 0.0262 $0 $1,150 $4,730 $15,212 $1,247 $127 I61A Distal Femoral Fractures, Major Complexity 0 0 8.4 2 25 100% 0 1.092 2.1407 0.2203 0.0434 $0 $0 $5,293 $10,376 $1,068 $210 I61B Distal Femoral Fractures, Minor Complexity 0 0 3.3 1 15 100% 0.7547 0.2107 0.0119 $0 $0 $0 $3,658 $1,021 $58 I63A Sprains, Strains And Dislocations Of Hip, Pelvis And Thigh, Major Complexity 0 0 4.4 1 13 100% 1.0402 0.2363 0.0046 $0 $0 $0 $5,042 $1,145 $22 I63B Sprains, Strains And Dislocations Of Hip, Pelvis And Thigh, Minor Complexity 0 0 1.4 1 4 100% 0.2829 0.2176 0.0063 $0 $0 $0 $1,371 $1,055 $31 I64A Osteomyelitis, Major Complexity 0 0 13.9 4 44 100% 0 0.9004 3.5881 0.1738 0.0134 $0 $0 $4,364 $17,392 $842 $65 I64B Osteomyelitis, Minor Complexity 0 0 6.3 2 20 100% 0 0.7199 1.4328 0.1084 0.0070 $0 $0 $3,489 $6,945 $525 $34 I65A Musculoskeletal Malignant Neoplasms, Major Complexity 0 0 10.5 3 31 100% 0 1.1555 3.4106 0.2661 0.0558 $0 $0 $5,601 $16,531 $1,290 $270 I65B Musculoskeletal Malignant Neoplasms, Minor Complexity 0 0 3.9 1 12 113% 1.2764 0.2735 0.0284 $0 $0 $0 $6,187 $1,326 $138 I66A Inflammatory Musculoskeletal Disorders, Major Complexity 0 0 6.7 2 21 108% 0 1.1894 2.3397 0.2774 0.0391 $0 $0 $5,765 $11,341 $1,345 $190 I66B Inflammatory Musculoskeletal Disorders, Minor Complexity 0 0 1.2 1 4 133% 0.3046 0.2597 0.0380 $0 $0 $0 $1,476 $1,259 $184 I67A Septic Arthritis, Major Complexity 0 0 11.2 4 38 100% 0 0.823 3.2786 0.1917 0.0135 $0 $0 $3,989 $15,891 $929 $65 I67B Septic Arthritis, Minor Complexity 0 0 5 1 14 119% 0.8511 0.1334 0.0168 $0 $0 $0 $4,125 $647 $81 I68A Non-Surgical Spinal Disorders, Major Complexity 0 0 5.5 1 16 113% 1.3183 0.2383 0.0105 $0 $0 $0 $6,390 $1,155 $51 I68B Non-Surgical Spinal Disorders, Minor Complexity 0 0 1.5 1 4 165% 0.2837 0.2052 0.0073 $0 $0 $0 $1,375 $995 $35 I69A Bone Diseases And Arthropathies, Major Complexity 0 0 5.1 1 15 80% 1.2216 0.2402 0.0116 $0 $0 $0 $5,921 $1,164 $56 I69B Bone Diseases And Arthropathies, Minor Complexity 0 0 1.7 1 5 137% 0.2921 0.2291 0.0179 $0 $0 $0 $1,416 $1,110 $87 I71A Other Musculotendinous Disorders, Major Complexity 0 0 4.1 1 13 100% 0.9542 0.2368 0.0192 $0 $0 $0 $4,625 $1,148 $93 I71B Other Musculotendinous Disorders, Minor Complexity 0 0 1.3 1 4 156% 0.2345 0.1767 0.0055 $0 $0 $0 $1,137 $856 $27 I72A Specific Musculotendinous Disorders, Major Complexity 0 0 5.7 1 17 100% 1.3025 0.2352 0.0116 $0 $0 $0 $6,313 $1,140 $56 I72B Specific Musculotendinous Disorders, Minor Complexity 0 0 1.8 1 5 114% 0.3365 0.2192 0.0057 $0 $0 $0 $1,631 $1,062 $28 I73A Aftercare Of Musculoskeletal Implants Or Prostheses, Major Complexity 0 0 10.7 3 32 100% 0 0.8585 2.5644 0.1636 0.0110 $0 $0 $4,161 $12,430 $793 $53 I73B Aftercare Of Musculoskeletal Implants Or Prostheses, Intermediate Complexity 0 0 4.2 1 13 106% 0.6487 0.1217 0.0043 $0 $0 $0 $3,144 $590 $21 I73C Aftercare Of Musculoskeletal Implants Or Prostheses, Minor Complexity 0 0 1.3 1 4 163% 0.3156 0.1447 0.0058 $0 $0 $0 $1,530 $701 $28
Note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 1.Qld Admitted Acute 6 of 11 qld‐nep‐abf‐priceweights_1920_v3.0
Back to 2019-20 Queensland Admitted Acute Price Weights (Q22) AR-DRG V9.0 See NOTES Queensland Weight (QWAU) see note 4 Queensland Price INDEX DRG CODE Description Same Day Bundled IHPA ALOS Lower Upper Paediatric Same Day Short-Stay Short-Stay Inlier Long-Stay PBS Same Day $ Short-Stay Short-Stay Inlier $ Long-Stay PBS $ Payment ICU Bound Bound Adjustment Outlier Outlier Per Outlier Per Outlier Outlier Per Outlier Per List Base Diem Diem Base $ Diem $ Diem $
I74A Injuries To Forearm, Wrist, Hand And Foot, Major Complexity 0 0 3.6 1 12 81% 0.7718 0.2171 0.0051 $0 $0 $0 $3,741 $1,052 $25 I74B Injuries To Forearm, Wrist, Hand And Foot, Minor Complexity 0 0 1.1 1 3 133% 0.2823 0.1769 0.0204 $0 $0 $0 $1,368 $857 $99 I75A Injuries To Shoulder, Arm, Elbow, Knee, Leg And Ankle, Major Complexity 0 0 8.3 2 25 100% 0 0.9961 1.9844 0.1995 0.0079 $0 $0 $4,828 $9,618 $967 $38 I75B Injuries To Shoulder, Arm, Elbow, Knee, Leg And Ankle, Intermediate Complexity 0 0 1.9 1 6 138% 0.4019 0.2269 0.0070 $0 $0 $0 $1,948 $1,100 $34 I75C Injuries To Shoulder, Arm, Elbow, Knee, Leg And Ankle, Minor Complexity 0 0 1.2 1 4 161% 0.1795 0.1399 0.0066 $0 $0 $0 $870 $678 $32 I76A Other Musculoskeletal Disorders, Major Complexity 0 0 6 2 18 100% 0.1002 0.8214 1.7287 0.1975 0.0143 $0 $486 $3,981 $8,379 $957 $69 I76B Other Musculoskeletal Disorders, Minor Complexity 0 0 1.3 1 4 129% 0.2864 0.2197 0.0040 $0 $0 $0 $1,388 $1,065 $19 I77A Fractures Of Pelvis, Major Complexity 0 0 8.4 2 25 100% 0 1.0657 2.1203 0.2243 0.0110 $0 $0 $5,165 $10,277 $1,087 $53 I77B Fractures Of Pelvis, Minor Complexity 0 0 3.3 1 10 100% 0.691 0.2194 0.0061 $0 $0 $0 $3,349 $1,063 $30 I78A Fractures Of Neck Of Femur, Major Complexity 0 0 10.5 3 32 100% 0 0.8483 2.5324 0.2015 0.0125 $0 $0 $4,112 $12,275 $977 $61 I78B Fractures Of Neck Of Femur, Minor Complexity 0 0 4.3 1 13 100% 0.8886 0.2180 0.0058 $0 $0 $0 $4,307 $1,057 $28 I79A Pathological Fractures, Major Complexity 0 0 12.3 4 45 100% 0 0.9257 3.6773 0.2667 0.0256 $0 $0 $4,487 $17,824 $1,293 $124 I79B Pathological Fractures, Intermediate Complexity 0 0 6.3 2 21 100% 0 0.9217 1.8082 0.2319 0.0351 $0 $0 $4,467 $8,764 $1,124 $170 I79C Pathological Fractures, Minor Complexity 0 0 3.2 1 10 100% 0.804 0.2578 0.0136 $0 $0 $0 $3,897 $1,250 $66 I80Z Femoral Fractures, Transferred To Acute Facility <2 Days 0 0 1 1 1 100% 0.2312 0.0076 $0 $0 $0 $1,121 $0 $37 J01A Microvas Tiss Transf For Skin, Subcut Tiss & Breast Disorders, Major Complexity 0 0 20 7 64 100% 4.1683 0.9586 10.8515 0.3032 0.0272 $0 $20,204 $4,646 $52,597 $1,470 $132 J01B Microvas Tiss Transf For Skin, Subcut Tiss & Breast Disorders, Minor Complexity 0 0 7.7 2 26 100% 2.6686 2.0979 6.8473 0.2424 0.0172 $0 $12,935 $10,169 $33,189 $1,175 $83 J06A Major Procedures For Breast Disorders, Major Complexity 0 0 5.7 2 19 100% 1.0596 1.0084 3.0408 0.1813 0.0355 $0 $5,136 $4,888 $14,739 $879 $172 J06B Major Procedures For Breast Disorders, Minor Complexity 0 0 2.9 1 9 100% 1.9384 0.1768 0.0391 $0 $0 $0 $9,395 $857 $190 J07Z Minor Procedures For Breast Disorders 0 0 1.1 1 3 100% 0.9904 0.4245 0.0217 $0 $0 $0 $4,800 $2,058 $105 J08A Other Skin Grafts And Debridement Procedures, Major Complexity 0 0 16.1 5 48 100% 0.4751 1.0014 5.4502 0.2611 0.0318 $0 $2,303 $4,854 $26,417 $1,266 $154 J08B Other Skin Grafts And Debridement Procedures, Intermediate Complexity 1 0 4.5 1 14 114% 0.6555 1.6188 0.2352 0.0295 $3,177 $0 $0 $7,846 $1,140 $143 J08C Other Skin Grafts And Debridement Procedures, Minor Complexity 1 0 2.4 1 8 121% 0.6154 1.2792 0.2145 0.0294 $2,983 $0 $0 $6,200 $1,040 $143 J09Z Perianal And Pilonidal Procedures 0 0 2 1 7 114% 0.6978 0.2681 0.0371 $0 $0 $0 $3,382 $1,299 $180 J10A Plastic GIs For Skin, Subcutaneous Tissue And Breast Disorders, Major Comp 1 0 4.5 1 14 100% 0.6941 2.0694 0.2388 0.0337 $3,364 $0 $0 $10,030 $1,157 $163 J10B Plastic GIs For Skin, Subcutaneous Tissue And Breast Disorders, Minor Comp 0 0 1.1 1 3 106% 0.632 0.2177 0.0253 $0 $0 $0 $3,063 $1,055 $123 J11A Other Skin, Subcutaneous Tissue And Breast Procedures, Major Complexity 1 0 4.6 1 13 110% 0.5773 1.4086 0.2228 0.0350 $2,798 $0 $0 $6,827 $1,080 $170 J11B Other Skin, Subcutaneous Tissue And Breast Procedures, Minor Complexity 0 0 1 1 3 100% 0.4437 0.1691 0.0277 $0 $0 $0 $2,151 $820 $134 J12A Lower Limb Procedures W Ulcer Or Cellulitis, Major Complexity 0 0 16.5 5 53 100% 0.3324 0.9462 5.0486 0.2480 0.0147 $0 $1,611 $4,586 $24,471 $1,202 $71 J12B Lower Limb Procedures W Ulcer Or Cellulitis, Minor Complexity 0 0 6.3 2 20 100% 0.2799 0.8935 2.0537 0.2333 0.0133 $0 $1,357 $4,331 $9,954 $1,131 $64 J13A Lower Limb Procedures W/O Ulcer Or Cellulitis, Major Complexity 0 0 7.6 2 23 100% 0.553 1.1578 2.8607 0.2615 0.0080 $0 $2,680 $5,612 $13,866 $1,267 $39 J13B Lower Limb Procedures W/O Ulcer Or Cellulitis, Minor Complexity 1 0 3.7 1 12 100% 0.5806 1.4676 0.2177 0.0202 $2,814 $0 $0 $7,113 $1,055 $98 J14Z Major Breast Reconstructions 0 0 6.5 2 19 100% 0.8233 2.1384 5.0086 0.3364 0.0914 $0 $3,991 $10,365 $24,277 $1,631 $443 J60A Skin Ulcers, Major Complexity 0 0 10.1 3 32 100% 0 0.872 2.6057 0.2100 0.0102 $0 $0 $4,227 $12,630 $1,018 $49 J60B Skin Ulcers, Intermediate Complexity 1 0 5.2 1 16 100% 0.1768 1.0039 0.1650 0.0046 $857 $0 $0 $4,866 $800 $22 J60C Skin Ulcers, Minor Complexity 1 0 4.1 1 13 100% 0.1863 0.6235 0.1327 0.0101 $903 $0 $0 $3,022 $643 $49 J62A Malignant Breast Disorders, Major Complexity 0 0 7.7 2 23 100% 0 1.1235 2.1418 0.2492 0.1053 $0 $0 $5,446 $10,381 $1,208 $510 J62B Malignant Breast Disorders, Minor Complexity 1 0 4.3 1 13 100% 0.2874 0.8351 0.1619 0.0805 $1,393 $0 $0 $4,048 $785 $390 J63A Non-Malignant Breast Disorders, Major Complexity 1 0 2.9 1 9 100% 0.2536 0.7723 0.1926 0.0064 $1,229 $0 $0 $3,743 $934 $31 J63B Non-Malignant Breast Disorders, Minor Complexity 1 0 2.8 1 8 100% 0.2556 0.5659 0.1522 0.0128 $1,239 $0 $0 $2,743 $738 $62 J64A Cellulitis, Major Complexity 0 0 5.4 1 18 93% 1.3322 0.2211 0.0127 $0 $0 $0 $6,457 $1,072 $62 J64B Cellulitis, Minor Complexity 1 0 2.8 1 9 121% 0.1676 0.6565 0.1436 0.0081 $812 $0 $0 $3,182 $696 $39 J65A Trauma To Skin, Subcutaneous Tissue And Breast, Major Complexity 1 0 4.7 1 15 91% 0.1333 1.0859 0.2232 0.0127 $646 $0 $0 $5,263 $1,082 $62 J65B Trauma To Skin, Subcutaneous Tissue And Breast, Minor Complexity 0 0 1.2 1 4 150% 0.1979 0.1545 0.0069 $0 $0 $0 $959 $749 $33 J67A Minor Skin Disorders, Major Complexity 1 0 4 1 12 110% 0.2535 1.0335 0.2434 0.0105 $1,229 $0 $0 $5,009 $1,180 $51 J67B Minor Skin Disorders, Minor Complexity 1 0 1.9 1 6 122% 0.2266 0.4404 0.1879 0.0271 $1,098 $0 $0 $2,135 $911 $131 J68A Major Skin Disorders, Major Complexity 1 0 5.1 1 15 100% 0.2039 1.4752 0.2745 0.0211 $988 $0 $0 $7,150 $1,331 $102 J68B Major Skin Disorders, Minor Complexity 1 0 2.8 1 9 118% 0.1702 0.7213 0.2346 0.0177 $825 $0 $0 $3,496 $1,137 $86 J69A Skin Malignancy, Major Complexity 0 0 8.2 3 27 100% 0 0.8889 2.4978 0.2381 0.1690 $0 $0 $4,308 $12,107 $1,154 $819 J69B Skin Malignancy, Minor Complexity 1 0 4.9 1 15 100% 0.1901 1.0862 0.1614 0.0705 $921 $0 $0 $5,265 $782 $342 K01A GIs For Diabetic Complications, Major Complexity 0 0 28.1 10 92 100% 0.6156 0.8727 9.3182 0.2475 0.0241 $0 $2,984 $4,230 $45,165 $1,200 $117 K01B GIs For Diabetic Complications, Intermediate Complexity 0 0 14.1 4 42 100% 0.2924 1.057 4.5046 0.2414 0.0156 $0 $1,417 $5,123 $21,834 $1,170 $76 K01C GIs For Diabetic Complications, Minor Complexity 0 0 6.3 2 19 100% 0.3206 1.1026 2.5129 0.2538 0.0130 $0 $1,554 $5,344 $12,180 $1,230 $63 K02Z Pituitary Procedures 0 0 6.7 2 21 100% 1.6944 1.3591 4.395 0.3576 0.0175 $0 $8,213 $6,588 $21,303 $1,733 $85 K03Z Adrenal Procedures 0 0 5.1 2 20 100% 1.0038 1.5175 3.8132 0.4020 0.2256 $0 $4,865 $7,355 $18,483 $1,948 $1,093 K05A Parathyroid Procedures, Major Complexity 0 0 5.2 1 15 100% 2.851 0.2951 0.0805 $0 $0 $0 $13,819 $1,430 $390 K05B Parathyroid Procedures, Minor Complexity 0 0 1.4 1 4 100% 1.3186 0.3527 0.0848 $0 $0 $0 $6,391 $1,710 $411 K06A Thyroid Procedures, Major Complexity 0 0 3.9 1 12 100% 3.0995 0.3484 0.0189 $0 $0 $0 $15,023 $1,689 $92 K06B Thyroid Procedures, Minor Complexity 0 0 1.5 1 5 100% 1.7436 0.4665 0.0285 $0 $0 $0 $8,451 $2,261 $138 K08Z Thyroglossal Procedures 0 0 1.3 1 4 94% 1.2837 0.4403 0.0239 $0 $0 $0 $6,222 $2,134 $116 K09A Other Endocrine, Nutritional And Metabolic GIs, Major Complexity 0 0 15.5 5 50 120% 0.7607 1.1642 6.5299 0.3154 0.0520 $0 $3,687 $5,643 $31,650 $1,529 $252 K09B Other Endocrine, Nutritional And Metabolic GIs, Minor Complexity 0 0 5.2 1 14 100% 2.326 0.2725 0.0164 $0 $0 $0 $11,274 $1,321 $79 K10Z Revisional And Open Bariatric Procedures 0 0 5.4 3 30 100% 1.685 0.6333 3.4437 0.2516 0.1414 $0 $8,167 $3,070 $16,692 $1,220 $685 K11Z Major Laparoscopic Bariatric Procedures 0 0 2.8 1 8 100% 2.2379 0.4388 0.0142 $0 $0 $0 $10,847 $2,127 $69 K12Z Other Bariatric Procedures 0 0 1.5 1 7 100% 1.6273 0.4522 0.0606 $0 $0 $0 $7,888 $2,192 $294 K13Z Plastic GIs For Endocrine, Nutritional And Metabolic Disorders 0 0 5 1 12 100% 2.2046 0.3014 0.0412 $0 $0 $0 $10,686 $1,461 $200 K40A Endoscopic And Investigative Procedures For Metabolic Disorders, Major Comp 0 0 9.4 3 29 105% 0.2851 1.1513 3.7086 0.2692 0.0305 $0 $1,382 $5,580 $17,976 $1,305 $148 K40B Endoscopic And Investigative Procedures For Metabolic Disorders, Minor Comp 0 0 1 1 3 195% 0.3928 0.3092 0.0179 $0 $0 $0 $1,904 $1,499 $87 K60A Diabetes, Major Complexity 0 0 5.2 1 17 143% 1.5558 0.2548 0.0166 $0 $0 $0 $7,541 $1,235 $80 K60B Diabetes, Minor Complexity 1 0 3.1 1 9 186% 0.1405 0.7764 0.2081 0.0124 $681 $0 $0 $3,763 $1,009 $60 K61A Severe Nutritional Disturbance, Major Complexity 0 0 11.9 4 37 134% 0 0.9714 3.8692 0.2878 0.0163 $0 $0 $4,708 $18,754 $1,395 $79 K61B Severe Nutritional Disturbance, Minor Complexity 0 0 5.9 2 19 100% 0 0.988 1.9692 0.2663 0.0068 $0 $0 $4,789 $9,545 $1,291 $33 K62A Miscellaneous Metabolic Disorders, Major Complexity 0 0 5.7 2 18 138% 0 0.8699 1.7185 0.2374 0.0213 $0 $0 $4,216 $8,330 $1,151 $103 K62B Miscellaneous Metabolic Disorders, Intermediate Complexity 1 0 2.7 1 9 144% 0.1608 0.7009 0.2457 0.0250 $779 $0 $0 $3,397 $1,191 $121
Note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 1.Qld Admitted Acute 7 of 11 qld‐nep‐abf‐priceweights_1920_v3.0
Back to 2019-20 Queensland Admitted Acute Price Weights (Q22) AR-DRG V9.0 See NOTES Queensland Weight (QWAU) see note 4 Queensland Price INDEX DRG CODE Description Same Day Bundled IHPA ALOS Lower Upper Paediatric Same Day Short-Stay Short-Stay Inlier Long-Stay PBS Same Day $ Short-Stay Short-Stay Inlier $ Long-Stay PBS $ Payment ICU Bound Bound Adjustment Outlier Outlier Per Outlier Per Outlier Outlier Per Outlier Per List Base Diem Diem Base $ Diem $ Diem $
K62C Miscellaneous Metabolic Disorders, Minor Complexity 1 0 1.9 1 6 157% 0.1216 0.4519 0.2742 0.0303 $589 $0 $0 $2,190 $1,329 $147 K63A Inborn Errors Of Metabolism, Major Complexity 0 0 3.8 1 11 111% 1.2197 0.3572 0.0055 $0 $0 $0 $5,912 $1,731 $27 K63B Inborn Errors Of Metabolism, Minor Complexity 0 0 1.1 1 3 157% 0.2195 0.1650 0.0060 $0 $0 $0 $1,064 $800 $29 K64A Endocrine Disorders, Major Complexity 1 0 4.5 1 14 171% 0.3813 1.3917 0.2454 0.0560 $1,848 $0 $0 $6,746 $1,189 $271 K64B Endocrine Disorders, Minor Complexity 1 0 2.3 1 7 200% 0.1561 0.6294 0.2474 0.0295 $757 $0 $0 $3,051 $1,199 $143 L02A Operative Insertion Of Peritoneal Catheter For Dialysis, Major Complexity 0 0 9.9 3 28 156% 0.5365 1.1268 3.9081 0.2728 0.0087 $0 $2,600 $5,462 $18,943 $1,322 $42 L02B Operative Insertion Of Peritoneal Catheter For Dialysis, Minor Complexity 0 0 1.5 1 5 100% 1.1131 0.3368 0.0174 $0 $0 $0 $5,395 $1,632 $84 L03A Kidney, Ureter And Major Bladder Procedures For Neoplasm, Major Complexity 0 0 12.7 4 44 100% 2.1408 1.3839 7.6581 0.3641 0.0183 $0 $10,376 $6,708 $37,119 $1,765 $89 L03B Kidney, Ureter And Major Bladder Procedures For Neoplasm, Intermediate Comp 0 0 5.6 2 18 100% 0.9979 1.6463 4.2671 0.3597 0.0235 $0 $4,837 $7,980 $20,683 $1,743 $114 L03C Kidney, Ureter And Major Bladder Procedures For Neoplasm, Minor Complexity 0 0 3.2 1 10 100% 2.6725 0.5521 0.0193 $0 $0 $0 $12,954 $2,676 $94 L04A Kidney, Ureter And Major Bladder Procedures For Non-Neoplasm, Major Complexity 0 0 10.5 3 31 100% 1.003 1.2548 4.749 0.3060 0.0183 $0 $4,862 $6,082 $23,018 $1,483 $89 L04B Kidney, Ureter And Major Bladder Procedures For Non-Neoplasm, Intermediate Comp 1 0 3.9 1 13 100% 0.8439 2.2324 0.2519 0.0302 $4,090 $0 $0 $10,820 $1,221 $146 L04C Kidney, Ureter And Major Bladder Procedures For Non-Neoplasm, Minor Complexity 1 0 1.8 1 6 141% 0.7892 1.4321 0.3421 0.0269 $3,825 $0 $0 $6,941 $1,658 $130 L05A Transurethral Prostatectomy For Urinary Disorder, Major Complexity 0 0 6.8 2 26 100% 0.5911 1.0607 2.6909 0.2815 0.0216 $0 $2,865 $5,141 $13,043 $1,364 $105 L05B Transurethral Prostatectomy For Urinary Disorder, Minor Complexity 0 0 2.3 1 7 100% 1.2615 0.2284 0.0111 $0 $0 $0 $6,114 $1,107 $54 L06A Minor Bladder Procedures, Major Complexity 0 0 11.2 4 37 100% 0.7939 0.9246 4.4588 0.2823 0.0334 $0 $3,848 $4,482 $21,612 $1,368 $162 L06B Minor Bladder Procedures, Intermediate Complexity 0 0 3.6 1 13 100% 1.6942 0.2597 0.0323 $0 $0 $0 $8,212 $1,259 $157 L06C Minor Bladder Procedures, Minor Complexity 1 0 2 1 6 100% 0.5557 1.0892 0.2474 0.0115 $2,693 $0 $0 $5,279 $1,199 $56 L07A Other Transurethral Procedures, Major Complexity 0 0 4.9 1 16 100% 1.8764 0.2621 0.0088 $0 $0 $0 $9,095 $1,270 $43 L07B Other Transurethral Procedures, Minor Complexity 0 0 1.3 1 4 111% 0.755 0.2989 0.0149 $0 $0 $0 $3,659 $1,449 $72 L08A Urethral Procedures, Major Complexity 1 0 3.6 1 14 100% 0.6508 1.9448 0.2734 0.0711 $3,154 $0 $0 $9,426 $1,325 $345 L08B Urethral Procedures, Minor Complexity 0 0 1.3 1 4 82% 0.8702 0.3032 0.0275 $0 $0 $0 $4,218 $1,470 $133 L09A Other Procedures For Kidney And Urinary Tract Disorders, Major Complexity 0 0 16 5 53 100% 0.7978 1.0689 6.1088 0.3044 0.0337 $0 $3,867 $5,181 $29,609 $1,475 $163 L09B Other Procedures For Kidney And Urinary Tract Disorders, Intermediate Complexity 0 0 3.8 1 11 100% 1.9354 0.2452 0.0081 $0 $0 $0 $9,381 $1,188 $39 L09C Other Procedures For Kidney And Urinary Tract Disorders, Minor Complexity 0 0 1.2 1 4 80% 1.0885 0.3232 0.0112 $0 $0 $0 $5,276 $1,567 $54 L10A Kidney Transplant, Age <=16 Years Or Major Complexity 0 0 14.4 4 38 108% 2.2248 2.2465 11.1906 0.4427 0.0202 $0 $10,784 $10,889 $54,241 $2,146 $98 L10B Kidney Transplant, Age >=17 Years And Minor Complexity 0 0 8 2 24 100% 2.2124 2.8354 7.8598 0.4246 0.0234 $0 $10,724 $13,743 $38,096 $2,058 $113 L40Z Ureteroscopy 0 0 1.6 1 5 100% 0.8109 0.2918 0.0307 $0 $0 $0 $3,930 $1,414 $149 L41Z Cystourethroscopy For Urinary Disorder, Sameday 0 0 1 1 1 200% 0.2352 0.0096 $0 $0 $0 $1,140 $0 $47 L42Z Esw Lithotripsy 0 0 1.1 1 3 100% 0.6128 0.2452 0.0539 $0 $0 $0 $2,970 $1,188 $261 L60A Kidney Failure, Major Complexity 0 0 10.4 3 34 100% 0 1.1162 3.2994 0.2652 0.0491 $0 $0 $5,410 $15,992 $1,285 $238 L60B Kidney Failure, Intermediate Complexity 1 0 4.4 1 14 155% 0.3957 1.2022 0.2504 0.0361 $1,918 $0 $0 $5,827 $1,214 $175 L60C Kidney Failure, Minor Complexity 1 0 2.3 1 7 163% 0.8329 0.4929 0.2280 0.1258 $4,037 $0 $0 $2,389 $1,105 $610 L61Z Haemodialysis 0 0 1 1 3 195% 0.1026 0.0872 0.0064 $0 $0 $0 $497 $423 $31 L62A Kidney And Urinary Tract Neoplasms, Major Complexity 0 0 9.9 3 32 100% 0 1.0025 2.9803 0.2423 0.0273 $0 $0 $4,859 $14,446 $1,174 $132 L62B Kidney And Urinary Tract Neoplasms, Intermediate Complexity 0 0 4.3 1 13 148% 1.1862 0.2272 0.0172 $0 $0 $0 $5,750 $1,101 $83 L62C Kidney And Urinary Tract Neoplasms, Minor Complexity 0 0 1.6 1 5 159% 0.4403 0.2320 0.0283 $0 $0 $0 $2,134 $1,125 $137 L63A Kidney And Urinary Tract Infections, Major Complexity 0 0 4.7 1 14 100% 1.1555 0.2356 0.0111 $0 $0 $0 $5,601 $1,142 $54 L63B Kidney And Urinary Tract Infections, Minor Complexity 1 0 2.2 1 8 126% 0.1062 0.5297 0.2080 0.0082 $515 $0 $0 $2,567 $1,008 $40 L64A Urinary Stones And Obstruction, Major Complexity 1 0 2.6 1 8 183% 0.1444 0.8752 0.2660 0.0174 $700 $0 $0 $4,242 $1,289 $84 L64B Urinary Stones And Obstruction, Minor Complexity 0 0 1.2 1 4 200% 0.2433 0.1668 0.0097 $0 $0 $0 $1,179 $808 $47 L65A Kidney And Urinary Tract Signs And Symptoms, Major Complexity 0 0 4.9 1 16 117% 1.284 0.2497 0.0137 $0 $0 $0 $6,224 $1,210 $66 L65B Kidney And Urinary Tract Signs And Symptoms, Minor Complexity 1 0 2.1 1 6 167% 0.1283 0.5298 0.2325 0.0080 $622 $0 $0 $2,568 $1,127 $39 L66Z Urethral Stricture 0 0 1.6 1 5 80% 0.5554 0.2475 0.0037 $0 $0 $0 $2,692 $1,200 $18 L67A Other Kidney And Urinary Tract Disorders, Major Complexity 1 0 5.1 1 16 148% 0.2685 1.4067 0.2513 0.0167 $1,301 $0 $0 $6,818 $1,218 $81 L67B Other Kidney And Urinary Tract Disorders, Intermediate Complexity 1 0 2.2 1 7 200% 0.2099 0.5658 0.2147 0.0172 $1,017 $0 $0 $2,742 $1,041 $83 L67C Other Kidney And Urinary Tract Disorders, Minor Complexity 0 0 1 1 3 200% 0.1908 0.1548 0.0061 $0 $0 $0 $925 $750 $30 L68Z Peritoneal Dialysis 0 0 1 1 3 200% 0.1625 0.1098 0.0007 $0 $0 $0 $788 $532 $3 M01A Major Male Pelvic Procedures, Major Complexity 0 0 5.8 2 19 100% 2.4417 1.0042 4.4388 0.3134 0.0113 $0 $11,835 $4,867 $21,515 $1,519 $55 M01B Major Male Pelvic Procedures, Minor Complexity 0 0 3.1 1 10 100% 3.2628 0.1907 0.0140 $0 $0 $0 $15,815 $924 $68 M02A Transurethral Prostatectomy For Reproductive System Disorder, Major Complexity 0 0 5.5 2 19 100% 0.5477 0.8923 2.3231 0.2637 0.0093 $0 $2,655 $4,325 $11,260 $1,278 $45 M02B Transurethral Prostatectomy For Reproductive System Disorder, Minor Complexity 0 0 2.3 1 7 100% 1.296 0.2746 0.0112 $0 $0 $0 $6,282 $1,331 $54 M03A Penis Procedures, Major Complexity 0 0 2.8 1 6 81% 1.6035 0.3982 0.1290 $0 $0 $0 $7,772 $1,930 $625 M03B Penis Procedures, Minor Complexity 0 0 1.2 1 4 118% 0.785 0.2787 0.0817 $0 $0 $0 $3,805 $1,351 $396 M04Z Testes Procedures 0 0 1.2 1 4 93% 0.8266 0.2987 0.0225 $0 $0 $0 $4,007 $1,448 $109 M05Z Circumcision 0 0 1 1 3 100% 0.6303 0.2165 0.0094 $0 $0 $0 $3,055 $1,049 $46 M06A Other Male Reproductive System GIs, Major Complexity 1 0 9 2 25 100% 0.8188 0.7609 1.5151 3.7674 0.2920 0.0236 $3,969 $3,688 $7,344 $18,261 $1,415 $114 M06B Other Male Reproductive System GIs, Minor Complexity 0 0 1.4 1 5 100% 1.5562 0.2831 0.0108 $0 $0 $0 $7,543 $1,372 $52 M40Z Cystourethroscopy For Male Reproductive System Disorder, Sameday 0 0 1 1 1 100% 0.2575 0.0252 $0 $0 $0 $1,248 $0 $122 M60A Male Reproductive System Malignancy, Major Complexity 0 0 6.5 2 20 100% 0.1085 0.9477 1.9291 0.2263 0.0747 $0 $526 $4,594 $9,350 $1,097 $362 M60B Male Reproductive System Malignancy, Minor Complexity 0 0 1.1 1 4 100% 0.4129 0.2488 0.0279 $0 $0 $0 $2,001 $1,206 $135 M61A Benign Prostatic Hypertrophy, Major Complexity 0 0 5.1 1 14 100% 1.261 0.2214 0.0139 $0 $0 $0 $6,112 $1,073 $67 M61B Benign Prostatic Hypertrophy, Minor Complexity 0 0 1.3 1 4 100% 0.389 0.2350 0.0069 $0 $0 $0 $1,885 $1,139 $33 M62A Male Reproductive System Inflammation, Major Complexity 1 0 4.9 1 15 100% 0.222 1.1511 0.2060 0.0289 $1,076 $0 $0 $5,579 $998 $140 M62B Male Reproductive System Inflammation, Minor Complexity 1 0 2.4 1 7 124% 0.1335 0.5309 0.1874 0.0167 $647 $0 $0 $2,573 $908 $81 M63Z Male Sterilisation Procedures 0 0 1 1 3 100% 0.4782 0.1589 0.0076 $0 $0 $0 $2,318 $770 $37 M64A Other Male Reproductive System Disorders, Major Complexity 0 0 2.3 1 8 100% 0.5945 0.2514 0.0334 $0 $0 $0 $2,882 $1,219 $162 M64B Other Male Reproductive System Disorders, Minor Complexity 0 0 1.1 1 3 135% 0.2384 0.1517 0.0103 $0 $0 $0 $1,156 $735 $50 N01Z Pelvic Evisceration And Radical Vulvectomy 0 0 6.6 2 20 100% 1.2917 1.5107 4.2812 0.4429 0.0319 $0 $6,261 $7,322 $20,751 $2,147 $155 N04A Hysterectomy For Non-Malignancy, Major Complexity 0 0 4.1 1 13 100% 2.922 0.3805 0.0160 $0 $0 $0 $14,163 $1,844 $78 N04B Hysterectomy For Non-Malignancy, Minor Complexity 0 0 2.5 1 8 100% 2.0781 0.3477 0.0182 $0 $0 $0 $10,073 $1,685 $88 N05A Oophorectomy And Complex Fallopian Tube Procedures For Non-Malignancy, Maj Comp 0 0 4 1 13 100% 2.6069 0.3521 0.0205 $0 $0 $0 $12,636 $1,707 $99 N05B Oophorectomy And Complex Fallopian Tube Procedures For Non-Malignancy, Min Comp 0 0 1.5 1 5 100% 1.468 0.3767 0.0145 $0 $0 $0 $7,115 $1,826 $70 N06A Female Reproductive System Reconstructive Procedures, Major Complexity 0 0 3.4 1 11 100% 2.2463 0.3004 0.0076 $0 $0 $0 $10,888 $1,456 $37
Note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 1.Qld Admitted Acute 8 of 11 qld‐nep‐abf‐priceweights_1920_v3.0
Back to 2019-20 Queensland Admitted Acute Price Weights (Q22) AR-DRG V9.0 See NOTES Queensland Weight (QWAU) see note 4 Queensland Price INDEX DRG CODE Description Same Day Bundled IHPA ALOS Lower Upper Paediatric Same Day Short-Stay Short-Stay Inlier Long-Stay PBS Same Day $ Short-Stay Short-Stay Inlier $ Long-Stay PBS $ Payment ICU Bound Bound Adjustment Outlier Outlier Per Outlier Per Outlier Outlier Per Outlier Per List Base Diem Diem Base $ Diem $ Diem $
N06B Female Reproductive System Reconstructive Procedures, Minor Complexity 0 0 1.8 1 6 100% 1.3811 0.3657 0.0153 $0 $0 $0 $6,694 $1,773 $74 N07A Other Uterus And Adnexa Procedures For Non-Malignancy, Major Complexity 1 0 2 1 6 100% 0.8657 1.5606 0.3000 0.0194 $4,196 $0 $0 $7,564 $1,454 $94 N07B Other Uterus And Adnexa Procedures For Non-Malignancy, Minor Complexity 0 0 1 1 3 100% 0.5658 0.1949 0.0099 $0 $0 $0 $2,742 $945 $48 N08Z Endoscopic And Laparoscopic Procedures, Female Reproductive System 1 0 2.1 1 6 105% 0.7673 1.3746 0.2820 0.0153 $3,719 $0 $0 $6,663 $1,367 $74 N09A Other Vagina, Cervix And Vulva Procedures, Major Complexity 0 0 2.1 1 7 100% 1.0569 0.3346 0.0097 $0 $0 $0 $5,123 $1,622 $47 N09B Other Vagina, Cervix And Vulva Procedures, Minor Complexity 0 0 1 1 3 121% 0.5035 0.1981 0.0103 $0 $0 $0 $2,440 $960 $50 N10Z Diagnostic Curettage And Diagnostic Hysteroscopy 0 0 1.1 1 3 100% 0.5002 0.1692 0.0080 $0 $0 $0 $2,424 $820 $39 N11A Other Female Reproductive System GIs, Major Complexity 0 0 6.6 1 17 100% 2.3964 0.3170 0.0233 $0 $0 $0 $11,615 $1,536 $113 N11B Other Female Reproductive System GIs, Minor Complexity 0 0 1 1 3 100% 0.3668 0.2941 0.0013 $0 $0 $0 $1,778 $1,426 $6 N12A Uterus And Adnexa Procedures For Malignancy, Major Complexity 0 0 9.5 3 31 100% 1.3723 1.3937 5.4944 0.3968 0.0589 $0 $6,652 $6,755 $26,631 $1,923 $285 N12B Uterus And Adnexa Procedures For Malignancy, Intermediate Complexity 0 0 4.3 1 14 100% 3.0409 0.3552 0.0209 $0 $0 $0 $14,739 $1,722 $101 N12C Uterus And Adnexa Procedures For Malignancy, Minor Complexity 0 0 2.3 1 8 100% 2.0879 0.3639 0.0078 $0 $0 $0 $10,120 $1,764 $38 N60A Female Reproductive System Malignancy, Major Complexity 0 0 9 3 29 100% 0 0.9363 2.7932 0.2384 0.0157 $0 $0 $4,538 $13,539 $1,156 $76 N60B Female Reproductive System Malignancy, Minor Complexity 0 0 2.5 1 8 179% 0.7661 0.2729 0.0174 $0 $0 $0 $3,713 $1,323 $84 N61A Female Reproductive System Infections, Major Complexity 0 0 3.2 1 10 100% 0.8669 0.2657 0.0112 $0 $0 $0 $4,202 $1,288 $54 N61B Female Reproductive System Infections, Minor Complexity 0 0 1.5 1 5 100% 0.3444 0.2742 0.0075 $0 $0 $0 $1,669 $1,329 $36 N62A Menstrual And Other Female Reproductive System Disorders, Major Complexity 0 0 2.2 1 7 128% 0.5854 0.2641 0.0086 $0 $0 $0 $2,837 $1,280 $42 N62B Menstrual And Other Female Reproductive System Disorders, Minor Complexity 0 0 1.1 1 4 158% 0.2329 0.1604 0.0077 $0 $0 $0 $1,129 $777 $37 O01A Caesarean Delivery, Major Complexity 0 0 6.7 2 21 100% 0.7729 1.2271 3.1885 0.2663 0.0386 $0 $3,746 $5,948 $15,455 $1,291 $187 O01B Caesarean Delivery, Intermediate Complexity 0 0 4.1 1 13 100% 2.262 0.2463 0.0137 $0 $0 $0 $10,964 $1,194 $66 O01C Caesarean Delivery, Minor Complexity 0 0 3 1 9 100% 1.8707 0.2817 0.0132 $0 $0 $0 $9,067 $1,365 $64 O02A Vaginal Delivery W GIs, Major Complexity 0 0 4.1 1 12 100% 2.3555 0.3290 0.0242 $0 $0 $0 $11,417 $1,595 $117 O02B Vaginal Delivery W GIs, Minor Complexity 0 0 2.8 1 9 100% 1.6647 0.3413 0.0143 $0 $0 $0 $8,069 $1,654 $69 O03Z Ectopic Pregnancy 0 0 1.7 1 5 100% 1.0851 0.3231 0.0217 $0 $0 $0 $5,259 $1,566 $105 O04A Postpartum And Post Abortion W GIs, Major Complexity 0 0 4.3 1 13 100% 2.0152 0.3467 0.0165 $0 $0 $0 $9,768 $1,680 $80 O04B Postpartum And Post Abortion W GIs, Minor Complexity 1 0 2.1 1 7 100% 0.5175 1.0474 0.3519 0.0170 $2,508 $0 $0 $5,077 $1,706 $82 O05Z Abortion W GIs 0 0 1.1 1 3 100% 0.4909 0.2085 0.0206 $0 $0 $0 $2,379 $1,011 $100 O60A Vaginal Delivery, Major Complexity 0 0 3.7 1 12 100% 1.6839 0.2818 0.0122 $0 $0 $0 $8,162 $1,366 $59 O60B Vaginal Delivery, Intermediate Complexity 0 0 2.4 1 7 112% 1.1491 0.3182 0.0133 $0 $0 $0 $5,570 $1,542 $64 O60C Vaginal Delivery, Minor Complexity 0 0 1.8 1 5 100% 0.8454 0.3354 0.0131 $0 $0 $0 $4,098 $1,626 $63 O61A Postpartum And Post Abortion W/O GIs, Major Complexity 0 0 4.4 1 13 100% 1.2087 0.2591 0.0083 $0 $0 $0 $5,859 $1,256 $40 O61B Postpartum And Post Abortion W/O GIs, Minor Complexity 1 0 2.2 1 7 100% 0.1411 0.6184 0.2149 0.0094 $684 $0 $0 $2,997 $1,042 $46 O63A Abortion W/O GIs, Major Complexity 0 0 1.6 1 5 100% 0.6813 0.4623 0.0217 $0 $0 $0 $3,302 $2,241 $105 O63B Abortion W/O GIs, Minor Complexity 0 0 1.1 1 3 100% 0.2099 0.1629 0.0095 $0 $0 $0 $1,017 $790 $46 O66A Antenatal And Other Obstetric Admissions, Major Complexity 1 0 3.1 1 10 100% 0.2053 0.9003 0.2276 0.0087 $995 $0 $0 $4,364 $1,103 $42 O66B Antenatal And Other Obstetric Admissions, Intermediate Complexity 0 0 1.2 1 4 142% 0.2495 0.1819 0.0059 $0 $0 $0 $1,209 $882 $29 O66C Antenatal And Other Obstetric Admissions, Minor Complexity 0 0 1 1 3 115% 0.1305 0.1066 0.0044 $0 $0 $0 $633 $517 $21 P01Z Neonate W Sig Gi/Vent>=96hrs, Died Or Transfer To Acute Facility <5days 0 1 1.5 1 4 100% 1.6961 0.6658 0.0037 $0 $0 $0 $8,221 $3,227 $18 P02Z Cardiothoracic And Vascular Procedures For Neonates 0 1 31.9 21 48 100% 2.6794 1.2521 28.9148 0.5947 0.0584 $0 $12,987 $6,069 $140,150 $2,883 $283 P03A Neonate, Admwt 1000-1499g W Significant Gi/Vent>=96hrs, Major Complexity 0 1 62.8 41 94 100% 0.2112 0.6887 28.383 0.4216 0.0648 $0 $1,024 $3,338 $137,572 $2,043 $314 P03B Neonate, Admwt 1000-1499g W Significant Gi/Vent>=96hrs, Minor Complexity 0 1 37.3 12 116 100% 0.0868 1.3399 16.1303 0.3635 0.0349 $0 $421 $6,494 $78,184 $1,762 $169 P04A Neonate, Admwt 1500-1999g W Significant Gi/Vent>=96hrs, Major Complexity 0 1 55.1 19 171 100% 0.3097 1.1455 22.0235 0.3722 0.0504 $0 $1,501 $5,552 $106,748 $1,804 $244 P04B Neonate, Admwt 1500-1999g W Significant Gi/Vent>=96hrs, Minor Complexity 0 1 26.1 9 84 100% 0.0675 1.1435 10.3352 0.3099 0.0236 $0 $327 $5,543 $50,095 $1,502 $114 P05A Neonate, Admwt 2000-2499g W Significant Gi/Vent>=96hrs, Major Complexity 0 1 50.8 31 71 100% 0.6109 0.843 26.6939 0.4749 0.0497 $0 $2,961 $4,086 $129,385 $2,302 $241 P05B Neonate, Admwt 2000-2499g W Significant Gi/Vent>=96hrs, Minor Complexity 0 1 18.8 6 57 100% 0.2532 1.3177 8.1414 0.3538 0.0180 $0 $1,227 $6,387 $39,461 $1,715 $87 P06A Neonate, Admwt >=2500g W Significant Gi/Vent>=96hrs, Major Complexity 0 1 32 10 96 100% 0.5212 1.663 17.1156 0.4780 0.0359 $0 $2,526 $8,061 $82,959 $2,317 $174 P06B Neonate, Admwt >=2500g W Significant Gi/Vent>=96hrs, Minor Complexity 0 1 11.9 3 35 100% 0.3346 1.8544 5.8849 0.4095 0.0129 $0 $1,622 $8,988 $28,524 $1,985 $63 P07Z Neonate, Admwt <750g W Significant GIs 0 1 112.6 39 358 100% 0.4619 1.6804 65.8678 0.4660 0.1315 $0 $2,239 $8,145 $319,261 $2,259 $637 P08Z Neonate, Admwt 750-999g W Significant GIs 0 1 92.6 32 297 100% 0.8027 1.5604 50.6275 0.4165 0.1077 $0 $3,891 $7,563 $245,391 $2,019 $522 P60A Neonate W/O Sig Gi/Vent>=96hrs, Died/Transfer Acute Facility <5 Days, Majc 0 1 2.4 1 4 100% 1.2185 0.0028 $0 $0 $0 $5,906 $0 $14 P60B Neonate W/O Sig Gi/Vent>=96hrs, Died/Transfer Acute Facility <5 Days, Minc 1 1 2 1 4 100% 0.319 0.9615 0.0022 $1,546 $0 $0 $4,660 $0 $11 P61Z Neonate, Admwt <750g W/O Significant Gi Procedure 0 1 79.9 27 249 100% 0 1.7227 46.4097 0.4296 0.1032 $0 $0 $8,350 $224,948 $2,082 $500 P62A Neonate, Admwt 750-999g W/O Significant GIs, Major Complexity 0 1 71.8 24 217 100% 0 1.4428 34.5474 0.4283 0.0801 $0 $0 $6,993 $167,451 $2,076 $388 P62B Neonate, Admwt 750-999g W/O Significant GIs, Minor Complexity 0 1 28.9 10 90 100% 0 1.3724 13.6978 0.3692 0.0266 $0 $0 $6,652 $66,393 $1,790 $129 P63A Neonate, Admwt 1000-1249g W/O Significant Gi/Vent>=96hrs, Major Complexity 0 1 38.4 11 101 100% 0 1.132 12.4247 0.3208 0.0275 $0 $0 $5,487 $60,223 $1,555 $133 P63B Neonate, Admwt 1000-1249g W/O Significant Gi/Vent>=96hrs, Minor Complexity 0 1 12.5 4 39 100% 0 1.518 6.059 0.2741 0.0131 $0 $0 $7,358 $29,368 $1,329 $63 P64A Neonate, Admwt 1250-1499g W/O Significant Gi/Vent>=96hrs, Major Complexity 0 1 32.5 11 101 100% 0 0.9824 10.7766 0.3110 0.0298 $0 $0 $4,762 $52,234 $1,507 $144 P64B Neonate, Admwt 1250-1499g W/O Significant Gi/Vent>=96hrs, Minor Complexity 0 1 21.7 7 65 100% 0 0.9988 6.9754 0.2539 0.0164 $0 $0 $4,841 $33,810 $1,231 $79 P65A Neonate, Admwt 1500-1999g W/O Significant Gi/Vent>=96hrs, Extreme Comp 0 1 27 9 86 100% 0 0.9603 8.6197 0.3001 0.0234 $0 $0 $4,655 $41,780 $1,455 $113 P65B Neonate, Admwt 1500-1999g W/O Significant Gi/Vent>=96hrs, Major Complexity 0 1 20 6 62 100% 0 1.05 6.2845 0.2816 0.0154 $0 $0 $5,089 $30,461 $1,365 $75 P65C Neonate, Admwt 1500-1999g W/O Significant Gi/Vent>=96hrs, Intermediate Comp 0 1 16.2 5 50 100% 0 0.9758 4.8675 0.2529 0.0114 $0 $0 $4,730 $23,593 $1,226 $55 P65D Neonate, Admwt 1500-1999g W/O Significant Gi/Vent>=96hrs, Minor Complexity 0 1 12.1 4 37 100% 0 0.9849 3.9304 0.2758 0.0092 $0 $0 $4,774 $19,051 $1,337 $45 P66A Neonate, Admwt 2000-2499g W/O Significant Gi/Vent>=96hrs, Extreme Comp 0 1 17 11 25 100% 0 0.5115 5.6116 0.2809 0.0146 $0 $0 $2,479 $27,199 $1,362 $71 P66B Neonate, Admwt 2000-2499g W/O Significant Gi/Vent>=96hrs, Major Complexity 0 1 12.1 4 38 100% 0 0.9771 3.8987 0.2841 0.0097 $0 $0 $4,736 $18,897 $1,377 $47 P66C Neonate, Admwt 2000-2499g W/O Significant Gi/Vent>=96hrs, Intermediate Comp 0 1 7.9 2 25 100% 0 1.261 2.5158 0.2727 0.0062 $0 $0 $6,112 $12,194 $1,322 $30 P66D Neonate, Admwt 2000-2499g W/O Significant Gi/Vent>=96hrs, Minor Complexity 0 1 3.8 1 11 100% 1.1801 0.2677 0.0028 $0 $0 $0 $5,720 $1,298 $14 P67A Neonate, Admwt >=2500g W/O Sig Gi/Vent>=96hrs, <37 Comp Wks Gest, Extr Comp 0 1 13.6 4 42 100% 0 1.1554 4.6093 0.2958 0.0122 $0 $0 $5,600 $22,341 $1,434 $59 P67B Neonate, Admwt >=2500g W/O Sig Gi/Vent>=96hrs, <37 Comp Wks Gest, Maj Comp 0 1 8.6 3 28 100% 0 0.9694 2.9007 0.2739 0.0076 $0 $0 $4,699 $14,060 $1,328 $37 P67C Neonate, Admwt >=2500g W/O Sig Gi/Vent>=96hrs, <37 Comp Wks Gest, Int Comp 0 1 6.7 2 22 100% 0 1.1559 2.3061 0.2820 0.0057 $0 $0 $5,603 $11,178 $1,367 $28 P67D Neonate, Admwt >=2500g W/O Sig Gi/Vent>=96hrs, <37 Comp Wks Gest, Min Comp 0 1 4.5 1 13 100% 1.4578 0.2760 0.0035 $0 $0 $0 $7,066 $1,338 $17 P68A Neonate, Admwt >=2500g W/O Sig Gi/Vent>=96hrs, >=37 Comp Wks Gest, Ext Comp 0 1 8 2 25 100% 0 1.446 2.8822 0.3311 0.0098 $0 $0 $7,009 $13,970 $1,605 $48 P68B Neonate, Admwt >=2500g W/O Sig Gi/Vent>=96hrs, >=37 Comp Wks Gest, Maj Comp 0 1 4.1 1 13 100% 1.4089 0.3087 0.0052 $0 $0 $0 $6,829 $1,496 $25 P68C Neonate, Admwt >=2500g W/O Sig Gi/Vent>=96hrs, >=37 Comp Wks Gest, Int Comp 0 1 2.9 1 9 100% 1.0132 0.2958 0.0034 $0 $0 $0 $4,911 $1,434 $16 P68D Neonate, Admwt >=2500g W/O Sig Gi/Vent>=96hrs, >=37 Comp Wks Gest, Min Comp 0 1 2.1 1 6 100% 0.7215 0.2818 0.0024 $0 $0 $0 $3,497 $1,366 $12
Note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 1.Qld Admitted Acute 9 of 11 qld‐nep‐abf‐priceweights_1920_v3.0
Back to 2019-20 Queensland Admitted Acute Price Weights (Q22) AR-DRG V9.0 See NOTES Queensland Weight (QWAU) see note 4 Queensland Price INDEX DRG CODE Description Same Day Bundled IHPA ALOS Lower Upper Paediatric Same Day Short-Stay Short-Stay Inlier Long-Stay PBS Same Day $ Short-Stay Short-Stay Inlier $ Long-Stay PBS $ Payment ICU Bound Bound Adjustment Outlier Outlier Per Outlier Per Outlier Outlier Per Outlier Per List Base Diem Diem Base $ Diem $ Diem $
Q01Z Splenectomy 0 0 6.9 2 19 100% 1.1248 1.4688 3.8299 0.3389 0.2326 $0 $5,452 $7,119 $18,564 $1,643 $1,127 Q02A Blood And Immune System Disorders W Other GIs, Major Complexity 0 0 10.9 3 30 137% 0.4533 1.2778 4.2445 0.3563 0.0421 $0 $2,197 $6,193 $20,573 $1,727 $204 Q02B Blood And Immune System Disorders W Other GIs, Minor Complexity 1 0 2.7 1 9 118% 0.595 1.4292 0.2324 0.0459 $2,884 $0 $0 $6,927 $1,126 $222 Q60A Reticuloendothelial And Immunity Disorders, Major Complexity 1 0 5.6 1 17 148% 0.2728 1.6252 0.3328 0.0703 $1,322 $0 $0 $7,877 $1,613 $341 Q60B Reticuloendothelial And Immunity Disorders, Minor Complexity 0 0 1.1 1 3 159% 0.1735 0.1630 0.0380 $0 $0 $0 $841 $790 $184 Q61A Red Blood Cell Disorders, Major Complexity 1 0 4.2 1 13 128% 0.3463 1.1675 0.2675 0.0236 $1,679 $0 $0 $5,659 $1,297 $114 Q61B Red Blood Cell Disorders, Intermediate Complexity 0 0 1.1 1 3 170% 0.2136 0.1481 0.0232 $0 $0 $0 $1,035 $718 $112 Q61C Red Blood Cell Disorders, Minor Complexity 0 0 1 1 3 100% 0.0653 0.0574 0.0186 $0 $0 $0 $317 $278 $90 Q62A Coagulation Disorders, Major Complexity 1 0 5.8 1 18 100% 0.2107 1.5596 0.2507 0.0251 $1,021 $0 $0 $7,559 $1,215 $122 Q62B Coagulation Disorders, Minor Complexity 1 0 2.3 1 7 124% 0.2031 0.5577 0.2306 0.0398 $984 $0 $0 $2,703 $1,118 $193 R01A Lymphoma And Leukaemia W Major GIs, Major Complexity 0 0 19.1 6 59 100% 0.8626 1.4202 9.3055 0.3574 0.0784 $0 $4,181 $6,884 $45,104 $1,732 $380 R01B Lymphoma And Leukaemia W Major GIs, Minor Complexity 0 0 3.5 1 12 100% 1.8784 0.4099 0.0276 $0 $0 $0 $9,105 $1,987 $134 R02A Other Neoplastic Disorders W Major GIs, Major Complexity 0 0 13.9 4 41 100% 2.0618 1.3437 7.3915 0.3090 0.0453 $0 $9,994 $6,513 $35,827 $1,498 $220 R02B Other Neoplastic Disorders W Major GIs, Intermediate Complexity 0 0 7.3 2 23 100% 0.7558 1.5857 3.8052 0.1819 0.1221 $0 $3,663 $7,686 $18,444 $882 $592 R02C Other Neoplastic Disorders W Major GIs, Minor Complexity 0 0 3.8 1 12 100% 2.0648 0.2278 0.0614 $0 $0 $0 $10,008 $1,104 $298 R03A Lymphoma And Leukaemia W Other GIs, Major Complexity 0 0 30.7 10 90 100% 0.4549 1.2883 13.2048 0.3502 0.1327 $0 $2,205 $6,244 $64,004 $1,697 $643 R03B Lymphoma And Leukaemia W Other GIs, Intermediate Complexity 0 0 11.3 3 34 100% 0.5679 1.4004 4.7246 0.2892 0.0444 $0 $2,753 $6,788 $22,900 $1,402 $215 R03C Lymphoma And Leukaemia W Other GIs, Minor Complexity 1 0 3.9 1 12 161% 0.6541 1.8689 0.3019 0.0540 $3,170 $0 $0 $9,059 $1,463 $262 R04A Other Neoplastic Disorders W Other GIs, Major Complexity 0 0 7.9 2 24 100% 0.784 1.515 3.7298 0.2477 0.0842 $0 $3,800 $7,343 $18,078 $1,201 $408 R04B Other Neoplastic Disorders W Other GIs, Minor Complexity 1 0 2.9 1 9 100% 0.884 1.6023 0.2105 0.0215 $4,285 $0 $0 $7,766 $1,020 $104 R05A Allogeneic Bone Marrow Transplant, Age <=16 Years Or Major Complexity 0 0 50.3 16 150 169% 0.0792 1.5587 24.929 0.4690 0.0894 $0 $384 $7,555 $120,831 $2,273 $433 R05B Allogeneic Bone Marrow Transplant, Age >=17 Years And Minor Complexity 0 0 25.8 8 73 100% 0 1.6594 13.0931 0.4448 0.1823 $0 $0 $8,043 $63,462 $2,156 $884 R06A Autologous Bone Marrow Transplant, Major Complexity 0 0 22.7 15 34 199% 0 0.595 8.7585 0.3870 0.1671 $0 $0 $2,884 $42,452 $1,876 $810 R06B Autologous Bone Marrow Transplant, Minor Complexity 0 0 12.9 4 38 100% 0 1.3436 5.2471 0.3126 0.1274 $0 $0 $6,512 $25,433 $1,515 $618 R60A Acute Leukaemia, Major Complexity 0 0 17 11 26 119% 0.1021 0.7248 7.8764 0.3430 0.1983 $0 $495 $3,513 $38,177 $1,663 $961 R60B Acute Leukaemia, Intermediate Complexity 1 0 5.8 2 19 105% 0.3514 0 1.1261 2.1137 0.2990 0.1386 $1,703 $0 $5,458 $10,245 $1,449 $672 R60C Acute Leukaemia, Minor Complexity 1 0 5.1 1 15 160% 0.2974 1.0763 0.1333 0.2218 $1,441 $0 $0 $5,217 $646 $1,075 R61A Lymphoma And Non-Acute Leukaemia, Major Complexity 0 0 9.8 3 30 155% 0 1.1861 3.3662 0.3093 0.1920 $0 $0 $5,749 $16,316 $1,499 $931 R61B Lymphoma And Non-Acute Leukaemia, Intermediate Complexity 1 0 3.9 1 12 161% 0.3195 1.303 0.2875 0.1700 $1,549 $0 $0 $6,316 $1,394 $824 R61C Lymphoma And Non-Acute Leukaemia, Minor Complexity 0 0 1.1 1 3 187% 0.2153 0.2102 0.0627 $0 $0 $0 $1,044 $1,019 $304 R62A Other Neoplastic Disorders, Major Complexity 0 0 9.2 3 28 100% 0 1.0321 3.0581 0.2650 0.0383 $0 $0 $5,003 $14,823 $1,284 $186 R62B Other Neoplastic Disorders, Intermediate Complexity 1 0 4.4 1 14 81% 1.0578 1.3769 0.2420 0.0508 $5,127 $0 $0 $6,674 $1,173 $246 R62C Other Neoplastic Disorders, Minor Complexity 1 0 2.8 1 8 142% 0.5207 0.6747 0.1723 0.0870 $2,524 $0 $0 $3,270 $835 $422 R63Z Chemotherapy 0011183% 0.2323 0.1047 $0 $0 $0 $1,126 $0 $507 T01A Infectious And Parasitic Diseases W GIs, Major Complexity 0 0 23.6 8 78 147% 0.7336 1.0783 9.3199 0.2885 0.0400 $0 $3,556 $5,227 $45,174 $1,398 $194 T01B Infectious And Parasitic Diseases W GIs, Intermediate Complexity 0 0 11 3 36 106% 0.4203 1.1564 3.8722 0.2360 0.0175 $0 $2,037 $5,605 $18,769 $1,144 $85 T01C Infectious And Parasitic Diseases W GIs, Minor Complexity 0 0 6 2 18 100% 0.331 0.9314 2.1711 0.2293 0.0227 $0 $1,604 $4,514 $10,523 $1,111 $110 T40Z Infectious And Parasitic Diseases W Ventilator Support 0 0 8.2 2 24 100% 0.0594 2.3806 4.7472 0.3381 0.0734 $0 $288 $11,539 $23,010 $1,639 $356 T60A Septicaemia, Major Complexity 0 0 12 4 40 133% 0 0.9799 3.8912 0.2549 0.0283 $0 $0 $4,750 $18,861 $1,236 $137 T60B Septicaemia, Intermediate Complexity 0 0 6.3 2 21 115% 0 0.9265 1.8384 0.2282 0.0147 $0 $0 $4,491 $8,911 $1,106 $71 T60C Septicaemia, Minor Complexity 0 0 3.8 1 12 123% 0.9682 0.2319 0.0120 $0 $0 $0 $4,693 $1,124 $58 T61A Postoperative Infections, Major Complexity 0 0 6.4 2 19 118% 0 0.804 1.598 0.1874 0.0101 $0 $0 $3,897 $7,746 $908 $49 T61B Postoperative Infections, Minor Complexity 0 0 3.1 1 10 146% 0.6248 0.1667 0.0055 $0 $0 $0 $3,028 $808 $27 T62A Fever Of Unknown Origin, Major Complexity 0 0 5.5 1 17 111% 1.5068 0.2803 0.0356 $0 $0 $0 $7,303 $1,359 $173 T62B Fever Of Unknown Origin, Minor Complexity 0 0 1.9 1 6 93% 0.4692 0.2721 0.0216 $0 $0 $0 $2,274 $1,319 $105 T63A Viral Illnesses, Major Complexity 1 0 4.3 1 13 112% 0.271 1.2095 0.2840 0.0143 $1,314 $0 $0 $5,862 $1,377 $69 T63B Viral Illnesses, Minor Complexity 0 0 1.3 1 5 100% 0.2941 0.2200 0.0063 $0 $0 $0 $1,426 $1,066 $31 T64A Other Infectious And Parasitic Diseases, Major Complexity 0 0 18.7 11 26 169% 0 0.6026 6.505 0.2808 0.1236 $0 $0 $2,921 $31,530 $1,361 $599 T64B Other Infectious And Parasitic Diseases, Intermediate Complexity 0 0 8.6 3 28 117% 0 0.8386 2.457 0.2051 0.0587 $0 $0 $4,065 $11,909 $994 $285 T64C Other Infectious And Parasitic Diseases, Minor Complexity 1 0 4.6 1 15 100% 0.2124 1.0986 0.1823 0.0387 $1,030 $0 $0 $5,325 $884 $188 U40A Mental Health Treatment W ECT, Sameday, Major Complexity 0 0 1 1 1 100% 0.209 0.0019 $0 $0 $0 $1,013 $0 $9 U40B Mental Health Treatment W ECT, Sameday, Minor Complexity 0 0 1 1 1 100% 0.2013 0.0073 $0 $0 $0 $976 $0 $35 U60Z Mental Health Treatment W/O ECT, Sameday 0 0 1 1 1 200% 0.1221 0.0184 $0 $0 $0 $592 $0 $89 U61A Schizophrenia Disorders, Major Complexity 0 0 47.4 29 67 100% 0 0.3564 10.2326 0.1807 0.1025 $0 $0 $1,727 $49,597 $876 $497 U61B Schizophrenia Disorders, Minor Complexity 0 0 19.3 13 30 100% 0 0.3779 4.8269 0.1914 0.0852 $0 $0 $1,832 $23,396 $928 $413 U62A Paranoia And Acute Psychotic Disorders, Major Complexity 0 0 21.5 14 34 100% 0 0.4275 5.9315 0.1934 0.0535 $0 $0 $2,072 $28,750 $937 $259 U62B Paranoia And Acute Psychotic Disorders, Minor Complexity 0 0 10.6 7 17 196% 0 0.4385 3.0138 0.2128 0.0559 $0 $0 $2,125 $14,608 $1,031 $271 U63A Major Affective Disorders, Major Complexity 0 0 28.3 18 42 169% 0 0.4058 7.2696 0.2035 0.0352 $0 $0 $1,967 $35,236 $986 $171 U63B Major Affective Disorders, Minor Complexity 0 0 11.9 8 18 154% 0 0.4312 3.4084 0.2112 0.0415 $0 $0 $2,090 $16,521 $1,024 $201 U64A Other Affective And Somatoform Disorders, Major Complexity 0 0 12.6 8 19 167% 0 0.445 3.5457 0.1954 0.0142 $0 $0 $2,157 $17,186 $947 $69 U64B Other Affective And Somatoform Disorders, Minor Complexity 0 0 5.5 3 8 179% 0 0.5026 1.4841 0.2150 0.0238 $0 $0 $2,436 $7,193 $1,042 $115 U65A Anxiety Disorders, Major Complexity 0 0 8.5 5 13 150% 0 0.5098 2.5247 0.2260 0.0242 $0 $0 $2,471 $12,237 $1,095 $117 U65B Anxiety Disorders, Minor Complexity 0 0 3.2 2 5 169% 0 0.4436 0.8715 0.2162 0.0157 $0 $0 $2,150 $4,224 $1,048 $76 U66A Eating And Obsessive-Compulsive Disorders, Major Complexity 0 0 23.3 15 36 112% 0 0.5034 7.5372 0.2492 0.0140 $0 $0 $2,440 $36,533 $1,208 $68 U66B Eating And Obsessive-Compulsive Disorders, Minor Complexity 0 0 12.8 8 19 120% 0 0.5286 4.2105 0.2568 0.0187 $0 $0 $2,562 $20,408 $1,245 $91 U67A Personality Disorders And Acute Reactions, Major Complexity 0 0 10.9 7 17 162% 0 0.4514 3.144 0.2140 0.0157 $0 $0 $2,188 $15,239 $1,037 $76 U67B Personality Disorders And Acute Reactions, Minor Complexity 0 0 4.5 3 7 169% 0 0.4627 1.3773 0.2202 0.0108 $0 $0 $2,243 $6,676 $1,067 $52 U68A Childhood Mental Disorders, Major Complexity 0 0 10.4 6 15 114% 0 0.623 3.7262 0.2823 0.0116 $0 $0 $3,020 $18,061 $1,368 $56 U68B Childhood Mental Disorders, Minor Complexity 0 0 5 3 8 123% 0 0.5878 1.769 0.2579 0.0000 $0 $0 $2,849 $8,574 $1,250 $0 V60A Alcohol Intoxication And Withdrawal, Major Complexity 0 0 3.2 2 5 100% 0 0.4395 0.8643 0.2185 0.0146 $0 $0 $2,130 $4,189 $1,059 $71 V60B Alcohol Intoxication And Withdrawal, Minor Complexity 0 0 1.3 1 2 86% 0.1768 0.1316 0.0076 $0 $0 $0 $857 $638 $37 V61A Drug Intoxication And Withdrawal, Major Complexity 0 0 7.1 4 11 184% 0 0.5138 2.0249 0.2273 0.0303 $0 $0 $2,490 $9,815 $1,102 $147 V61B Drug Intoxication And Withdrawal, Minor Complexity 0 0 3 2 5 100% 0 0.4177 0.81 0.1936 0.0254 $0 $0 $2,025 $3,926 $938 $123 V62A Alcohol Use And Dependence, Major Complexity 0 0 8.3 5 13 100% 0 0.4255 2.1021 0.2602 0.0252 $0 $0 $2,062 $10,189 $1,261 $122
Note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 1.Qld Admitted Acute 10 of 11 qld‐nep‐abf‐priceweights_1920_v3.0
Back to 2019-20 Queensland Admitted Acute Price Weights (Q22) AR-DRG V9.0 See NOTES Queensland Weight (QWAU) see note 4 Queensland Price INDEX DRG CODE Description Same Day Bundled IHPA ALOS Lower Upper Paediatric Same Day Short-Stay Short-Stay Inlier Long-Stay PBS Same Day $ Short-Stay Short-Stay Inlier $ Long-Stay PBS $ Payment ICU Bound Bound Adjustment Outlier Outlier Per Outlier Per Outlier Outlier Per Outlier Per List Base Diem Diem Base $ Diem $ Diem $
V62B Alcohol Use And Dependence, Minor Complexity 0 0 4 2 6 100% 0 0.4266 0.8377 0.1623 0.0155 $0 $0 $2,068 $4,060 $787 $75 V63Z Opioid Use And Dependence 0 0 5.5 3 8 100% 0 0.4699 1.3625 0.2024 0.0472 $0 $0 $2,278 $6,604 $981 $229 V64A Other Drug Use And Dependence, Major Complexity 0 0 8.2 5 13 100% 0 0.4274 2.1061 0.2152 0.0307 $0 $0 $2,072 $10,208 $1,043 $149 V64B Other Drug Use And Dependence, Minor Complexity 0 0 3.7 2 6 100% 0 0.4786 0.9414 0.1933 0.0158 $0 $0 $2,320 $4,563 $937 $77 W01A Vent, Trac & Cran Procs For Mult Sig Trauma, Major Complexity 0 0 24.4 8 73 100% 3.6319 2.1239 20.5292 0.3981 0.0940 $0 $17,604 $10,295 $99,505 $1,930 $456 W01B Vent, Trac & Cran Procs For Mult Sig Trauma, Intermediate Complexity 0 0 13.7 4 41 100% 2.4091 2.5935 12.7333 0.4151 0.0500 $0 $11,677 $12,571 $61,718 $2,012 $242 W01C Vent, Trac & Cran Procs For Mult Sig Trauma, Minor Complexity 0 0 8.5 3 30 100% 1.6665 2.4034 8.844 0.4685 0.0328 $0 $8,078 $11,649 $42,867 $2,271 $159 W02A Hip, Femur And Lower Limb Procedures For Multiple Sig Trauma, Major Complexity 0 0 18.4 7 66 100% 2.0721 1.2547 10.8318 0.3507 0.0234 $0 $10,043 $6,082 $52,502 $1,700 $113 W02B Hip, Femur And Lower Limb Procedures For Multiple Sig Trauma, Minor Complexity 0 0 10.1 4 36 100% 1.1552 0.8888 4.6939 0.2755 0.0164 $0 $5,599 $4,308 $22,751 $1,335 $79 W03Z Abdominal Procedures For Multiple Significant Trauma 0 0 9.7 3 30 100% 1.3517 1.2845 5.1274 0.3570 0.0776 $0 $6,552 $6,226 $24,853 $1,730 $376 W04A Multiple Significant Trauma W Other GIs, Major Complexity 0 0 15.9 6 54 100% 1.6889 1.1903 8.7601 0.4037 0.0706 $0 $8,186 $5,769 $42,460 $1,957 $342 W04B Multiple Significant Trauma W Other GIs, Minor Complexity 0 0 7.4 2 24 100% 0.9071 1.7319 4.35 0.4026 0.0210 $0 $4,397 $8,395 $21,084 $1,951 $102 W60Z Multiple Sig Trauma, Transferred To Acute Facility <5 Days 0 0 1.6 1 4 100% 1.392 0.0175 $0 $0 $0 $6,747 $0 $85 W61A Multiple Significant Trauma W/O GIs, Major Complexity 0 0 11 4 36 126% 0 0.8447 3.3568 0.2575 0.0218 $0 $0 $4,094 $16,270 $1,248 $106 W61B Multiple Significant Trauma W/O GIs, Minor Complexity 0 0 4.6 1 14 123% 1.3853 0.2749 0.0233 $0 $0 $0 $6,715 $1,332 $113 X02A Microvascular Tissue Transfer And Skin Grafts For Injuries To Hand, Major Comp 0 0 7.2 2 23 100% 0.5434 2.0128 4.539 0.4511 0.0300 $0 $2,634 $9,756 $22,001 $2,186 $145 X02B Microvascular Tissue Transfer And Skin Grafts For Injuries To Hand, Minor Comp 0 0 1.7 1 5 121% 1.0321 0.5196 0.0062 $0 $0 $0 $5,003 $2,519 $30 X04A Other Procedures For Injuries To Lower Limb, Major Complexity 0 0 10.4 3 32 100% 0.5381 1.1686 4.0301 0.2636 0.0137 $0 $2,608 $5,664 $19,534 $1,278 $66 X04B Other Procedures For Injuries To Lower Limb, Minor Complexity 1 0 2.2 1 7 100% 0.5074 1.0234 0.2664 0.0086 $2,459 $0 $0 $4,960 $1,291 $42 X05A Other Procedures For Injuries To Hand, Major Complexity 0 0 2.7 1 8 112% 1.4871 0.3145 0.0328 $0 $0 $0 $7,208 $1,524 $159 X05B Other Procedures For Injuries To Hand, Minor Complexity 0 0 1.3 1 4 100% 0.568 0.2170 0.0423 $0 $0 $0 $2,753 $1,052 $205 X06A Other Procedures For Other Injuries, Major Complexity 0 0 11.9 4 37 166% 0.6867 0.9794 4.5714 0.2438 0.0328 $0 $3,328 $4,747 $22,158 $1,182 $159 X06B Other Procedures For Other Injuries, Intermediate Complexity 0 0 4.1 1 13 100% 1.5418 0.2246 0.0141 $0 $0 $0 $7,473 $1,089 $68 X06C Other Procedures For Other Injuries, Minor Complexity 0 0 1.7 1 5 100% 0.8091 0.2810 0.0196 $0 $0 $0 $3,922 $1,362 $95 X07A Skin Grafts For Injuries Excluding Hand, Major Complexity 0 0 18.8 7 70 100% 0.8918 0.879 7.0185 0.3126 0.0265 $0 $4,323 $4,261 $34,019 $1,515 $128 X07B Skin Grafts For Injuries Excluding Hand, Intermediate Complexity 0 0 8.3 3 28 100% 0.5243 0.9186 3.1941 0.2574 0.0860 $0 $2,541 $4,452 $15,482 $1,248 $417 X07C Skin Grafts For Injuries Excluding Hand, Minor Complexity 0 0 4.1 1 13 100% 1.6206 0.2639 0.0187 $0 $0 $0 $7,855 $1,279 $91 X40A Injuries, Poisoning And Toxic Effects Of Drugs W Ventilator Support, Major Comp 0 0 6.4 2 19 100% 0.1098 1.7516 3.5849 0.2716 0.0281 $0 $532 $8,490 $17,376 $1,316 $136 X40B Injuries, Poisoning And Toxic Effects Of Drugs W Ventilator Support, Minor Comp 0 0 2.8 1 9 100% 1.709 0.3091 0.0222 $0 $0 $0 $8,284 $1,498 $108 X60A Injuries, Major Complexity 1 0 4.4 1 14 106% 0.1822 1.0245 0.2196 0.0108 $883 $0 $0 $4,966 $1,064 $52 X60B Injuries, Minor Complexity 0 0 1.2 1 4 156% 0.2044 0.1585 0.0065 $0 $0 $0 $991 $768 $32 X61A Allergic Reactions, Major Complexity 0 0 1.7 1 5 105% 0.4039 0.2873 0.0117 $0 $0 $0 $1,958 $1,393 $57 X61B Allergic Reactions, Minor Complexity 0011392% 0.1098 0.0884 0.0113 $0 $0 $0 $532 $428 $55 X62A Poisoning/Toxic Effects Of Drugs And Other Substances, Major Complexity 1 0 4.3 1 13 144% 0.1565 1.1187 0.2492 0.0176 $759 $0 $0 $5,422 $1,208 $85 X62B Poisoning/Toxic Effects Of Drugs And Other Substances, Minor Complexity 0 0 1.3 1 4 117% 0.2533 0.1884 0.0103 $0 $0 $0 $1,228 $913 $50 X63A Sequelae Of Treatment, Major Complexity 1 0 5.5 1 17 139% 0.1975 1.3492 0.2194 0.0077 $957 $0 $0 $6,540 $1,063 $37 X63B Sequelae Of Treatment, Minor Complexity 1 0 2.2 1 7 109% 0.1645 0.5 0.1558 0.0094 $797 $0 $0 $2,424 $755 $46 X64A Other Injuries, Poisonings And Toxic Effects, Major Complexity 0 0 5.3 1 18 115% 1.2847 0.2324 0.0088 $0 $0 $0 $6,227 $1,126 $43 X64B Other Injuries, Poisonings And Toxic Effects, Intermediate Complexity 0 0 1.6 1 5 165% 0.3251 0.2383 0.0054 $0 $0 $0 $1,576 $1,155 $26 X64C Other Injuries, Poisonings And Toxic Effects, Minor Complexity 0 0 1.1 1 3 116% 0.1567 0.1270 0.0075 $0 $0 $0 $760 $616 $36 Y01Z Vent >=96hrs Or Trach For Burns Or GIs For Severe Full Thickness Burns 0 0 32.2 18 164 100% 2.9356 1.9818 38.3789 0.7521 0.2292 $0 $14,229 $9,606 $186,023 $3,645 $1,111 Y02A Skin Grafts For Other Burns, Major Complexity 0 0 16.1 11 25 120% 0.7088 0.6784 8.1483 0.4512 0.0227 $0 $3,436 $3,288 $39,495 $2,187 $110 Y02B Skin Grafts For Other Burns, Intermediate Complexity 0 0 5.8 2 19 100% 0.3881 1.5965 3.567 0.3490 0.0141 $0 $1,881 $7,738 $17,289 $1,692 $68 Y02C Skin Grafts For Other Burns, Minor Complexity 0 0 2.1 1 7 100% 1.1341 0.5993 0.0053 $0 $0 $0 $5,497 $2,905 $26 Y03A Other GIs For Other Burns, Major Complexity 0 0 5.9 2 23 121% 0.4871 1.113 2.6976 0.2740 0.0156 $0 $2,361 $5,395 $13,075 $1,328 $76 Y03B Other GIs For Other Burns, Minor Complexity 0 0 1.8 1 5 92% 0.7921 0.3807 0.0028 $0 $0 $0 $3,839 $1,845 $14 Y60Z Burns, Transferred To Acute Facility <5 Days 0 0 1.3 1 4 100% 0.4604 0.0019 $0 $0 $0 $2,232 $0 $9 Y61Z Severe Burns 0 0 3.3 1 10 136% 0.8038 0.2374 0.0029 $0 $0 $0 $3,896 $1,151 $14 Y62A Other Burns, Major Complexity 1 0 5 1 17 111% 0.267 1.5801 0.2873 0.0269 $1,294 $0 $0 $7,659 $1,393 $130 Y62B Other Burns, Minor Complexity 1 0 2.2 1 7 149% 0.1197 0.5517 0.2478 0.0113 $580 $0 $0 $2,674 $1,201 $55 Z01A Other Contacts W Health Services W GIs, Major Complexity 0 0 8.4 3 28 100% 0.6383 1.0875 3.8703 0.2304 0.0303 $0 $3,094 $5,271 $18,759 $1,117 $147 Z01B Other Contacts W Health Services W GIs, Minor Complexity 0 0 1.1 1 4 115% 0.6858 0.2914 0.0206 $0 $0 $0 $3,324 $1,412 $100 Z40Z Other Contacts W Health Services W Endoscopy 0 0 1.1 1 3 180% 0.2831 0.1179 0.0169 $0 $0 $0 $1,372 $571 $82 Z60A Rehabilitation, Major Complexity 000000%00000.0000 0.0000 $0 $0 $0 $0 $0 $0 Z60B Rehabilitation, Minor Complexity 000000%00000.0000 0.0000 $0 $0 $0 $0 $0 $0 Z61A Signs And Symptoms, Major Complexity 1 0 5.5 1 17 127% 0.1998 1.2735 0.2127 0.0141 $968 $0 $0 $6,173 $1,031 $68 Z61B Signs And Symptoms, Minor Complexity 1 0 2.4 1 7 117% 0.2324 0.4995 0.1972 0.0113 $1,126 $0 $0 $2,421 $956 $55 Z63A Other Follow Up After Surgery Or Medical Care, Major Complexity 0 0 8.5 3 28 162% 0 0.7056 2.1073 0.1868 0.0095 $0 $0 $3,420 $10,214 $905 $46 Z63B Other Follow Up After Surgery Or Medical Care, Minor Complexity 0 0 3.2 1 10 86% 0.6203 0.1605 0.0093 $0 $0 $0 $3,007 $778 $45 Z64A Other Factors Influencing Health Status, Major Complexity 0 0 5.9 2 19 81% 0 0.8441 1.6587 0.1788 0.0295 $0 $0 $4,091 $8,040 $867 $143 Z64B Other Factors Influencing Health Status, Minor Complexity 1 0 3.4 1 13 123% 0.2161 0.6149 0.1791 0.0383 $1,047 $0 $0 $2,980 $868 $186 Z65Z Congenital Anomalies And Problems Arising From Neonatal Period 0 0 2.3 1 12 105% 0.7356 0.3133 0.0190 $0 $0 $0 $3,565 $1,519 $92 Z66Z Sleep Disorders 0 0 2.4 1 8 100% 0.3756 0.1815 0.0111 $0 $0 $0 $1,821 $880 $54
Note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 1.Qld Admitted Acute 11 of 11
Appendix 2 National Admitted Acute Price Weights 2019-20 (N1920)
Queensland Health Funding Policy and Principles 2019-20 - 71 -
qld‐nep‐abf‐priceweights_1920_v2.0
2019-20 National Admitted Acute Price Weights (N1920) AR-DRG V9.0 National Weight (NWAU) see note 4 National Price DRG CODE Description Same Day Bundled IHPA ALOS Lower Upper Private Private Private Paediatric Same Day Short-Stay Short-Stay Inlier Long-Stay Same Day $ Short-Stay Short-Stay Inlier $ Long-Stay Payment ICU Bound Bound Patient Patient Patient Adjustment Outlier Outlier Per Outlier Per Outlier Base Outlier Per Outlier Per List Service Accomodatio Accomodatio Base Diem Diem $ Diem $ Diem $ Adjustment n Adjustment n Adjustment (Same Day) (Overnight) 801A GIs Unrelated To Principal Diagnosis, Major Complexity 0 0 20.9 8 75 13% 0.0524 0.0724 147% 0.942 0.9684 8.6896 0.2919 $0 $4,836 $4,972 $44,612 $1,499 801B GIs Unrelated To Principal Diagnosis, Intermediate Complexity 0 0 8.7 3 27 21% 0.0524 0.0724 95% 0.6172 1.1252 3.9927 0.2561 $0 $3,169 $5,777 $20,499 $1,315 801C GIs Unrelated To Principal Diagnosis, Minor Complexity 0 0 2.7 1 9 22% 0.0524 0.0724 100% 1.3153 0.3134 $0 $0 $0 $6,753 $1,609 960Z Ungroupable 00000 0% 0 00%00000 $0 $0 $0 $0 $0 961Z Unacceptable Principal Diagnosis 00000 0% 0 00%00000 $0 $0 $0 $0 $0 963Z Neonatal Diagnosis Not Consistent W Age/Weight 0 0000 0% 0 00%00000 $0 $0 $0 $0 $0 A13A Ventilation >=336hours, Major Complexity 0 0 25.4 8 76 12% 0.0524 0.0724 155% 2.3837 3.3082 28.849 0.3914 $0 $12,238 $16,984 $148,111 $2,009 A13B Ventilation >=336hours, Minor Complexity 0 0 11.8 4 40 11% 0.0524 0.0724 100% 1.2575 4.3087 18.4924 0.374 $0 $6,456 $22,121 $94,940 $1,920 A14A Ventilation >=96hours & <336hours, Major Complexity 0 0 25.7 8 77 13% 0.0524 0.0724 120% 2.5791 2.0759 19.1859 0.3782 $0 $13,241 $10,658 $98,500 $1,942 A14B Ventilation >=96hours & <336hours, Intermediate Complexity 0 0 13.1 4 39 12% 0.0524 0.0724 108% 0.9044 2.5275 11.0146 0.3796 $0 $4,643 $12,976 $56,549 $1,949 A14C Ventilation >=96hours & <336hours, Minor Complexity 0 0 6.7 2 20 12% 0.0524 0.0724 100% 0.4116 3.1954 6.8024 0.3846 $0 $2,113 $16,405 $34,924 $1,975 A15A Tracheostomy, Major Complexity 0 0 32.3 11 107 14% 0.0524 0.0724 100% 4.1421 1.3602 19.1043 0.3039 $0 $21,266 $6,983 $98,081 $1,560 A15B Tracheostomy, Intermediate Complexity 0 0 19.3 6 55 16% 0.0524 0.0724 100% 2.3647 1.609 12.0185 0.3142 $0 $12,140 $8,261 $61,703 $1,613 A15C Tracheostomy, Minor Complexity 0 0 11.6 4 37 13% 0.0524 0.0724 100% 0.7158 1.6075 7.1457 0.3393 $0 $3,675 $8,253 $36,686 $1,742 A40Z ECMO 0 0 11.3 4 39 17% 0.0524 0.0724 200% 2.212 4.4139 19.8678 0.5614 $0 $11,356 $22,661 $102,001 $2,882 B01Z Ventricular Shunt Revision 0 0 5.6 2 21 16% 0.0524 0.0724 87% 0.9119 1.1644 3.2407 0.3376 $0 $4,682 $5,978 $16,638 $1,733 B02A Cranial Procedures, Major Complexity 0 0 16.5 5 50 17% 0.0524 0.0724 132% 1.6302 1.645 9.8552 0.3213 $0 $8,369 $8,445 $50,597 $1,650 B02B Cranial Procedures, Intermediate Complexity 0 0 8 2 24 21% 0.0524 0.0724 111% 1.5578 1.8384 5.2346 0.277 $0 $7,998 $9,438 $26,874 $1,422 B02C Cranial Procedures, Minor Complexity 0 0 5.6 2 19 25% 0.0524 0.0724 93% 1.347 1.3175 3.9819 0.2398 $0 $6,915 $6,764 $20,443 $1,231 B03A Spinal Procedures, Major Complexity 0 0 15.1 5 45 16% 0.0524 0.0724 100% 2.111 1.2594 8.4078 0.3109 $0 $10,838 $6,466 $43,166 $1,596 B03B Spinal Procedures, Intermediate Complexity 0 0 6.8 2 19 23% 0.0524 0.0724 100% 1.7409 1.2995 4.3398 0.2955 $0 $8,938 $6,672 $22,281 $1,517 B03C Spinal Procedures, Minor Complexity 0 0 3.2 1 10 32% 0.0524 0.0724 100% 2.6935 0.2925 $0 $0 $0 $13,828 $1,502 B04A Extracranial Vascular Procedures, Major Complexity 0 0 10.9 4 43 18% 0.0524 0.0724 100% 1.4877 1.14 6.0477 0.2875 $0 $7,638 $5,853 $31,049 $1,476 B04B Extracranial Vascular Procedures, Intermediate Complexity 0 0 6.4 2 21 18% 0.0524 0.0724 100% 1.2803 1.349 3.9784 0.2116 $0 $6,573 $6,926 $20,425 $1,086 B04C Extracranial Vascular Procedures, Minor Complexity 0 0 3.2 1 10 20% 0.0524 0.0724 100% 2.6782 0.271 $0 $0 $0 $13,750 $1,391 B05Z Carpal Tunnel Release 0011328%0.0524 0.0724 100% 0.43 0.1333 $0 $0 $0 $2,208 $684 B06A Procedures For Cerebral Palsy, Muscular Dystrophy And Neuropathy, Major Comp 0 0 12.7 4 38 12% 0.0524 0.0724 80% 1.154 1.3231 6.4464 0.2911 $0 $5,925 $6,793 $33,096 $1,495 B06B Procedures For Cerebral Palsy, Muscular Dystrophy And Neuropathy, Interm Comp 0 0 5.1 1 15 16% 0.0524 0.0724 84% 2.5261 0.2581 $0 $0 $0 $12,969 $1,325 B06C Procedures For Cerebral Palsy, Muscular Dystrophy And Neuropathy, Minor Comp 1 0 2.2 1 8 19% 0.0524 0.0724 157% 0.6653 1.4391 0.272 $3,416 $0 $0 $7,388 $1,396 B07A Cranial Or Peripheral Nerve And Other Nervous System Procedures, Major Comp 0 0 9.5 3 28 14% 0.0524 0.0724 100% 0.9199 1.0229 3.9887 0.2135 $0 $4,723 $5,252 $20,478 $1,096 B07B Cranial Or Peripheral Nerve And Other Nervous System Procedures, Minor Comp 1 0 1.9 1 6 19% 0.0524 0.0724 119% 0.6424 1.2981 0.2583 $3,298 $0 $0 $6,664 $1,326 B40Z Plasmapheresis W Neurological Disease, Sameday 0 0111 9%0.0524 0.0724 100% 0.2264 $0 $0 $0 $1,162 $0 B41A Telemetric EEG Monitoring, Major Complexity 0 0 6.6 2 22 13% 0.0524 0.0724 135% 0.0102 1.0461 2.1025 0.297 $0 $52 $5,371 $10,794 $1,525 B41B Telemetric EEG Monitoring, Minor Complexity 0 0 3.7 1 11 12% 0.0524 0.0724 80% 1.6326 0.2907 $0 $0 $0 $8,382 $1,492 B42A Nervous System Disorders W Ventilator Support, Major Complexity 0 0 12.7 5 48 9% 0.0524 0.0724 100% 0.0594 1.4055 7.0868 0.3017 $0 $305 $7,216 $36,384 $1,549 B42B Nervous System Disorders W Ventilator Support, Intermediate Complexity 0 0 5.4 2 18 10% 0.0524 0.0724 145% 0.1018 1.7429 3.5875 0.3663 $0 $523 $8,948 $18,418 $1,881 B42C Nervous System Disorders W Ventilator Support, Minor Complexity 0 0 2.2 1 7 10% 0.0524 0.0724 100% 1.8228 0.2782 $0 $0 $0 $9,358 $1,428 B62Z Apheresis 00113 6%0.0524 0.0724 100% 0.2891 0.3253 $0 $0 $0 $1,484 $1,670 B63A Dementia And Other Chronic Disturbances Of Cerebral Function, Major Complexity 0 0 17.1 6 55 5% 0.0524 0.0724 100% 0 0.661 3.9662 0.1934 $0 $0 $3,394 $20,362 $993 B63B Dementia And Other Chronic Disturbances Of Cerebral Function, Minor Complexity 0 0 7 2 23 6% 0.0524 0.0724 100% 0 0.8344 1.6688 0.1903 $0 $0 $4,284 $8,568 $977 B64A Delirium, Major Complexity 0 0 7.8 2 25 9% 0.0524 0.0724 100% 0 1.0104 2.0209 0.2313 $0 $0 $5,187 $10,375 $1,187 B64B Delirium, Minor Complexity 1031912%0.0524 0.0724 100% 0.1056 0.7086 0.2208 $542 $0 $0 $3,638 $1,134 B65Z Cerebral Palsy 0 0 1.5 1 4 9% 0.0524 0.0724 123% 0.432 0.291 $0 $0 $0 $2,218 $1,494 B66A Nervous System Neoplasms, Major Complexity 0 0 10 3 30 7% 0.0524 0.0724 115% 0 1.0132 3.0397 0.2425 $0 $0 $5,202 $15,606 $1,245 B66B Nervous System Neoplasms, Minor Complexity 1 0 4.4 1 15 11% 0.0524 0.0724 134% 0.3577 1.2611 0.238 $1,836 $0 $0 $6,474 $1,222 B67A Degenerative Nervous System Disorders, Major Complexity 0 0 12.4 4 40 6% 0.0524 0.0724 136% 0 0.8311 3.3243 0.2382 $0 $0 $4,267 $17,067 $1,223 B67B Degenerative Nervous System Disorders, Intermediate Complexity 1 0 5.2 2 19 8% 0.0524 0.0724 136% 0.1828 0 0.7547 1.5094 0.2156 $938 $0 $3,875 $7,749 $1,107 B67C Degenerative Nervous System Disorders, Minor Complexity 0 0 1.1 1 4 11% 0.0524 0.0724 200% 0.1888 0.139 $0 $0 $0 $969 $714 B68A Multiple Sclerosis And Cerebellar Ataxia, Major Complexity 1 0 7.2 2 22 8% 0.0524 0.0724 160% 0.272 0 0.958 1.9161 0.2553 $1,396 $0 $4,918 $9,837 $1,311 B68B Multiple Sclerosis And Cerebellar Ataxia, Minor Complexity 0 0 1.1 1 3 7% 0.0524 0.0724 199% 0.2414 0.1767 $0 $0 $0 $1,239 $907 B69A Tia And Precerebral Occlusion, Major Complexity 0 0 5.1 1 15 13% 0.0524 0.0724 100% 1.3329 0.2345 $0 $0 $0 $6,843 $1,204 B69B Tia And Precerebral Occlusion, Minor Complexity 0 0 1.8 1 6 21% 0.0524 0.0724 100% 0.4576 0.2524 $0 $0 $0 $2,349 $1,296 B70A Stroke And Other Cerebrovascular Disorders, Major Complexity 0 0 13.9 4 42 8% 0.0524 0.0724 100% 0 1.0311 4.1244 0.2662 $0 $0 $5,294 $21,175 $1,367 B70B Stroke And Other Cerebrovascular Disorders, Intermediate Complexity 0 0 6.4 2 19 11% 0.0524 0.0724 100% 0 0.9538 1.9077 0.2429 $0 $0 $4,897 $9,794 $1,247 B70C Stroke And Other Cerebrovascular Disorders, Minor Complexity 1 0 3.8 1 11 15% 0.0524 0.0724 191% 0.2039 1.0712 0.2429 $1,047 $0 $0 $5,500 $1,247 B70D Stroke And Other Cerebrovascular Disorders, Transferred <5 Days 1 0 2.3 1 4 16% 0.0524 0.0724 100% 0.2394 0.808 $1,229 $0 $0 $4,148 $0 B71A Cranial And Peripheral Nerve Disorders, Major Complexity 1 0 5.3 1 18 9% 0.0524 0.0724 162% 0.1932 1.4061 0.269 $992 $0 $0 $7,219 $1,381 B71B Cranial And Peripheral Nerve Disorders, Minor Complexity 0 0 1.1 1 3 12% 0.0524 0.0724 200% 0.1634 0.1189 $0 $0 $0 $839 $610 B72A Nervous System Infection Except Viral Meningitis, Major Complexity 0 0 10.9 3 34 9% 0.0524 0.0724 131% 0 1.1922 3.5765 0.2487 $0 $0 $6,121 $18,362 $1,277 B72B Nervous System Infection Except Viral Meningitis, Minor Complexity 0 0 3.2 1 10 8% 0.0524 0.0724 198% 0.6062 0.202 $0 $0 $0 $3,112 $1,037 B73A Viral Meningitis, Major Complexity 0 0 5.2 1 15 11% 0.0524 0.0724 100% 1.3155 0.2263 $0 $0 $0 $6,754 $1,162 B73B Viral Meningitis, Minor Complexity 0 0 2.4 1 7 10% 0.0524 0.0724 128% 0.6537 0.2697 $0 $0 $0 $3,356 $1,385 B74A Nontraumatic Stupor And Coma, Major Complexity 0 0 4.8 1 14 11% 0.0524 0.0724 100% 1.2073 0.2537 $0 $0 $0 $6,198 $1,302 B74B Nontraumatic Stupor And Coma, Minor Complexity 0 0 1.5 1 5 16% 0.0524 0.0724 173% 0.3078 0.231 $0 $0 $0 $1,580 $1,186 B75Z Febrile Convulsions 0 0 1.2 1 4 11% 0.0524 0.0724 100% 0.3215 0.2515 $0 $0 $0 $1,651 $1,291 B76A Seizures, Major Complexity 1 0 4.6 1 15 8% 0.0524 0.0724 133% 0.2215 1.2741 0.2598 $1,137 $0 $0 $6,541 $1,334 B76B Seizures, Minor Complexity 1 0 1.8 1 6 12% 0.0524 0.0724 182% 0.1314 0.4749 0.2696 $675 $0 $0 $2,438 $1,384 B77A Headaches, Major Complexity 1 0 3.2 1 10 13% 0.0524 0.0724 135% 0.1369 0.8154 0.2399 $703 $0 $0 $4,186 $1,232 B77B Headaches, Minor Complexity 0 0 1.2 1 4 18% 0.0524 0.0724 186% 0.1788 0.1229 $0 $0 $0 $918 $631 B78A Intracranial Injuries, Major Complexity 0 0 10 3 34 9% 0.0524 0.0724 136% 0 0.9762 2.9285 0.2465 $0 $0 $5,012 $15,035 $1,266 B78B Intracranial Injuries, Minor Complexity 0 0 3.1 1 10 12% 0.0524 0.0724 113% 0.8113 0.2575 $0 $0 $0 $4,165 $1,322 B78C Intracranial Injuries, Transferred <5 Days 0 0 1.5 1 4 15% 0.0524 0.0724 100% 0.507 $0 $0 $0 $2,603 $0 B79A Skull Fractures, Major Complexity 0 0 4.9 1 16 10% 0.0524 0.0724 127% 1.3039 0.2486 $0 $0 $0 $6,694 $1,276 B79B Skull Fractures, Minor Complexity 0 0 1.6 1 5 10% 0.0524 0.0724 148% 0.3801 0.2443 $0 $0 $0 $1,951 $1,254 B80A Other Head Injuries, Major Complexity 1 0 3.6 1 12 15% 0.0524 0.0724 92% 0.1246 0.8158 0.2071 $640 $0 $0 $4,188 $1,063 B80B Other Head Injuries, Minor Complexity 0 0 1.1 1 3 17% 0.0524 0.0724 83% 0.1422 0.1091 $0 $0 $0 $730 $560 B81A Other Disorders Of The Nervous System, Major Complexity 0 0 7.5 2 22 10% 0.0524 0.0724 128% 0 1.0041 2.0082 0.2165 $0 $0 $5,155 $10,310 $1,112 B81B Other Disorders Of The Nervous System, Minor Complexity 1 0 3.5 1 11 15% 0.0524 0.0724 155% 0.2496 0.7352 0.2025 $1,281 $0 $0 $3,775 $1,040 B82A Chronic & Unspec Para/Quadriplegia, Major Complexity 0 0 15.3 5 46 8% 0.0524 0.0724 100% 0 0.9264 4.6319 0.2497 $0 $0 $4,756 $23,780 $1,282 B82B Chronic & Unspec Para/Quadriplegia, Intermediate Complexity 0 0 5.3 2 19 7% 0.0524 0.0724 100% 0 0.8235 1.6469 0.2454 $0 $0 $4,228 $8,455 $1,260 B82C Chronic & Unspec Para/Quadriplegia, Minor Complexity 0 0 2.5 1 8 9% 0.0524 0.0724 100% 0.6729 0.2478 $0 $0 $0 $3,455 $1,272
Note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 2.National Admitted Acute 1 of 10 qld‐nep‐abf‐priceweights_1920_v2.0
2019-20 National Admitted Acute Price Weights (N1920) AR-DRG V9.0 National Weight (NWAU) see note 4 National Price DRG CODE Description Same Day Bundled IHPA ALOS Lower Upper Private Private Private Paediatric Same Day Short-Stay Short-Stay Inlier Long-Stay Same Day $ Short-Stay Short-Stay Inlier $ Long-Stay Payment ICU Bound Bound Patient Patient Patient Adjustment Outlier Outlier Per Outlier Per Outlier Base Outlier Per Outlier Per List Service Accomodatio Accomodatio Base Diem Diem $ Diem $ Diem $ Adjustment n Adjustment n Adjustment (Same Day) (Overnight) B83A Acute Paraplegia And Quadriplegia And Spinal Cord Conditions, Major Complexity 0 0 19 8 81 9% 0.0524 0.0724 100% 0 0.8635 6.9084 0.2974 $0 $0 $4,433 $35,468 $1,527 B83B Acute Paraplegia And Quadriplegia And Spinal Cord Conditions, Interm Comp 0 0 6.5 2 24 11% 0.0524 0.0724 100% 0 1.1931 2.3862 0.2644 $0 $0 $6,125 $12,251 $1,357 B83C Acute Paraplegia And Quadriplegia And Spinal Cord Conditions, Minor Complexity 0 0 2.9 1 10 11% 0.0524 0.0724 100% 0.9643 0.2664 $0 $0 $0 $4,951 $1,368 C01A Procedures For Penetrating Eye Injury, Major Complexity 0 0 3.9 1 13 20% 0.0524 0.0724 100% 2.2759 0.3737 $0 $0 $0 $11,684 $1,919 C01B Procedures For Penetrating Eye Injury, Minor Complexity 0 0 1.7 1 5 20% 0.0524 0.0724 147% 1.1817 0.4056 $0 $0 $0 $6,067 $2,082 C02A Enucleations And Orbital Procedures, Major Complexity 1 0 5.2 1 17 12% 0.0524 0.0724 148% 0.6754 2.4764 0.2956 $3,468 $0 $0 $12,714 $1,518 C02B Enucleations And Orbital Procedures, Minor Complexity 1 021613%0.0524 0.0724 105% 0.7283 1.6043 0.3166 $3,739 $0 $0 $8,236 $1,625 C03A Retinal Procedures, Major Complexity 0 0 1.4 1 4 74% 0.0524 0.0724 139% 0.8631 0.2957 $0 $0 $0 $4,431 $1,518 C03B Retinal Procedures, Minor Complexity 0011381%0.0524 0.0724 200% 0.2775 0.15 $0 $0 $0 $1,425 $770 C04A Major Corneal, Scleral And Conjunctival Procedures, Major Complexity 0 0 3.9 1 15 43% 0.0524 0.0724 100% 2.0937 0.3195 $0 $0 $0 $10,749 $1,640 C04B Major Corneal, Scleral And Conjunctival Procedures, Minor Complexity 0 0 1.1 1 4 63% 0.0524 0.0724 100% 1.2689 0.3233 $0 $0 $0 $6,515 $1,660 C05Z Dacryocystorhinostomy 0 0 1.1 1 3 38% 0.0524 0.0724 100% 0.8968 0.3109 $0 $0 $0 $4,604 $1,596 C10Z Strabismus Procedures 0011322%0.0524 0.0724 126% 0.7642 0.2577 $0 $0 $0 $3,923 $1,323 C11Z Eyelid Procedures 1 0 1.9 1 6 30% 0.0524 0.0724 117% 0.5814 0.9901 0.3226 $2,985 $0 $0 $5,083 $1,656 C12A Other Corneal, Scleral And Conjunctival Procedures, Major Complexity 0 0 4.1 1 13 17% 0.0524 0.0724 100% 1.4656 0.2881 $0 $0 $0 $7,524 $1,479 C12B Other Corneal, Scleral And Conjunctival Procedures, Minor Complexity 0 011325%0.0524 0.0724 136% 0.6249 0.24 $0 $0 $0 $3,208 $1,232 C13Z Lacrimal Procedures 0 0 1.1 1 3 37% 0.0524 0.0724 100% 0.4563 0.1813 $0 $0 $0 $2,343 $931 C14A Other Eye Procedures, Major Complexity 0 0 4.7 1 13 2% 0.0524 0.0724 100% 1.3789 0.2493 $0 $0 $0 $7,079 $1,280 C14B Other Eye Procedures, Minor Complexity 0 0 1.1 1 3 28% 0.0524 0.0724 121% 0.4376 0.25 $0 $0 $0 $2,247 $1,284 C15Z Glaucoma And Complex Cataract Procedures 0 0 1.3 1 4 38% 0.0524 0.0724 158% 0.7738 0.259 $0 $0 $0 $3,973 $1,330 C16Z Lens Procedures 0011476%0.0524 0.0724 197% 0.5285 0.2183 $0 $0 $0 $2,713 $1,121 C60A Acute And Major Eye Infections, Major Complexity 0 0 7.2 2 22 4% 0.0524 0.0724 100% 0 1.0901 2.1801 0.2703 $0 $0 $5,597 $11,193 $1,388 C60B Acute And Major Eye Infections, Minor Complexity 0 0319 4%0.0524 0.0724 138% 0.7681 0.2812 $0 $0 $0 $3,943 $1,444 C61A Neurological And Vascular Disorders Of The Eye, Major Complexity 1 0 4.2 1 12 13% 0.0524 0.0724 134% 0.3087 1.1712 0.2513 $1,585 $0 $0 $6,013 $1,290 C61B Neurological And Vascular Disorders Of The Eye, Minor Complexity 1 0 2.3 1 8 16% 0.0524 0.0724 191% 0.154 0.6363 0.2404 $791 $0 $0 $3,267 $1,234 C62A Hyphaema And Medically Managed Trauma To The Eye, Major Complexity 1 0 4.1 1 14 10% 0.0524 0.0724 143% 0.1771 1.0317 0.2182 $909 $0 $0 $5,297 $1,120 C62B Hyphaema And Medically Managed Trauma To The Eye, Minor Complexity 0 0 1.2 1 4 17% 0.0524 0.0724 189% 0.1853 0.1294 $0 $0 $0 $951 $664 C63A Other Disorders Of The Eye, Major Complexity 1 0 4 1 13 7% 0.0524 0.0724 123% 0.3631 1.1364 0.2537 $1,864 $0 $0 $5,834 $1,302 C63B Other Disorders Of The Eye, Minor Complexity 1 021610%0.0524 0.0724 189% 0.1754 0.5115 0.2434 $901 $0 $0 $2,626 $1,250 D01Z Cochlear Implant 0 0 1.2 1 3 64% 0.0524 0.0724 112% 6.5265 0.8976 $0 $0 $0 $33,507 $4,608 D02A Head And Neck Procedures, Major Complexity 0 0 9.4 2 27 13% 0.0524 0.0724 100% 0.9525 2.3463 5.6452 0.4097 $0 $4,890 $12,046 $28,982 $2,103 D02B Head And Neck Procedures, Minor Complexity 0 021712%0.0524 0.0724 100% 1.6722 0.4815 $0 $0 $0 $8,585 $2,472 D03A Surgical Repair For Cleft Lip And Palate Disorders, Major Complexity 0 0 2.3 1 7 8% 0.0524 0.0724 120% 1.8985 0.4238 $0 $0 $0 $9,747 $2,176 D03B Surgical Repair For Cleft Lip And Palate Disorders, Minor Complexity 0 0 1.6 1 5 10% 0.0524 0.0724 113% 1.4092 0.4359 $0 $0 $0 $7,235 $2,238 D04A Maxillo Surgery, Major Complexity 0 0 2.5 1 8 17% 0.0524 0.0724 100% 2.188 0.3885 $0 $0 $0 $11,233 $1,995 D04B Maxillo Surgery, Minor Complexity 0 0 1.5 1 5 16% 0.0524 0.0724 117% 1.3659 0.4151 $0 $0 $0 $7,013 $2,131 D05Z Parotid Gland Procedures 0 0 2.4 1 7 21% 0.0524 0.0724 100% 2.3644 0.4091 $0 $0 $0 $12,139 $2,100 D06Z Sinus And Complex Middle Ear Procedures 0 0 1.2 1 4 25% 0.0524 0.0724 100% 1.2978 0.414 $0 $0 $0 $6,663 $2,125 D10Z Nasal Procedures 0 0 1.1 1 3 23% 0.0524 0.0724 90% 0.9699 0.343 $0 $0 $0 $4,979 $1,761 D11Z Tonsillectomy And Adenoidectomy 0 0 1.1 1 3 17% 0.0524 0.0724 114% 0.7019 0.3427 $0 $0 $0 $3,604 $1,759 D12A Other Ear, Nose, Mouth And Throat Procedures, Major Complexity 1 0 5.2 1 15 10% 0.0524 0.0724 117% 0.7389 2.1539 0.2848 $3,794 $0 $0 $11,058 $1,462 D12B Other Ear, Nose, Mouth And Throat Procedures, Minor Complexity 0 0 1.3 1 4 20% 0.0524 0.0724 117% 0.7861 0.2577 $0 $0 $0 $4,036 $1,323 D13Z Myringotomy W Tube Insertion 0 0 1.1 1 3 25% 0.0524 0.0724 120% 0.4021 0.14 $0 $0 $0 $2,064 $719 D14A Mouth And Salivary Gland Procedures, Major Complexity 0 021610%0.0524 0.0724 112% 1.0712 0.3058 $0 $0 $0 $5,500 $1,570 D14B Mouth And Salivary Gland Procedures, Minor Complexity 0 0 1.1 1 3 14% 0.0524 0.0724 114% 0.5198 0.1831 $0 $0 $0 $2,669 $940 D15Z Mastoid Procedures 0 0 1.9 1 6 23% 0.0524 0.0724 100% 2.1949 0.2693 $0 $0 $0 $11,269 $1,383 D40Z Dental Extractions And Restorations 0 0 1.1 1 3 12% 0.0524 0.0724 100% 0.6757 0.1916 $0 $0 $0 $3,469 $984 D60A Ear, Nose, Mouth And Throat Malignancy, Major Complexity 0 0 8.3 2 27 6% 0.0524 0.0724 100% 0.1645 1.4227 3.0098 0.2863 $0 $845 $7,304 $15,452 $1,470 D60B Ear, Nose, Mouth And Throat Malignancy, Minor Complexity 1 0 2.4 1 8 12% 0.0524 0.0724 147% 0.3447 0.9841 0.2153 $1,770 $0 $0 $5,052 $1,105 D61A Dysequilibrium, Major Complexity 1 0 3.6 1 12 14% 0.0524 0.0724 100% 0.1206 0.879 0.2105 $619 $0 $0 $4,513 $1,081 D61B Dysequilibrium, Minor Complexity 0 0 1.3 1 4 17% 0.0524 0.0724 170% 0.2303 0.1698 $0 $0 $0 $1,182 $872 D62A Epistaxis, Major Complexity 0 0 3.4 1 11 9% 0.0524 0.0724 100% 0.8451 0.2441 $0 $0 $0 $4,339 $1,253 D62B Epistaxis, Minor Complexity 0 0 1.3 1 4 8% 0.0524 0.0724 114% 0.2388 0.1606 $0 $0 $0 $1,226 $825 D63A Otitis Media And Upper Respiratory Infections, Major Complexity 1 0 3.1 1 9 9% 0.0524 0.0724 116% 0.1531 0.8211 0.2413 $786 $0 $0 $4,216 $1,239 D63B Otitis Media And Upper Respiratory Infections, Minor Complexity 0 0 1.2 1 4 9% 0.0524 0.0724 113% 0.2415 0.1879 $0 $0 $0 $1,240 $965 D64A Laryngotracheitis And Epiglottitis, Major Complexity 0 0 1.7 1 5 9% 0.0524 0.0724 110% 0.5515 0.2889 $0 $0 $0 $2,831 $1,483 D64B Laryngotracheitis And Epiglottitis, Minor Complexity 0 0 1.1 1 3 10% 0.0524 0.0724 80% 0.2133 0.164 $0 $0 $0 $1,095 $842 D65A Nasal Trauma And Deformity, Major Complexity 0 0 3.3 1 10 15% 0.0524 0.0724 100% 0.7202 0.22 $0 $0 $0 $3,698 $1,129 D65B Nasal Trauma And Deformity, Minor Complexity 0 0 1.1 1 3 20% 0.0524 0.0724 126% 0.2334 0.1121 $0 $0 $0 $1,198 $576 D66A Other Ear, Nose, Mouth And Throat Disorders, Major Complexity 1 0 3.8 1 12 10% 0.0524 0.0724 120% 0.277 0.9367 0.2703 $1,422 $0 $0 $4,809 $1,388 D66B Other Ear, Nose, Mouth And Throat Disorders, Minor Complexity 0 0 1.2 1 4 11% 0.0524 0.0724 135% 0.2393 0.1162 $0 $0 $0 $1,229 $597 D67A Oral And Dental Disorders, Major Complexity 1 0 4 1 12 9% 0.0524 0.0724 118% 0.2371 1.1169 0.2744 $1,217 $0 $0 $5,734 $1,409 D67B Oral And Dental Disorders, Minor Complexity 0 0 1.2 1 4 15% 0.0524 0.0724 141% 0.2602 0.1396 $0 $0 $0 $1,336 $717 E01A Major Chest Procedures, Major Complexity 0 0 15.9 5 48 13% 0.0524 0.0724 100% 1.2787 1.2118 7.3378 0.2894 $0 $6,565 $6,221 $37,672 $1,486 E01B Major Chest Procedures, Intermediate Complexity 0 0 9.1 3 30 16% 0.0524 0.0724 110% 1.1704 1.1108 4.5027 0.2547 $0 $6,009 $5,703 $23,117 $1,308 E01C Major Chest Procedures, Minor Complexity 0 0 6 2 19 18% 0.0524 0.0724 120% 0.5559 1.3616 3.279 0.2589 $0 $2,854 $6,990 $16,834 $1,329 E02A Other Respiratory System GIs, Major Complexity 0 0 12.1 4 37 14% 0.0524 0.0724 132% 0.5923 1.034 4.7281 0.2562 $0 $3,041 $5,309 $24,274 $1,315 E02B Other Respiratory System GIs, Intermediate Complexity 1 0 3.1 1 9 22% 0.0524 0.0724 80% 0.674 1.7685 0.2842 $3,460 $0 $0 $9,079 $1,459 E02C Other Respiratory System GIs, Minor Complexity 0 0 1.1 1 3 18% 0.0524 0.0724 100% 0.7754 0.315 $0 $0 $0 $3,981 $1,617 E03Z Lung Or Heart-Lung Transplant 0 0 20.4 10 98 12% 0.0524 0.0724 100% 5.0123 1.6606 21.6183 0.3188 $0 $25,733 $8,526 $110,988 $1,637 E40A Respiratory System Disorders W Ventilator Support, Major Complexity 0 0 8.4 3 29 10% 0.0524 0.0724 100% 0.0254 1.6002 4.8258 0.2956 $0 $130 $8,215 $24,776 $1,518 E40B Respiratory System Disorders W Ventilator Support, Minor Complexity 0 0 4.5 1 15 11% 0.0524 0.0724 83% 2.6875 0.3267 $0 $0 $0 $13,798 $1,677 E41A Respiratory System Disorders W Non-Invasive Ventilation, Major Complexity 0 0 10.6 3 35 9% 0.0524 0.0724 100% 0.022 1.3674 4.1243 0.29 $0 $113 $7,020 $21,174 $1,489 E41B Respiratory System Disorders W Non-Invasive Ventilation, Minor Complexity 0 0 5.6 2 18 8% 0.0524 0.0724 80% 0 1.0605 2.1211 0.2927 $0 $0 $5,445 $10,890 $1,503 E42A Bronchoscopy, Major Complexity 0 0 12 4 38 10% 0.0524 0.0724 156% 0.2217 1.032 4.3496 0.2637 $0 $1,138 $5,298 $22,331 $1,354 E42B Bronchoscopy, Intermediate Complexity 1 0 6.2 2 19 22% 0.0524 0.0724 139% 0.5355 0.3039 1.0394 2.3828 0.2386 $2,749 $1,560 $5,336 $12,233 $1,225 E42C Bronchoscopy, Minor Complexity 1 0 2.9 1 9 25% 0.0524 0.0724 125% 0.4539 1.2143 0.2294 $2,330 $0 $0 $6,234 $1,178 E60A Cystic Fibrosis, Major Complexity 0 0 11.4 4 36 3% 0.0524 0.0724 131% 0 1.0613 4.2453 0.2687 $0 $0 $5,449 $21,795 $1,380 E60B Cystic Fibrosis, Minor Complexity 0 0 6.6 2 20 4% 0.0524 0.0724 125% 0 1.1327 2.2655 0.173 $0 $0 $5,815 $11,631 $888 E61A Pulmonary Embolism, Major Complexity 0 0 6.2 2 20 14% 0.0524 0.0724 100% 0 0.8981 1.7961 0.2282 $0 $0 $4,611 $9,221 $1,172 E61B Pulmonary Embolism, Minor Complexity 1 0 2.9 1 10 17% 0.0524 0.0724 100% 0.1856 0.7313 0.1816 $953 $0 $0 $3,754 $932
Note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 2.National Admitted Acute 2 of 10 qld‐nep‐abf‐priceweights_1920_v2.0
2019-20 National Admitted Acute Price Weights (N1920) AR-DRG V9.0 National Weight (NWAU) see note 4 National Price DRG CODE Description Same Day Bundled IHPA ALOS Lower Upper Private Private Private Paediatric Same Day Short-Stay Short-Stay Inlier Long-Stay Same Day $ Short-Stay Short-Stay Inlier $ Long-Stay Payment ICU Bound Bound Patient Patient Patient Adjustment Outlier Outlier Per Outlier Per Outlier Base Outlier Per Outlier Per List Service Accomodatio Accomodatio Base Diem Diem $ Diem $ Diem $ Adjustment n Adjustment n Adjustment (Same Day) (Overnight) E62A Respiratory Infections And Inflammations, Major Complexity 0 0 5.8 2 19 9% 0.0524 0.0724 110% 0 0.8191 1.6382 0.2401 $0 $0 $4,205 $8,411 $1,233 E62B Respiratory Infections And Inflammations, Minor Complexity 1 0 2.8 1 9 10% 0.0524 0.0724 80% 0.1221 0.7332 0.2258 $627 $0 $0 $3,764 $1,159 E63A Sleep Apnoea, Major Complexity 0 0 1.7 1 5 10% 0.0524 0.0724 124% 0.4895 0.2755 $0 $0 $0 $2,513 $1,414 E63B Sleep Apnoea, Minor Complexity 0 0 1.1 1 4 16% 0.0524 0.0724 116% 0.3172 0.1651 $0 $0 $0 $1,629 $848 E64A Pulmonary Oedema And Respiratory Failure, Major Complexity 0 0 5.9 2 18 9% 0.0524 0.0724 100% 0 0.9031 1.8062 0.2369 $0 $0 $4,637 $9,273 $1,216 E64B Pulmonary Oedema And Respiratory Failure, Minor Complexity 0 0 2.4 1 8 11% 0.0524 0.0724 100% 0.5986 0.2267 $0 $0 $0 $3,073 $1,164 E65A Chronic Obstructive Airways Disease, Major Complexity 0 0 5.7 2 18 9% 0.0524 0.0724 100% 0 0.756 1.5121 0.2241 $0 $0 $3,881 $7,763 $1,151 E65B Chronic Obstructive Airways Disease, Minor Complexity 0 0 2.7 1 9 10% 0.0524 0.0724 196% 0.6159 0.2171 $0 $0 $0 $3,162 $1,115 E66A Major Chest Trauma, Major Complexity 0 0 8.7 3 28 11% 0.0524 0.0724 100% 0 0.8033 2.4098 0.227 $0 $0 $4,124 $12,372 $1,165 E66B Major Chest Trauma, Intermediate Complexity 0 0 4 1 12 11% 0.0524 0.0724 100% 1.0335 0.2392 $0 $0 $0 $5,306 $1,228 E66C Major Chest Trauma, Minor Complexity 0 0 1.8 1 6 16% 0.0524 0.0724 100% 0.4205 0.2503 $0 $0 $0 $2,159 $1,285 E67A Respiratory Signs And Symptoms, Major Complexity 1 0 3.2 1 10 13% 0.0524 0.0724 89% 0.2338 0.8539 0.246 $1,200 $0 $0 $4,384 $1,263 E67B Respiratory Signs And Symptoms, Minor Complexity 0 0 1.2 1 4 14% 0.0524 0.0724 80% 0.2329 0.1802 $0 $0 $0 $1,196 $925 E68A Pneumothorax, Major Complexity 0 0 5.3 1 18 10% 0.0524 0.0724 100% 1.5204 0.2659 $0 $0 $0 $7,806 $1,365 E68B Pneumothorax, Minor Complexity 0 0 2.3 1 7 13% 0.0524 0.0724 127% 0.5885 0.2593 $0 $0 $0 $3,021 $1,331 E69A Bronchitis And Asthma, Major Complexity 0 0 3.1 1 10 9% 0.0524 0.0724 107% 0.8257 0.2384 $0 $0 $0 $4,239 $1,224 E69B Bronchitis And Asthma, Minor Complexity 0 0 1.4 1 4 8% 0.0524 0.0724 80% 0.2988 0.2152 $0 $0 $0 $1,534 $1,105 E70A Whooping Cough And Acute Bronchiolitis, Major Complexity 0 0 2.8 1 8 5% 0.0524 0.0724 108% 0.9715 0.351 $0 $0 $0 $4,988 $1,802 E70B Whooping Cough And Acute Bronchiolitis, Minor Complexity 0 0 1.6 1 6 5% 0.0524 0.0724 80% 0.5409 0.3311 $0 $0 $0 $2,777 $1,700 E71A Respiratory Neoplasms, Major Complexity 0 0 8.4 2 27 9% 0.0524 0.0724 100% 0 1.2208 2.4415 0.2459 $0 $0 $6,268 $12,535 $1,262 E71B Respiratory Neoplasms, Minor Complexity 1 0 4.1 1 13 13% 0.0524 0.0724 161% 0.3122 1.0728 0.2434 $1,603 $0 $0 $5,508 $1,250 E72Z Respiratory Problems Arising From Neonatal Period 0 0 1.8 1 5 10% 0.0524 0.0724 87% 0.4898 0.2861 $0 $0 $0 $2,515 $1,469 E73A Pleural Effusion, Major Complexity 0 0 8.9 3 28 12% 0.0524 0.0724 100% 0 0.8641 2.5923 0.2271 $0 $0 $4,436 $13,309 $1,166 E73B Pleural Effusion, Intermediate Complexity 0 0 4.2 1 14 14% 0.0524 0.0724 100% 1.114 0.2363 $0 $0 $0 $5,719 $1,213 E73C Pleural Effusion, Minor Complexity 1 0 2.7 1 8 21% 0.0524 0.0724 100% 0.1639 0.7076 0.2083 $841 $0 $0 $3,633 $1,069 E74A Interstitial Lung Disease, Major Complexity 0 0 6.6 2 20 9% 0.0524 0.0724 100% 0 0.8949 1.7899 0.2252 $0 $0 $4,594 $9,189 $1,156 E74B Interstitial Lung Disease, Minor Complexity 1 0 3.9 1 12 9% 0.0524 0.0724 89% 0.255 1.0118 0.2193 $1,309 $0 $0 $5,195 $1,126 E75A Other Respiratory System Disorders, Major Complexity 0 0 3.8 1 12 10% 0.0524 0.0724 136% 0.969 0.2459 $0 $0 $0 $4,975 $1,262 E75B Other Respiratory System Disorders, Minor Complexity 1 0 1.8 1 6 11% 0.0524 0.0724 82% 0.1282 0.483 0.2401 $658 $0 $0 $2,480 $1,233 E76Z Respiratory Tuberculosis 0 0 15.8 4 43 10% 0.0524 0.0724 100% 0 1.0281 4.1124 0.2299 $0 $0 $5,278 $21,113 $1,180 E77A Bronchiectasis, Major Complexity 0 0 7.7 2 24 8% 0.0524 0.0724 200% 0 1.0424 2.0849 0.2441 $0 $0 $5,352 $10,704 $1,253 E77B Bronchiectasis, Minor Complexity 0 0 4.4 1 13 9% 0.0524 0.0724 166% 0.9749 0.1899 $0 $0 $0 $5,005 $975 F01A Implantation And Replacement Of AICD, Total System, Major Complexity 0 0 10.7 3 32 61% 0.0524 0.0724 100% 4.3793 1.4106 8.6111 0.3106 $0 $22,483 $7,242 $44,209 $1,595 F01B Implantation And Replacement Of AICD, Total System, Minor Complexity 1 0 2.3 1 7 89% 0.0524 0.0724 100% 2.9069 4.6829 0.3199 $14,924 $0 $0 $24,042 $1,642 F02Z Other AICD Procedures 0 0 3.6 1 12 30% 0.0524 0.0724 100% 2.5967 0.3388 $0 $0 $0 $13,331 $1,739 F03A Cardiac Valve Procedures W CPB Pump W Invasive Cardiac Investigation, Major Comp 0 0 22 7 67 21% 0.0524 0.0724 100% 4.5688 1.2507 13.3236 0.3051 $0 $23,456 $6,421 $68,403 $1,566 F03B Cardiac Valve Procedures W CPB Pump W Invasive Cardiac Investigation, Minor Comp 0 0 11.6 4 39 21% 0.0524 0.0724 100% 6.2466 0.7822 9.3755 0.178 $0 $32,070 $4,016 $48,134 $914 F04A Cardiac Valve Procedures W CPB Pump W/O Invasive Cardiac Invest, Major Comp 0 0 17.2 5 54 18% 0.0524 0.0724 116% 4.2331 1.6283 12.3747 0.3122 $0 $21,733 $8,360 $63,532 $1,603 F04B Cardiac Valve Procedures W CPB Pump W/O Invasive Cardiac Invest, Interm Comp 0 0 8.4 3 28 23% 0.0524 0.0724 100% 6.0168 0.6288 7.9034 0.2548 $0 $30,890 $3,228 $40,576 $1,308 F04C Cardiac Valve Procedures W CPB Pump W/O Invasive Cardiac Invest, Minor Comp 0 0 5.8 2 19 16% 0.0524 0.0724 100% 5.0382 0.7674 6.573 0.1655 $0 $25,866 $3,940 $33,746 $850 F05A Coronary Bypass W Invasive Cardiac Investigation, Major Complexity 0 0 15.9 6 55 20% 0.0524 0.0724 100% 2.9354 1.1485 9.8264 0.3492 $0 $15,070 $5,896 $50,449 $1,793 F05B Coronary Bypass W Invasive Cardiac Investigation, Minor Complexity 0 0 11.6 4 36 21% 0.0524 0.0724 100% 2.5404 1.2483 7.5335 0.2978 $0 $13,042 $6,409 $38,677 $1,529 F06A Coronary Bypass W/O Invasive Cardiac Investigation, Major Complexity 0 0 13.1 4 41 18% 0.0524 0.0724 100% 3.2008 1.3626 8.6512 0.3471 $0 $16,433 $6,996 $44,415 $1,782 F06B Coronary Bypass W/O Invasive Cardiac Investigation, Intermediate Complexity 0 0 8.1 2 25 21% 0.0524 0.0724 100% 2.2407 1.9413 6.1232 0.2592 $0 $11,504 $9,967 $31,437 $1,331 F06C Coronary Bypass W/O Invasive Cardiac Investigation, Minor Complexity 0 0 6.3 2 19 22% 0.0524 0.0724 100% 2.1878 1.5285 5.2449 0.2383 $0 $11,232 $7,847 $26,927 $1,223 F07A Other Cardiothoracic/Vascular Procedures W CPB Pump, Major Complexity 0 0 10.9 3 35 16% 0.0524 0.0724 110% 3.9898 1.8849 9.6445 0.4429 $0 $20,484 $9,677 $49,515 $2,274 F07B Other Cardiothoracic/Vascular Procedures W CPB Pump, Minor Complexity 0 0 6.1 2 19 23% 0.0524 0.0724 100% 2.2434 1.7331 5.7097 0.3247 $0 $11,518 $8,898 $29,314 $1,667 F08A Major Reconstructive Vascular Procedures W/O CPB Pump, Major Complexity 0 0 17.9 6 58 18% 0.0524 0.0724 100% 3.8074 1.0973 10.391 0.267 $0 $19,547 $5,634 $53,347 $1,371 F08B Major Reconstructive Vascular Procedures W/O CPB Pump, Intermediate Complexity 0 0 8.5 2 26 29% 0.0524 0.0724 100% 3.0991 1.5349 6.1689 0.2352 $0 $15,911 $7,880 $31,671 $1,208 F08C Major Reconstructive Vascular Procedures W/O CPB Pump, Minor Complexity 0 0 4.1 1 13 33% 0.0524 0.0724 100% 3.8901 0.2905 $0 $0 $0 $19,972 $1,491 F09A Other Cardiothoracic Procedures W/O CPB Pump, Major Complexity 0 0 9.9 3 30 17% 0.0524 0.0724 100% 1.1332 1.7118 6.2686 0.3029 $0 $5,818 $8,788 $32,183 $1,555 F09B Other Cardiothoracic Procedures W/O CPB Pump, Intermediate Complexity 0 0 5 1 17 26% 0.0524 0.0724 100% 3.4527 0.3199 $0 $0 $0 $17,726 $1,642 F09C Other Cardiothoracic Procedures W/O CPB Pump, Minor Complexity 0 0 2.1 1 7 31% 0.0524 0.0724 100% 1.8842 0.4128 $0 $0 $0 $9,673 $2,119 F10A Interventional Coronary Procedures, Admitted For Ami, Major Complexity 0 0 6.7 2 21 29% 0.0524 0.0724 100% 0.9433 1.297 3.5374 0.3089 $0 $4,843 $6,659 $18,161 $1,586 F10B Interventional Coronary Procedures, Admitted For Ami, Minor Complexity 0 0 3.1 1 9 42% 0.0524 0.0724 100% 2.0144 0.3143 $0 $0 $0 $10,342 $1,614 F11A Amputation, Except Upper Limb And Toe, For Circulatory Disorders, Major Comp 0 0 28.8 12 114 8% 0.0524 0.0724 100% 1.3012 0.9502 12.7041 0.3195 $0 $6,680 $4,878 $65,223 $1,640 F11B Amputation, Except Upper Limb And Toe, For Circulatory Disorders, Minor Comp 0 0 15.5 5 50 8% 0.0524 0.0724 100% 1.0004 0.9484 5.7422 0.2798 $0 $5,136 $4,869 $29,480 $1,436 F12A Implantation And Replacement Of Pacemaker, Total System, Major Complexity 0 0 7.5 2 24 44% 0.0524 0.0724 100% 1.3186 1.3317 3.982 0.2811 $0 $6,770 $6,837 $20,444 $1,443 F12B Implantation And Replacement Of Pacemaker, Total System, Minor Complexity 1 0 2.6 1 8 63% 0.0524 0.0724 100% 1.2304 2.137 0.2608 $6,317 $0 $0 $10,971 $1,339 F13A Amputation, Upper Limb And Toe, For Circulatory Disorders, Major Complexity 0 0 16.5 5 51 10% 0.0524 0.0724 100% 0.4763 1.1184 6.0685 0.2747 $0 $2,445 $5,742 $31,156 $1,410 F13B Amputation, Upper Limb And Toe, For Circulatory Disorders, Minor Complexity 0 0 7.3 2 22 12% 0.0524 0.0724 100% 0.4332 1.1969 2.8271 0.263 $0 $2,224 $6,145 $14,514 $1,350 F14A Vascular Procedures, Except Major Reconstruction, W/O CPB Pump, Major Complexity 0 0 12.4 4 40 20% 0.0524 0.0724 150% 1.0058 1.2087 5.8406 0.2869 $0 $5,164 $6,205 $29,986 $1,473 F14B Vascular Procedures, Except Major Reconstruction, W/O CPB Pump, Interm Comp 0 0 3.7 1 11 26% 0.0524 0.0724 117% 2.4311 0.2967 $0 $0 $0 $12,481 $1,523 F14C Vascular Procedures, Except Major Reconstruction, W/O CPB Pump, Minor Complexity 1 0 1.9 1 6 37% 0.0524 0.0724 134% 0.995 1.6492 0.2823 $5,108 $0 $0 $8,467 $1,449 F17A Insertion And Replacement Of Pacemaker Generator, Major Complexity 0 0 4.2 1 11 72% 0.0524 0.0724 100% 2.5659 0.3716 $0 $0 $0 $13,173 $1,908 F17B Insertion And Replacement Of Pacemaker Generator, Minor Complexity 0 0 1.1 1 3 80% 0.0524 0.0724 100% 1.2958 0.1959 $0 $0 $0 $6,653 $1,006 F18Z Other Pacemaker Procedures 0 0 3.8 1 13 25% 0.0524 0.0724 100% 2.1595 0.3568 $0 $0 $0 $11,087 $1,832 F19A Trans-Vascular Percutaneous Cardiac Intervention, Major Complexity 0 0 5.6 2 19 25% 0.0524 0.0724 100% 1.6514 1.5788 4.8091 0.2453 $0 $8,478 $8,106 $24,690 $1,259 F19B Trans-Vascular Percutaneous Cardiac Intervention, Minor Complexity 0 0 1.5 1 5 42% 0.0524 0.0724 134% 2.0746 0.2731 $0 $0 $0 $10,651 $1,402 F20Z Vein Ligation And Stripping 0 0 1.2 1 4 21% 0.0524 0.0724 112% 0.9242 0.2964 $0 $0 $0 $4,745 $1,522 F21A Other Circulatory System GIs, Major Complexity 0 0 21.9 8 76 10% 0.0524 0.0724 100% 0.4708 0.8694 7.4259 0.2588 $0 $2,417 $4,463 $38,125 $1,329 F21B Other Circulatory System GIs, Intermediate Complexity 0 0 9.3 3 30 9% 0.0524 0.0724 100% 0.5269 0.9092 3.2544 0.2197 $0 $2,705 $4,668 $16,708 $1,128 F21C Other Circulatory System GIs, Minor Complexity 1 0 3.3 1 10 22% 0.0524 0.0724 100% 0.8042 1.6299 0.2228 $4,129 $0 $0 $8,368 $1,144 F22Z Insertion Of Artificial Heart Device 0 0 36.4 14 132 30% 0.0524 0.0724 100% 31.9741 2.2977 64.1415 0.4069 $0 $164,155 $11,796 $329,302 $2,089 F23Z Heart Transplant 0 0 22.7 13 121 30% 0.0524 0.0724 100% 4.0805 1.7635 27.0065 0.6499 $0 $20,949 $9,054 $138,651 $3,337 F24A Interventional Coronary Procs, Not Adm For Ami, Major Comp 0 0 6.6 2 19 25% 0.0524 0.0724 100% 1.0551 1.2886 3.6323 0.29 $0 $5,417 $6,616 $18,648 $1,489 F24B Interventional Coronary Procs, Not Adm For Ami, Minor Comp 0 0 1.6 1 5 42% 0.0524 0.0724 171% 1.642 0.3092 $0 $0 $0 $8,430 $1,587 F40A Circulatory Disorders W Ventilator Support, Major Complexity 0 0 8.6 3 31 10% 0.0524 0.0724 100% 0.0946 1.839 5.6117 0.3182 $0 $486 $9,441 $28,810 $1,634 F40B Circulatory Disorders W Ventilator Support, Minor Complexity 0 0 2.7 1 9 16% 0.0524 0.0724 100% 1.8287 0.2311 $0 $0 $0 $9,389 $1,186 F41A Circulatory Disorders, Adm For Ami W Invasive Cardiac Inves Proc, Major Comp 0 0 6.8 2 21 15% 0.0524 0.0724 100% 0.3349 1.1621 2.6591 0.2671 $0 $1,719 $5,966 $13,652 $1,371 F41B Circulatory Disorders, Adm For Ami W Invasive Cardiac Inves Proc, Minor Comp 1 0 3.5 1 11 20% 0.0524 0.0724 100% 0.5249 1.5169 0.2494 $2,695 $0 $0 $7,788 $1,280
Note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 2.National Admitted Acute 3 of 10 qld‐nep‐abf‐priceweights_1920_v2.0
2019-20 National Admitted Acute Price Weights (N1920) AR-DRG V9.0 National Weight (NWAU) see note 4 National Price DRG CODE Description Same Day Bundled IHPA ALOS Lower Upper Private Private Private Paediatric Same Day Short-Stay Short-Stay Inlier Long-Stay Same Day $ Short-Stay Short-Stay Inlier $ Long-Stay Payment ICU Bound Bound Patient Patient Patient Adjustment Outlier Outlier Per Outlier Per Outlier Base Outlier Per Outlier Per List Service Accomodatio Accomodatio Base Diem Diem $ Diem $ Diem $ Adjustment n Adjustment n Adjustment (Same Day) (Overnight) F42A Circulatory Disorders, Not Adm For Ami W Invasive Cardiac Inves Proc, Major Comp 0 0 5.7 1 18 16% 0.0524 0.0724 118% 2.1503 0.2748 $0 $0 $0 $11,040 $1,411 F42B Circulatory Disorders, Not Adm For Ami W Invasive Cardiac Inves Proc, Minor Comp 1 0 2.6 1 8 29% 0.0524 0.0724 200% 0.528 1.1632 0.2213 $2,711 $0 $0 $5,972 $1,136 F43A Circulatory Disorders W Non-Invasive Ventilation, Major Complexity 0 0 12.8 4 45 9% 0.0524 0.0724 100% 0.0544 1.2426 5.025 0.2448 $0 $279 $6,380 $25,798 $1,257 F43B Circulatory Disorders W Non-Invasive Ventilation, Minor Complexity 0 0 7.5 2 23 11% 0.0524 0.0724 100% 0.0193 1.3296 2.6785 0.2567 $0 $99 $6,826 $13,751 $1,318 F60A Circulatory Disorder, Adm For Ami W/O Invas Card Inves Proc 0 0 4.7 1 14 11% 0.0524 0.0724 100% 1.3382 0.2545 $0 $0 $0 $6,870 $1,307 F60B Circulatory Disorder, Adm For Ami W/O Invas Card Inves Proc, Transf <5 Days 0 0 1.5 1 4 21% 0.0524 0.0724 100% 0.5501 $0 $0 $0 $2,824 $0 F61A Infective Endocarditis, Major Complexity 0 0 23.1 7 70 10% 0.0524 0.0724 100% 0 1.0468 7.3276 0.2162 $0 $0 $5,374 $37,620 $1,110 F61B Infective Endocarditis, Intermediate Complexity 0 0 14.3 4 40 16% 0.0524 0.0724 100% 0 1.0679 4.2715 0.1846 $0 $0 $5,483 $21,930 $948 F61C Infective Endocarditis, Minor Complexity 0 0 7.5 2 22 10% 0.0524 0.0724 80% 0 0.8925 1.785 0.1102 $0 $0 $4,582 $9,164 $566 F62A Heart Failure And Shock, Major Complexity 0 0 7.8 2 25 9% 0.0524 0.0724 100% 0 1.0473 2.0946 0.2404 $0 $0 $5,377 $10,754 $1,234 F62B Heart Failure And Shock, Minor Complexity 0 0 3.4 1 11 11% 0.0524 0.0724 100% 0.8099 0.2244 $0 $0 $0 $4,158 $1,152 F62C Heart Failure And Shock, Transferred <5 Days 0 0 1.6 1 4 15% 0.0524 0.0724 100% 0.4375 $0 $0 $0 $2,246 $0 F63A Venous Thrombosis, Major Complexity 0 0 4.9 1 15 13% 0.0524 0.0724 100% 1.1996 0.2218 $0 $0 $0 $6,159 $1,139 F63B Venous Thrombosis, Minor Complexity 1 0 2.9 1 11 17% 0.0524 0.0724 100% 0.118 0.5904 0.1447 $606 $0 $0 $3,031 $743 F64A Skin Ulcers In Circulatory Disorders, Major Complexity 0 0 11.2 4 40 7% 0.0524 0.0724 100% 0 0.7612 3.0449 0.2316 $0 $0 $3,908 $15,633 $1,189 F64B Skin Ulcers In Circulatory Disorders, Intermediate Complexity 0 0 5.5 1 16 6% 0.0524 0.0724 100% 1.2468 0.216 $0 $0 $0 $6,401 $1,109 F64C Skin Ulcers In Circulatory Disorders, Minor Complexity 1 0 3.7 1 12 18% 0.0524 0.0724 100% 0.1739 0.8153 0.1906 $893 $0 $0 $4,186 $979 F65A Peripheral Vascular Disorders, Major Complexity 0 0 5.6 1 17 12% 0.0524 0.0724 100% 1.5472 0.2498 $0 $0 $0 $7,943 $1,282 F65B Peripheral Vascular Disorders, Minor Complexity 1 0 2.7 1 9 16% 0.0524 0.0724 138% 0.2845 0.7799 0.1855 $1,461 $0 $0 $4,004 $952 F66A Coronary Atherosclerosis, Major Complexity 0 0 4 1 12 10% 0.0524 0.0724 100% 1.0513 0.2599 $0 $0 $0 $5,397 $1,334 F66B Coronary Atherosclerosis, Minor Complexity 0 0 1.4 1 4 20% 0.0524 0.0724 100% 0.2834 0.2122 $0 $0 $0 $1,455 $1,089 F67A Hypertension, Major Complexity 1 0 4.4 1 13 11% 0.0524 0.0724 167% 0.175 1.1279 0.2352 $898 $0 $0 $5,791 $1,208 F67B Hypertension, Minor Complexity 0 0 1.4 1 4 16% 0.0524 0.0724 149% 0.2465 0.1804 $0 $0 $0 $1,266 $926 F68Z Congenital Heart Disease 0 0 1.9 1 5 9% 0.0524 0.0724 186% 0.5296 0.2582 $0 $0 $0 $2,719 $1,326 F69A Valvular Disorders, Major Complexity 1 0 5.6 2 18 11% 0.0524 0.0724 100% 0.2509 0 0.8649 1.7298 0.2406 $1,288 $0 $4,440 $8,881 $1,235 F69B Valvular Disorders, Minor Complexity 0 0 1.2 1 4 23% 0.0524 0.0724 200% 0.225 0.1707 $0 $0 $0 $1,155 $876 F72A Unstable Angina, Major Complexity 1 0 3.7 1 12 15% 0.0524 0.0724 100% 0.1887 1.0602 0.2397 $969 $0 $0 $5,443 $1,231 F72B Unstable Angina, Minor Complexity 1 0 1.8 1 6 17% 0.0524 0.0724 100% 0.1358 0.5133 0.2472 $697 $0 $0 $2,635 $1,269 F73A Syncope And Collapse, Major Complexity 0 0 4.5 1 13 11% 0.0524 0.0724 100% 1.099 0.2307 $0 $0 $0 $5,642 $1,184 F73B Syncope And Collapse, Minor Complexity 1 0 1.8 1 6 20% 0.0524 0.0724 128% 0.1192 0.4403 0.2246 $612 $0 $0 $2,261 $1,153 F74A Chest Pain, Major Complexity 0 0 1.9 1 6 17% 0.0524 0.0724 200% 0.4142 0.2467 $0 $0 $0 $2,127 $1,267 F74B Chest Pain, Minor Complexity 0 0 1.1 1 3 24% 0.0524 0.0724 156% 0.1452 0.1094 $0 $0 $0 $745 $562 F75A Other Circulatory Disorders, Major Complexity 0 0 9.5 3 30 10% 0.0524 0.0724 173% 0 1.0313 3.0939 0.2431 $0 $0 $5,295 $15,884 $1,248 F75B Other Circulatory Disorders, Intermediate Complexity 1 0 4.6 1 15 13% 0.0524 0.0724 177% 0.2738 1.3707 0.2486 $1,406 $0 $0 $7,037 $1,276 F75C Other Circulatory Disorders, Minor Complexity 1 0 2.4 1 8 15% 0.0524 0.0724 196% 0.226 0.6715 0.2265 $1,160 $0 $0 $3,447 $1,163 F76A Arrhythmia, Cardiac Arrest And Conduction Disorders, Major Complexity 0 0 4 1 13 13% 0.0524 0.0724 197% 1.0982 0.2482 $0 $0 $0 $5,638 $1,274 F76B Arrhythmia, Cardiac Arrest And Conduction Disorders, Minor Complexity 1 0 1.9 1 6 18% 0.0524 0.0724 200% 0.1739 0.4713 0.2181 $893 $0 $0 $2,420 $1,120 G01A Rectal Resection, Major Complexity 0 0 23.5 8 78 15% 0.0524 0.0724 100% 2.268 1.1124 11.1668 0.3154 $0 $11,644 $5,711 $57,330 $1,619 G01B Rectal Resection, Intermediate Complexity 0 0 12.7 4 42 17% 0.0524 0.0724 100% 2.1472 1.0985 6.5412 0.2743 $0 $11,024 $5,640 $33,583 $1,408 G01C Rectal Resection, Minor Complexity 0 0 7.6 2 24 18% 0.0524 0.0724 100% 1.8069 1.4222 4.6513 0.266 $0 $9,277 $7,302 $23,880 $1,366 G02A Major Small And Large Bowel Procedures, Major Complexity 0 0 21.7 8 73 13% 0.0524 0.0724 145% 1.6662 1.0078 9.7289 0.2996 $0 $8,554 $5,174 $49,948 $1,538 G02B Major Small And Large Bowel Procedures, Intermediate Complexity 0 0 10 3 31 15% 0.0524 0.0724 118% 1.3756 1.1557 4.8426 0.3006 $0 $7,062 $5,933 $24,862 $1,543 G02C Major Small And Large Bowel Procedures, Minor Complexity 0 0 5.4 1 17 17% 0.0524 0.0724 100% 2.9515 0.3272 $0 $0 $0 $15,153 $1,680 G03A Stomach, Oesophageal And Duodenal Procedures, Major Complexity 0 0 16.3 5 51 15% 0.0524 0.0724 100% 2.0248 1.3786 8.9179 0.3404 $0 $10,395 $7,078 $45,784 $1,748 G03B Stomach, Oesophageal And Duodenal Procedures, Intermediate Complexity 0 0 7.2 2 24 13% 0.0524 0.0724 116% 0.975 1.6076 4.1901 0.3389 $0 $5,006 $8,253 $21,512 $1,740 G03C Stomach, Oesophageal And Duodenal Procedures, Minor Complexity 0 0 3.4 1 11 14% 0.0524 0.0724 126% 2.2284 0.3044 $0 $0 $0 $11,441 $1,563 G04A Peritoneal Adhesiolysis, Major Complexity 0 0 13 4 40 11% 0.0524 0.0724 154% 1.1055 1.1088 5.5407 0.3205 $0 $5,676 $5,693 $28,446 $1,645 G04B Peritoneal Adhesiolysis, Intermediate Complexity 0 0 5.8 2 18 14% 0.0524 0.0724 136% 0.8226 1.0327 2.888 0.2954 $0 $4,223 $5,302 $14,827 $1,517 G04C Peritoneal Adhesiolysis, Minor Complexity 0 0 2.6 1 9 14% 0.0524 0.0724 129% 1.6096 0.3212 $0 $0 $0 $8,264 $1,649 G05A Minor Small And Large Bowel Procedures, Major Complexity 0 0 10.6 3 31 11% 0.0524 0.0724 118% 0.8846 1.1023 4.1916 0.2831 $0 $4,542 $5,659 $21,520 $1,453 G05B Minor Small And Large Bowel Procedures, Minor Complexity 0 0 3.9 1 11 15% 0.0524 0.0724 80% 2.0894 0.3581 $0 $0 $0 $10,727 $1,838 G06Z Pyloromyotomy 0 0 3.1 1 11 16% 0.0524 0.0724 100% 1.7452 0.3194 $0 $0 $0 $8,960 $1,640 G07A Appendicectomy, Major Complexity 0 0 4.3 1 13 11% 0.0524 0.0724 137% 1.9815 0.3181 $0 $0 $0 $10,173 $1,633 G07B Appendicectomy, Minor Complexity 0 0 2.1 1 7 13% 0.0524 0.0724 126% 1.2016 0.3138 $0 $0 $0 $6,169 $1,611 G10A Hernia Procedures, Major Complexity 0 0 3.6 1 11 13% 0.0524 0.0724 92% 1.9818 0.304 $0 $0 $0 $10,175 $1,561 G10B Hernia Procedures, Minor Complexity 0 0 1.2 1 4 20% 0.0524 0.0724 80% 1.0291 0.3077 $0 $0 $0 $5,283 $1,580 G11A Anal And Stomal Procedures, Major Complexity 0 0 4.5 1 14 10% 0.0524 0.0724 170% 1.5094 0.244 $0 $0 $0 $7,749 $1,253 G11B Anal And Stomal Procedures, Minor Complexity 0 0 1.4 1 4 15% 0.0524 0.0724 110% 0.6539 0.246 $0 $0 $0 $3,357 $1,263 G12A Other Digestive System GIs, Major Complexity 0 0 16.9 6 55 13% 0.0524 0.0724 100% 0.5106 0.9475 6.1954 0.2677 $0 $2,621 $4,864 $31,807 $1,374 G12B Other Digestive System GIs, Intermediate Complexity 0 0 7 2 22 15% 0.0524 0.0724 120% 0.508 1.0583 2.6247 0.2432 $0 $2,608 $5,433 $13,475 $1,249 G12C Other Digestive System GIs, Minor Complexity 1 0 3.3 1 10 15% 0.0524 0.0724 139% 0.719 1.4844 0.2208 $3,691 $0 $0 $7,621 $1,134 G46A Complex Endoscopy, Major Complexity 1 0 6.6 2 21 14% 0.0524 0.0724 170% 0.5034 0.2962 1.0346 2.3654 0.287 $2,584 $1,521 $5,312 $12,144 $1,473 G46B Complex Endoscopy, Minor Complexity 0 0 1.1 1 3 32% 0.0524 0.0724 194% 0.4533 0.312 $0 $0 $0 $2,327 $1,602 G47A Gastroscopy, Major Complexity 0 0 6 2 19 12% 0.0524 0.0724 159% 0.2259 0.9127 2.0513 0.2709 $0 $1,160 $4,686 $10,531 $1,391 G47B Gastroscopy, Intermediate Complexity 1031918%0.0524 0.0724 142% 0.3589 0.9964 0.2429 $1,843 $0 $0 $5,116 $1,247 G47C Gastroscopy, Minor Complexity 1 0 1.9 1 6 27% 0.0524 0.0724 156% 0.283 0.6729 0.187 $1,453 $0 $0 $3,455 $960 G48A Colonoscopy, Major Complexity 1 0 5.9 2 18 13% 0.0524 0.0724 170% 0.3959 0.2419 0.8447 1.9312 0.2373 $2,033 $1,242 $4,337 $9,915 $1,218 G48B Colonoscopy, Minor Complexity 0 0 1.1 1 3 35% 0.0524 0.0724 200% 0.3752 0.1429 $0 $0 $0 $1,926 $734 G60A Digestive Malignancy, Major Complexity 0 0 7.4 2 24 8% 0.0524 0.0724 100% 0 1.0748 2.1496 0.2421 $0 $0 $5,518 $11,036 $1,243 G60B Digestive Malignancy, Minor Complexity 1 0 2.9 1 10 10% 0.0524 0.0724 100% 0.3134 0.7101 0.2327 $1,609 $0 $0 $3,646 $1,195 G61A Gastrointestinal Haemorrhage, Major Complexity 0 0 4 1 13 12% 0.0524 0.0724 107% 0.9658 0.2316 $0 $0 $0 $4,958 $1,189 G61B Gastrointestinal Haemorrhage, Minor Complexity 1 021614%0.0524 0.0724 135% 0.1129 0.4577 0.2311 $580 $0 $0 $2,350 $1,186 G64A Inflammatory Bowel Disease, Major Complexity 1 0 5 1 15 9% 0.0524 0.0724 173% 0.2129 1.1992 0.2505 $1,093 $0 $0 $6,157 $1,286 G64B Inflammatory Bowel Disease, Minor Complexity 0 0 1.1 1 3 12% 0.0524 0.0724 100% 0.2046 0.1348 $0 $0 $0 $1,050 $692 G65A Gastrointestinal Obstruction, Major Complexity 0 0 5.6 1 17 11% 0.0524 0.0724 114% 1.4611 0.2631 $0 $0 $0 $7,501 $1,351 G65B Gastrointestinal Obstruction, Minor Complexity 0 0 2.5 1 8 14% 0.0524 0.0724 87% 0.5955 0.2238 $0 $0 $0 $3,057 $1,149 G66A Abdominal Pain And Mesenteric Adenitis, Major Complexity 1 0 2.5 1 8 14% 0.0524 0.0724 119% 0.1241 0.6003 0.2245 $637 $0 $0 $3,082 $1,153 G66B Abdominal Pain And Mesenteric Adenitis, Minor Complexity 0 0 1.2 1 4 20% 0.0524 0.0724 130% 0.1956 0.1518 $0 $0 $0 $1,004 $779 G67A Oesophagitis And Gastroenteritis, Major Complexity 0 0 3.5 1 11 10% 0.0524 0.0724 108% 0.8822 0.2534 $0 $0 $0 $4,529 $1,301 G67B Oesophagitis And Gastroenteritis, Minor Complexity 0 0 1.3 1 4 13% 0.0524 0.0724 107% 0.2202 0.1667 $0 $0 $0 $1,131 $856 G70A Other Digestive System Disorders, Major Complexity 0 0 5.1 1 16 10% 0.0524 0.0724 142% 1.2773 0.2583 $0 $0 $0 $6,558 $1,326
Note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 2.National Admitted Acute 4 of 10 qld‐nep‐abf‐priceweights_1920_v2.0
2019-20 National Admitted Acute Price Weights (N1920) AR-DRG V9.0 National Weight (NWAU) see note 4 National Price DRG CODE Description Same Day Bundled IHPA ALOS Lower Upper Private Private Private Paediatric Same Day Short-Stay Short-Stay Inlier Long-Stay Same Day $ Short-Stay Short-Stay Inlier $ Long-Stay Payment ICU Bound Bound Patient Patient Patient Adjustment Outlier Outlier Per Outlier Per Outlier Base Outlier Per Outlier Per List Service Accomodatio Accomodatio Base Diem Diem $ Diem $ Diem $ Adjustment n Adjustment n Adjustment (Same Day) (Overnight) G70B Other Digestive System Disorders, Intermediate Complexity 1 0 2.8 1 9 12% 0.0524 0.0724 163% 0.1619 0.6743 0.2189 $831 $0 $0 $3,462 $1,124 G70C Other Digestive System Disorders, Minor Complexity 0 0 1.3 1 4 15% 0.0524 0.0724 150% 0.2258 0.1695 $0 $0 $0 $1,159 $870 H01A Pancreas, Liver And Shunt Procedures, Major Complexity 0 0 19.2 6 61 17% 0.0524 0.0724 100% 2.7863 1.249 10.2804 0.3024 $0 $14,305 $6,412 $52,780 $1,553 H01B Pancreas, Liver And Shunt Procedures, Intermediate Complexity 0 0 7.3 2 26 17% 0.0524 0.0724 100% 0.3793 2.2401 4.8594 0.3534 $0 $1,947 $11,501 $24,948 $1,814 H01C Pancreas, Liver And Shunt Procedures, Minor Complexity 0 0 2.7 1 9 21% 0.0524 0.0724 100% 1.8345 0.4897 $0 $0 $0 $9,418 $2,514 H02A Major Biliary Tract Procedures, Major Complexity 0 0 17.3 6 60 12% 0.0524 0.0724 100% 1.1773 1.0928 7.734 0.2877 $0 $6,044 $5,610 $39,706 $1,477 H02B Major Biliary Tract Procedures, Intermediate Complexity 0 0 9 3 27 16% 0.0524 0.0724 100% 0.7239 1.1602 4.2046 0.2922 $0 $3,717 $5,956 $21,586 $1,500 H02C Major Biliary Tract Procedures, Minor Complexity 0 0 4.1 1 12 19% 0.0524 0.0724 100% 1.7553 0.2533 $0 $0 $0 $9,012 $1,300 H05A Hepatobiliary Diagnostic Procedures, Major Complexity 0 0 9.9 3 31 19% 0.0524 0.0724 100% 0.8852 1.2438 4.6166 0.2664 $0 $4,545 $6,386 $23,702 $1,368 H05B Hepatobiliary Diagnostic Procedures, Intermediate Complexity 0 0 4 1 13 19% 0.0524 0.0724 100% 1.7761 0.2786 $0 $0 $0 $9,118 $1,430 H05C Hepatobiliary Diagnostic Procedures, Minor Complexity 0 0 1.4 1 4 31% 0.0524 0.0724 100% 0.6623 0.3257 $0 $0 $0 $3,400 $1,672 H06A Other Hepatobiliary And Pancreas GIs, Major Complexity 0 0 20.1 13 29 16% 0.0524 0.0724 100% 0.347 0.5106 6.985 0.2317 $0 $1,781 $2,621 $35,861 $1,190 H06B Other Hepatobiliary And Pancreas GIs, Intermediate Complexity 0 0 8.5 2 25 20% 0.0524 0.0724 100% 0.3854 1.2807 2.9469 0.2134 $0 $1,979 $6,575 $15,129 $1,096 H06C Other Hepatobiliary And Pancreas GIs, Minor Complexity 0 0 1.6 1 5 38% 0.0524 0.0724 100% 1.2819 0.258 $0 $0 $0 $6,581 $1,325 H07A Open Cholecystectomy, Major Complexity 0 0 13.1 5 46 12% 0.0524 0.0724 100% 1.3996 0.9112 5.9556 0.2607 $0 $7,186 $4,678 $30,576 $1,338 H07B Open Cholecystectomy, Intermediate Complexity 0 0 7.5 2 23 17% 0.0524 0.0724 100% 1.1884 1.2991 3.7865 0.3166 $0 $6,101 $6,670 $19,440 $1,625 H07C Open Cholecystectomy, Minor Complexity 0 0 4.7 1 14 16% 0.0524 0.0724 100% 2.783 0.331 $0 $0 $0 $14,288 $1,699 H08A Laparoscopic Cholecystectomy, Major Complexity 0 0 5.8 2 18 15% 0.0524 0.0724 100% 0.8351 1.0552 2.9455 0.2766 $0 $4,287 $5,417 $15,122 $1,420 H08B Laparoscopic Cholecystectomy, Minor Complexity 0 021618%0.0524 0.0724 124% 1.5019 0.2732 $0 $0 $0 $7,711 $1,403 H09Z Liver Transplant 0 0 21.6 6 63 8% 0.0524 0.0724 151% 5.2623 2.9025 22.6774 0.5464 $0 $27,017 $14,901 $116,426 $2,805 H60A Cirrhosis And Alcoholic Hepatitis, Major Complexity 0 0 11.7 3 36 10% 0.0524 0.0724 100% 0 1.2479 3.7437 0.2836 $0 $0 $6,407 $19,220 $1,456 H60B Cirrhosis And Alcoholic Hepatitis, Intermediate Complexity 0 0 4.9 1 15 10% 0.0524 0.0724 100% 1.368 0.2622 $0 $0 $0 $7,023 $1,346 H60C Cirrhosis And Alcoholic Hepatitis, Minor Complexity 1 0 3 1 10 15% 0.0524 0.0724 100% 0.33 0.8074 0.2201 $1,694 $0 $0 $4,145 $1,130 H61A Malignancy Of Hepatobiliary System And Pancreas, Major Complexity 0 0 8.6 2 26 12% 0.0524 0.0724 100% 0.1578 1.2015 2.5609 0.264 $0 $810 $6,169 $13,148 $1,355 H61B Malignancy Of Hepatobiliary System And Pancreas, Minor Complexity 1 0 3.7 1 11 18% 0.0524 0.0724 141% 0.359 1.0335 0.2454 $1,843 $0 $0 $5,306 $1,260 H62A Disorders Of Pancreas, Except Malignancy, Major Complexity 0 0 6.4 2 20 12% 0.0524 0.0724 157% 0 0.9581 1.9161 0.2897 $0 $0 $4,919 $9,837 $1,487 H62B Disorders Of Pancreas, Except Malignancy, Minor Complexity 1 0 2.8 1 9 15% 0.0524 0.0724 158% 0.2547 0.7245 0.2314 $1,308 $0 $0 $3,720 $1,188 H63A Other Disorders Of Liver, Major Complexity 0 0 7.4 2 22 12% 0.0524 0.0724 139% 0 1.0378 2.0756 0.2434 $0 $0 $5,328 $10,656 $1,250 H63B Other Disorders Of Liver, Intermediate Complexity 1 0 3.5 1 11 17% 0.0524 0.0724 148% 0.2674 0.884 0.1996 $1,373 $0 $0 $4,538 $1,025 H63C Other Disorders Of Liver, Minor Complexity 1 0 2.1 1 6 26% 0.0524 0.0724 149% 0.2482 0.5367 0.1756 $1,274 $0 $0 $2,755 $902 H64A Disorders Of The Biliary Tract, Major Complexity 0 0 7.1 2 22 14% 0.0524 0.0724 132% 0.1871 1.02 2.2271 0.2529 $0 $961 $5,237 $11,434 $1,298 H64B Disorders Of The Biliary Tract, Intermediate Complexity 1 0 3.6 1 11 18% 0.0524 0.0724 165% 0.3373 1.0345 0.2283 $1,732 $0 $0 $5,311 $1,172 H64C Disorders Of The Biliary Tract, Minor Complexity 1 0 2.3 1 7 24% 0.0524 0.0724 140% 0.2555 0.638 0.2336 $1,312 $0 $0 $3,275 $1,199 H65A Bleeding Oesophageal Varices, Major Complexity 0 0 9.5 3 28 8% 0.0524 0.0724 100% 0.3952 1.2559 4.1629 0.3026 $0 $2,029 $6,448 $21,372 $1,554 H65B Bleeding Oesophageal Varices, Intermediate Complexity 0 0 4.4 1 14 10% 0.0524 0.0724 100% 1.7591 0.2754 $0 $0 $0 $9,031 $1,414 H65C Bleeding Oesophageal Varices, Minor Complexity 0 0 2.3 1 8 11% 0.0524 0.0724 100% 0.8403 0.3436 $0 $0 $0 $4,314 $1,764 I01A Bilateral And Multiple Major Joint Procedures Of Lower Limb, Major Complexity 0 0 24.3 8 75 29% 0.0524 0.0724 100% 3.882 0.9955 11.8461 0.2837 $0 $19,930 $5,111 $60,818 $1,457 I01B Bilateral And Multiple Major Joint Procedures Of Lower Limb, Minor Complexity 0 0 5.5 2 19 29% 0.0524 0.0724 100% 3.6323 1.2856 6.2034 0.2622 $0 $18,648 $6,600 $31,848 $1,346 I02A Microvascular Tissue Transfers Or Skin Grafts, Excluding Hand, Major Complexity 0 0 33.8 12 115 13% 0.0524 0.0724 100% 4.2951 0.9823 16.0832 0.312 $0 $22,051 $5,043 $82,571 $1,602 I02B Microvascular Tissue Transfers Or Skin Grafts, Excluding Hand, Intermediate Comp 0 0 17.1 5 53 16% 0.0524 0.0724 100% 1.2875 1.4151 8.3629 0.335 $0 $6,610 $7,265 $42,935 $1,720 I02C Microvascular Tissue Transfers Or Skin Grafts, Excluding Hand, Minor Complexity 0 0 6 2 20 23% 0.0524 0.0724 89% 0.5074 1.5215 3.5504 0.3175 $0 $2,605 $7,811 $18,228 $1,630 I03A Hip Replacement For Trauma, Major Complexity 0 0 13.1 4 39 25% 0.0524 0.0724 100% 1.868 0.972 5.7559 0.2623 $0 $9,590 $4,990 $29,551 $1,347 I03B Hip Replacement For Trauma, Minor Complexity 0 0 7.4 2 25 30% 0.0524 0.0724 100% 1.3786 1.2625 3.9036 0.2299 $0 $7,078 $6,482 $20,041 $1,180 I04A Knee Replacement, Major Complexity 0 0 8.4 3 30 30% 0.0524 0.0724 100% 2.2472 0.9043 4.9602 0.2577 $0 $11,537 $4,643 $25,466 $1,323 I04B Knee Replacement, Minor Complexity 0 0 4.4 1 14 43% 0.0524 0.0724 100% 3.7345 0.2273 $0 $0 $0 $19,173 $1,167 I05A Other Joint Replacement, Major Complexity 0 0 8.3 2 27 38% 0.0524 0.0724 100% 3.0371 1.2488 5.5347 0.2594 $0 $15,592 $6,411 $28,415 $1,332 I05B Other Joint Replacement, Minor Complexity 0 0 3.2 1 9 44% 0.0524 0.0724 100% 3.8173 0.2595 $0 $0 $0 $19,598 $1,332 I06Z Spinal Fusion For Deformity 0 0 7.5 2 26 34% 0.0524 0.0724 108% 3.8756 3.3057 10.487 0.5066 $0 $19,897 $16,971 $53,840 $2,601 I07Z Amputation 0 0 21.3 8 73 24% 0.0524 0.0724 100% 1.0142 0.8606 7.8991 0.2445 $0 $5,207 $4,418 $40,554 $1,255 I08A Other Hip And Femur Procedures, Major Complexity 0 0 16.8 5 50 16% 0.0524 0.0724 92% 1.5013 1.0337 6.6699 0.2464 $0 $7,708 $5,307 $34,243 $1,265 I08B Other Hip And Femur Procedures, Intermediate Complexity 0 0 9.3 3 32 20% 0.0524 0.0724 100% 1.1914 0.9438 4.0227 0.2364 $0 $6,117 $4,845 $20,653 $1,214 I08C Other Hip And Femur Procedures, Minor Complexity 0 0 5.9 2 19 23% 0.0524 0.0724 110% 0.9595 0.9208 2.8011 0.2262 $0 $4,926 $4,727 $14,381 $1,161 I09A Spinal Fusion, Major Complexity 0 0 16.7 6 58 35% 0.0524 0.0724 100% 4.2968 1.0368 10.5177 0.2969 $0 $22,060 $5,323 $53,998 $1,524 I09B Spinal Fusion, Intermediate Complexity 0 0 7 2 23 35% 0.0524 0.0724 106% 3.1294 1.6185 6.3664 0.3501 $0 $16,066 $8,309 $32,685 $1,797 I09C Spinal Fusion, Minor Complexity 0 0 4 1 13 38% 0.0524 0.0724 100% 4.6109 0.4 $0 $0 $0 $23,672 $2,054 I10A Other Back And Neck Procedures, Major Complexity 0 0 8 2 24 13% 0.0524 0.0724 100% 1.5899 1.2425 4.075 0.2835 $0 $8,163 $6,379 $20,921 $1,455 I10B Other Back And Neck Procedures, Minor Complexity 0 0 2.6 1 9 30% 0.0524 0.0724 100% 2.1109 0.2941 $0 $0 $0 $10,837 $1,510 I11Z Limb Lengthening Procedures 0 0 5.7 1 14 24% 0.0524 0.0724 180% 3.6039 0.3849 $0 $0 $0 $18,502 $1,976 I12A Misc Musculoskeletal Procs For Infect/Inflam Of Bone/Joint, Major Complexity 0 0 21.9 15 33 8% 0.0524 0.0724 109% 0.7586 0.4415 7.3812 0.212 $0 $3,895 $2,267 $37,895 $1,088 I12B Misc Musculoskeletal Procs For Infect/Inflam Of Bone/Joint, Intermediate Comp 0 0 10 3 30 10% 0.0524 0.0724 90% 0.5888 0.9547 3.453 0.1932 $0 $3,023 $4,901 $17,728 $992 I12C Misc Musculoskeletal Procs For Infect/Inflam Of Bone/Joint, Minor Complexity 0 0 4.3 1 13 11% 0.0524 0.0724 123% 1.4295 0.1927 $0 $0 $0 $7,339 $989 I13A Humerus, Tibia, Fibula And Ankle Procedures, Major Complexity 0 0 11 4 36 17% 0.0524 0.0724 100% 1.2537 0.9272 4.9624 0.2636 $0 $6,436 $4,760 $25,477 $1,353 I13B Humerus, Tibia, Fibula And Ankle Procedures, Intermediate Complexity 0 0 4.8 1 15 23% 0.0524 0.0724 93% 2.6363 0.2892 $0 $0 $0 $13,535 $1,485 I13C Humerus, Tibia, Fibula And Ankle Procedures, Minor Complexity 0 0 2.2 1 7 24% 0.0524 0.0724 80% 1.6901 0.3028 $0 $0 $0 $8,677 $1,555 I15Z Cranio-Facial Surgery 0 0 4.6 1 14 21% 0.0524 0.0724 155% 3.1851 0.2837 $0 $0 $0 $16,352 $1,457 I16Z Other Shoulder Procedures 0 0 1.3 1 4 27% 0.0524 0.0724 100% 1.551 0.4475 $0 $0 $0 $7,963 $2,297 I17A Maxillo-Facial Surgery, Major Complexity 0 0 3.8 1 11 18% 0.0524 0.0724 100% 3.1531 0.3929 $0 $0 $0 $16,188 $2,017 I17B Maxillo-Facial Surgery, Minor Complexity 0 0 1.5 1 4 13% 0.0524 0.0724 100% 1.4644 0.4503 $0 $0 $0 $7,518 $2,312 I18A Other Knee Procedures, Major Complexity 1 0 3.6 1 12 15% 0.0524 0.0724 107% 0.7141 1.7341 0.2288 $3,666 $0 $0 $8,903 $1,175 I18B Other Knee Procedures, Minor Complexity 0011331%0.0524 0.0724 162% 0.6964 0.202 $0 $0 $0 $3,575 $1,037 I19A Other Elbow And Forearm Procedures, Major Complexity 0 0 5.7 2 18 23% 0.0524 0.0724 100% 1.147 0.9406 3.0282 0.2766 $0 $5,889 $4,829 $15,547 $1,420 I19B Other Elbow And Forearm Procedures, Minor Complexity 0 0 1.6 1 5 32% 0.0524 0.0724 92% 1.5454 0.3048 $0 $0 $0 $7,934 $1,565 I20A Other Foot Procedures, Major Complexity 0 0 5.6 1 16 20% 0.0524 0.0724 108% 2.5355 0.2447 $0 $0 $0 $13,017 $1,256 I20B Other Foot Procedures, Minor Complexity 0 0 1.5 1 5 20% 0.0524 0.0724 100% 1.2897 0.2821 $0 $0 $0 $6,621 $1,448 I21A Local Excision And Removal Of Internal Fixation Devices Of Hip & Femur, Maj Comp 0 0 3.1 1 13 12% 0.0524 0.0724 85% 1.7055 0.3072 $0 $0 $0 $8,756 $1,577 I21B Local Excision And Removal Of Internal Fixation Devices Of Hip & Femur, Min Comp 0 0 1.1 1 3 13% 0.0524 0.0724 100% 0.9591 0.3465 $0 $0 $0 $4,924 $1,779 I23A Local Excision & Removal Of Internal Fixation Device, Except Hip & Fmr, Maj Comp 1 0 2.7 1 9 16% 0.0524 0.0724 115% 0.6821 1.6923 0.2912 $3,502 $0 $0 $8,688 $1,495 I23B Local Excision & Removal Of Internal Fixation Device, Except Hip & Fmr, Min Comp 0 011313%0.0524 0.0724 100% 0.5811 0.1774 $0 $0 $0 $2,983 $911 I24A Arthroscopy, Major Complexity 0 0 3.4 1 10 16% 0.0524 0.0724 100% 1.5331 0.2313 $0 $0 $0 $7,871 $1,187 I24B Arthroscopy, Minor Complexity 0 0 1.1 1 3 16% 0.0524 0.0724 108% 0.7436 0.2745 $0 $0 $0 $3,818 $1,409 I25A Bone And Joint Diagnostic Procedures Including Biopsy, Major Complexity 0 0 10 3 35 13% 0.0524 0.0724 100% 0.3458 1.3198 4.3053 0.2524 $0 $1,775 $6,776 $22,103 $1,296
Note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 2.National Admitted Acute 5 of 10 qld‐nep‐abf‐priceweights_1920_v2.0
2019-20 National Admitted Acute Price Weights (N1920) AR-DRG V9.0 National Weight (NWAU) see note 4 National Price DRG CODE Description Same Day Bundled IHPA ALOS Lower Upper Private Private Private Paediatric Same Day Short-Stay Short-Stay Inlier Long-Stay Same Day $ Short-Stay Short-Stay Inlier $ Long-Stay Payment ICU Bound Bound Patient Patient Patient Adjustment Outlier Outlier Per Outlier Per Outlier Base Outlier Per Outlier Per List Service Accomodatio Accomodatio Base Diem Diem $ Diem $ Diem $ Adjustment n Adjustment n Adjustment (Same Day) (Overnight) I25B Bone And Joint Diagnostic Procedures Including Biopsy, Minor Complexity 1 0 3.9 1 13 24% 0.0524 0.0724 123% 0.5014 1.4429 0.2084 $2,574 $0 $0 $7,408 $1,070 I27A Soft Tissue Procedures, Major Complexity 0 0 9.7 3 29 13% 0.0524 0.0724 93% 0.7059 1.1042 4.0185 0.2554 $0 $3,624 $5,669 $20,631 $1,311 I27B Soft Tissue Procedures, Minor Complexity 1 0 2.2 1 7 16% 0.0524 0.0724 116% 0.5901 1.2492 0.2597 $3,030 $0 $0 $6,413 $1,333 I28A Other Musculoskeletal Procedures, Major Complexity 0 0 11.6 4 38 15% 0.0524 0.0724 100% 0.9026 0.916 4.5667 0.2454 $0 $4,634 $4,703 $23,445 $1,260 I28B Other Musculoskeletal Procedures, Intermediate Complexity 1 0 2.7 1 8 24% 0.0524 0.0724 116% 1.0024 1.7691 0.2006 $5,146 $0 $0 $9,083 $1,030 I28C Other Musculoskeletal Procedures, Minor Complexity 1 0 1.9 1 6 13% 0.0524 0.0724 110% 0.555 1.0374 0.2549 $2,849 $0 $0 $5,326 $1,309 I29Z Knee Reconstructions, And Revisions Of Reconstructions 0 0 1.2 1 4 26% 0.0524 0.0724 117% 1.7219 0.4729 $0 $0 $0 $8,840 $2,428 I30Z Hand Procedures 0 0 1.2 1 4 22% 0.0524 0.0724 100% 0.83 0.2292 $0 $0 $0 $4,261 $1,177 I31A Revision Of Hip Replacement, Major Complexity 0 0 22.3 8 78 28% 0.0524 0.0724 100% 2.9297 0.8684 9.8765 0.2254 $0 $15,041 $4,458 $50,706 $1,157 I31B Revision Of Hip Replacement, Intermediate Complexity 0 0 11.4 4 36 28% 0.0524 0.0724 100% 3.1506 0.8497 6.5495 0.1932 $0 $16,175 $4,362 $33,625 $992 I31C Revision Of Hip Replacement, Minor Complexity 0 0 6.2 2 21 32% 0.0524 0.0724 100% 2.4142 1.0966 4.6073 0.173 $0 $12,395 $5,630 $23,654 $888 I32A Revision Of Knee Replacement, Major Complexity 0 0 15.5 10 23 25% 0.0524 0.0724 100% 3.3964 0.4474 7.8704 0.1842 $0 $17,437 $2,297 $40,407 $946 I32B Revision Of Knee Replacement, Minor Complexity 0 0 6.5 2 23 26% 0.0524 0.0724 100% 2.4861 1.1782 4.8425 0.2108 $0 $12,764 $6,049 $24,861 $1,082 I33A Hip Replacement For Non-Trauma, Major Complexity 0 0 8.5 3 28 34% 0.0524 0.0724 100% 2.6449 0.8411 5.1683 0.2473 $0 $13,579 $4,318 $26,534 $1,270 I33B Hip Replacement For Non-Trauma, Minor Complexity 0 0 4.2 1 13 46% 0.0524 0.0724 100% 3.8794 0.2258 $0 $0 $0 $19,917 $1,159 I60Z Femoral Shaft Fractures 0 0 8.3 3 28 5% 0.0524 0.0724 93% 0.2361 0.9675 3.1384 0.2556 $0 $1,212 $4,967 $16,113 $1,312 I61A Distal Femoral Fractures, Major Complexity 0 0 8.4 2 25 10% 0.0524 0.0724 100% 0 1.0704 2.1407 0.2159 $0 $0 $5,495 $10,990 $1,108 I61B Distal Femoral Fractures, Minor Complexity 0 0 3.3 1 15 14% 0.0524 0.0724 100% 0.7547 0.2089 $0 $0 $0 $3,875 $1,072 I63A Sprains, Strains And Dislocations Of Hip, Pelvis And Thigh, Major Complexity 0 0 4.4 1 13 10% 0.0524 0.0724 100% 1.0402 0.2354 $0 $0 $0 $5,340 $1,209 I63B Sprains, Strains And Dislocations Of Hip, Pelvis And Thigh, Minor Complexity 0 0 1.4 1 4 16% 0.0524 0.0724 100% 0.2829 0.2126 $0 $0 $0 $1,452 $1,091 I64A Osteomyelitis, Major Complexity 0 0 13.9 4 44 7% 0.0524 0.0724 100% 0 0.897 3.5881 0.1733 $0 $0 $4,605 $18,421 $890 I64B Osteomyelitis, Minor Complexity 0 0 6.3 2 20 8% 0.0524 0.0724 100% 0 0.7164 1.4328 0.1078 $0 $0 $3,678 $7,356 $553 I65A Musculoskeletal Malignant Neoplasms, Major Complexity 0 0 10.5 3 31 7% 0.0524 0.0724 100% 0 1.1369 3.4106 0.2657 $0 $0 $5,837 $17,510 $1,364 I65B Musculoskeletal Malignant Neoplasms, Minor Complexity 0 0 3.9 1 12 8% 0.0524 0.0724 114% 1.2764 0.2698 $0 $0 $0 $6,553 $1,385 I66A Inflammatory Musculoskeletal Disorders, Major Complexity 0 0 6.7 2 21 10% 0.0524 0.0724 108% 0 1.1698 2.3397 0.2692 $0 $0 $6,006 $12,012 $1,382 I66B Inflammatory Musculoskeletal Disorders, Minor Complexity 0 0 1.2 1 4 9% 0.0524 0.0724 143% 0.3046 0.2289 $0 $0 $0 $1,564 $1,175 I67A Septic Arthritis, Major Complexity 0 0 11.2 4 38 8% 0.0524 0.0724 100% 0 0.8196 3.2786 0.191 $0 $0 $4,208 $16,832 $981 I67B Septic Arthritis, Minor Complexity 0 0 5 1 14 9% 0.0524 0.0724 119% 0.8511 0.132 $0 $0 $0 $4,370 $678 I68A Non-Surgical Spinal Disorders, Major Complexity 0 0 5.5 1 16 9% 0.0524 0.0724 113% 1.3183 0.2363 $0 $0 $0 $6,768 $1,213 I68B Non-Surgical Spinal Disorders, Minor Complexity 0 0 1.5 1 4 12% 0.0524 0.0724 168% 0.2837 0.1998 $0 $0 $0 $1,457 $1,026 I69A Bone Diseases And Arthropathies, Major Complexity 0 0 5.1 1 15 10% 0.0524 0.0724 80% 1.2216 0.2369 $0 $0 $0 $6,272 $1,216 I69B Bone Diseases And Arthropathies, Minor Complexity 0 0 1.7 1 5 10% 0.0524 0.0724 140% 0.2921 0.2145 $0 $0 $0 $1,500 $1,101 I71A Other Musculotendinous Disorders, Major Complexity 0 0 4.1 1 13 11% 0.0524 0.0724 100% 0.9542 0.2351 $0 $0 $0 $4,899 $1,207 I71B Other Musculotendinous Disorders, Minor Complexity 0 0 1.3 1 4 15% 0.0524 0.0724 157% 0.2345 0.1725 $0 $0 $0 $1,204 $886 I72A Specific Musculotendinous Disorders, Major Complexity 0 0 5.7 1 17 9% 0.0524 0.0724 100% 1.3025 0.2338 $0 $0 $0 $6,687 $1,200 I72B Specific Musculotendinous Disorders, Minor Complexity 0 0 1.8 1 5 10% 0.0524 0.0724 114% 0.3365 0.2162 $0 $0 $0 $1,728 $1,110 I73A Aftercare Of Musculoskeletal Implants Or Prostheses, Major Complexity 0 0 10.7 3 32 8% 0.0524 0.0724 100% 0 0.8548 2.5644 0.163 $0 $0 $4,389 $13,166 $837 I73B Aftercare Of Musculoskeletal Implants Or Prostheses, Intermediate Complexity 0 0 4.2 1 13 11% 0.0524 0.0724 107% 0.6487 0.1211 $0 $0 $0 $3,330 $622 I73C Aftercare Of Musculoskeletal Implants Or Prostheses, Minor Complexity 0 0 1.3 1 4 15% 0.0524 0.0724 163% 0.3156 0.1442 $0 $0 $0 $1,620 $740 I74A Injuries To Forearm, Wrist, Hand And Foot, Major Complexity 0 0 3.6 1 12 13% 0.0524 0.0724 81% 0.7718 0.2155 $0 $0 $0 $3,962 $1,106 I74B Injuries To Forearm, Wrist, Hand And Foot, Minor Complexity 0 0 1.1 1 3 26% 0.0524 0.0724 138% 0.2823 0.1581 $0 $0 $0 $1,449 $812 I75A Injuries To Shoulder, Arm, Elbow, Knee, Leg And Ankle, Major Complexity 0 0 8.3 2 25 9% 0.0524 0.0724 100% 0 0.9922 1.9844 0.1989 $0 $0 $5,094 $10,188 $1,021 I75B Injuries To Shoulder, Arm, Elbow, Knee, Leg And Ankle, Intermediate Complexity 0 0 1.9 1 6 15% 0.0524 0.0724 140% 0.4019 0.2243 $0 $0 $0 $2,063 $1,152 I75C Injuries To Shoulder, Arm, Elbow, Knee, Leg And Ankle, Minor Complexity 0 0 1.2 1 4 14% 0.0524 0.0724 162% 0.1795 0.1347 $0 $0 $0 $922 $692 I76A Other Musculoskeletal Disorders, Major Complexity 0 0 6 2 18 11% 0.0524 0.0724 100% 0.1 0.8143 1.7287 0.1962 $0 $513 $4,181 $8,875 $1,007 I76B Other Musculoskeletal Disorders, Minor Complexity 0 0 1.3 1 4 13% 0.0524 0.0724 129% 0.2864 0.2166 $0 $0 $0 $1,470 $1,112 I77A Fractures Of Pelvis, Major Complexity 0 0 8.4 2 25 9% 0.0524 0.0724 100% 0 1.0601 2.1203 0.2235 $0 $0 $5,443 $10,886 $1,147 I77B Fractures Of Pelvis, Minor Complexity 0 0 3.3 1 10 11% 0.0524 0.0724 100% 0.691 0.2172 $0 $0 $0 $3,548 $1,115 I78A Fractures Of Neck Of Femur, Major Complexity 0 0 10.5 3 32 7% 0.0524 0.0724 100% 0 0.8441 2.5324 0.2009 $0 $0 $4,334 $13,001 $1,031 I78B Fractures Of Neck Of Femur, Minor Complexity 0 0 4.3 1 13 16% 0.0524 0.0724 100% 0.8886 0.217 $0 $0 $0 $4,562 $1,114 I79A Pathological Fractures, Major Complexity 0 0 12.3 4 45 8% 0.0524 0.0724 100% 0 0.9193 3.6773 0.2653 $0 $0 $4,720 $18,879 $1,362 I79B Pathological Fractures, Intermediate Complexity 0 0 6.3 2 21 9% 0.0524 0.0724 100% 0 0.9041 1.8082 0.2284 $0 $0 $4,642 $9,283 $1,173 I79C Pathological Fractures, Minor Complexity 0 0 3.2 1 10 10% 0.0524 0.0724 100% 0.804 0.2552 $0 $0 $0 $4,128 $1,310 I80Z Femoral Fractures, Transferred To Acute Facility <2 Days 0 0 1 1 1 46% 0.0524 0.0724 100% 0.2312 $0 $0 $0 $1,187 $0 J01A Microvas Tiss Transf For Skin, Subcut Tiss & Breast Disorders, Major Complexity 0 0 20 7 64 26% 0.0524 0.0724 100% 4.1612 0.9558 10.8515 0.3025 $0 $21,364 $4,907 $55,712 $1,553 J01B Microvas Tiss Transf For Skin, Subcut Tiss & Breast Disorders, Minor Complexity 0 0 7.7 2 26 29% 0.0524 0.0724 100% 2.664 2.0916 6.8473 0.242 $0 $13,677 $10,738 $35,154 $1,242 J06A Major Procedures For Breast Disorders, Major Complexity 0 0 5.7 2 19 17% 0.0524 0.0724 100% 1.0572 0.9918 3.0408 0.1795 $0 $5,428 $5,092 $15,611 $922 J06B Major Procedures For Breast Disorders, Minor Complexity 0 0 2.9 1 9 20% 0.0524 0.0724 100% 1.9384 0.1735 $0 $0 $0 $9,952 $891 J07Z Minor Procedures For Breast Disorders 0 0 1.1 1 3 24% 0.0524 0.0724 100% 0.9904 0.4043 $0 $0 $0 $5,085 $2,076 J08A Other Skin Grafts And Debridement Procedures, Major Complexity 0 0 16.1 5 48 9% 0.0524 0.0724 100% 0.4741 0.9952 5.4502 0.2583 $0 $2,434 $5,109 $27,981 $1,326 J08B Other Skin Grafts And Debridement Procedures, Intermediate Complexity 1 0 4.5 1 14 10% 0.0524 0.0724 115% 0.6459 1.6188 0.2306 $3,316 $0 $0 $8,311 $1,184 J08C Other Skin Grafts And Debridement Procedures, Minor Complexity 1 0 2.4 1 8 19% 0.0524 0.0724 121% 0.6013 1.2792 0.2122 $3,087 $0 $0 $6,567 $1,089 J09Z Perianal And Pilonidal Procedures 0021713%0.0524 0.0724 115% 0.6978 0.2329 $0 $0 $0 $3,583 $1,196 J10A Plastic GIs For Skin, Subcutaneous Tissue And Breast Disorders, Major Comp 1 0 4.5 1 14 14% 0.0524 0.0724 100% 0.6825 2.0694 0.2337 $3,504 $0 $0 $10,624 $1,200 J10B Plastic GIs For Skin, Subcutaneous Tissue And Breast Disorders, Minor Comp 0 0 1.1 1 3 24% 0.0524 0.0724 108% 0.632 0.1958 $0 $0 $0 $3,245 $1,005 J11A Other Skin, Subcutaneous Tissue And Breast Procedures, Major Complexity 1 0 4.6 1 13 14% 0.0524 0.0724 111% 0.5631 1.4086 0.2141 $2,891 $0 $0 $7,232 $1,099 J11B Other Skin, Subcutaneous Tissue And Breast Procedures, Minor Complexity 0 011321%0.0524 0.0724 106% 0.4437 0.1473 $0 $0 $0 $2,278 $756 J12A Lower Limb Procedures W Ulcer Or Cellulitis, Major Complexity 0 0 16.5 5 53 8% 0.0524 0.0724 100% 0.3318 0.9434 5.0486 0.2475 $0 $1,703 $4,843 $25,920 $1,271 J12B Lower Limb Procedures W Ulcer Or Cellulitis, Minor Complexity 0 0 6.3 2 20 7% 0.0524 0.0724 100% 0.2794 0.8872 2.0537 0.232 $0 $1,434 $4,555 $10,544 $1,191 J13A Lower Limb Procedures W/O Ulcer Or Cellulitis, Major Complexity 0 0 7.6 2 23 8% 0.0524 0.0724 100% 0.552 1.1543 2.8607 0.2609 $0 $2,834 $5,926 $14,687 $1,339 J13B Lower Limb Procedures W/O Ulcer Or Cellulitis, Minor Complexity 1 0 3.7 1 12 13% 0.0524 0.0724 100% 0.5724 1.4676 0.216 $2,939 $0 $0 $7,535 $1,109 J14Z Major Breast Reconstructions 0 0 6.5 2 19 16% 0.0524 0.0724 100% 0.8221 2.0932 5.0086 0.3304 $0 $4,221 $10,746 $25,714 $1,696 J60A Skin Ulcers, Major Complexity 0 0 10.1 3 32 8% 0.0524 0.0724 100% 0 0.8686 2.6057 0.2094 $0 $0 $4,459 $13,378 $1,075 J60B Skin Ulcers, Intermediate Complexity 1 0 5.2 1 16 7% 0.0524 0.0724 100% 0.1755 1.0039 0.1644 $901 $0 $0 $5,154 $844 J60C Skin Ulcers, Minor Complexity 1 0 4.1 1 13 11% 0.0524 0.0724 100% 0.1785 0.6235 0.1316 $916 $0 $0 $3,201 $676 J62A Malignant Breast Disorders, Major Complexity 0 0 7.7 2 23 9% 0.0524 0.0724 100% 0 1.0709 2.1418 0.2401 $0 $0 $5,498 $10,996 $1,233 J62B Malignant Breast Disorders, Minor Complexity 1 0 4.3 1 13 10% 0.0524 0.0724 100% 0.2551 0.8351 0.1605 $1,310 $0 $0 $4,287 $824 J63A Non-Malignant Breast Disorders, Major Complexity 1 0 2.9 1 9 10% 0.0524 0.0724 100% 0.2512 0.7723 0.1911 $1,290 $0 $0 $3,965 $981 J63B Non-Malignant Breast Disorders, Minor Complexity 1 0 2.8 1 8 11% 0.0524 0.0724 100% 0.2525 0.5659 0.1623 $1,296 $0 $0 $2,905 $833 J64A Cellulitis, Major Complexity 0 0 5.4 1 18 9% 0.0524 0.0724 93% 1.3322 0.2195 $0 $0 $0 $6,840 $1,127 J64B Cellulitis, Minor Complexity 1 0 2.8 1 9 8% 0.0524 0.0724 121% 0.1651 0.6565 0.1421 $848 $0 $0 $3,370 $730
Note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 2.National Admitted Acute 6 of 10 qld‐nep‐abf‐priceweights_1920_v2.0
2019-20 National Admitted Acute Price Weights (N1920) AR-DRG V9.0 National Weight (NWAU) see note 4 National Price DRG CODE Description Same Day Bundled IHPA ALOS Lower Upper Private Private Private Paediatric Same Day Short-Stay Short-Stay Inlier Long-Stay Same Day $ Short-Stay Short-Stay Inlier $ Long-Stay Payment ICU Bound Bound Patient Patient Patient Adjustment Outlier Outlier Per Outlier Per Outlier Base Outlier Per Outlier Per List Service Accomodatio Accomodatio Base Diem Diem $ Diem $ Diem $ Adjustment n Adjustment n Adjustment (Same Day) (Overnight) J65A Trauma To Skin, Subcutaneous Tissue And Breast, Major Complexity 1 0 4.7 1 15 11% 0.0524 0.0724 92% 0.1313 1.0859 0.2214 $674 $0 $0 $5,575 $1,137 J65B Trauma To Skin, Subcutaneous Tissue And Breast, Minor Complexity 0 0 1.2 1 4 16% 0.0524 0.0724 153% 0.1979 0.1491 $0 $0 $0 $1,016 $765 J67A Minor Skin Disorders, Major Complexity 1 0 4 1 12 8% 0.0524 0.0724 111% 0.2499 1.0335 0.2408 $1,283 $0 $0 $5,306 $1,236 J67B Minor Skin Disorders, Minor Complexity 1 0 1.9 1 6 15% 0.0524 0.0724 126% 0.2157 0.4404 0.1779 $1,107 $0 $0 $2,261 $913 J68A Major Skin Disorders, Major Complexity 1 0 5.1 1 15 7% 0.0524 0.0724 100% 0.1988 1.4752 0.2711 $1,021 $0 $0 $7,574 $1,392 J68B Major Skin Disorders, Minor Complexity 1 0 2.8 1 9 8% 0.0524 0.0724 119% 0.1626 0.7213 0.2313 $835 $0 $0 $3,703 $1,187 J69A Skin Malignancy, Major Complexity 0 0 8.2 3 27 7% 0.0524 0.0724 100% 0 0.8326 2.4978 0.2249 $0 $0 $4,275 $12,824 $1,155 J69B Skin Malignancy, Minor Complexity 1 0 4.9 1 15 19% 0.0524 0.0724 100% 0.1691 1.0862 0.1619 $868 $0 $0 $5,577 $831 K01A GIs For Diabetic Complications, Major Complexity 0 0 28.1 10 92 10% 0.0524 0.0724 100% 0.6145 0.8704 9.3182 0.2469 $0 $3,155 $4,469 $47,840 $1,268 K01B GIs For Diabetic Complications, Intermediate Complexity 0 0 14.1 4 42 7% 0.0524 0.0724 100% 0.2919 1.0532 4.5046 0.2407 $0 $1,499 $5,407 $23,127 $1,236 K01C GIs For Diabetic Complications, Minor Complexity 0 0 6.3 2 19 9% 0.0524 0.0724 100% 0.32 1.0964 2.5129 0.2505 $0 $1,643 $5,629 $12,901 $1,286 K02Z Pituitary Procedures 0 0 6.7 2 21 27% 0.0524 0.0724 100% 1.6915 1.3517 4.395 0.356 $0 $8,684 $6,940 $22,564 $1,828 K03Z Adrenal Procedures 0 0 5.1 2 20 15% 0.0524 0.0724 100% 0.9681 1.4226 3.8132 0.3966 $0 $4,970 $7,304 $19,577 $2,036 K05A Parathyroid Procedures, Major Complexity 0 0 5.2 1 15 19% 0.0524 0.0724 100% 2.851 0.2956 $0 $0 $0 $14,637 $1,518 K05B Parathyroid Procedures, Minor Complexity 0 0 1.4 1 4 31% 0.0524 0.0724 100% 1.3186 0.3483 $0 $0 $0 $6,770 $1,788 K06A Thyroid Procedures, Major Complexity 0 0 3.9 1 12 17% 0.0524 0.0724 100% 3.0995 0.3472 $0 $0 $0 $15,913 $1,783 K06B Thyroid Procedures, Minor Complexity 0 0 1.5 1 5 18% 0.0524 0.0724 100% 1.7436 0.4458 $0 $0 $0 $8,952 $2,289 K08Z Thyroglossal Procedures 0 0 1.3 1 4 15% 0.0524 0.0724 95% 1.2837 0.4215 $0 $0 $0 $6,591 $2,164 K09A Other Endocrine, Nutritional And Metabolic GIs, Major Complexity 0 0 15.5 5 50 14% 0.0524 0.0724 121% 0.7583 1.1543 6.5299 0.3143 $0 $3,893 $5,926 $33,525 $1,614 K09B Other Endocrine, Nutritional And Metabolic GIs, Minor Complexity 0 0 5.2 1 14 19% 0.0524 0.0724 100% 2.326 0.2679 $0 $0 $0 $11,942 $1,375 K10Z Revisional And Open Bariatric Procedures 0 0 5.4 3 30 15% 0.0524 0.0724 100% 1.6815 0.5874 3.4437 0.3012 $0 $8,633 $3,016 $17,680 $1,546 K11Z Major Laparoscopic Bariatric Procedures 0 0 2.8 1 8 32% 0.0524 0.0724 100% 2.2379 0.4119 $0 $0 $0 $11,489 $2,115 K12Z Other Bariatric Procedures 0 0 1.5 1 7 15% 0.0524 0.0724 100% 1.6273 0.3773 $0 $0 $0 $8,355 $1,937 K13Z Plastic GIs For Endocrine, Nutritional And Metabolic Disorders 0 0 5 1 12 15% 0.0524 0.0724 100% 2.2046 0.305 $0 $0 $0 $11,318 $1,566 K40A Endoscopic And Investigative Procedures For Metabolic Disorders, Major Comp 0 0 9.4 3 29 10% 0.0524 0.0724 106% 0.2842 1.1414 3.7086 0.2673 $0 $1,459 $5,860 $19,040 $1,372 K40B Endoscopic And Investigative Procedures For Metabolic Disorders, Minor Comp 0 011327%0.0524 0.0724 197% 0.3928 0.3074 $0 $0 $0 $2,017 $1,578 K60A Diabetes, Major Complexity 0 0 5.2 1 17 9% 0.0524 0.0724 143% 1.5558 0.253 $0 $0 $0 $7,987 $1,299 K60B Diabetes, Minor Complexity 1 0 3.1 1 9 15% 0.0524 0.0724 187% 0.1377 0.7764 0.2057 $707 $0 $0 $3,986 $1,056 K61A Severe Nutritional Disturbance, Major Complexity 0 0 11.9 4 37 7% 0.0524 0.0724 134% 0 0.9673 3.8692 0.2867 $0 $0 $4,966 $19,864 $1,472 K61B Severe Nutritional Disturbance, Minor Complexity 0 0 5.9 2 19 8% 0.0524 0.0724 100% 0 0.9846 1.9692 0.2656 $0 $0 $5,055 $10,110 $1,364 K62A Miscellaneous Metabolic Disorders, Major Complexity 0 0 5.7 2 18 9% 0.0524 0.0724 139% 0 0.8592 1.7185 0.2352 $0 $0 $4,411 $8,823 $1,208 K62B Miscellaneous Metabolic Disorders, Intermediate Complexity 1 0 2.7 1 9 10% 0.0524 0.0724 147% 0.1536 0.7009 0.2393 $789 $0 $0 $3,598 $1,229 K62C Miscellaneous Metabolic Disorders, Minor Complexity 1 0 1.9 1 6 11% 0.0524 0.0724 162% 0.1116 0.4519 0.2552 $573 $0 $0 $2,320 $1,310 K63A Inborn Errors Of Metabolism, Major Complexity 0 0 3.8 1 11 7% 0.0524 0.0724 111% 1.2197 0.3557 $0 $0 $0 $6,262 $1,826 K63B Inborn Errors Of Metabolism, Minor Complexity 0 0 1.1 1 3 8% 0.0524 0.0724 160% 0.2195 0.1613 $0 $0 $0 $1,127 $828 K64A Endocrine Disorders, Major Complexity 1 0 4.5 1 14 10% 0.0524 0.0724 174% 0.3635 1.3917 0.2361 $1,866 $0 $0 $7,145 $1,212 K64B Endocrine Disorders, Minor Complexity 1 0 2.3 1 7 14% 0.0524 0.0724 200% 0.1476 0.6294 0.2359 $758 $0 $0 $3,231 $1,211 L02A Operative Insertion Of Peritoneal Catheter For Dialysis, Major Complexity 0 0 9.9 3 28 9% 0.0524 0.0724 156% 0.5355 1.1242 3.9081 0.2723 $0 $2,749 $5,772 $20,064 $1,398 L02B Operative Insertion Of Peritoneal Catheter For Dialysis, Minor Complexity 0 0 1.5 1 5 10% 0.0524 0.0724 100% 1.1131 0.3366 $0 $0 $0 $5,715 $1,728 L03A Kidney, Ureter And Major Bladder Procedures For Neoplasm, Major Complexity 0 0 12.7 4 44 15% 0.0524 0.0724 100% 2.1371 1.3803 7.6581 0.3634 $0 $10,972 $7,086 $39,317 $1,866 L03B Kidney, Ureter And Major Bladder Procedures For Neoplasm, Intermediate Comp 0 0 5.6 2 18 16% 0.0524 0.0724 100% 0.9962 1.6355 4.2671 0.3591 $0 $5,114 $8,397 $21,907 $1,844 L03C Kidney, Ureter And Major Bladder Procedures For Neoplasm, Minor Complexity 0 0 3.2 1 10 23% 0.0524 0.0724 100% 2.6725 0.5498 $0 $0 $0 $13,721 $2,823 L04A Kidney, Ureter And Major Bladder Procedures For Non-Neoplasm, Major Complexity 0 0 10.5 3 31 13% 0.0524 0.0724 100% 1.0012 1.2493 4.749 0.3079 $0 $5,140 $6,414 $24,381 $1,581 L04B Kidney, Ureter And Major Bladder Procedures For Non-Neoplasm, Intermediate Comp 1 0 3.9 1 13 16% 0.0524 0.0724 100% 0.8357 2.2324 0.2473 $4,290 $0 $0 $11,461 $1,270 L04C Kidney, Ureter And Major Bladder Procedures For Non-Neoplasm, Minor Complexity 1 0 1.8 1 6 21% 0.0524 0.0724 142% 0.7781 1.4321 0.34 $3,995 $0 $0 $7,352 $1,746 L05A Transurethral Prostatectomy For Urinary Disorder, Major Complexity 0 0 6.8 2 26 21% 0.0524 0.0724 100% 0.59 1.0505 2.6909 0.2791 $0 $3,029 $5,393 $13,815 $1,433 L05B Transurethral Prostatectomy For Urinary Disorder, Minor Complexity 0 0 2.3 1 7 22% 0.0524 0.0724 100% 1.2615 0.2273 $0 $0 $0 $6,477 $1,167 L06A Minor Bladder Procedures, Major Complexity 0 0 11.2 4 37 10% 0.0524 0.0724 100% 0.7924 0.9166 4.4588 0.2807 $0 $4,068 $4,706 $22,891 $1,441 L06B Minor Bladder Procedures, Intermediate Complexity 0 0 3.6 1 13 14% 0.0524 0.0724 100% 1.6942 0.2612 $0 $0 $0 $8,698 $1,341 L06C Minor Bladder Procedures, Minor Complexity 1 021615%0.0524 0.0724 100% 0.5501 1.0892 0.2458 $2,824 $0 $0 $5,592 $1,262 L07A Other Transurethral Procedures, Major Complexity 0 0 4.9 1 16 16% 0.0524 0.0724 100% 1.8764 0.2613 $0 $0 $0 $9,633 $1,342 L07B Other Transurethral Procedures, Minor Complexity 0 0 1.3 1 4 23% 0.0524 0.0724 112% 0.755 0.2873 $0 $0 $0 $3,876 $1,475 L08A Urethral Procedures, Major Complexity 1 0 3.6 1 14 13% 0.0524 0.0724 100% 0.6387 1.9448 0.2646 $3,279 $0 $0 $9,985 $1,358 L08B Urethral Procedures, Minor Complexity 0 0 1.3 1 4 14% 0.0524 0.0724 83% 0.8702 0.2811 $0 $0 $0 $4,468 $1,443 L09A Other Procedures For Kidney And Urinary Tract Disorders, Major Complexity 0 0 16 5 53 11% 0.0524 0.0724 100% 0.7964 1.0625 6.1088 0.3034 $0 $4,089 $5,455 $31,363 $1,558 L09B Other Procedures For Kidney And Urinary Tract Disorders, Intermediate Complexity 0 0 3.8 1 11 14% 0.0524 0.0724 100% 1.9354 0.2451 $0 $0 $0 $9,936 $1,258 L09C Other Procedures For Kidney And Urinary Tract Disorders, Minor Complexity 0 0 1.2 1 4 15% 0.0524 0.0724 80% 1.0885 0.322 $0 $0 $0 $5,588 $1,653 L10A Kidney Transplant, Age <=16 Years Or Major Complexity 0 0 14.4 4 38 11% 0.0524 0.0724 107% 2.2237 2.2417 11.1906 0.4421 $0 $11,416 $11,509 $57,453 $2,270 L10B Kidney Transplant, Age >=17 Years And Minor Complexity 0 0 8 2 24 8% 0.0524 0.0724 100% 2.2086 2.8256 7.8598 0.4229 $0 $11,339 $14,507 $40,352 $2,171 L40Z Ureteroscopy 0 0 1.6 1 5 25% 0.0524 0.0724 100% 0.8109 0.2698 $0 $0 $0 $4,163 $1,385 L41Z Cystourethroscopy For Urinary Disorder, Sameday 0 011125%0.0524 0.0724 200% 0.2352 $0 $0 $0 $1,208 $0 L42Z Esw Lithotripsy 0 0 1.1 1 3 30% 0.0524 0.0724 100% 0.6128 0.1759 $0 $0 $0 $3,146 $903 L60A Kidney Failure, Major Complexity 0 0 10.4 3 34 11% 0.0524 0.0724 100% 0 1.0998 3.2994 0.2624 $0 $0 $5,646 $16,939 $1,347 L60B Kidney Failure, Intermediate Complexity 1 0 4.4 1 14 11% 0.0524 0.0724 156% 0.38 1.2022 0.245 $1,951 $0 $0 $6,172 $1,258 L60C Kidney Failure, Minor Complexity 1 0 2.3 1 7 8% 0.0524 0.0724 169% 0.504 0.4929 0.1923 $2,588 $0 $0 $2,531 $987 L61Z Haemodialysis 0011314%0.0524 0.0724 199% 0.1026 0.0821 $0 $0 $0 $527 $422 L62A Kidney And Urinary Tract Neoplasms, Major Complexity 0 0 9.9 3 32 9% 0.0524 0.0724 100% 0 0.9934 2.9803 0.2458 $0 $0 $5,100 $15,301 $1,262 L62B Kidney And Urinary Tract Neoplasms, Intermediate Complexity 0 0 4.3 1 13 11% 0.0524 0.0724 152% 1.1862 0.2236 $0 $0 $0 $6,090 $1,148 L62C Kidney And Urinary Tract Neoplasms, Minor Complexity 0 0 1.6 1 5 18% 0.0524 0.0724 162% 0.4403 0.2298 $0 $0 $0 $2,261 $1,180 L63A Kidney And Urinary Tract Infections, Major Complexity 0 0 4.7 1 14 10% 0.0524 0.0724 100% 1.1555 0.2338 $0 $0 $0 $5,932 $1,200 L63B Kidney And Urinary Tract Infections, Minor Complexity 1 0 2.2 1 8 11% 0.0524 0.0724 127% 0.1041 0.5297 0.2057 $534 $0 $0 $2,719 $1,056 L64A Urinary Stones And Obstruction, Major Complexity 1 0 2.6 1 8 18% 0.0524 0.0724 184% 0.1418 0.8752 0.2614 $728 $0 $0 $4,493 $1,342 L64B Urinary Stones And Obstruction, Minor Complexity 0 0 1.2 1 4 27% 0.0524 0.0724 200% 0.2433 0.1592 $0 $0 $0 $1,249 $817 L65A Kidney And Urinary Tract Signs And Symptoms, Major Complexity 0 0 4.9 1 16 9% 0.0524 0.0724 118% 1.284 0.2448 $0 $0 $0 $6,592 $1,257 L65B Kidney And Urinary Tract Signs And Symptoms, Minor Complexity 1 0 2.1 1 6 12% 0.0524 0.0724 168% 0.126 0.5298 0.2292 $647 $0 $0 $2,720 $1,177 L66Z Urethral Stricture 0 0 1.6 1 5 15% 0.0524 0.0724 80% 0.5554 0.2448 $0 $0 $0 $2,851 $1,257 L67A Other Kidney And Urinary Tract Disorders, Major Complexity 1 0 5.1 1 16 10% 0.0524 0.0724 149% 0.2643 1.4067 0.2491 $1,357 $0 $0 $7,222 $1,279 L67B Other Kidney And Urinary Tract Disorders, Intermediate Complexity 1 0 2.2 1 7 13% 0.0524 0.0724 200% 0.2021 0.5658 0.212 $1,038 $0 $0 $2,905 $1,088 L67C Other Kidney And Urinary Tract Disorders, Minor Complexity 0 011313%0.0524 0.0724 200% 0.1908 0.15 $0 $0 $0 $980 $770 L68Z Peritoneal Dialysis 00113 7%0.0524 0.0724 200% 0.1625 0.1095 $0 $0 $0 $834 $562 M01A Major Male Pelvic Procedures, Major Complexity 0 0 5.8 2 19 17% 0.0524 0.0724 100% 2.4376 1.0006 4.4388 0.3129 $0 $12,515 $5,137 $22,789 $1,606
Note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 2.National Admitted Acute 7 of 10 qld‐nep‐abf‐priceweights_1920_v2.0
2019-20 National Admitted Acute Price Weights (N1920) AR-DRG V9.0 National Weight (NWAU) see note 4 National Price DRG CODE Description Same Day Bundled IHPA ALOS Lower Upper Private Private Private Paediatric Same Day Short-Stay Short-Stay Inlier Long-Stay Same Day $ Short-Stay Short-Stay Inlier $ Long-Stay Payment ICU Bound Bound Patient Patient Patient Adjustment Outlier Outlier Per Outlier Per Outlier Base Outlier Per Outlier Per List Service Accomodatio Accomodatio Base Diem Diem $ Diem $ Diem $ Adjustment n Adjustment n Adjustment (Same Day) (Overnight) M01B Major Male Pelvic Procedures, Minor Complexity 0 0 3.1 1 10 18% 0.0524 0.0724 100% 3.2628 0.1899 $0 $0 $0 $16,751 $975 M02A Transurethral Prostatectomy For Reproductive System Disorder, Major Complexity 0 0 5.5 2 19 17% 0.0524 0.0724 100% 0.5468 0.8882 2.3231 0.2598 $0 $2,807 $4,560 $11,927 $1,334 M02B Transurethral Prostatectomy For Reproductive System Disorder, Minor Complexity 0 0 2.3 1 7 22% 0.0524 0.0724 100% 1.296 0.2752 $0 $0 $0 $6,654 $1,413 M03A Penis Procedures, Major Complexity 0 0 2.8 1 6 18% 0.0524 0.0724 83% 1.6035 0.3491 $0 $0 $0 $8,232 $1,792 M03B Penis Procedures, Minor Complexity 0 0 1.2 1 4 18% 0.0524 0.0724 124% 0.785 0.225 $0 $0 $0 $4,030 $1,155 M04Z Testes Procedures 0 0 1.2 1 4 16% 0.0524 0.0724 94% 0.8266 0.2808 $0 $0 $0 $4,244 $1,442 M05Z Circumcision 0011314%0.0524 0.0724 100% 0.6303 0.2089 $0 $0 $0 $3,236 $1,072 M06A Other Male Reproductive System GIs, Major Complexity 1 0 9 2 25 18% 0.0524 0.0724 100% 0.8138 0.7595 1.5039 3.7674 0.2905 $4,178 $3,899 $7,721 $19,342 $1,491 M06B Other Male Reproductive System GIs, Minor Complexity 0 0 1.4 1 5 22% 0.0524 0.0724 100% 1.5562 0.2815 $0 $0 $0 $7,990 $1,445 M40Z Cystourethroscopy For Male Reproductive System Disorder, Sameday 0 011137%0.0524 0.0724 100% 0.2575 $0 $0 $0 $1,322 $0 M60A Male Reproductive System Malignancy, Major Complexity 0 0 6.5 2 20 8% 0.0524 0.0724 105% 0.1083 0.9104 1.9291 0.2208 $0 $556 $4,674 $9,904 $1,134 M60B Male Reproductive System Malignancy, Minor Complexity 0 0 1.1 1 4 38% 0.0524 0.0724 100% 0.4129 0.2436 $0 $0 $0 $2,120 $1,251 M61A Benign Prostatic Hypertrophy, Major Complexity 0 0 5.1 1 14 12% 0.0524 0.0724 100% 1.261 0.2186 $0 $0 $0 $6,474 $1,122 M61B Benign Prostatic Hypertrophy, Minor Complexity 0 0 1.3 1 4 14% 0.0524 0.0724 100% 0.389 0.23 $0 $0 $0 $1,997 $1,181 M62A Male Reproductive System Inflammation, Major Complexity 1 0 4.9 1 15 12% 0.0524 0.0724 100% 0.2162 1.1511 0.2021 $1,110 $0 $0 $5,910 $1,038 M62B Male Reproductive System Inflammation, Minor Complexity 1 0 2.4 1 7 12% 0.0524 0.0724 125% 0.1277 0.5309 0.1837 $656 $0 $0 $2,726 $943 M63Z Male Sterilisation Procedures 0011318%0.0524 0.0724 100% 0.4782 0.1529 $0 $0 $0 $2,455 $785 M64A Other Male Reproductive System Disorders, Major Complexity 0 0 2.3 1 8 8% 0.0524 0.0724 100% 0.5945 0.2444 $0 $0 $0 $3,052 $1,255 M64B Other Male Reproductive System Disorders, Minor Complexity 0 0 1.1 1 3 11% 0.0524 0.0724 136% 0.2384 0.143 $0 $0 $0 $1,224 $734 N01Z Pelvic Evisceration And Radical Vulvectomy 0 0 6.6 2 20 14% 0.0524 0.0724 100% 1.2894 1.4959 4.2812 0.4488 $0 $6,620 $7,680 $21,980 $2,304 N04A Hysterectomy For Non-Malignancy, Major Complexity 0 0 4.1 1 13 11% 0.0524 0.0724 100% 2.922 0.3786 $0 $0 $0 $15,002 $1,944 N04B Hysterectomy For Non-Malignancy, Minor Complexity 0 0 2.5 1 8 14% 0.0524 0.0724 100% 2.0781 0.3487 $0 $0 $0 $10,669 $1,790 N05A Oophorectomy And Complex Fallopian Tube Procedures For Non-Malignancy, Maj Comp 0 0 4 1 13 11% 0.0524 0.0724 100% 2.6069 0.3496 $0 $0 $0 $13,384 $1,795 N05B Oophorectomy And Complex Fallopian Tube Procedures For Non-Malignancy, Min Comp 0 0 1.5 1 5 16% 0.0524 0.0724 100% 1.468 0.3764 $0 $0 $0 $7,537 $1,932 N06A Female Reproductive System Reconstructive Procedures, Major Complexity 0 0 3.4 1 11 18% 0.0524 0.0724 100% 2.2463 0.2995 $0 $0 $0 $11,533 $1,538 N06B Female Reproductive System Reconstructive Procedures, Minor Complexity 0 0 1.8 1 6 19% 0.0524 0.0724 100% 1.3811 0.3649 $0 $0 $0 $7,091 $1,873 N07A Other Uterus And Adnexa Procedures For Non-Malignancy, Major Complexity 1 021616%0.0524 0.0724 100% 0.8564 1.5606 0.2974 $4,397 $0 $0 $8,012 $1,527 N07B Other Uterus And Adnexa Procedures For Non-Malignancy, Minor Complexity 0 011326%0.0524 0.0724 100% 0.5658 0.1869 $0 $0 $0 $2,905 $960 N08Z Endoscopic And Laparoscopic Procedures, Female Reproductive System 1 0 2.1 1 6 16% 0.0524 0.0724 105% 0.76 1.3746 0.2782 $3,902 $0 $0 $7,057 $1,428 N09A Other Vagina, Cervix And Vulva Procedures, Major Complexity 0 0 2.1 1 7 11% 0.0524 0.0724 100% 1.0569 0.3313 $0 $0 $0 $5,426 $1,701 N09B Other Vagina, Cervix And Vulva Procedures, Minor Complexity 0011315%0.0524 0.0724 121% 0.5035 0.1895 $0 $0 $0 $2,585 $973 N10Z Diagnostic Curettage And Diagnostic Hysteroscopy 0 0 1.1 1 3 16% 0.0524 0.0724 100% 0.5002 0.1632 $0 $0 $0 $2,568 $838 N11A Other Female Reproductive System GIs, Major Complexity 0 0 6.6 1 17 9% 0.0524 0.0724 100% 2.3964 0.3068 $0 $0 $0 $12,303 $1,575 N11B Other Female Reproductive System GIs, Minor Complexity 0 011316%0.0524 0.0724 100% 0.3668 0.2932 $0 $0 $0 $1,883 $1,505 N12A Uterus And Adnexa Procedures For Malignancy, Major Complexity 0 0 9.5 3 31 13% 0.0524 0.0724 100% 1.3695 1.3749 5.4944 0.3928 $0 $7,031 $7,059 $28,208 $2,017 N12B Uterus And Adnexa Procedures For Malignancy, Intermediate Complexity 0 0 4.3 1 14 15% 0.0524 0.0724 100% 3.0409 0.3478 $0 $0 $0 $15,612 $1,786 N12C Uterus And Adnexa Procedures For Malignancy, Minor Complexity 0 0 2.3 1 8 19% 0.0524 0.0724 100% 2.0879 0.3629 $0 $0 $0 $10,719 $1,863 N60A Female Reproductive System Malignancy, Major Complexity 0 0 9 3 29 10% 0.0524 0.0724 100% 0 0.9311 2.7932 0.2375 $0 $0 $4,780 $14,340 $1,219 N60B Female Reproductive System Malignancy, Minor Complexity 0 0 2.5 1 8 10% 0.0524 0.0724 180% 0.7661 0.2666 $0 $0 $0 $3,933 $1,369 N61A Female Reproductive System Infections, Major Complexity 0 0 3.2 1 10 8% 0.0524 0.0724 100% 0.8669 0.2629 $0 $0 $0 $4,451 $1,350 N61B Female Reproductive System Infections, Minor Complexity 0 0 1.5 1 5 10% 0.0524 0.0724 100% 0.3444 0.269 $0 $0 $0 $1,768 $1,381 N62A Menstrual And Other Female Reproductive System Disorders, Major Complexity 0 0 2.2 1 7 9% 0.0524 0.0724 128% 0.5854 0.264 $0 $0 $0 $3,005 $1,355 N62B Menstrual And Other Female Reproductive System Disorders, Minor Complexity 0 0 1.1 1 4 14% 0.0524 0.0724 159% 0.2329 0.1538 $0 $0 $0 $1,196 $790 O01A Caesarean Delivery, Major Complexity 0 0 6.7 2 21 10% 0.0524 0.0724 100% 0.7715 1.2085 3.1885 0.2653 $0 $3,961 $6,204 $16,370 $1,362 O01B Caesarean Delivery, Intermediate Complexity 0 0 4.1 1 13 13% 0.0524 0.0724 100% 2.262 0.2448 $0 $0 $0 $11,613 $1,257 O01C Caesarean Delivery, Minor Complexity 0031915%0.0524 0.0724 100% 1.8707 0.2799 $0 $0 $0 $9,604 $1,437 O02A Vaginal Delivery W GIs, Major Complexity 0 0 4.1 1 12 8% 0.0524 0.0724 100% 2.3555 0.3278 $0 $0 $0 $12,093 $1,683 O02B Vaginal Delivery W GIs, Minor Complexity 0 0 2.8 1 9 8% 0.0524 0.0724 100% 1.6647 0.34 $0 $0 $0 $8,547 $1,746 O03Z Ectopic Pregnancy 0 0 1.7 1 5 11% 0.0524 0.0724 100% 1.0851 0.309 $0 $0 $0 $5,571 $1,586 O04A Postpartum And Post Abortion W GIs, Major Complexity 0 0 4.3 1 13 11% 0.0524 0.0724 100% 2.0152 0.3433 $0 $0 $0 $10,346 $1,763 O04B Postpartum And Post Abortion W GIs, Minor Complexity 1 0 2.1 1 7 14% 0.0524 0.0724 100% 0.5101 1.0474 0.3492 $2,619 $0 $0 $5,377 $1,793 O05Z Abortion W GIs 0 0 1.1 1 3 17% 0.0524 0.0724 100% 0.4909 0.1914 $0 $0 $0 $2,520 $983 O60A Vaginal Delivery, Major Complexity 0 0 3.7 1 12 11% 0.0524 0.0724 100% 1.6839 0.2781 $0 $0 $0 $8,645 $1,428 O60B Vaginal Delivery, Intermediate Complexity 0 0 2.4 1 7 14% 0.0524 0.0724 112% 1.1491 0.3155 $0 $0 $0 $5,899 $1,620 O60C Vaginal Delivery, Minor Complexity 0 0 1.8 1 5 15% 0.0524 0.0724 100% 0.8454 0.3332 $0 $0 $0 $4,340 $1,711 O61A Postpartum And Post Abortion W/O GIs, Major Complexity 0 0 4.4 1 13 5% 0.0524 0.0724 100% 1.2087 0.2571 $0 $0 $0 $6,205 $1,320 O61B Postpartum And Post Abortion W/O GIs, Minor Complexity 1 0 2.2 1 7 9% 0.0524 0.0724 100% 0.1377 0.6184 0.2123 $707 $0 $0 $3,175 $1,090 O63A Abortion W/O GIs, Major Complexity 0 0 1.6 1 5 14% 0.0524 0.0724 100% 0.6813 0.4478 $0 $0 $0 $3,498 $2,299 O63B Abortion W/O GIs, Minor Complexity 0 0 1.1 1 3 14% 0.0524 0.0724 100% 0.2099 0.1549 $0 $0 $0 $1,078 $795 O66A Antenatal And Other Obstetric Admissions, Major Complexity 1 0 3.1 1 10 7% 0.0524 0.0724 100% 0.2027 0.9003 0.2254 $1,041 $0 $0 $4,622 $1,157 O66B Antenatal And Other Obstetric Admissions, Intermediate Complexity 0 0 1.2 1 4 8% 0.0524 0.0724 142% 0.2495 0.1768 $0 $0 $0 $1,281 $908 O66C Antenatal And Other Obstetric Admissions, Minor Complexity 0 011311%0.0524 0.0724 116% 0.1305 0.1031 $0 $0 $0 $670 $529 P01Z Neonate W Sig Gi/Vent>=96hrs, Died Or Transfer To Acute Facility <5days 0 1 1.5 1 4 11% 0.0524 0.0724 100% 1.6961 0.6642 $0 $0 $0 $8,708 $3,410 P02Z Cardiothoracic And Vascular Procedures For Neonates 0 1 31.9 21 48 14% 0.0524 0.0724 100% 2.6747 1.2495 28.9148 0.5936 $0 $13,732 $6,415 $148,449 $3,048 P03A Neonate, Admwt 1000-1499g W Significant Gi/Vent>=96hrs, Major Complexity 0 1 62.8 41 94 12% 0.0524 0.0724 100% 0.2108 0.6871 28.383 0.4206 $0 $1,082 $3,528 $145,718 $2,159 P03B Neonate, Admwt 1000-1499g W Significant Gi/Vent>=96hrs, Minor Complexity 0 1 37.3 12 116 9% 0.0524 0.0724 100% 0.0867 1.337 16.1303 0.3626 $0 $445 $6,864 $82,813 $1,862 P04A Neonate, Admwt 1500-1999g W Significant Gi/Vent>=96hrs, Major Complexity 0 1 55.1 19 171 11% 0.0524 0.0724 100% 0.3092 1.1429 22.0235 0.3712 $0 $1,587 $5,868 $113,069 $1,906 P04B Neonate, Admwt 1500-1999g W Significant Gi/Vent>=96hrs, Minor Complexity 0 1 26.1 9 84 11% 0.0524 0.0724 100% 0.0674 1.1409 10.3352 0.3092 $0 $346 $5,857 $53,061 $1,587 P05A Neonate, Admwt 2000-2499g W Significant Gi/Vent>=96hrs, Major Complexity 0 1 50.8 31 71 10% 0.0524 0.0724 100% 0.6099 0.8414 26.6939 0.474 $0 $3,131 $4,320 $137,046 $2,434 P05B Neonate, Admwt 2000-2499g W Significant Gi/Vent>=96hrs, Minor Complexity 0 1 18.8 6 57 10% 0.0524 0.0724 100% 0.2527 1.3148 8.1414 0.353 $0 $1,297 $6,750 $41,798 $1,812 P06A Neonate, Admwt >=2500g W Significant Gi/Vent>=96hrs, Major Complexity 0 1 32 10 96 10% 0.0524 0.0724 100% 0.5203 1.6595 17.1156 0.477 $0 $2,671 $8,520 $87,871 $2,449 P06B Neonate, Admwt >=2500g W Significant Gi/Vent>=96hrs, Minor Complexity 0 1 11.9 3 35 12% 0.0524 0.0724 100% 0.334 1.8503 5.8849 0.4085 $0 $1,715 $9,499 $30,213 $2,097 P07Z Neonate, Admwt <750g W Significant GIs 0 1 112.6 39 358 11% 0.0524 0.0724 100% 0.4612 1.6771 65.8678 0.4648 $0 $2,368 $8,610 $338,165 $2,386 P08Z Neonate, Admwt 750-999g W Significant GIs 0 1 92.6 32 297 11% 0.0524 0.0724 100% 0.8016 1.5571 50.6275 0.4155 $0 $4,115 $7,994 $259,922 $2,133 P60A Neonate W/O Sig Gi/Vent>=96hrs, Died/Transfer Acute Facility <5 Days, Majc 0 1 2.4 1 4 9% 0.0524 0.0724 100% 1.2185 $0 $0 $0 $6,256 $0 P60B Neonate W/O Sig Gi/Vent>=96hrs, Died/Transfer Acute Facility <5 Days, Minc 1 121413%0.0524 0.0724 100% 0.3182 0.9615 $1,634 $0 $0 $4,936 $0 P61Z Neonate, Admwt <750g W/O Significant Gi Procedure 0 1 79.9 27 249 9% 0.0524 0.0724 100% 0 1.7189 46.4097 0.4285 $0 $0 $8,825 $238,267 $2,200 P62A Neonate, Admwt 750-999g W/O Significant GIs, Major Complexity 0 1 71.8 24 217 11% 0.0524 0.0724 100% 0 1.4395 34.5474 0.4273 $0 $0 $7,390 $177,366 $2,194 P62B Neonate, Admwt 750-999g W/O Significant GIs, Minor Complexity 0 1 28.9 10 90 11% 0.0524 0.0724 100% 0 1.3698 13.6978 0.3687 $0 $0 $7,033 $70,325 $1,893 P63A Neonate, Admwt 1000-1249g W/O Significant Gi/Vent>=96hrs, Major Complexity 0 1 38.4 11 101 9% 0.0524 0.0724 100% 0 1.1295 12.4247 0.3201 $0 $0 $5,799 $63,788 $1,643 P63B Neonate, Admwt 1000-1249g W/O Significant Gi/Vent>=96hrs, Minor Complexity 0 1 12.5 4 39 9% 0.0524 0.0724 100% 0 1.5147 6.059 0.2735 $0 $0 $7,776 $31,107 $1,404
Note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 2.National Admitted Acute 8 of 10 qld‐nep‐abf‐priceweights_1920_v2.0
2019-20 National Admitted Acute Price Weights (N1920) AR-DRG V9.0 National Weight (NWAU) see note 4 National Price DRG CODE Description Same Day Bundled IHPA ALOS Lower Upper Private Private Private Paediatric Same Day Short-Stay Short-Stay Inlier Long-Stay Same Day $ Short-Stay Short-Stay Inlier $ Long-Stay Payment ICU Bound Bound Patient Patient Patient Adjustment Outlier Outlier Per Outlier Per Outlier Base Outlier Per Outlier Per List Service Accomodatio Accomodatio Base Diem Diem $ Diem $ Diem $ Adjustment n Adjustment n Adjustment (Same Day) (Overnight) P64A Neonate, Admwt 1250-1499g W/O Significant Gi/Vent>=96hrs, Major Complexity 0 1 32.5 11 101 10% 0.0524 0.0724 100% 0 0.9797 10.7766 0.3101 $0 $0 $5,030 $55,327 $1,592 P64B Neonate, Admwt 1250-1499g W/O Significant Gi/Vent>=96hrs, Minor Complexity 0 1 21.7 7 65 12% 0.0524 0.0724 100% 0 0.9965 6.9754 0.2533 $0 $0 $5,116 $35,812 $1,300 P65A Neonate, Admwt 1500-1999g W/O Significant Gi/Vent>=96hrs, Extreme Comp 0 1 27 9 86 5% 0.0524 0.0724 100% 0 0.9577 8.6197 0.2993 $0 $0 $4,917 $44,254 $1,537 P65B Neonate, Admwt 1500-1999g W/O Significant Gi/Vent>=96hrs, Major Complexity 0 1 20 6 62 7% 0.0524 0.0724 100% 0 1.0474 6.2845 0.281 $0 $0 $5,377 $32,265 $1,443 P65C Neonate, Admwt 1500-1999g W/O Significant Gi/Vent>=96hrs, Intermediate Comp 0 1 16.2 5 50 6% 0.0524 0.0724 100% 0 0.9735 4.8675 0.2523 $0 $0 $4,998 $24,990 $1,295 P65D Neonate, Admwt 1500-1999g W/O Significant Gi/Vent>=96hrs, Minor Complexity 0 1 12.1 4 37 6% 0.0524 0.0724 100% 0 0.9826 3.9304 0.2751 $0 $0 $5,045 $20,179 $1,412 P66A Neonate, Admwt 2000-2499g W/O Significant Gi/Vent>=96hrs, Extreme Comp 0 1 17 11 25 7% 0.0524 0.0724 100% 0 0.5101 5.6116 0.2802 $0 $0 $2,619 $28,810 $1,439 P66B Neonate, Admwt 2000-2499g W/O Significant Gi/Vent>=96hrs, Major Complexity 0 1 12.1 4 38 11% 0.0524 0.0724 100% 0 0.9747 3.8987 0.2833 $0 $0 $5,004 $20,016 $1,454 P66C Neonate, Admwt 2000-2499g W/O Significant Gi/Vent>=96hrs, Intermediate Comp 0 1 7.9 2 25 8% 0.0524 0.0724 100% 0 1.2579 2.5158 0.272 $0 $0 $6,458 $12,916 $1,396 P66D Neonate, Admwt 2000-2499g W/O Significant Gi/Vent>=96hrs, Minor Complexity 0 1 3.8 1 11 14% 0.0524 0.0724 100% 1.1801 0.2671 $0 $0 $0 $6,059 $1,371 P67A Neonate, Admwt >=2500g W/O Sig Gi/Vent>=96hrs, <37 Comp Wks Gest, Extr Comp 0 1 13.6 4 42 9% 0.0524 0.0724 100% 0 1.1523 4.6093 0.295 $0 $0 $5,916 $23,664 $1,515 P67B Neonate, Admwt >=2500g W/O Sig Gi/Vent>=96hrs, <37 Comp Wks Gest, Maj Comp 0 1 8.6 3 28 6% 0.0524 0.0724 100% 0 0.9669 2.9007 0.2732 $0 $0 $4,964 $14,892 $1,403 P67C Neonate, Admwt >=2500g W/O Sig Gi/Vent>=96hrs, <37 Comp Wks Gest, Int Comp 0 1 6.7 2 22 11% 0.0524 0.0724 100% 0 1.153 2.3061 0.2813 $0 $0 $5,920 $11,840 $1,444 P67D Neonate, Admwt >=2500g W/O Sig Gi/Vent>=96hrs, <37 Comp Wks Gest, Min Comp 0 1 4.5 1 13 12% 0.0524 0.0724 100% 1.4578 0.2753 $0 $0 $0 $7,484 $1,413 P68A Neonate, Admwt >=2500g W/O Sig Gi/Vent>=96hrs, >=37 Comp Wks Gest, Ext Comp 0 1 8 2 25 10% 0.0524 0.0724 100% 0 1.4411 2.8822 0.3301 $0 $0 $7,399 $14,797 $1,695 P68B Neonate, Admwt >=2500g W/O Sig Gi/Vent>=96hrs, >=37 Comp Wks Gest, Maj Comp 0 1 4.1 1 13 9% 0.0524 0.0724 100% 1.4089 0.3076 $0 $0 $0 $7,233 $1,579 P68C Neonate, Admwt >=2500g W/O Sig Gi/Vent>=96hrs, >=37 Comp Wks Gest, Int Comp 0 1 2.9 1 9 9% 0.0524 0.0724 100% 1.0132 0.2949 $0 $0 $0 $5,202 $1,514 P68D Neonate, Admwt >=2500g W/O Sig Gi/Vent>=96hrs, >=37 Comp Wks Gest, Min Comp 0 1 2.1 1 6 9% 0.0524 0.0724 100% 0.7215 0.281 $0 $0 $0 $3,704 $1,443 Q01Z Splenectomy 0 0 6.9 2 19 14% 0.0524 0.0724 100% 1.1217 1.3541 3.8299 0.3145 $0 $5,759 $6,952 $19,663 $1,615 Q02A Blood And Immune System Disorders W Other GIs, Major Complexity 0 0 10.9 3 30 13% 0.0524 0.0724 137% 0.4524 1.264 4.2445 0.3516 $0 $2,323 $6,489 $21,791 $1,805 Q02B Blood And Immune System Disorders W Other GIs, Minor Complexity 1 0 2.7 1 9 19% 0.0524 0.0724 119% 0.5732 1.4292 0.2304 $2,943 $0 $0 $7,338 $1,183 Q60A Reticuloendothelial And Immunity Disorders, Major Complexity 1 0 5.6 1 17 9% 0.0524 0.0724 151% 0.2611 1.6252 0.3196 $1,340 $0 $0 $8,344 $1,641 Q60B Reticuloendothelial And Immunity Disorders, Minor Complexity 0 0 1.1 1 3 13% 0.0524 0.0724 180% 0.1735 0.1315 $0 $0 $0 $891 $675 Q61A Red Blood Cell Disorders, Major Complexity 1 0 4.2 1 13 14% 0.0524 0.0724 130% 0.3365 1.1675 0.2627 $1,728 $0 $0 $5,994 $1,349 Q61B Red Blood Cell Disorders, Intermediate Complexity 0 0 1.1 1 3 15% 0.0524 0.0724 173% 0.2136 0.1287 $0 $0 $0 $1,097 $661 Q61C Red Blood Cell Disorders, Minor Complexity 0 011332%0.0524 0.0724 100% 0.0653 0.0454 $0 $0 $0 $335 $233 Q62A Coagulation Disorders, Major Complexity 1 0 5.8 1 18 13% 0.0524 0.0724 100% 0.2054 1.5596 0.2482 $1,055 $0 $0 $8,007 $1,274 Q62B Coagulation Disorders, Minor Complexity 1 0 2.3 1 7 11% 0.0524 0.0724 130% 0.1845 0.5577 0.2208 $947 $0 $0 $2,863 $1,134 R01A Lymphoma And Leukaemia W Major GIs, Major Complexity 0 0 19.1 6 59 16% 0.0524 0.0724 100% 0.8604 1.4075 9.3055 0.357 $0 $4,417 $7,226 $47,774 $1,833 R01B Lymphoma And Leukaemia W Major GIs, Minor Complexity 0 0 3.5 1 12 25% 0.0524 0.0724 100% 1.8784 0.4045 $0 $0 $0 $9,644 $2,077 R02A Other Neoplastic Disorders W Major GIs, Major Complexity 0 0 13.9 4 41 14% 0.0524 0.0724 100% 2.0582 1.3333 7.3915 0.3069 $0 $10,567 $6,845 $37,948 $1,576 R02B Other Neoplastic Disorders W Major GIs, Intermediate Complexity 0 0 7.3 2 23 14% 0.0524 0.0724 100% 0.7545 1.5254 3.8052 0.1751 $0 $3,874 $7,831 $19,536 $899 R02C Other Neoplastic Disorders W Major GIs, Minor Complexity 0 0 3.8 1 12 19% 0.0524 0.0724 100% 2.0648 0.2225 $0 $0 $0 $10,601 $1,142 R03A Lymphoma And Leukaemia W Other GIs, Major Complexity 0 0 30.7 10 90 13% 0.0524 0.0724 100% 0.4541 1.2751 13.2048 0.3477 $0 $2,331 $6,546 $67,793 $1,785 R03B Lymphoma And Leukaemia W Other GIs, Intermediate Complexity 0 0 11.3 3 34 15% 0.0524 0.0724 100% 0.5668 1.3859 4.7246 0.2871 $0 $2,910 $7,115 $24,256 $1,474 R03C Lymphoma And Leukaemia W Other GIs, Minor Complexity 1 0 3.9 1 12 20% 0.0524 0.0724 162% 0.6337 1.8689 0.2901 $3,253 $0 $0 $9,595 $1,489 R04A Other Neoplastic Disorders W Other GIs, Major Complexity 0 0 7.9 2 24 15% 0.0524 0.0724 100% 0.782 1.4739 3.7298 0.243 $0 $4,015 $7,567 $19,149 $1,248 R04B Other Neoplastic Disorders W Other GIs, Minor Complexity 1 0 2.9 1 9 15% 0.0524 0.0724 100% 0.8749 1.6023 0.2058 $4,492 $0 $0 $8,226 $1,057 R05A Allogeneic Bone Marrow Transplant, Age <=16 Years Or Major Complexity 0 0 50.3 16 150 7% 0.0524 0.0724 169% 0.079 1.5531 24.929 0.4675 $0 $406 $7,974 $127,985 $2,400 R05B Allogeneic Bone Marrow Transplant, Age >=17 Years And Minor Complexity 0 0 25.8 8 73 7% 0.0524 0.0724 100% 0 1.6366 13.0931 0.4388 $0 $0 $8,402 $67,220 $2,253 R06A Autologous Bone Marrow Transplant, Major Complexity 0 0 22.7 15 34 8% 0.0524 0.0724 200% 0 0.5839 8.7585 0.3794 $0 $0 $2,998 $44,966 $1,948 R06B Autologous Bone Marrow Transplant, Minor Complexity 0 0 12.9 4 38 8% 0.0524 0.0724 100% 0 1.3118 5.2471 0.3038 $0 $0 $6,735 $26,939 $1,560 R60A Acute Leukaemia, Major Complexity 0 0 17 11 26 9% 0.0524 0.0724 121% 0.1015 0.7068 7.8764 0.3362 $0 $521 $3,629 $40,437 $1,726 R60B Acute Leukaemia, Intermediate Complexity 1 0 5.8 2 19 11% 0.0524 0.0724 109% 0.3323 0 1.0568 2.1137 0.2759 $1,706 $0 $5,426 $10,852 $1,416 R60C Acute Leukaemia, Minor Complexity 1 0 5.1 1 15 17% 0.0524 0.0724 173% 0.2489 1.0763 0.1007 $1,278 $0 $0 $5,526 $517 R61A Lymphoma And Non-Acute Leukaemia, Major Complexity 0 0 9.8 3 30 10% 0.0524 0.0724 158% 0 1.1221 3.3662 0.2961 $0 $0 $5,761 $17,282 $1,520 R61B Lymphoma And Non-Acute Leukaemia, Intermediate Complexity 1 0 3.9 1 12 11% 0.0524 0.0724 167% 0.2634 1.303 0.2663 $1,352 $0 $0 $6,690 $1,367 R61C Lymphoma And Non-Acute Leukaemia, Minor Complexity 0 0 1.1 1 3 13% 0.0524 0.0724 200% 0.2153 0.1618 $0 $0 $0 $1,105 $831 R62A Other Neoplastic Disorders, Major Complexity 0 0 9.2 3 28 10% 0.0524 0.0724 100% 0 1.0194 3.0581 0.2625 $0 $0 $5,234 $15,700 $1,348 R62B Other Neoplastic Disorders, Intermediate Complexity 1 0 4.4 1 14 6% 0.0524 0.0724 82% 1.0134 1.3769 0.2385 $5,203 $0 $0 $7,069 $1,224 R62C Other Neoplastic Disorders, Minor Complexity 1 0 2.8 1 8 10% 0.0524 0.0724 148% 0.4772 0.6747 0.1403 $2,450 $0 $0 $3,464 $720 R63Z Chemotherapy 0011110%0.0524 0.0724 100% 0.2323 $0 $0 $0 $1,193 $0 T01A Infectious And Parasitic Diseases W GIs, Major Complexity 0 0 23.6 8 78 11% 0.0524 0.0724 147% 0.7323 1.0734 9.3199 0.2872 $0 $3,760 $5,511 $47,848 $1,474 T01B Infectious And Parasitic Diseases W GIs, Intermediate Complexity 0 0 11 3 36 11% 0.0524 0.0724 106% 0.4196 1.1509 3.8722 0.235 $0 $2,154 $5,909 $19,880 $1,206 T01C Infectious And Parasitic Diseases W GIs, Minor Complexity 0 0 6 2 18 13% 0.0524 0.0724 100% 0.3304 0.9204 2.1711 0.2275 $0 $1,696 $4,725 $11,146 $1,168 T40Z Infectious And Parasitic Diseases W Ventilator Support 0 0 8.2 2 24 10% 0.0524 0.0724 100% 0.0592 2.344 4.7472 0.3358 $0 $304 $12,034 $24,372 $1,724 T60A Septicaemia, Major Complexity 0 0 12 4 40 11% 0.0524 0.0724 133% 0 0.9728 3.8912 0.2541 $0 $0 $4,994 $19,977 $1,305 T60B Septicaemia, Intermediate Complexity 0 0 6.3 2 21 11% 0.0524 0.0724 115% 0 0.9192 1.8384 0.2265 $0 $0 $4,719 $9,438 $1,163 T60C Septicaemia, Minor Complexity 0 0 3.8 1 12 12% 0.0524 0.0724 124% 0.9682 0.2303 $0 $0 $0 $4,971 $1,182 T61A Postoperative Infections, Major Complexity 0 0 6.4 2 19 9% 0.0524 0.0724 118% 0 0.799 1.598 0.1864 $0 $0 $4,102 $8,204 $957 T61B Postoperative Infections, Minor Complexity 0 0 3.1 1 10 9% 0.0524 0.0724 146% 0.6248 0.1655 $0 $0 $0 $3,208 $850 T62A Fever Of Unknown Origin, Major Complexity 0 0 5.5 1 17 11% 0.0524 0.0724 112% 1.5068 0.275 $0 $0 $0 $7,736 $1,412 T62B Fever Of Unknown Origin, Minor Complexity 0 0 1.9 1 6 12% 0.0524 0.0724 95% 0.4692 0.2605 $0 $0 $0 $2,409 $1,337 T63A Viral Illnesses, Major Complexity 1 0 4.3 1 13 9% 0.0524 0.0724 112% 0.4251 1.2095 0.2802 $2,182 $0 $0 $6,210 $1,439 T63B Viral Illnesses, Minor Complexity 0 0 1.3 1 5 10% 0.0524 0.0724 100% 0.2941 0.2152 $0 $0 $0 $1,510 $1,105 T64A Other Infectious And Parasitic Diseases, Major Complexity 0 0 18.7 11 26 6% 0.0524 0.0724 170% 0 0.5914 6.505 0.2796 $0 $0 $3,036 $33,397 $1,435 T64B Other Infectious And Parasitic Diseases, Intermediate Complexity 0 0 8.6 3 28 9% 0.0524 0.0724 118% 0 0.819 2.457 0.1988 $0 $0 $4,205 $12,614 $1,021 T64C Other Infectious And Parasitic Diseases, Minor Complexity 1 0 4.6 1 15 11% 0.0524 0.0724 105% 0.2037 1.0986 0.1786 $1,046 $0 $0 $5,640 $917 U40A Mental Health Treatment W ECT, Sameday, Major Complexity 0 0 1 1 1 14% 0.0524 0.0724 100% 0.209 $0 $0 $0 $1,073 $0 U40B Mental Health Treatment W ECT, Sameday, Minor Complexity 0 0 1 1 1 11% 0.0524 0.0724 100% 0.2013 $0 $0 $0 $1,033 $0 U60Z Mental Health Treatment W/O ECT, Sameday 0 011110%0.0524 0.0724 200% 0.1221 $0 $0 $0 $627 $0 U61A Schizophrenia Disorders, Major Complexity 0 0 47.4 29 67 1% 0.0524 0.0724 100% 0 0.3528 10.2326 0.1789 $0 $0 $1,811 $52,534 $918 U61B Schizophrenia Disorders, Minor Complexity 0 0 19.3 13 30 1% 0.0524 0.0724 100% 0 0.3713 4.8269 0.1893 $0 $0 $1,906 $24,781 $972 U62A Paranoia And Acute Psychotic Disorders, Major Complexity 0 0 21.5 14 34 2% 0.0524 0.0724 100% 0 0.4237 5.9315 0.1889 $0 $0 $2,175 $30,452 $970 U62B Paranoia And Acute Psychotic Disorders, Minor Complexity 0 0 10.6 7 17 3% 0.0524 0.0724 197% 0 0.4305 3.0138 0.2098 $0 $0 $2,210 $15,473 $1,077 U63A Major Affective Disorders, Major Complexity 0 0 28.3 18 42 2% 0.0524 0.0724 169% 0 0.4039 7.2696 0.2027 $0 $0 $2,074 $37,322 $1,041 U63B Major Affective Disorders, Minor Complexity 0 0 11.9 8 18 3% 0.0524 0.0724 154% 0 0.4261 3.4084 0.209 $0 $0 $2,188 $17,499 $1,073 U64A Other Affective And Somatoform Disorders, Major Complexity 0 0 12.6 8 19 2% 0.0524 0.0724 167% 0 0.4432 3.5457 0.1949 $0 $0 $2,275 $18,204 $1,001 U64B Other Affective And Somatoform Disorders, Minor Complexity 0 0 5.5 3 8 3% 0.0524 0.0724 180% 0 0.4947 1.4841 0.2132 $0 $0 $2,540 $7,619 $1,095 U65A Anxiety Disorders, Major Complexity 0 0 8.5 5 13 4% 0.0524 0.0724 150% 0 0.5049 2.5247 0.2248 $0 $0 $2,592 $12,962 $1,154 U65B Anxiety Disorders, Minor Complexity 0 0 3.2 2 5 6% 0.0524 0.0724 169% 0 0.4357 0.8715 0.2151 $0 $0 $2,237 $4,474 $1,104
Note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 2.National Admitted Acute 9 of 10 qld‐nep‐abf‐priceweights_1920_v2.0
2019-20 National Admitted Acute Price Weights (N1920) AR-DRG V9.0 National Weight (NWAU) see note 4 National Price DRG CODE Description Same Day Bundled IHPA ALOS Lower Upper Private Private Private Paediatric Same Day Short-Stay Short-Stay Inlier Long-Stay Same Day $ Short-Stay Short-Stay Inlier $ Long-Stay Payment ICU Bound Bound Patient Patient Patient Adjustment Outlier Outlier Per Outlier Per Outlier Base Outlier Per Outlier Per List Service Accomodatio Accomodatio Base Diem Diem $ Diem $ Diem $ Adjustment n Adjustment n Adjustment (Same Day) (Overnight) U66A Eating And Obsessive-Compulsive Disorders, Major Complexity 0 0 23.3 15 36 3% 0.0524 0.0724 112% 0 0.5025 7.5372 0.2488 $0 $0 $2,580 $38,696 $1,277 U66B Eating And Obsessive-Compulsive Disorders, Minor Complexity 0 0 12.8 8 19 2% 0.0524 0.0724 120% 0 0.5263 4.2105 0.2558 $0 $0 $2,702 $21,617 $1,313 U67A Personality Disorders And Acute Reactions, Major Complexity 0 0 10.9 7 17 1% 0.0524 0.0724 162% 0 0.4491 3.144 0.2131 $0 $0 $2,306 $16,141 $1,094 U67B Personality Disorders And Acute Reactions, Minor Complexity 0 0 4.5 3 7 2% 0.0524 0.0724 169% 0 0.4591 1.3773 0.2188 $0 $0 $2,357 $7,071 $1,123 U68A Childhood Mental Disorders, Major Complexity 0 0 10.4 6 15 1% 0.0524 0.0724 114% 0 0.621 3.7262 0.2814 $0 $0 $3,188 $19,130 $1,445 U68B Childhood Mental Disorders, Minor Complexity 0 0538 1%0.0524 0.0724 123% 0 0.5897 1.769 0.2464 $0 $0 $3,028 $9,082 $1,265 V60A Alcohol Intoxication And Withdrawal, Major Complexity 0 0 3.2 2 5 7% 0.0524 0.0724 100% 0 0.4322 0.8643 0.2157 $0 $0 $2,219 $4,437 $1,107 V60B Alcohol Intoxication And Withdrawal, Minor Complexity 0 0 1.3 1 2 12% 0.0524 0.0724 87% 0.1768 0.1249 $0 $0 $0 $908 $641 V61A Drug Intoxication And Withdrawal, Major Complexity 0 0 7.1 4 11 3% 0.0524 0.0724 184% 0 0.5062 2.0249 0.2249 $0 $0 $2,599 $10,396 $1,155 V61B Drug Intoxication And Withdrawal, Minor Complexity 0 0325 4%0.0524 0.0724 100% 0 0.405 0.81 0.1882 $0 $0 $2,079 $4,159 $966 V62A Alcohol Use And Dependence, Major Complexity 0 0 8.3 5 13 4% 0.0524 0.0724 100% 0 0.4204 2.1021 0.259 $0 $0 $2,158 $10,792 $1,330 V62B Alcohol Use And Dependence, Minor Complexity 0 0426 4%0.0524 0.0724 100% 0 0.4188 0.8377 0.1599 $0 $0 $2,150 $4,301 $821 V63Z Opioid Use And Dependence 0 0 5.5 3 8 2% 0.0524 0.0724 100% 0 0.4542 1.3625 0.2006 $0 $0 $2,332 $6,995 $1,030 V64A Other Drug Use And Dependence, Major Complexity 0 0 8.2 5 13 2% 0.0524 0.0724 100% 0 0.4212 2.1061 0.2128 $0 $0 $2,162 $10,813 $1,093 V64B Other Drug Use And Dependence, Minor Complexity 0 0 3.7 2 6 2% 0.0524 0.0724 100% 0 0.4707 0.9414 0.1905 $0 $0 $2,417 $4,833 $978 W01A Vent, Trac & Cran Procs For Mult Sig Trauma, Major Complexity 0 0 24.4 8 73 12% 0.0524 0.0724 100% 3.6255 2.113 20.5292 0.3973 $0 $18,613 $10,848 $105,397 $2,040 W01B Vent, Trac & Cran Procs For Mult Sig Trauma, Intermediate Complexity 0 0 13.7 4 41 12% 0.0524 0.0724 100% 2.4046 2.5822 12.7333 0.4143 $0 $12,345 $13,257 $65,373 $2,127 W01C Vent, Trac & Cran Procs For Mult Sig Trauma, Minor Complexity 0 0 8.5 3 30 12% 0.0524 0.0724 100% 1.6631 2.3937 8.844 0.4674 $0 $8,538 $12,289 $45,405 $2,400 W02A Hip, Femur And Lower Limb Procedures For Multiple Sig Trauma, Major Complexity 0 0 18.4 7 66 20% 0.0524 0.0724 100% 2.0685 1.2519 10.8318 0.35 $0 $10,620 $6,427 $55,610 $1,797 W02B Hip, Femur And Lower Limb Procedures For Multiple Sig Trauma, Minor Complexity 0 0 10.1 4 36 23% 0.0524 0.0724 100% 1.1532 0.8852 4.6939 0.2749 $0 $5,921 $4,545 $24,098 $1,411 W03Z Abdominal Procedures For Multiple Significant Trauma 0 0 9.7 3 30 14% 0.0524 0.0724 100% 1.3491 1.2594 5.1274 0.3509 $0 $6,926 $6,466 $26,324 $1,802 W04A Multiple Significant Trauma W Other GIs, Major Complexity 0 0 15.9 6 54 19% 0.0524 0.0724 100% 1.6855 1.1791 8.7601 0.4019 $0 $8,653 $6,053 $44,974 $2,063 W04B Multiple Significant Trauma W Other GIs, Minor Complexity 0 0 7.4 2 24 19% 0.0524 0.0724 100% 0.9056 1.7222 4.35 0.3935 $0 $4,649 $8,842 $22,333 $2,020 W60Z Multiple Sig Trauma, Transferred To Acute Facility <5 Days 0 0 1.6 1 4 35% 0.0524 0.0724 100% 1.392 $0 $0 $0 $7,147 $0 W61A Multiple Significant Trauma W/O GIs, Major Complexity 0 0 11 4 36 8% 0.0524 0.0724 126% 0 0.8392 3.3568 0.2568 $0 $0 $4,308 $17,234 $1,318 W61B Multiple Significant Trauma W/O GIs, Minor Complexity 0 0 4.6 1 14 10% 0.0524 0.0724 124% 1.3853 0.2724 $0 $0 $0 $7,112 $1,399 X02A Microvascular Tissue Transfer And Skin Grafts For Injuries To Hand, Major Comp 0 0 7.2 2 23 29% 0.0524 0.0724 100% 0.5425 1.9983 4.539 0.448 $0 $2,785 $10,259 $23,303 $2,300 X02B Microvascular Tissue Transfer And Skin Grafts For Injuries To Hand, Minor Comp 0 0 1.7 1 5 33% 0.0524 0.0724 122% 1.0321 0.516 $0 $0 $0 $5,299 $2,649 X04A Other Procedures For Injuries To Lower Limb, Major Complexity 0 0 10.4 3 32 10% 0.0524 0.0724 100% 0.5371 1.1643 4.0301 0.2628 $0 $2,757 $5,978 $20,691 $1,349 X04B Other Procedures For Injuries To Lower Limb, Minor Complexity 1 0 2.2 1 7 15% 0.0524 0.0724 100% 0.5027 1.0234 0.268 $2,581 $0 $0 $5,254 $1,376 X05A Other Procedures For Injuries To Hand, Major Complexity 0 0 2.7 1 8 11% 0.0524 0.0724 113% 1.4871 0.3061 $0 $0 $0 $7,635 $1,572 X05B Other Procedures For Injuries To Hand, Minor Complexity 0 0 1.3 1 4 20% 0.0524 0.0724 100% 0.568 0.1847 $0 $0 $0 $2,916 $948 X06A Other Procedures For Other Injuries, Major Complexity 0 0 11.9 4 37 13% 0.0524 0.0724 166% 0.6851 0.9716 4.5714 0.2425 $0 $3,517 $4,988 $23,470 $1,245 X06B Other Procedures For Other Injuries, Intermediate Complexity 0 0 4.1 1 13 12% 0.0524 0.0724 100% 1.5418 0.2233 $0 $0 $0 $7,916 $1,146 X06C Other Procedures For Other Injuries, Minor Complexity 0 0 1.7 1 5 13% 0.0524 0.0724 100% 0.8091 0.2797 $0 $0 $0 $4,154 $1,436 X07A Skin Grafts For Injuries Excluding Hand, Major Complexity 0 0 18.8 7 70 11% 0.0524 0.0724 100% 0.8903 0.8755 7.0185 0.3118 $0 $4,571 $4,495 $36,033 $1,601 X07B Skin Grafts For Injuries Excluding Hand, Intermediate Complexity 0 0 8.3 3 28 9% 0.0524 0.0724 100% 0.523 0.8904 3.1941 0.2524 $0 $2,685 $4,571 $16,399 $1,296 X07C Skin Grafts For Injuries Excluding Hand, Minor Complexity 0 0 4.1 1 13 12% 0.0524 0.0724 100% 1.6206 0.2621 $0 $0 $0 $8,320 $1,346 X40A Injuries, Poisoning And Toxic Effects Of Drugs W Ventilator Support, Major Comp 0 0 6.4 2 19 9% 0.0524 0.0724 100% 0.1095 1.7377 3.5849 0.2708 $0 $562 $8,921 $18,405 $1,390 X40B Injuries, Poisoning And Toxic Effects Of Drugs W Ventilator Support, Minor Comp 0 0 2.8 1 9 10% 0.0524 0.0724 100% 1.709 0.3084 $0 $0 $0 $8,774 $1,583 X60A Injuries, Major Complexity 1 0 4.4 1 14 11% 0.0524 0.0724 106% 0.1802 1.0245 0.2187 $925 $0 $0 $5,260 $1,123 X60B Injuries, Minor Complexity 0 0 1.2 1 4 18% 0.0524 0.0724 160% 0.2044 0.1535 $0 $0 $0 $1,049 $788 X61A Allergic Reactions, Major Complexity 0 0 1.7 1 5 12% 0.0524 0.0724 105% 0.4039 0.2804 $0 $0 $0 $2,074 $1,440 X61B Allergic Reactions, Minor Complexity 0011312%0.0524 0.0724 95% 0.1098 0.0783 $0 $0 $0 $564 $402 X62A Poisoning/Toxic Effects Of Drugs And Other Substances, Major Complexity 1 0 4.3 1 13 8% 0.0524 0.0724 145% 0.1532 1.1187 0.2474 $787 $0 $0 $5,743 $1,270 X62B Poisoning/Toxic Effects Of Drugs And Other Substances, Minor Complexity 0 0 1.3 1 4 8% 0.0524 0.0724 120% 0.2533 0.1803 $0 $0 $0 $1,300 $926 X63A Sequelae Of Treatment, Major Complexity 1 0 5.5 1 17 10% 0.0524 0.0724 139% 0.1957 1.3492 0.2177 $1,005 $0 $0 $6,927 $1,118 X63B Sequelae Of Treatment, Minor Complexity 1 0 2.2 1 7 12% 0.0524 0.0724 110% 0.1609 0.5 0.1552 $826 $0 $0 $2,567 $797 X64A Other Injuries, Poisonings And Toxic Effects, Major Complexity 0 0 5.3 1 18 8% 0.0524 0.0724 115% 1.2847 0.2313 $0 $0 $0 $6,596 $1,187 X64B Other Injuries, Poisonings And Toxic Effects, Intermediate Complexity 0 0 1.6 1 5 14% 0.0524 0.0724 165% 0.3251 0.2339 $0 $0 $0 $1,669 $1,201 X64C Other Injuries, Poisonings And Toxic Effects, Minor Complexity 0 0 1.1 1 3 16% 0.0524 0.0724 117% 0.1567 0.1211 $0 $0 $0 $804 $622 Y01Z Vent >=96hrs Or Trach For Burns Or GIs For Severe Full Thickness Burns 0 0 32.2 18 164 6% 0.0524 0.0724 100% 2.9294 1.9694 38.3789 0.7482 $0 $15,040 $10,111 $197,037 $3,841 Y02A Skin Grafts For Other Burns, Major Complexity 0 0 16.1 11 25 6% 0.0524 0.0724 120% 0.7074 0.6764 8.1483 0.45 $0 $3,632 $3,473 $41,833 $2,310 Y02B Skin Grafts For Other Burns, Intermediate Complexity 0 0 5.8 2 19 6% 0.0524 0.0724 100% 0.3874 1.5898 3.567 0.3474 $0 $1,989 $8,162 $18,313 $1,784 Y02C Skin Grafts For Other Burns, Minor Complexity 0 0 2.1 1 7 6% 0.0524 0.0724 100% 1.1341 0.604 $0 $0 $0 $5,822 $3,101 Y03A Other GIs For Other Burns, Major Complexity 0 0 5.9 2 23 5% 0.0524 0.0724 121% 0.4863 1.1056 2.6976 0.2732 $0 $2,497 $5,676 $13,849 $1,403 Y03B Other GIs For Other Burns, Minor Complexity 0 0 1.8 1 5 4% 0.0524 0.0724 92% 0.7921 0.3793 $0 $0 $0 $4,067 $1,947 Y60Z Burns, Transferred To Acute Facility <5 Days 0 0 1.3 1 4 4% 0.0524 0.0724 100% 0.4604 $0 $0 $0 $2,364 $0 Y61Z Severe Burns 0 0 3.3 1 10 4% 0.0524 0.0724 136% 0.8038 0.2362 $0 $0 $0 $4,127 $1,213 Y62A Other Burns, Major Complexity 1 0 5 1 17 4% 0.0524 0.0724 111% 0.2624 1.5801 0.2813 $1,347 $0 $0 $8,112 $1,444 Y62B Other Burns, Minor Complexity 1 0 2.2 1 7 4% 0.0524 0.0724 150% 0.1171 0.5517 0.2394 $601 $0 $0 $2,832 $1,229 Z01A Other Contacts W Health Services W GIs, Major Complexity 0 0 8.4 3 28 20% 0.0524 0.0724 100% 0.6367 1.0779 3.8703 0.2293 $0 $3,269 $5,534 $19,870 $1,177 Z01B Other Contacts W Health Services W GIs, Minor Complexity 0 0 1.1 1 4 31% 0.0524 0.0724 115% 0.6858 0.2892 $0 $0 $0 $3,521 $1,485 Z40Z Other Contacts W Health Services W Endoscopy 0 0 1.1 1 3 37% 0.0524 0.0724 184% 0.2831 0.1034 $0 $0 $0 $1,453 $531 Z60A Rehabilitation, Major Complexity 00000000000000 $0 $0 $0 $0 $0 Z60B Rehabilitation, Minor Complexity 00000000000000 $0 $0 $0 $0 $0 Z61A Signs And Symptoms, Major Complexity 1 0 5.5 1 17 9% 0.0524 0.0724 127% 0.197 1.2735 0.2109 $1,011 $0 $0 $6,538 $1,083 Z61B Signs And Symptoms, Minor Complexity 1 0 2.4 1 7 15% 0.0524 0.0724 117% 0.2265 0.4995 0.1944 $1,163 $0 $0 $2,564 $998 Z63A Other Follow Up After Surgery Or Medical Care, Major Complexity 0 0 8.5 3 28 7% 0.0524 0.0724 162% 0 0.7024 2.1073 0.1861 $0 $0 $3,606 $10,819 $955 Z63B Other Follow Up After Surgery Or Medical Care, Minor Complexity 0 0 3.2 1 10 13% 0.0524 0.0724 86% 0.6203 0.1578 $0 $0 $0 $3,185 $810 Z64A Other Factors Influencing Health Status, Major Complexity 0 0 5.9 2 19 8% 0.0524 0.0724 81% 0 0.8294 1.6587 0.1776 $0 $0 $4,258 $8,516 $912 Z64B Other Factors Influencing Health Status, Minor Complexity 1 0 3.4 1 13 38% 0.0524 0.0724 127% 0.2013 0.6149 0.1706 $1,033 $0 $0 $3,157 $876 Z65Z Congenital Anomalies And Problems Arising From Neonatal Period 0 0 2.3 1 12 13% 0.0524 0.0724 105% 0.7356 0.3064 $0 $0 $0 $3,777 $1,573 Z66Z Sleep Disorders 0 0 2.4 1 8 8% 0.0524 0.0724 100% 0.3756 0.1733 $0 $0 $0 $1,928 $890
Note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 2.National Admitted Acute 10 of 10
Appendix 3 Mental Health Admitted (QH Standard Units) 2019-20 – Q22 Only
Queensland Health Funding Policy and Principles 2019-20 - 83 - qld‐nep‐abf‐priceweights_1920_v3.0
2019-20 Mental Health Admitted (QH Standard Unit Codes) - Q22 Only Back to INDEX See NOTES Std Unit Unit Description Queensland weight Queensland Price per diem
PYAA Psychiatric Adult Acute Unit 0.3412 $1,654 PYAM Psychiatric Adult - Mother and Baby 0.3412 $1,654 PYAQ Psychiatric Adult Extended ABI 0.2142 $1,038 PYAW Psychiatric Adult Special Care Suite 0.3412 $1,654 PYCA Psychiatric Child Acute Unit 0.4882 $2,366 PYCW Psychiatric Child Acute Unit in Paediatric Ward 0.4882 $2,366 PYDD Psychiatric Adult Extended Dual Diagnosis 0.1585 $768 PYET Psychiatric Adult Extended Treament Rehab Unit 0.1675 $812 PYFA Psychiatric Forensic Acute 0.2883 $1,397 PYGE Psychiatric Older Persons Acute 0.2032 $985 PYOA Psychiatric Young Persons (Youth) Acute Unit 0.3412 $1,654 PYPG Psychiatric Adult Extended Older Person 0.2352 $1,140 PYRA Psychiatric Adult Residential 0.1675 $812 PYRY Psychiatric Young Persons (Youth) - Youth Residential 0.1466 $711 PYSA Psychiatric Adult - Step Up Step Down 0.1207 $585 PYSD Psychiatric Adolescent – Step Up Step Down N/A N/A PYSH Psychiatric Adult Extended High Security 0.2883 $1,397 PYSM Psychiatric Adult Extended Secure Unit 0.3636 $1,762 PYSY Psychiatric Young Persons (Youth) - Step Up Step Down 0.2341 $1,135 PYYA Psychiatric Adolescent Acute Unit 0.5476 $2,654 PYYW Psychiatric Adolescent Acute Unit in Adult Ward 0.5476 $2,654
Note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 3.Mental Health 1 of 1 Appendix 4 Queensland Subacute and Non-acute Admitted 2019-20 (Q22)
Queensland Health Funding Policy and Principles 2019-20 - 86 - Back to See NOTES Queensland Weight (QWAU) Queensland Price 2019-20 Queensland Subacute and Non-acute (SNAP) Admitted AN-SNAP V4.0 (Q22) INDEX AN-SNAP v SAME_DAY Qld Care National SNAP Episode Type Description Lower Upper Same Day Short Stay Inlier Long Stay Same Day $ Short Stay Episode $ Long Stay 4.0 FLAG Type Code Care Type Bound Bound Outlier Per Outlier Per Outlier Per Outlier Per Code Diem Diem Diem $ Diem $
4A21 FALSE 20 2 Admitted Adult Rehabilitation Orthopaedic conditions, all other (including replacements), weighted FIM motor 68-91 7 14 0.2607 1.8246 0.1685 $0 $1,264 $8,844 $817 4A22 FALSE 20 2 Admitted Adult Rehabilitation Orthopaedic conditions, all other (including replacements), weighted FIM motor 50-67 8 19 0.2983 2.3867 0.1775 $0 $1,446 $11,568 $860 4A23 FALSE 20 2 Admitted Adult Rehabilitation Orthopaedic conditions, all other (including replacements), weighted FIM motor 19-49 11 26 0.3183 3.5016 0.1982 $0 $1,543 $16,972 $961 4A31 FALSE 20 2 Admitted Adult Rehabilitation Cardiac, Pain syndromes, Pulmonary, weighted FIM motor 72-91 7 16 0.305 2.1353 0.1954 $0 $1,478 $10,350 $947 4A32 FALSE 20 2 Admitted Adult Rehabilitation Cardiac, Pain syndromes, Pulmonary, weighted FIM motor 55-71 9 21 0.2933 2.6396 0.171 $0 $1,422 $12,794 $829 4A33 FALSE 20 2 Admitted Adult Rehabilitation Cardiac, Pain syndromes, Pulmonary, weighted FIM motor 34-54 10 25 0.3219 3.2185 0.1848 $0 $1,560 $15,600 $896 4A34 FALSE 20 2 Admitted Adult Rehabilitation Cardiac, Pain syndromes, Pulmonary, weighted FIM motor 19-33 14 34 0.3316 4.6431 0.1941 $0 $1,607 $22,505 $941 4A91 FALSE 20 2 Admitted Adult Rehabilitation All other impairments, weighted FIM motor 55-91 10 22 0.322 3.2199 0.1938 $0 $1,561 $15,607 $939 4A92 FALSE 20 2 Admitted Adult Rehabilitation All other impairments, weighted FIM motor 33-54 11 27 0.3656 4.0213 0.2114 $0 $1,772 $19,491 $1,025 4A93 FALSE 20 2 Admitted Adult Rehabilitation All other impairments, weighted FIM motor 19-32 16 38 0.3917 6.267 0.2305 $0 $1,899 $30,376 $1,117 4AA1 FALSE 20 2 Admitted Adult Rehabilitation Stroke, weighted FIM motor 51-91, FIM cognition 29-35 8 20 0.3597 2.8777 0.2129 $0 $1,743 $13,948 $1,032 4AA2 FALSE 20 2 Admitted Adult Rehabilitation Stroke, weighted FIM motor 51-91, FIM cognition 19-28 11 26 0.3473 3.8206 0.2045 $0 $1,683 $18,518 $991 4AA3 FALSE 20 2 Admitted Adult Rehabilitation Stroke, weighted FIM motor 51-91, FIM cognition 5-18 14 34 0.3602 5.0428 0.1914 $0 $1,746 $24,442 $928 4AA4 FALSE 20 2 Admitted Adult Rehabilitation Stroke, weighted FIM motor 36-50, Age >= 68 16 37 0.3451 5.5214 0.2046 $0 $1,673 $26,762 $992 4AA5 FALSE 20 2 Admitted Adult Rehabilitation Stroke, weighted FIM motor 36-50, Age <= 67 21 48 0.3677 7.7216 0.24 $0 $1,782 $37,427 $1,163 4AA6 FALSE 20 2 Admitted Adult Rehabilitation Stroke, weighted FIM motor 19-35, Age >= 68 22 49 0.344 7.569 0.1993 $0 $1,667 $36,687 $966 4AA7 FALSE 20 2 Admitted Adult Rehabilitation Stroke, weighted FIM motor 19-35, Age <= 67 31 68 0.3652 11.32 0.2193 $0 $1,770 $54,868 $1,063 4AB1 FALSE 20 2 Admitted Adult Rehabilitation Brain dysfunction, weighted FIM motor 71-91, FIM cognition 26-35 8 20 0.3665 2.9319 0.22 $0 $1,776 $14,211 $1,066 4AB2 FALSE 20 2 Admitted Adult Rehabilitation Brain dysfunction, weighted FIM motor 71-91, FIM cognition 5-25 13 31 0.4439 5.7713 0.3108 $0 $2,152 $27,973 $1,506 4AB3 FALSE 20 2 Admitted Adult Rehabilitation Brain dysfunction, weighted FIM motor 41-70, FIM cognition 26-35 13 30 0.3229 4.1982 0.2109 $0 $1,565 $20,349 $1,022 4AB4 FALSE 20 2 Admitted Adult Rehabilitation Brain dysfunction, weighted FIM motor 41-70, FIM cognition 17-25 14 34 0.3785 5.2991 0.2526 $0 $1,835 $25,685 $1,224 4AB5 FALSE 20 2 Admitted Adult Rehabilitation Brain dysfunction, weighted FIM motor 41-70, FIM cognition 5-16 17 41 0.4077 6.9307 0.2709 $0 $1,976 $33,593 $1,313 4AB6 FALSE 20 2 Admitted Adult Rehabilitation Brain dysfunction, weighted FIM motor 29-40 21 48 0.3573 7.5028 0.2125 $0 $1,732 $36,366 $1,030 4AB7 FALSE 20 2 Admitted Adult Rehabilitation Brain dysfunction, weighted FIM motor 19-28 26 60 0.3779 9.8247 0.2224 $0 $1,832 $47,620 $1,078 4AC1 FALSE 20 2 Admitted Adult Rehabilitation Neurological conditions, weighted FIM motor 62-91 9 21 0.3243 2.9183 0.1877 $0 $1,572 $14,145 $910 4AC2 FALSE 20 2 Admitted Adult Rehabilitation Neurological conditions, weighted FIM motor 43-61 12 29 0.3286 3.9435 0.2074 $0 $1,593 $19,114 $1,005 4AC3 FALSE 20 2 Admitted Adult Rehabilitation Neurological conditions, weighted FIM motor 19-42 17 41 0.3455 5.8738 0.2038 $0 $1,675 $28,470 $988 4AD1 FALSE 20 2 Admitted Adult Rehabilitation Spinal cord dysfunction, Age >= 50, weighted FIM motor 42-91 17 40 0.3683 6.2612 0.2148 $0 $1,785 $30,348 $1,041 4AD2 FALSE 20 2 Admitted Adult Rehabilitation Spinal cord dysfunction, Age >= 50, weighted FIM motor 19-41 32 69 0.3805 12.1757 0.2939 $0 $1,844 $59,016 $1,425 4AD3 FALSE 20 2 Admitted Adult Rehabilitation Spinal cord dysfunction, Age <= 49, weighted FIM motor 34-91 21 56 0.4108 8.6266 0.2269 $0 $1,991 $41,813 $1,100 4AD4 FALSE 20 2 Admitted Adult Rehabilitation Spinal cord dysfunction, Age <= 49, weighted FIM motor 19-33 30 66 0.5141 15.4216 0.3308 $0 $2,492 $74,748 $1,603 4AE1 FALSE 20 2 Admitted Adult Rehabilitation Amputation of limb, Age >= 54, weighted FIM motor 68-91 15 35 0.3196 4.7944 0.1717 $0 $1,549 $23,238 $832 4AE2 FALSE 20 2 Admitted Adult Rehabilitation Amputation of limb, Age >= 54, weighted FIM motor 31-67 18 41 0.3247 5.8453 0.1961 $0 $1,574 $28,332 $950 4AE3 FALSE 20 2 Admitted Adult Rehabilitation Amputation of limb, Age >= 54, weighted FIM motor 19-30 17 46 0.3939 6.6964 0.2124 $0 $1,909 $32,457 $1,030 4AE4 FALSE 20 2 Admitted Adult Rehabilitation Amputation of limb, Age <= 53, weighted FIM motor 19-91 13 31 0.3884 5.0487 0.2112 $0 $1,883 $24,471 $1,024 4AH1 FALSE 20 2 Admitted Adult Rehabilitation Orthopaedic conditions, fractures, weighted FIM motor 49-91, FIM cognition 33-35 9 22 0.3146 2.8317 0.1818 $0 $1,525 $13,725 $881 4AH2 FALSE 20 2 Admitted Adult Rehabilitation Orthopaedic conditions, fractures, weighted FIM motor 49-91, FIM cognition 5-32 11 26 0.2989 3.2883 0.1692 $0 $1,449 $15,938 $820 4AH3 FALSE 20 2 Admitted Adult Rehabilitation Orthopaedic conditions, fractures, weighted FIM motor 38-48 13 31 0.3129 4.0681 0.1745 $0 $1,517 $19,718 $846 4AH4 FALSE 20 2 Admitted Adult Rehabilitation Orthopaedic conditions, fractures, weighted FIM motor 19-37 15 35 0.3226 4.839 0.1846 $0 $1,564 $23,455 $895 4AP1 FALSE 20 2 Admitted Adult Rehabilitation Major Multiple Trauma, weighted FIM motor 19-91 19 44 0.4278 8.129 0.2881 $0 $2,074 $39,401 $1,396 4AR1 FALSE 20 2 Admitted Adult Rehabilitation Reconditioning, weighted FIM motor 67-91 819 0.3141 2.5126 0.1862 $0 $1,522 $12,179 $903 4AR2 FALSE 20 2 Admitted Adult Rehabilitation Reconditioning, weighted FIM motor 50-66, FIM cognition 26-35 9 22 0.3379 3.0409 0.1986 $0 $1,638 $14,739 $963 4AR3 FALSE 20 2 Admitted Adult Rehabilitation Reconditioning, weighted FIM motor 50-66, FIM cognition 5-25 10 24 0.3271 3.271 0.1863 $0 $1,585 $15,855 $903 4AR4 FALSE 20 2 Admitted Adult Rehabilitation Reconditioning, weighted FIM motor 34-49, FIM cognition 31-35 12 27 0.3379 4.0542 0.1925 $0 $1,638 $19,651 $933 4AR5 FALSE 20 2 Admitted Adult Rehabilitation Reconditioning, weighted FIM motor 34-49, FIM cognition 5-30 12 28 0.3356 4.0274 0.1928 $0 $1,627 $19,521 $935 4AR6 FALSE 20 2 Admitted Adult Rehabilitation Reconditioning, weighted FIM motor 19-33 14 35 0.375 5.2505 0.2182 $0 $1,818 $25,449 $1,058 4AZ1 FALSE 20 2 Admitted Adult Rehabilitation Weighted FIM motor score 13-18, Brain, Spine, MMT, Age >= 49 34 72 0.4067 13.8278 0.2943 $0 $1,971 $67,023 $1,426 4AZ2 FALSE 20 2 Admitted Adult Rehabilitation Weighted FIM motor score 13-18, Brain, Spine, MMT, Age <= 48 44 87 0.4201 18.4863 0.2828 $0 $2,036 $89,603 $1,371 4AZ3 FALSE 20 2 Admitted Adult Rehabilitation Weighted FIM motor score 13-18, All other impairments, Age >= 65 19 42 0.3466 6.5845 0.2297 $0 $1,680 $31,915 $1,113 4AZ4 FALSE 20 2 Admitted Adult Rehabilitation Weighted FIM motor score 13-18, All other impairments, Age <= 64 30 66 0.3887 11.6623 0.2439 $0 $1,884 $56,527 $1,182 4BD1 FALSE 30 3 Admitted Adult Palliative Care Deteriorating phase, RUG-ADL 4-14 39 0.4311 1.2932 0.2226 $0 $2,090 $6,268 $1,079 4BD2 FALSE 30 3 Admitted Adult Palliative Care Deteriorating phase, RUG-ADL 15-18, Age >= 75 2 7 0.4647 0.9294 0.2284 $0 $2,252 $4,505 $1,107 4BD3 FALSE 30 3 Admitted Adult Palliative Care Deteriorating phase, RUG-ADL 15-18, Age 55-74 2 7 0.4873 0.9747 0.2421 $0 $2,362 $4,724 $1,173 4BD4 FALSE 30 3 Admitted Adult Palliative Care Deteriorating phase, RUG-ADL 15-18, Age <= 54 3 9 0.4345 1.3034 0.2111 $0 $2,106 $6,318 $1,023 4BS1 FALSE 30 3 Admitted Adult Palliative Care Stable phase, RUG-ADL 4-5 410 0.3863 1.5452 0.2166 $0 $1,872 $7,490 $1,050 4BS2 FALSE 30 3 Admitted Adult Palliative Care Stable phase, RUG-ADL 6-16 512 0.3783 1.8913 0.2201 $0 $1,834 $9,167 $1,067 4BS3 FALSE 30 3 Admitted Adult Palliative Care Stable phase, RUG-ADL 17-18 512 0.3731 1.8657 0.2156 $0 $1,808 $9,043 $1,045 4BT1 FALSE 30 3 Admitted Adult Palliative Care Terminal phase 14 0.5234 0.2539 $0 $0 $2,537 $1,231 4BU1 FALSE 30 3 Admitted Adult Palliative Care Unstable phase, First Phase in Episode, RUG-ADL 4-13 1 5 0.4547 0.2581 $0 $0 $2,204 $1,251 4BU2 FALSE 30 3 Admitted Adult Palliative Care Unstable phase, First Phase in Episode, RUG-ADL 14-18 1 4 0.3685 0.241 $0 $0 $1,786 $1,168 4BU3 FALSE 30 3 Admitted Adult Palliative Care Unstable phase, Not first Phase in Episode, RUG-ADL 4-5 1 4 0.4625 0.2466 $0 $0 $2,242 $1,195 4BU4 FALSE 30 3 Admitted Adult Palliative Care Unstable phase, Not first Phase in Episode, RUG-ADL 6-18 1 4 0.4454 0.2306 $0 $0 $2,159 $1,118 4CH1 FALSE 09 4 Admitted GEM FIM motor 57-91 with Delirium or Dementia 11 27 0.2968 3.2652 0.1688 $0 $1,439 $15,826 $818 4CH2 FALSE 09 4 Admitted GEM FIM motor 57-91 without Delirium or Dementia 9 21 0.2743 2.4686 0.1409 $0 $1,330 $11,965 $683 4CL1 FALSE 09 4 Admitted GEM FIM motor 13-17 with Delirium or Dementia 14 33 0.3038 4.2534 0.1724 $0 $1,473 $20,616 $836 4CL2 FALSE 09 4 Admitted GEM FIM motor 13-17 without Delirium or Dementia 14 31 0.2987 4.1816 0.1772 $0 $1,448 $20,268 $859 4CM1 FALSE 09 4 Admitted GEM FIM motor 18-56 with Delirium or Dementia 14 33 0.2966 4.1518 0.1674 $0 $1,438 $20,124 $811 4CM2 FALSE 09 4 Admitted GEM FIM motor 18-56 without Delirium or Dementia 12 29 0.297 3.5641 0.1611 $0 $1,440 $17,275 $781 4DL1 FALSE 10 5 Admitted Psychogeriatric Long term care 119 200 0.3017 35.9004 0.1853 $0 $1,462 $174,009 $898 4DS1 FALSE 10 5 Admitted Psychogeriatric HoNOS 65+ Overactive behaviour 3-4, LOS <= 91 15 36 0.4556 6.8334 0.2814 $0 $2,208 $33,121 $1,364 4DS2 FALSE 10 5 Admitted Psychogeriatric HoNOS 65+ Overactive behaviour 1-2, HoNOS 65+ ADL 4, LOS <= 91 22 51 0.3451 7.5924 0.2057 $0 $1,673 $36,800 $997
Note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. Qld SNAP 1 of 2 Back to See NOTES Queensland Weight (QWAU) Queensland Price 2019-20 Queensland Subacute and Non-acute (SNAP) Admitted AN-SNAP V4.0 (Q22) INDEX AN-SNAP v SAME_DAY Qld Care National SNAP Episode Type Description Lower Upper Same Day Short Stay Inlier Long Stay Same Day $ Short Stay Episode $ Long Stay 4.0 FLAG Type Code Care Type Bound Bound Outlier Per Outlier Per Outlier Per Outlier Per Code Diem Diem Diem $ Diem $
4DS3 FALSE 10 5 Admitted Psychogeriatric HoNOS 65+ Overactive behaviour 1-2, HoNOS 65+ ADL 0-3, LOS <= 91 16 38 0.5166 8.265 0.3223 $0 $2,504 $40,060 $1,562 4DS4 FALSE 10 5 Admitted Psychogeriatric HoNOS 65+ Overactive behaviour 0, HoNOS 65+ total 18-48, LOS <= 91 24 55 0.4361 10.466 0.2815 $0 $2,114 $50,729 $1,364 4DS5 FALSE 10 5 Admitted Psychogeriatric HoNOS 65+ Overactive behaviour 0, HoNOS 65+ total 0-17, LOS <= 91 11 27 0.488 5.3681 0.3708 $0 $2,365 $26,019 $1,797 4EL1 FALSE 11 6 Admitted Non-Acute Long term care 109 185 0.2474 26.9653 0.1996 $0 $1,199 $130,701 $967 4ES1 FALSE 11 6 Admitted Non-Acute Age >= 60, RUG-ADL 4-11, LOS <= 91 820 0.3326 2.6606 0.1892 $0 $1,612 $12,896 $917 4ES2 FALSE 11 6 Admitted Non-Acute Age >= 60, RUG-ADL 12-15, LOS <= 91 820 0.3345 2.6757 0.1874 $0 $1,621 $12,969 $908 4ES3 FALSE 11 6 Admitted Non-Acute Age >= 60, RUG-ADL 16-18, LOS <= 91 10 23 0.325 3.2496 0.1968 $0 $1,575 $15,751 $954 4ES4 FALSE 11 6 Admitted Non-Acute Age 18-59, LOS <= 91 10 24 0.3747 3.7468 0.2406 $0 $1,816 $18,161 $1,166 4ES5 FALSE 11 6 Admitted Non-Acute Age <= 17, LOS <= 91 616 0.6759 4.0556 0.4131 $0 $3,276 $19,657 $2,002 4F01 FALSE 20 2 Admitted Paediatric Rehabilitation Rehabilitation, Age <= 3 14 33 0.6676 9.3459 0.5031 $0 $3,236 $45,300 $2,439 4F02 FALSE 20 2 Admitted Paediatric Rehabilitation Rehabilitation, Age >= 4, Spinal cord dysfunction 29 64 0.5428 15.7414 0.306 $0 $2,631 $76,299 $1,483 4F03 FALSE 20 2 Admitted Paediatric Rehabilitation Rehabilitation, Age >= 4, Brain dysfunction 19 44 0.6054 11.5029 0.4448 $0 $2,934 $55,755 $2,156 4F04 FALSE 20 2 Admitted Paediatric Rehabilitation Rehabilitation, Age >= 4, Neurological conditions 10 24 0.5394 5.3935 0.3781 $0 $2,614 $26,142 $1,833 4F05 FALSE 20 2 Admitted Paediatric Rehabilitation Rehabilitation, Age >= 4, All other impairments 11 27 0.5775 6.353 0.3558 $0 $2,799 $30,793 $1,725 4G02 FALSE 30 3 Admitted Paediatric Palliative Care Palliative Care, Stable phase, Age >= 1 year 4 10 0.8257 3.3027 0.4888 $0 $4,002 $16,008 $2,369 4G03 FALSE 30 3 Admitted Paediatric Palliative Care Palliative Care, Unstable or Deteriorating phase, Age >= 1 year 2 5 0.9075 1.8149 0.4877 $0 $4,399 $8,797 $2,364 4J01 TRUE 20 2 Admitted Adult Rehabilitation Adult Same-Day Rehabilitation 0.1091 $529 $0 $0 $0 4K01 TRUE 30 3 Admitted Adult Palliative Care Adult Same-Day Palliative Care 0.1446 $701 $0 $0 $0 4L01 TRUE 09 4 Admitted GEM Same-Day GEM 0.1348 $653 $0 $0 $0 4M01 TRUE 10 5 Admitted Psychogeriatric Same-Day Psychogeriatric Care 0.1246 $604 $0 $0 $0 4O01 TRUE 20 2 Admitted Paediatric Rehabilitation Paediatric Same-Day Rehabilitation 0.4097 $1,986 $0 $0 $0
Note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. Qld SNAP 2 of 2
Appendix 5 National Subacute and Non-acute Admitted 2019-20 (N1920)
Queensland Health Funding Policy and Principles 2019-20 88
Back to See NOTES National Weight (NWAU) National Price 2019-20 National Subacute and Non-acute (SNAP) Admitted AN-SNAP V4.0 (N1920) INDEX AN-SNAP SAME_DA National SNAP Episode Type Description Lower Upper Private Private Patient Private Patient Same Day Short Stay Inlier Long Stay Same Day $ Short Stay Episode $ Long Stay v 4.0 Y FLAG Care Type Bound Bound Patient Service Service Outlier Per Outlier Per Outlier Per Outlier Per Code Service Accomodation Accomodation Diem Diem Diem $ Diem $ Adjustment Adjustment Adjustment (Same Day) (Overnight 4A21 FALSE 2 Admitted Adult Rehabilitation Orthopaedic conditions, all other (including replacements), weighted FIM motor 68-91 7 14 3.6% 0.0724 0.2607 1.8246 0.1685 $0 $1,338 $9,367 $865 4A22 FALSE 2 Admitted Adult Rehabilitation Orthopaedic conditions, all other (including replacements), weighted FIM motor 50-67 8 19 3.6% 0.0724 0.2983 2.3867 0.1775 $0 $1,531 $12,253 $911 4A23 FALSE 2 Admitted Adult Rehabilitation Orthopaedic conditions, all other (including replacements), weighted FIM motor 19-49 11 26 3.6% 0.0724 0.3183 3.5016 0.1982 $0 $1,634 $17,977 $1,018 4A31 FALSE 2 Admitted Adult Rehabilitation Cardiac, Pain syndromes, Pulmonary, weighted FIM motor 72-91 7 16 3.6% 0.0724 0.305 2.1353 0.1954 $0 $1,566 $10,963 $1,003 4A32 FALSE 2 Admitted Adult Rehabilitation Cardiac, Pain syndromes, Pulmonary, weighted FIM motor 55-71 9 21 3.6% 0.0724 0.2933 2.6396 0.171 $0 $1,506 $13,552 $878 4A33 FALSE 2 Admitted Adult Rehabilitation Cardiac, Pain syndromes, Pulmonary, weighted FIM motor 34-54 10 25 3.6% 0.0724 0.3219 3.2185 0.1848 $0 $1,653 $16,524 $949 4A34 FALSE 2 Admitted Adult Rehabilitation Cardiac, Pain syndromes, Pulmonary, weighted FIM motor 19-33 14 34 3.6% 0.0724 0.3316 4.6431 0.1941 $0 $1,702 $23,838 $997 4A91 FALSE 2 Admitted Adult Rehabilitation All other impairments, weighted FIM motor 55-91 10 22 3.6% 0.0724 0.322 3.2199 0.1938 $0 $1,653 $16,531 $995 4A92 FALSE 2 Admitted Adult Rehabilitation All other impairments, weighted FIM motor 33-54 11 27 3.6% 0.0724 0.3656 4.0213 0.2114 $0 $1,877 $20,645 $1,085 4A93 FALSE 2 Admitted Adult Rehabilitation All other impairments, weighted FIM motor 19-32 16 38 3.6% 0.0724 0.3917 6.267 0.2305 $0 $2,011 $32,175 $1,183 4AA1 FALSE 2 Admitted Adult Rehabilitation Stroke, weighted FIM motor 51-91, FIM cognition 29-35 8 20 3.6% 0.0724 0.3597 2.8777 0.2129 $0 $1,847 $14,774 $1,093 4AA2 FALSE 2 Admitted Adult Rehabilitation Stroke, weighted FIM motor 51-91, FIM cognition 19-28 11 26 3.6% 0.0724 0.3473 3.8206 0.2045 $0 $1,783 $19,615 $1,050 4AA3 FALSE 2 Admitted Adult Rehabilitation Stroke, weighted FIM motor 51-91, FIM cognition 5-18 14 34 3.6% 0.0724 0.3602 5.0428 0.1914 $0 $1,849 $25,890 $983 4AA4 FALSE 2 Admitted Adult Rehabilitation Stroke, weighted FIM motor 36-50, Age >= 68 16 37 3.6% 0.0724 0.3451 5.5214 0.2046 $0 $1,772 $28,347 $1,050 4AA5 FALSE 2 Admitted Adult Rehabilitation Stroke, weighted FIM motor 36-50, Age <= 67 21 48 3.6% 0.0724 0.3677 7.7216 0.24 $0 $1,888 $39,643 $1,232 4AA6 FALSE 2 Admitted Adult Rehabilitation Stroke, weighted FIM motor 19-35, Age >= 68 22 49 3.6% 0.0724 0.344 7.569 0.1993 $0 $1,766 $38,859 $1,023 4AA7 FALSE 2 Admitted Adult Rehabilitation Stroke, weighted FIM motor 19-35, Age <= 67 31 68 3.6% 0.0724 0.3652 11.32 0.2193 $0 $1,875 $58,117 $1,126 4AB1 FALSE 2 Admitted Adult Rehabilitation Brain dysfunction, weighted FIM motor 71-91, FIM cognition 26-35 8 20 3.6% 0.0724 0.3665 2.9319 0.22 $0 $1,882 $15,052 $1,129 4AB2 FALSE 2 Admitted Adult Rehabilitation Brain dysfunction, weighted FIM motor 71-91, FIM cognition 5-25 13 31 3.6% 0.0724 0.4439 5.7713 0.3108 $0 $2,279 $29,630 $1,596 4AB3 FALSE 2 Admitted Adult Rehabilitation Brain dysfunction, weighted FIM motor 41-70, FIM cognition 26-35 13 30 3.6% 0.0724 0.3229 4.1982 0.2109 $0 $1,658 $21,554 $1,083 4AB4 FALSE 2 Admitted Adult Rehabilitation Brain dysfunction, weighted FIM motor 41-70, FIM cognition 17-25 14 34 3.6% 0.0724 0.3785 5.2991 0.2526 $0 $1,943 $27,206 $1,297 4AB5 FALSE 2 Admitted Adult Rehabilitation Brain dysfunction, weighted FIM motor 41-70, FIM cognition 5-16 17 41 3.6% 0.0724 0.4077 6.9307 0.2709 $0 $2,093 $35,582 $1,391 4AB6 FALSE 2 Admitted Adult Rehabilitation Brain dysfunction, weighted FIM motor 29-40 21 48 3.6% 0.0724 0.3573 7.5028 0.2125 $0 $1,834 $38,519 $1,091 4AB7 FALSE 2 Admitted Adult Rehabilitation Brain dysfunction, weighted FIM motor 19-28 26 60 3.6% 0.0724 0.3779 9.8247 0.2224 $0 $1,940 $50,440 $1,142 4AC1 FALSE 2 Admitted Adult Rehabilitation Neurological conditions, weighted FIM motor 62-91 9 21 3.6% 0.0724 0.3243 2.9183 0.1877 $0 $1,665 $14,983 $964 4AC2 FALSE 2 Admitted Adult Rehabilitation Neurological conditions, weighted FIM motor 43-61 12 29 3.6% 0.0724 0.3286 3.9435 0.2074 $0 $1,687 $20,246 $1,065 4AC3 FALSE 2 Admitted Adult Rehabilitation Neurological conditions, weighted FIM motor 19-42 17 41 3.6% 0.0724 0.3455 5.8738 0.2038 $0 $1,774 $30,156 $1,046 4AD1 FALSE 2 Admitted Adult Rehabilitation Spinal cord dysfunction, Age >= 50, weighted FIM motor 42-91 17 40 3.6% 0.0724 0.3683 6.2612 0.2148 $0 $1,891 $32,145 $1,103 4AD2 FALSE 2 Admitted Adult Rehabilitation Spinal cord dysfunction, Age >= 50, weighted FIM motor 19-41 32 69 3.6% 0.0724 0.3805 12.1757 0.2939 $0 $1,953 $62,510 $1,509 4AD3 FALSE 2 Admitted Adult Rehabilitation Spinal cord dysfunction, Age <= 49, weighted FIM motor 34-91 21 56 3.6% 0.0724 0.4108 8.6266 0.2269 $0 $2,109 $44,289 $1,165 4AD4 FALSE 2 Admitted Adult Rehabilitation Spinal cord dysfunction, Age <= 49, weighted FIM motor 19-33 30 66 3.6% 0.0724 0.5141 15.4216 0.3308 $0 $2,639 $79,174 $1,698 4AE1 FALSE 2 Admitted Adult Rehabilitation Amputation of limb, Age >= 54, weighted FIM motor 68-91 15 35 3.6% 0.0724 0.3196 4.7944 0.1717 $0 $1,641 $24,614 $882 4AE2 FALSE 2 Admitted Adult Rehabilitation Amputation of limb, Age >= 54, weighted FIM motor 31-67 18 41 3.6% 0.0724 0.3247 5.8453 0.1961 $0 $1,667 $30,010 $1,007 4AE3 FALSE 2 Admitted Adult Rehabilitation Amputation of limb, Age >= 54, weighted FIM motor 19-30 17 46 3.6% 0.0724 0.3939 6.6964 0.2124 $0 $2,022 $34,379 $1,090 4AE4 FALSE 2 Admitted Adult Rehabilitation Amputation of limb, Age <= 53, weighted FIM motor 19-91 13 31 3.6% 0.0724 0.3884 5.0487 0.2112 $0 $1,994 $25,920 $1,084 4AH1 FALSE 2 Admitted Adult Rehabilitation Orthopaedic conditions, fractures, weighted FIM motor 49-91, FIM cognition 33-35 9 22 3.6% 0.0724 0.3146 2.8317 0.1818 $0 $1,615 $14,538 $933 4AH2 FALSE 2 Admitted Adult Rehabilitation Orthopaedic conditions, fractures, weighted FIM motor 49-91, FIM cognition 5-32 11 26 3.6% 0.0724 0.2989 3.2883 0.1692 $0 $1,535 $16,882 $869 4AH3 FALSE 2 Admitted Adult Rehabilitation Orthopaedic conditions, fractures, weighted FIM motor 38-48 13 31 3.6% 0.0724 0.3129 4.0681 0.1745 $0 $1,606 $20,886 $896 4AH4 FALSE 2 Admitted Adult Rehabilitation Orthopaedic conditions, fractures, weighted FIM motor 19-37 15 35 3.6% 0.0724 0.3226 4.839 0.1846 $0 $1,656 $24,843 $948 4AP1 FALSE 2 Admitted Adult Rehabilitation Major Multiple Trauma, weighted FIM motor 19-91 19 44 3.6% 0.0724 0.4278 8.129 0.2881 $0 $2,196 $41,734 $1,479 4AR1 FALSE 2 Admitted Adult Rehabilitation Reconditioning, weighted FIM motor 67-91 8 19 3.6% 0.0724 0.3141 2.5126 0.1862 $0 $1,613 $12,900 $956 4AR2 FALSE 2 Admitted Adult Rehabilitation Reconditioning, weighted FIM motor 50-66, FIM cognition 26-35 9 22 3.6% 0.0724 0.3379 3.0409 0.1986 $0 $1,735 $15,612 $1,020 4AR3 FALSE 2 Admitted Adult Rehabilitation Reconditioning, weighted FIM motor 50-66, FIM cognition 5-25 10 24 3.6% 0.0724 0.3271 3.271 0.1863 $0 $1,679 $16,793 $956 4AR4 FALSE 2 Admitted Adult Rehabilitation Reconditioning, weighted FIM motor 34-49, FIM cognition 31-35 12 27 3.6% 0.0724 0.3379 4.0542 0.1925 $0 $1,735 $20,814 $988 4AR5 FALSE 2 Admitted Adult Rehabilitation Reconditioning, weighted FIM motor 34-49, FIM cognition 5-30 12 28 3.6% 0.0724 0.3356 4.0274 0.1928 $0 $1,723 $20,677 $990 4AR6 FALSE 2 Admitted Adult Rehabilitation Reconditioning, weighted FIM motor 19-33 14 35 3.6% 0.0724 0.375 5.2505 0.2182 $0 $1,925 $26,956 $1,120 4AZ1 FALSE 2 Admitted Adult Rehabilitation Weighted FIM motor score 13-18, Brain, Spine, MMT, Age >= 49 34 72 3.6% 0.0724 0.4067 13.8278 0.2943 $0 $2,088 $70,992 $1,511 4AZ2 FALSE 2 Admitted Adult Rehabilitation Weighted FIM motor score 13-18, Brain, Spine, MMT, Age <= 48 44 87 3.6% 0.0724 0.4201 18.4863 0.2828 $0 $2,157 $94,909 $1,452 4AZ3 FALSE 2 Admitted Adult Rehabilitation Weighted FIM motor score 13-18, All other impairments, Age >= 65 19 42 3.6% 0.0724 0.3466 6.5845 0.2297 $0 $1,779 $33,805 $1,179 4AZ4 FALSE 2 Admitted Adult Rehabilitation Weighted FIM motor score 13-18, All other impairments, Age <= 64 30 66 3.6% 0.0724 0.3887 11.6623 0.2439 $0 $1,996 $59,874 $1,252 4BD1 FALSE 3 Admitted Adult Palliative Care Deteriorating phase, RUG-ADL 4-14 3 9 3.8% 0.0724 0.4311 1.2932 0.2226 $0 $2,213 $6,639 $1,143 4BD2 FALSE 3 Admitted Adult Palliative Care Deteriorating phase, RUG-ADL 15-18, Age >= 75 2 7 3.8% 0.0724 0.4647 0.9294 0.2284 $0 $2,386 $4,772 $1,173 4BD3 FALSE 3 Admitted Adult Palliative Care Deteriorating phase, RUG-ADL 15-18, Age 55-74 2 7 3.8% 0.0724 0.4873 0.9747 0.2421 $0 $2,502 $5,004 $1,243 4BD4 FALSE 3 Admitted Adult Palliative Care Deteriorating phase, RUG-ADL 15-18, Age <= 54 3 9 3.8% 0.0724 0.4345 1.3034 0.2111 $0 $2,231 $6,692 $1,084 4BS1 FALSE 3 Admitted Adult Palliative Care Stable phase, RUG-ADL 4-5 4 10 3.8% 0.0724 0.3863 1.5452 0.2166 $0 $1,983 $7,933 $1,112 4BS2 FALSE 3 Admitted Adult Palliative Care Stable phase, RUG-ADL 6-16 5 12 3.8% 0.0724 0.3783 1.8913 0.2201 $0 $1,942 $9,710 $1,130 4BS3 FALSE 3 Admitted Adult Palliative Care Stable phase, RUG-ADL 17-18 5 12 3.8% 0.0724 0.3731 1.8657 0.2156 $0 $1,915 $9,579 $1,107 4BT1 FALSE 3 Admitted Adult Palliative Care Terminal phase 1 4 3.8% 0.0724 0.5234 0.2539 $0 $0 $2,687 $1,304 4BU1 FALSE 3 Admitted Adult Palliative Care Unstable phase, First Phase in Episode, RUG-ADL 4-13 1 5 3.8% 0.0724 0.4547 0.2581 $0 $0 $2,334 $1,325 4BU2 FALSE 3 Admitted Adult Palliative Care Unstable phase, First Phase in Episode, RUG-ADL 14-18 1 4 3.8% 0.0724 0.3685 0.241 $0 $0 $1,892 $1,237 4BU3 FALSE 3 Admitted Adult Palliative Care Unstable phase, Not first Phase in Episode, RUG-ADL 4-5 1 4 3.8% 0.0724 0.4625 0.2466 $0 $0 $2,374 $1,266 4BU4 FALSE 3 Admitted Adult Palliative Care Unstable phase, Not first Phase in Episode, RUG-ADL 6-18 1 4 3.8% 0.0724 0.4454 0.2306 $0 $0 $2,287 $1,184 4CH1 FALSE 4 Admitted GEM FIM motor 57-91 with Delirium or Dementia 11 27 3.2% 0.0724 0.2968 3.2652 0.1688 $0 $1,524 $16,764 $867 4CH2 FALSE 4 Admitted GEM FIM motor 57-91 without Delirium or Dementia 9 21 3.2% 0.0724 0.2743 2.4686 0.1409 $0 $1,408 $12,674 $723 4CL1 FALSE 4 Admitted GEM FIM motor 13-17 with Delirium or Dementia 14 33 3.2% 0.0724 0.3038 4.2534 0.1724 $0 $1,560 $21,837 $885 4CL2 FALSE 4 Admitted GEM FIM motor 13-17 without Delirium or Dementia 14 31 3.2% 0.0724 0.2987 4.1816 0.1772 $0 $1,534 $21,468 $910 4CM1 FALSE 4 Admitted GEM FIM motor 18-56 with Delirium or Dementia 14 33 3.2% 0.0724 0.2966 4.1518 0.1674 $0 $1,523 $21,315 $859 4CM2 FALSE 4 Admitted GEM FIM motor 18-56 without Delirium or Dementia 12 29 3.2% 0.0724 0.297 3.5641 0.1611 $0 $1,525 $18,298 $827 4DL1 FALSE 5 Admitted Psychogeriatric Long term care 119 200 1.7% 0.0724 0.3017 35.9004 0.1853 $0 $1,549 $184,313 $951 4DS1 FALSE 5 Admitted Psychogeriatric HoNOS 65+ Overactive behaviour 3-4, LOS <= 91 15 36 1.7% 0.0724 0.4556 6.8334 0.2814 $0 $2,339 $35,083 $1,445 4DS2 FALSE 5 Admitted Psychogeriatric HoNOS 65+ Overactive behaviour 1-2, HoNOS 65+ ADL 4, LOS <= 91 22 51 1.7% 0.0724 0.3451 7.5924 0.2057 $0 $1,772 $38,979 $1,056 4DS3 FALSE 5 Admitted Psychogeriatric HoNOS 65+ Overactive behaviour 1-2, HoNOS 65+ ADL 0-3, LOS <= 91 16 38 1.7% 0.0724 0.5166 8.265 0.3223 $0 $2,652 $42,433 $1,655 4DS4 FALSE 5 Admitted Psychogeriatric HoNOS 65+ Overactive behaviour 0, HoNOS 65+ total 18-48, LOS <= 91 24 55 1.7% 0.0724 0.4361 10.466 0.2815 $0 $2,239 $53,732 $1,445 4DS5 FALSE 5 Admitted Psychogeriatric HoNOS 65+ Overactive behaviour 0, HoNOS 65+ total 0-17, LOS <= 91 11 27 1.7% 0.0724 0.488 5.3681 0.3708 $0 $2,505 $27,560 $1,904 4EL1 FALSE 6 Admitted Non-Acute Long term care 109 185 1.6% 0.0724 0.2474 26.9653 0.1996 $0 $1,270 $138,440 $1,025 4ES1 FALSE 6 Admitted Non-Acute Age >= 60, RUG-ADL 4-11, LOS <= 91 8 20 1.6% 0.0724 0.3326 2.6606 0.1892 $0 $1,708 $13,660 $971 4ES2 FALSE 6 Admitted Non-Acute Age >= 60, RUG-ADL 12-15, LOS <= 91 8 20 1.6% 0.0724 0.3345 2.6757 0.1874 $0 $1,717 $13,737 $962 4ES3 FALSE 6 Admitted Non-Acute Age >= 60, RUG-ADL 16-18, LOS <= 91 10 23 1.6% 0.0724 0.325 3.2496 0.1968 $0 $1,669 $16,683 $1,010
Note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. National SNAP 1 of 2 Back to See NOTES National Weight (NWAU) National Price 2019-20 National Subacute and Non-acute (SNAP) Admitted AN-SNAP V4.0 (N1920) INDEX AN-SNAP SAME_DA National SNAP Episode Type Description Lower Upper Private Private Patient Private Patient Same Day Short Stay Inlier Long Stay Same Day $ Short Stay Episode $ Long Stay v 4.0 Y FLAG Care Type Bound Bound Patient Service Service Outlier Per Outlier Per Outlier Per Outlier Per Code Service Accomodation Accomodation Diem Diem Diem $ Diem $ Adjustment Adjustment Adjustment (Same Day) (Overnight 4ES4 FALSE 6 Admitted Non-Acute Age 18-59, LOS <= 91 10 24 1.6% 0.0724 0.3747 3.7468 0.2406 $0 $1,924 $19,236 $1,235 4ES5 FALSE 6 Admitted Non-Acute Age <= 17, LOS <= 91 6 16 1.6% 0.0724 0.6759 4.0556 0.4131 $0 $3,470 $20,821 $2,121 4F01 FALSE 2 Admitted Paediatric Rehabilitation Rehabilitation, Age <= 3 14 33 3.6% 0.0724 0.6676 9.3459 0.5031 $0 $3,427 $47,982 $2,583 4F02 FALSE 2 Admitted Paediatric Rehabilitation Rehabilitation, Age >= 4, Spinal cord dysfunction 29 64 3.6% 0.0724 0.5428 15.7414 0.306 $0 $2,787 $80,816 $1,571 4F03 FALSE 2 Admitted Paediatric Rehabilitation Rehabilitation, Age >= 4, Brain dysfunction 19 44 3.6% 0.0724 0.6054 11.5029 0.4448 $0 $3,108 $59,056 $2,284 4F04 FALSE 2 Admitted Paediatric Rehabilitation Rehabilitation, Age >= 4, Neurological conditions 10 24 3.6% 0.0724 0.5394 5.3935 0.3781 $0 $2,769 $27,690 $1,941 4F05 FALSE 2 Admitted Paediatric Rehabilitation Rehabilitation, Age >= 4, All other impairments 11 27 3.6% 0.0724 0.5775 6.353 0.3558 $0 $2,965 $32,616 $1,827 4G02 FALSE 3 Admitted Paediatric Palliative Care Palliative Care, Stable phase, Age >= 1 year 4 10 3.8% 0.0724 0.8257 3.3027 0.4888 $0 $4,239 $16,956 $2,509 4G03 FALSE 3 Admitted Paediatric Palliative Care Palliative Care, Unstable or Deteriorating phase, Age >= 1 year 2 5 3.8% 0.0724 0.9075 1.8149 0.4877 $0 $4,659 $9,318 $2,504 4J01 TRUE 2 Admitted Adult Rehabilitation Adult Same-Day Rehabilitation 3.6% 0.0524 0.1091 $560 $0 $0 $0 4K01 TRUE 3 Admitted Adult Palliative Care Adult Same-Day Palliative Care 3.8% 0.0524 0.1446 $742 $0 $0 $0 4L01 TRUE 4 Admitted GEM Same-Day GEM 3.2% 0.0524 0.1348 $692 $0 $0 $0 4M01 TRUE 5 Admitted Psychogeriatric Same-Day Psychogeriatric Care 1.7% 0.0524 0.1246 $640 $0 $0 $0 4O01 TRUE 2 Admitted Paediatric Rehabilitation Paediatric Same-Day Rehabilitation 3.6% 0.0524 0.4097 $2,103 $0 $0 $0
Note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. National SNAP 2 of 2
Appendix 6 Paediatric SNAP Price Weights 2019-20 (N1920 and Q22)
Queensland Health Funding Policy and Principles 2019-20 91
2019-20 Paediatric SNAP Price Weights (Q22 and N1920) Back to INDEX See NOTES
Queensland and National Queensland Price National Price Weight (WAU) Care Type Care Type Description Same Day Per Overnight Per Same Day $ Overnight $ Same Day $ Overnight $ ID Diem Diem 30 Palliative 0.6389 0.6389 $3,097 $3,097 $3,280 $3,280
Note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. SNAP_Paed 1 of 1
Appendix 7 Queensland Unscored SNAP price weights 2019-20 – Q22 Only
Queensland Health Funding Policy and Principles 2019-20 93
2019-20 Queensland Unscored SNAP price weights - Q22 Only Back to INDEX See NOTES
Queensland Weight (QWAU) Queensland Price
Qld Care type Episode Type Same Day Per Overnight Per Same Day $ Overnight $ code Diem Diem 09 Geriatric Evaluation and Management 0.0885 0.1473 $429 $714 10 Psychogeriatric 0.0742 0.1901 $360 $921 11 Maintenance 0.0649 0.1314 $315 $637 20 Rehabilitation 0.1003 0.1646 $486 $798 30 Palliative Care 0.2006 0.2006 $972 $972
Note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. Qld Unscored SNAP 1 of 1
Appendix 8 Non-Admitted price weights 2019-20 (N1920 and Q22)
Queensland Health Funding Policy and Principles 2019-20 95
qld‐nep‐abf‐priceweights_1920_v3.0
2019-20 Non-Admitted price weights (N1920 and Q22) - Tier 2 non-admitted services classification V5.0 Back to INDEX See NOTES
Queensland Weight (QWAU)see note 5 Queensland Price National Weight National Price
Tier 2 Description New Review Telephone PBS New $ Review $ Telephone $ PBS $ NWAU Price $ Clinic 10.01 Hyperbaric Medicine 0.0909 0.0909 0 0.0132 $441 $441 $0 $64 0.0909 $467 10.02 Interventional Imaging 0.4189 0.4189 0 0 $2,030 $2,030 $0 $0 0.4189 $2,151 10.03 Minor Surgical 0.0486 0.0486 0 0 $236 $236 $0 $0 0.0486 $250 10.04 Dental 0.0583 0.0583 0 0.0084 $283 $283 $0 $41 0.0583 $299 10.05 Angioplasty/Angiography 0.2791 0.2791 0 0.0378 $1,353 $1,353 $0 $183 0.2791 $1,433 10.06 Endoscopy - Gastrointestinal 0.4042 0.4042 0 0 $1,959 $1,959 $0 $0 0.4042 $2,075 10.07 Endoscopy- Urological/Gynaecological 0.063 0.063 0 0.0125 $305 $305 $0 $61 0.063 $323 10.08 Endoscopy- Orthopaedic 0.0427 0.0427 0 0 $207 $207 $0 $0 0.0427 $219 10.09 Endoscopy - Respiratory/ENT 0.0421 0.0421 0 0.0056 $204 $204 $0 $27 0.0421 $216 10.10 Renal Dialysis - Hospital Delivered 0.0522 0.0522 0 0.0069 $253 $253 $0 $33 0.0522 $268 10.11 Chemotherapy - Treatment 0.0382 0.0382 0 0.005 $185 $185 $0 $24 0.0382 $196 10.12 Radiotherapy - Treatment 0.0711 0.0711 0 0.0101 $345 $345 $0 $49 0.0711 $365 10.13 Minor Medical Procedures 0.0898 0.0898 0 0.012 $435 $435 $0 $58 0.0898 $461 10.14 Pain Management Interventions 0.0752 0.0752 0 0.0132 $364 $364 $0 $64 0.0752 $386 10.15 Renal Dialysis - Haemodialysis - Home Delivered 0.9349 0.9349 0 0.1244 $4,531 $4,531 $0 $603 0.9349 $4,800 10.16 Renal Dialysis - Peritoneal Dialysis - Home Delivered 0.9634 0.9634 0 0.1282 $4,670 $4,670 $0 $621 0.9634 $4,946 10.17 Total Parenteral Nutrition - Home Delivered 2.2089 2.2089 0 0.2938 $10,707 $10,707 $0 $1,424 2.2089 $11,340 10.18 Enteral Nutrition - Home Delivered 0.1404 0.1404 0 0 $681 $681 $0 $0 0.1404 $721 10.19 Ventilation - Home Delivered 000 $0 $0 $0 $0 0$0 10.20 Radiation Oncology - Simulation and Planning 0.1595 0.1595 0 0.0342 $773 $773 $0 $166 0.1595 $819 20.01 Transplants 0.0832 0.0832 0.0246 0.0275 $403 $403 $119 $133 0.0832 $427 20.02 Anaesthetics 0.0719 0.0719 0.0246 0.0114 $348 $348 $119 $55 0.0719 $369 20.03 Pain Management 0.0844 0.0844 0.0246 0.0141 $409 $409 $119 $68 0.0844 $433 20.04 Developmental Disabilities 0.0947 0.0947 0.0246 0.0236 $459 $459 $119 $114 0.0947 $486 20.05 General Medicine 0.0573 0.0573 0.0246 0.0128 $278 $278 $119 $62 0.0573 $294 20.06 General Practice and Primary Care 000 $0 $0 $0 $0 0$0 20.07 General Surgery 0.0482 0.0482 0.0246 0.0089 $234 $234 $119 $43 0.0482 $247 20.08 Genetics 0.1349 0.1349 0.0246 0.0236 $654 $654 $119 $114 0.1349 $693 20.09 Geriatric Medicine 0.0661 0.0661 0.0246 0.0101 $320 $320 $119 $49 0.0661 $339 20.10 Haematology 0.0458 0.0458 0.0246 0.0061 $222 $222 $119 $30 0.0458 $235 20.11 Paediatric Medicine 0.0678 0.0678 0.0246 0.011 $329 $329 $119 $53 0.0678 $348 20.12 Paediatric Surgery 0.0575 0.0575 0.0246 0.0096 $279 $279 $119 $47 0.0575 $295 20.13 Palliative Care 0.0658 0.0658 0.0246 0.0099 $319 $319 $119 $48 0.0658 $338 20.14 Epilepsy 0.058 0.058 0.0246 0.0141 $281 $281 $119 $68 0.058 $298 20.15 Neurology 0.0652 0.0652 0.0246 0.0152 $316 $316 $119 $74 0.0652 $335 20.16 Neurosurgery 0.061 0.061 0.0246 0.0205 $296 $296 $119 $99 0.061 $313 20.17 Ophthalmology 0.0387 0.0387 0.0246 0.0084 $188 $188 $119 $41 0.0387 $199 20.18 Ear, Nose and Throat (ENT) 0.043 0.043 0.0246 0.0077 $208 $208 $119 $37 0.043 $221 20.19 Respiratory 0.0645 0.0645 0.0246 0.013 $313 $313 $119 $63 0.0645 $331 20.20 Respiratory - Cystic Fibrosis 0.1455 0.1455 0.0246 0.0193 $705 $705 $119 $94 0.1455 $747 20.21 Anti coagulant Screening and Management 0.0479 0.0479 0.0246 0.0076 $232 $232 $119 $37 0.0479 $246 20.22 Cardiology 0.0555 0.0555 0.0246 0.01 $269 $269 $119 $48 0.0555 $285 20.23 Cardiothoracic 0.0719 0.0719 0.0246 0.0115 $348 $348 $119 $56 0.0719 $369 20.24 Vascular Surgery 0.0572 0.0572 0.0246 0.0098 $277 $277 $119 $48 0.0572 $294 20.25 Gastroenterology 0.0955 0.0955 0.0246 0.0446 $463 $463 $119 $216 0.0955 $490 20.26 Hepatobiliary 0.122 0.122 0.0246 0.0318 $591 $591 $119 $154 0.122 $626
Note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 8.Tier_2_NonAdmitted 1 of 4 qld‐nep‐abf‐priceweights_1920_v3.0
2019-20 Non-Admitted price weights (N1920 and Q22) - Tier 2 non-admitted services classification V5.0 Back to INDEX See NOTES
Queensland Weight (QWAU)see note 5 Queensland Price National Weight National Price
Tier 2 Description New Review Telephone PBS New $ Review $ Telephone $ PBS $ NWAU Price $ Clinic 20.27 Craniofacial 0.05 0.05 0.0246 0.0087 $242 $242 $119 $42 0.05 $257 20.28 Metabolic Bone 0.049 0.049 0.0246 0.0113 $238 $238 $119 $55 0.049 $252 20.29 Orthopaedics 0.0405 0.0405 0.0246 0.0069 $196 $196 $119 $33 0.0405 $208 20.30 Rheumatology 0.058 0.058 0.0246 0.0138 $281 $281 $119 $67 0.058 $298 20.31 Spinal 0.0774 0.0774 0.0246 0.012 $375 $375 $119 $58 0.0774 $397 20.32 Breast 0.0666 0.0666 0.0246 0.015 $323 $323 $119 $73 0.0666 $342 20.33 Dermatology 0.0419 0.0419 0.0246 0.0102 $203 $203 $119 $49 0.0419 $215 20.34 Endocrinology 0.0527 0.0527 0.0246 0.0102 $255 $255 $119 $49 0.0527 $271 20.35 Nephrology 0.0747 0.0747 0.0246 0.016 $362 $362 $119 $78 0.0747 $384 20.36 Urology 0.0504 0.0504 0.0246 0.0101 $244 $244 $119 $49 0.0504 $259 20.37 Assisted Reproductive Technology 0.0652 0.0652 0.0246 0.0105 $316 $316 $119 $51 0.0652 $335 20.38 Gynaecology 0.0534 0.0534 0.0246 0.0096 $259 $259 $119 $47 0.0534 $274 20.39 Gynaecology Oncology 0.0582 0.0582 0.0246 0.0078 $282 $282 $119 $38 0.0582 $299 20.40 Obstetrics – management of pregnancy without complication 0.0391 0.0391 0.0246 0.0059 $190 $190 $119 $29 0.0391 $201 20.41 Immunology 0.0636 0.0636 0.0246 0.0179 $308 $308 $119 $87 0.0636 $327 20.42 Medical Oncology (Consultation) 0.0688 0.0688 0.0246 0.0169 $333 $333 $119 $82 0.0688 $353 20.43 Radiation therapy - consultation 0.0554 0.0554 0.0246 0.0165 $269 $269 $119 $80 0.0554 $284 20.44 Infectious Diseases 0.0398 0.0398 0.0246 0.0053 $193 $193 $119 $26 0.0398 $204 20.45 Psychiatry 0.0366 0.0366 0.0246 0.0049 $177 $177 $119 $24 0.0366 $188 20.46 Plastic and Reconstructive Surgery 0.0387 0.0387 0.0246 0.0058 $188 $188 $119 $28 0.0387 $199 20.47 Rehabilitation 0.0419 0.0419 0.0246 0.0056 $203 $203 $119 $27 0.0419 $215 20.48 Multidisciplinary Burns Clinic 0.0599 0.0599 0.0246 0.008 $290 $290 $119 $39 0.0599 $308 20.49 Geriatric Evaluation and Management (GEM) 0.0836 0.0836 0.0246 0.0121 $405 $405 $119 $59 0.0836 $429 20.50 Psychogeriatric 0.0563 0.0563 0.0246 0.0095 $273 $273 $119 $46 0.0563 $289 20.51 Sleep Disorders 0.0631 0.0631 0.0246 0.016 $306 $306 $119 $78 0.0631 $324 20.52 Addiction Medicine 0.0614 0.0614 0.0246 0.0129 $298 $298 $119 $63 0.0614 $315 20.53 Obstetrics - Management of Complex Pregnancy 0.0668 0.0668 0.0246 0.0089 $324 $324 $119 $43 0.0668 $343 20.54 Maternal Fetal Medicine 0.0668 0.0668 0.0246 0.0089 $324 $324 $119 $43 0.0668 $343 20.55 Telehealth - Patient Location 0.0183 0.0183 0 0.0024 $89 $89 $0 $12 0.0183 $94 20.56 Multi-disciplinary case conference - patient not present 0000$0 $0 $0 $0 0$0 30.01 General Imaging 000 $0 $0 $0 $0 0$0 30.02 Medical Resonance Imaging (MRI) 000 $0 $0 $0 $0 0$0 30.03 Computerised Tomography (CT) 000 $0 $0 $0 $0 0$0 30.04 Nuclear Medicine 000 $0 $0 $0 $0 0$0 30.05 Pathology (Microbiology, Haematology, Biochemistry) 000 $0 $0 $0 $0 0$0 30.06 Positron Emission Tomography (PET) 000 $0 $0 $0 $0 0$0 30.07 Mammography Screening 000 $0 $0 $0 $0 0$0 30.08 Clinical Measurement 0.0368 0.0368 0 $178 $178 $0 $0 0$0 40.02 Aged Care Assessment 000 $0 $0 $0 $0 0$0 40.03 Aids and Appliances 0.0391 0.0391 0.0116 0.0063 $190 $190 $56 $31 0.0391 $201 40.04 Clinical Pharmacy 0.0866 0.0866 0.0116 0 $420 $420 $56 $0 0.0866 $445 40.05 Hydrotherapy 0.0347 0.0347 0.0116 0.0046 $168 $168 $56 $22 0.0347 $178 40.06 Occupational Therapy 0.0349 0.0349 0.0116 0.0059 $169 $169 $56 $29 0.0349 $179 40.07 Pre-Admission and Pre-Anaesthesia 0.0483 0.0483 0.0116 0.0074 $234 $234 $56 $36 0.0483 $248 40.08 Primary Health Care 000 $0 $0 $0 $0 0$0 40.09 Physiotherapy 0.0274 0.0274 0.0116 0.005 $133 $133 $56 $24 0.0274 $141
Note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 8.Tier_2_NonAdmitted 2 of 4 qld‐nep‐abf‐priceweights_1920_v3.0
2019-20 Non-Admitted price weights (N1920 and Q22) - Tier 2 non-admitted services classification V5.0 Back to INDEX See NOTES
Queensland Weight (QWAU)see note 5 Queensland Price National Weight National Price
Tier 2 Description New Review Telephone PBS New $ Review $ Telephone $ PBS $ NWAU Price $ Clinic 40.10 Sexual Health 0.0284 0.0284 0.0116 0.0037 $138 $138 $56 $18 0.0284 $146 40.11 Social Work 0.0477 0.0477 0.0116 0.0075 $231 $231 $56 $36 0.0477 $245 40.12 Rehabilitation 0.0426 0.0426 0.0116 0.0061 $206 $206 $56 $30 0.0426 $219 40.13 Wound Management 0.0322 0.0322 0.0116 0.0049 $156 $156 $56 $24 0.0322 $165 40.14 Neuropsychology 0.107 0.107 0.0116 0.0171 $519 $519 $56 $83 0.107 $549 40.15 Optometry 0.0079 0.0079 0.0116 0.0011 $38 $38 $56 $5 0.0079 $41 40.16 Orthoptics 0.0245 0.0245 0.0116 0.0055 $119 $119 $56 $27 0.0245 $126 40.17 Audiology 0.0484 0.0484 0.0116 0.0083 $235 $235 $56 $40 0.0484 $248 40.18 Speech Pathology 0.0417 0.0417 0.0116 0.006 $202 $202 $56 $29 0.0417 $214 40.21 Cardiac Rehabilitation 0.0369 0.0369 0.0116 0.0054 $179 $179 $56 $26 0.0369 $189 40.22 Stomal Therapy 0.0554 0.0554 0.0116 0.0012 $269 $269 $56 $6 0.0554 $284 40.23 Nutrition/Dietetics 0.0336 0.0336 0.0116 0.0046 $163 $163 $56 $22 0.0336 $173 40.24 Orthotics 0.0606 0.0606 0.0116 0.0107 $294 $294 $56 $52 0.0606 $311 40.25 Podiatry 0.0363 0.0363 0.0116 0.0056 $176 $176 $56 $27 0.0363 $186 40.27 Family Planning 000 $0 $0 $0 $0 0$0 40.28 Midwifery and Maternity 0.0341 0.0341 0.0116 0.0054 $165 $165 $56 $26 0.0341 $175 40.29 Psychology 0.0295 0.0295 0.0116 0.0363 $143 $143 $56 $176 0.0295 $151 40.30 Alcohol and Other Drugs 0.0358 0.0358 0.0116 0.005 $174 $174 $56 $24 0.0358 $184 40.31 Burns 0.0443 0.0443 0.0116 0.0064 $215 $215 $56 $31 0.0443 $227 40.32 Continence 0.0283 0.0283 0.0116 0.0089 $137 $137 $56 $43 0.0283 $145 40.33 General Counselling 000 $0 $0 $0 $0 0$0 40.34 Specialist Mental Health 000 $0 $0 $0 $0 0$0 40.35 Palliative Care 0.0496 0.0496 0.0116 0.0066 $240 $240 $56 $32 0.0496 $255 40.36 Geriatric Evaluation and Management (GEM) 0.0462 0.0462 0.0116 0.0062 $224 $224 $56 $30 0.0462 $237 40.37 Psychogeriatric 0.0167 0.0167 0.0116 0.0023 $81 $81 $56 $11 0.0167 $86 40.38 Infectious Diseases 0.0702 0.0702 0.0116 0.018 $340 $340 $56 $87 0.0702 $360 40.39 Neurology 0.0585 0.0585 0.0116 0.007 $284 $284 $56 $34 0.0585 $300 40.40 Respiratory 0.0389 0.0389 0.0116 0.0078 $189 $189 $56 $38 0.0389 $200 40.41 Gastroenterology 0.04 0.04 0.0116 0.0053 $194 $194 $56 $26 0.04 $205 40.42 Circulatory 0.0498 0.0498 0.0116 0.0045 $241 $241 $56 $22 0.0498 $256 40.43 Hepatobiliary 0.109 0.109 0.0116 0.274 $528 $528 $56 $1,328 0.109 $560 40.44 Orthopaedics 0.0253 0.0253 0.0116 0.0036 $123 $123 $56 $17 0.0253 $130 40.45 Dermatology 0.0289 0.0289 0.0116 0.0045 $140 $140 $56 $22 0.0289 $148 40.46 Endocrinology 0.039 0.039 0.0116 0.0058 $189 $189 $56 $28 0.039 $200 40.47 Nephrology 0.0377 0.0377 0.0116 0.005 $183 $183 $56 $24 0.0377 $194 40.48 Haematology and Immunology 0.0692 0.0692 0.0116 0.0178 $335 $335 $56 $86 0.0692 $355 40.49 Gynaecology 0.0459 0.0459 0.0116 0.0062 $222 $222 $56 $30 0.0459 $236 40.50 Urology 0.0411 0.0411 0.0116 0.0111 $199 $199 $56 $54 0.0411 $211 40.51 Breast 0.0528 0.0528 0.0116 0.0071 $256 $256 $56 $34 0.0528 $271 40.52 Oncology 0.0331 0.0331 0.0116 0.0212 $160 $160 $56 $103 0.0331 $170 40.53 General Medicine 0.0458 0.0458 0.0116 0.0098 $222 $222 $56 $48 0.0458 $235 40.54 General Surgery 0.0329 0.0329 0.0116 0.0043 $159 $159 $56 $21 0.0329 $169 40.55 Paediatrics 0.0383 0.0383 0.0116 0.0056 $186 $186 $56 $27 0.0383 $197 40.56 Falls Prevention 0.0122 0.0122 0.0116 0.0016 $59 $59 $56 $8 0.0122 $63 40.57 Memory and Cognition 0.0577 0.0577 0.0116 0.0081 $280 $280 $56 $39 0.0577 $296 40.58 Hospital Avoidance Programs 0.0475 0.0475 0.0116 0.006 $230 $230 $56 $29 0.0475 $244
Note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 8.Tier_2_NonAdmitted 3 of 4 qld‐nep‐abf‐priceweights_1920_v3.0
2019-20 Non-Admitted price weights (N1920 and Q22) - Tier 2 non-admitted services classification V5.0 Back to INDEX See NOTES
Queensland Weight (QWAU)see note 5 Queensland Price National Weight National Price
Tier 2 Description New Review Telephone PBS New $ Review $ Telephone $ PBS $ NWAU Price $ Clinic 40.59 Post Acute Care 0.0388 0.0388 0.0116 0.0052 $188 $188 $56 $25 0.0388 $199 40.60 Pulmonary Rehabilitation 0.0347 0.0347 0.0116 0.0003 $168 $168 $56 $1 0.0347 $178 40.61 Telehealth - Patient Location 0.0086 0.0086 0 0.0012 $42 $42 $0 $6 0.0086 $44 40.62 Multi-disciplinary case conference - patient not present 0000$0 $0 $0 $0 0.0000 $0 70.04 Oral Health * 0.0120 0.0120 0 0 $58 $58 $0 $0 0.0000 $0 70.07 Breastsceen ** 0.0268 0.0268 0 0 $130 $130 $0 $0 0.0000 $0 70.50 Statewide Urology Outreach Service 0.0663 0.0663 0.0663 0 $321 $321 $321 $0 0.0000 $0 72.06 Offender Health Services 0000$0 $0 $0 $0 0.0000 $0 72.07 Women's and Men's Health 0000$0 $0 $0 $0 0.0000 $0 72.08 Community Health Services - Allied Health 0000$0 $0 $0 $0 0.0000 $0 72.09 Community Health Services - Care Co-ordination 0000$0 $0 $0 $0 0.0000 $0 72.10 Community Health Services - Aged Care 0000$0 $0 $0 $0 0.0000 $0 72.11 Community Health Services - Geriatric 0000$0 $0 $0 $0 0.0000 $0 72.12 Community Health Services - Psychogeriatric 0000$0 $0 $0 $0 0.0000 $0 72.13 Community Health Services - Rehabilitation 0000$0 $0 $0 $0 0.0000 $0 72.14 Community Health Services - Other 0000$0 $0 $0 $0 0.0000 $0 72.15 Community Health Services - Child & Youth Health 0000$0 $0 $0 $0 0.0000 $0 72.16 Community Health Services - Chronic Disease 0000$0 $0 $0 $0 0.0000 $0 72.17 Community Health Services - Communicable Diseases 0000$0 $0 $0 $0 0.0000 $0 72.18 Community Health Services - Palliative Care 0000$0 $0 $0 $0 0.0000 $0 72.19 Community Health Services - Preventative Health 0000$0 $0 $0 $0 0.0000 $0 72.21 Maternal Health 0000$0 $0 $0 $0 0.0000 $0 72.23 Community Health Services – Sexual Health 0000$0 $0 $0 $0 0.0000 $0 73.01 Store and Forward Image Assessment 0000$0 $0 $0 $0 0.0000 $0 73.02 Telehealth provider admitted - MED 0.04126 0.04126 0.04126 0 $200 $200 $200 $0 $0 73.03 Telehealth provider admitted - OHP 0.02063 0.02063 0.02063 0 $100 $100 $100 $0 $0 76.35 Other Outreach Services (HACC, MOW) 0000$0 $0 $0 $0 $0
* Note for Breastscreen and Oral health services that there are different Qld prices per HHS group, refer to section 4.5.7 and 4.5.8 for more information. These services continue to be nominally converted to WAUs in the service agreements in order to align all output-based models to a common currency. ** The Breastscreen Price Weight and Base Price is for Metro group HHSs. Additional localisation weights apply for Regional group HHSs (+ 0.0080, Base Price of $168) and Sunshine Coast HHS (+0.0011, Base Price of $135).
Note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 8.Tier_2_NonAdmitted 4 of 4
Appendix 9 Emergency Department price weights 2019-20 (N1920 and Q22)
Queensland Health Funding Policy and Principles 2019-20 100
2019-20 Emergency Department price weights (N1920 and Q22) - URG V1.4 Back to INDEX See NOTES URG Description Queensland Queensland National National Price Weight (QWAU) Price Weight
URG003 Adm_T1_Injury 0.4358 $2,112 0.4358 $2,237 URG004 Adm_T1_Poisoning/Toxic effects of drugs 0.3159 $1,531 0.3159 $1,622 URG005 Adm_T1_Respiratory system illness 0.3175 $1,539 0.3175 $1,630 URG006 Adm_T1_Circulatory system and Endocrine, nutritional and metabolic illness 0.2834 $1,374 0.2834 $1,455 URG007 Adm_T1_All other MDB groups 0.3324 $1,611 0.3324 $1,707 URG009 Adm_T2_Poisoning 0.2170 $1,052 0.2170 $1,114 URG010 Adm_T2_Injury 0.2785 $1,350 0.2785 $1,430 URG011 Adm_T2_Gastrointestinal system and Digestive system illness 0.2356 $1,142 0.2356 $1,210 URG012 Adm_T2_Respiratory system illness 0.2260 $1,095 0.2260 $1,160 URG014 Adm_T2_Neurological illness 0.2641 $1,280 0.2641 $1,356 URG015 Adm_T2_Toxic effects of drugs 0.2410 $1,168 0.2410 $1,237 URG016 Adm_T2_Circulatory system and Endocrine, nutritional and metabolic illness 0.1967 $953 0.1967 $1,010 URG017 Adm_T2_All other MDB groups 0.1937 $939 0.1937 $994 URG019 Adm_T3_Blood/Immune system illness & system infection/parasites 0.1928 $935 0.1928 $990 URG020 Adm_T3_Injury 0.1872 $907 0.1872 $961 URG021 Adm_T3_Neurological illness 0.1906 $924 0.1906 $979 URG022 Adm_T3_Obstetric/Gynaecological illness 0.1129 $547 0.1129 $580 URG023 Adm_T3_Digestive system illness 0.1796 $871 0.1796 $922 URG024 Adm_T3_Circulatory system illness and endocrine, nutritional and metabolic illness 0.1738 $842 0.1738 $892 URG025 Adm_T3_Poisoning/Toxic effects of drugs 0.1690 $819 0.1690 $868 URG026 Adm_T3_Urological illness 0.1747 $847 0.1747 $897 URG027 Adm_T3_Respiratory system illness 0.1825 $885 0.1825 $937 URG029 Adm_T3_All other MDB groups 0.1644 $797 0.1644 $844 URG030 Adm_T4_Poisoning/Toxic effects of drugs 0.1329 $644 0.1329 $682 URG031 Adm_T4_Respiratory system illness 0.1526 $740 0.1526 $783 URG032 Adm_T4_Gastrointestinal system and Digestive system illness 0.1469 $712 0.1469 $754 URG033 Adm_T4_All other MDB groups 0.1379 $668 0.1379 $708 URG034 Adm_T4_Injury 0.1359 $659 0.1359 $698 URG035 Adm_T4_Social problem/Other presentation 0.1383 $670 0.1383 $710 URG037 Adm_T5_All other MDB groups 1 0.0829 $402 0.0829 $426 URG038 Dead on Arrival w any Triage w any MDB 0.0507 $246 0.0507 $260 URG039 N-A_T1_All MDB groups 0.3107 $1,506 0.3107 $1,595 URG040 N-A_T2_Toxic effects of drugs 0.2363 $1,145 0.2363 $1,213 URG043 N-A_T2_Circulatory system / Endocrine, nutritional and metabolic diseases 0.1731 $839 0.1731 $889 URG044 N-A_T2_Injury 0.1682 $815 0.1682 $864 URG045 N-A_T2_Poisoning 0.2061 $999 0.2061 $1,058
Note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. ED URG 1 of 4 2019-20 Emergency Department price weights (N1920 and Q22) - URG V1.4 Back to INDEX See NOTES URG Description Queensland Queensland National National Price Weight (QWAU) Price Weight
URG046 N-A_T2_All other MDB groups 0.1470 $713 0.1470 $755 URG048 N-A_T3_Circulatory system and Endocrine, nutritional and metabolic illness 0.1316 $638 0.1316 $676 URG050 N-A_T3_Injury 0.1140 $553 0.1140 $585 URG051 N-A_T3_Genitourinary illness 0.1324 $642 0.1324 $680 URG052 N-A_T3_Gastrointestinal system and Digestive system illness 0.1286 $623 0.1286 $660 URG053 N-A_T3_Neurological illness 0.1382 $670 0.1382 $710 URG055 N-A_T3_Respiratory system illness 0.1150 $557 0.1150 $590 URG056 N-A_T3_Musculoskeletal/connective tissue illness 0.1193 $578 0.1193 $612 URG057 N-A_T3_All other MDB groups 0.1032 $500 0.1032 $530 URG058 N-A_T4_Injury 0.0803 $389 0.0803 $412 URG060 N-A_T4_Urological system illness 0.0985 $477 0.0985 $506 URG061 N-A_T4_Circulatory system / Endocrine, nutritional and metabolic illness 0.1005 $487 0.1005 $516 URG062 N-A_T4_Gastrointestinal system and Digestive system illness 0.0978 $474 0.0978 $502 URG063 N-A_T4_Musculoskeletal/connective tissue illness 0.0911 $442 0.0911 $468 URG065 N-A_T4_Illness of the ENT 0.0717 $348 0.0717 $368 URG066 N-A_T4_Illness of the Eyes 0.0658 $319 0.0658 $338 URG067 N-A_T4_Other presentation block 0.0766 $371 0.0766 $393 URG068 N-A_T4_All other MDB groups 0.0863 $418 0.0863 $443 URG069 N-A_T5_Poisoning/Toxic effects of drugs 0.0678 $329 0.0678 $348 URG070 N-A_T5_Injury 0.0668 $324 0.0668 $343 URG071 N-A_T5_Other presentation block 0.0528 $256 0.0528 $271 URG072 N-A_T5_All other MDB groups 0.0684 $332 0.0684 $351 URG073 Did Not Wait 0.0000 $0 0.0380 $195 URG074 Transfer presentation_1, 2 0.3494 $1,694 0.3494 $1,794 URG075 Died in emergency department_triage 1 0.2696 $1,307 0.2696 $1,384 URG076 Adm_Return visit, planned w any Triage 0.1264 $613 0.1264 $649 URG077 N-A Return visit, planned – Triage 1, 2 0.1504 $729 0.1504 $772 URG078 N-A Return visit, planned – Triage 3-5 0.0683 $331 0.0683 $351 URG079 Adm_T1_Psychiatric illness 0.3545 $1,718 0.3545 $1,820 URG080 Adm_T2_System infection/parasites 0.2480 $1,202 0.2480 $1,273 URG081 Adm_T2_Urological system illness 0.2175 $1,054 0.2175 $1,117 URG082 Adm_T2_Psychiatric illness 0.2518 $1,220 0.2518 $1,293 URG083 Adm_T3_Illness of eyes, ear, nose, throat 0.1396 $677 0.1396 $717 URG084 Adm_T3_Hepatobiliary system illness 0.1947 $944 0.1947 $1,000 URG085 Adm_T3_Psychiatric illness 0.1841 $892 0.1841 $945 URG086 Adm_T4_Circulatory system illness and Endocrine, nutritional and metabolic illness 0.1481 $718 0.1481 $760
Note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. ED URG 2 of 4 2019-20 Emergency Department price weights (N1920 and Q22) - URG V1.4 Back to INDEX See NOTES URG Description Queensland Queensland National National Price Weight (QWAU) Price Weight
URG087 Adm_T4_Illness of eyes, ear nose and throat 0.1167 $566 0.1167 $599 URG088 Adm_T4_Blood/immune system illness/system infection/parasites 0.1531 $742 0.1531 $786 URG089 Adm_T4_Gynaecological and Male reproductive system illness 0.1250 $606 0.1250 $642 URG090 Adm_T4_Psychiatric illness 0.1468 $712 0.1468 $754 URG091 Adm_T5_All other MDB groups 2 0.1124 $545 0.1124 $577 URG092 Adm_T5_Injury 0.1008 $489 0.1008 $518 URG093 Adm_T5_Gastrointestinal system and Digestive system illness 0.1147 $556 0.1147 $589 URG094 Adm_T5_Psychiatric illness 0.1126 $546 0.1126 $578 URG095 N-A_T2_Respiratory system illness 0.1615 $783 0.1615 $829 URG096 N-A_T2_Urological system illness 0.1790 $868 0.1790 $919 URG097 N-A_T2_Gastrointestinal system and Digestive system illness 0.1675 $812 0.1675 $860 URG098 N-A_T2_Neurological illness 0.1981 $960 0.1981 $1,017 URG099 N-A_T2_Blood/immune system illness/system infection/parasites 0.1601 $776 0.1601 $822 URG100 N-A_T2_Psychiatric illness 0.1984 $962 0.1984 $1,019 URG101 N-A_T3_Poisoning 0.1329 $644 0.1329 $682 URG102 N-A_T3_Toxic effects of drugs 0.1511 $732 0.1511 $776 URG103 N-A_T3_Illness of eyes 0.0867 $420 0.0867 $445 URG104 N-A_T3_Blood/immune system illness/system infection/parasites 0.1083 $525 0.1083 $556 URG105 N-A_T3_Psychiatric illness 0.1409 $683 0.1409 $723 URG106 N-A_T4_Poisoning 0.0819 $397 0.0819 $420 URG107 N-A_T4_Toxic effects of drugs 0.1066 $517 0.1066 $547 URG108 N-A_T4_Respiratory system illness 0.0866 $420 0.0866 $445 URG109 N-A_T4_Blood/Immune system illness/System infection/parasites 0.0815 $395 0.0815 $418 URG110 N-A_T4_Obstetric and Newborn/Neonate 0.0838 $406 0.0838 $430 URG111 N-A_T4_Gynecological/Male reproductive system illness 0.0957 $464 0.0957 $491 URG112 N-A_T4_Psychiatric illness 0.1022 $495 0.1022 $525 URG113 N-A_T5_Circulatory system illness/Endocrine, nutritional and metabolic diseases 0.0773 $375 0.0773 $397 URG114 N-A_T5_Gastrointestinal system and Digestive system illness 0.0716 $347 0.0716 $368 URG115 N-A_T5_Illness of the eyes, ear, nose and throat 0.0544 $264 0.0544 $279 URG116 N-A_T5_Illness of the skin, subcutaneous tissue, breast/Musculoskeletal/Conn 0.0673 $326 0.0673 $346 URG117 N-A_T5_Blood/immune system illness/system infection/parasites 0.0643 $312 0.0643 $330 URG118 N-A_T5_Obstetric illness/Newborn/Neonate 0.0494 $239 0.0494 $254 URG119 N-A_T5_Genitourinary system illness 0.0683 $331 0.0683 $351 URG120 N-A_T5_Psychiatric illness 0.0749 $363 0.0749 $385 URG121 Transfer presentation_3 0.2641 $1,280 0.2641 $1,356 URG122 Transfer presentation_4 0.2016 $977 0.2016 $1,035
Note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. ED URG 3 of 4 2019-20 Emergency Department price weights (N1920 and Q22) - URG V1.4 Back to INDEX See NOTES URG Description Queensland Queensland National National Price Weight (QWAU) Price Weight
URG123 Transfer presentation_5 0.1389 $673 0.1389 $713 URG124 Died in emergency department_triage 2-5 0.2828 $1,371 0.2828 $1,452 URG125 Left at own risk_1, 2 0.1693 $821 0.1693 $869 URG126 Left at own risk_3 0.1043 $506 0.1043 $535 URG127 Left at own risk_4 0.0750 $364 0.0750 $385 URG128 Left at own risk_5 0.0605 $293 0.0605 $311
Note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. ED URG 4 of 4
Appendix 10 Emergency Service price weights 2019-20 (N1920 and Q22)
Queensland Health Funding Policy and Principles 2019-20 111
2019-20 Emergency Service price weights (N1920 and Q22) - UDG V1.3 Back to INDEX See NOTES UDG Description Queensland Queensland National National Price Weight Price Weight (QWAU)
UDG01 Adm_T1 0.3395 $1,646 0.3395 $1,743 UDG02 Adm_T2 0.2228 $1,080 0.2228 $1,144 UDG03 Adm_T3 0.1778 $862 0.1778 $913 UDG04 Adm_T4 0.1409 $683 0.1409 $723 UDG05 Adm_T5 0.1036 $502 0.1036 $532 UDG06 N-A_T1 0.308 $1,493 0.308 $1,581 UDG07 N-A_T2 0.1701 $824 0.1701 $873 UDG08 N-A_T3 0.1196 $580 0.1196 $614 UDG09 N-A_T4 0.0844 $409 0.0844 $433 UDG10 N-A_T5 0.0635 $308 0.0635 $326 UDG11 Did Not Wait 0$00.0329 $169 UDG12 Dead on Arrival w any Triage w any MDB 0.0507 $246 0.0507 $260 UDG13 Transfer presentation 0.224 $1,086 0.224 $1,150 UDG14 Died in emergency department 0.2746 $1,331 0.2746 $1,410 UDG15 Adm_Return visit, planned w any Triage 0.1264 $613 0.1264 $649 UDG16 N-A Return visit, planned – Triage 1, 2, 3 0.1104 $535 0.1104 $567 UDG17 N-A Return visit, planned – Triage 4,5 0.0666 $323 0.0666 $342
Note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. ED UDG 1 of 1
Appendix 11 ABF model adjustments and localisations 2019-20
Queensland Health Funding Policy and Principles 2019-20 111
qld‐nep‐abf‐priceweights_1920_v3.0
2019-20 ABF Model adjustments and localisations Back to INDEX See NOTES
Order of application Adjustment Type Name Criteria Adjustment or Loading 1 National - IHPA Paediatric Adjustment Is in respect of a person who: Refer to column headed 'Paediatric Adjustment' in 2019-20 Acute Admitted Price Weights (N1920 and a) is aged up to and including 17 years (< 17 years); and Q22) AR-DRG V9.0. b) is admitted to a Specialised Children's Hospital The Queensland Specialised Children's Hospitals in 2019-20 are Queensland Children's Hospital and The Townsville Hospital.
2a National - IHPA Specialist Psychiatric Age Adjustment Is in respect of a person who is aged 17 years or less at the time of admission, Admitted Acute Patient NOT in Specialised Children's Hospital 49% loading (≤ 17 years, in MDC 19 or 20) with a mental health‐related principal diagnosis (Major Diagnostic Category Admitted Acute Patient in Specialised Children's Hospital 16% loading [MDC] 19 or 20) and has one or more Total Psychiatric Care Days recorded. NB: Not applied for Queensland QWAU as Queensland operates a per diem funding model for mental health services which has designated unit types for paediatric services, thus already incorporating the additional cost associated with treating paediatric patients.
2b National - IHPA Specialist Psychiatric Age Adjustment Is in respect of a person who is aged 17 years or less at the time of admission, Admitted Acute Patient NOT in Specialised Children's Hospital 89% loading (≤ 17 years, not in MDC 19 or 20) with a principal diagnosis which is not mental health‐related (not in MDC 19 or Admitted Acute Patient in Specialised Children's Hospital 72% loading 20) and has one or more Total Psychiatric Care Days recorded. NB: Not applied for Queensland QWAU as Queensland operates a per diem funding model for mental health services which has designated unit types for paediatric services, thus already incorporating the additional cost associated with treating paediatric patients.
2c National - IHPA Specialist Psychiatric Age Adjustment Is in respect of a person who is aged over 17 at the time of admission, with a Admitted Acute Patient: 32% loading (> 17 years, not in MDC 19 or 20) principal diagnosis which is not mental health-related (not in MDC 19 or 20) and has one or more Total Psychiatric Care Days recorded. NB: Not applied for Queensland QWAU as Queensland operates a per diem funding model for mental health services which has designated unit types for paediatric services, thus already incorporating the additional cost associated with treating paediatric patients.
3a National - IHPA Patient Remoteness Area Adjustment - Is in respect of a person whose residential address is within an area that is Admitted Acute, Admitted Subacute OR Non-admitted Patient: 8% loading Outer Regional classified as being Outer Regional . 3b National - IHPA Patient Remoteness Area Adjustment - Is in respect of a person whose residential address is within an area that is Admitted Acute, Admitted Subacute OR Non-admitted Patient: 27% loading Remote Area classified as being Remote. Emergency Department Patient: 24% loading
3c National - IHPA Patient Remoteness Area Adjustment - Is in respect of a person whose residential address is within an area that is Admitted Acute, Admitted Subacute OR Non-admitted Patient: 29% loading Very Remote Area classified as being Very Remote. Emergency Department Patient: 24% loading
4 National - IHPA Indigenous Adjustment Is in respect of a person who identifies as being of Aboriginal and/or Torres Strait Admitted Acute, Admitted Subacute, Emergency Department, Islander origin. or Non-admitted Patient: 4% loading
5 National - IHPA Radiotherapy Adjustment Is in respect of an Admitted Acute or Admitted Subacute Patient with a specified Admitted Acute or Admitted Subacute Patient: 36% loading ICD-10-AM 11th edition radiotherapy procedure code recorded in their medical record.
6 National - IHPA Dialysis Adjustment Is in respect of an Admitted Acute Patient or Admitted Subacute Patient with a Admitted Acute or Admitted Subacute Patient: 27% loading specified ICD-10-AM 11th edition renal dialysis code who is not assigned to the AR-DRG L61Z Haemodialysis or AR-DRG L68Z Peritoneal Dialysis.
7 National - IHPA Patient Treatment Remoteness Area Is in respect of a person who receives care in a hospital which is within an area Admitted Acute, Admitted Subacute or Non-admitted Patient: 8% loading Adjustment - Remote Area that is classified as being Remote. Emergency Department or Emergency Service Patient: 5% loading
7 National - IHPA Patient Treatment Remoteness Area Is in respect of a person who receives care in a hospital which is within an area Admitted Acute, Admitted Subacute or Non-admitted Patient: 10% loading Adjustment - Very Remote Area that is classified as being Very Remote Area. Emergency Department or Emergency Service Patient: 5% loading
8 National - IHPA Intensive Care Unit (ICU) Adjustment (a) Is not represented by a newborn/neonate AR-DRG identified as ‘Bundled ICU’ 0.0432 NWAU(19) / hour spent by that person within the Specified ICU in the tables of Admitted Acute Price Weights; but NB: for Queensland the following is applied (b) Is in respect of a person who has spent time within a Specified ICU. 0.0432 QWAU / hour spent by that person within the Specified ICU
Please note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 11.Adjustments ‐ Localisations qld‐nep‐abf‐priceweights_1920_v3.0
2019-20 ABF Model adjustments and localisations Back to INDEX See NOTES
Order of application Adjustment Type Name Criteria Adjustment or Loading 9 National - IHPA Private Patient Service Adjustment Is in respect of an Eligible Admitted Private Patient. Admitted Acute Patient: refer to column headed 'Private Patient Service' in 2019-20 National Acute Admitted Price Weights (N1920) AR-DRG V9.0.
Admitted Subacute Patient - Palliative Care: 3.8% loading Admitted Subacute Patient - Rehabilitation: 3.6% loading Admitted Subacute Patient - Psyhogeriatric Care: 1.7% loading Admitted Subacute Patient - Geriatric (GEM): 3.2% loading Admitted Subacute Patient - Maintenance: 1.6% loading
NB: Not applied for Queensland QWAU as all revenue sources are in the price weight.
10 National - IHPA Private Patient Accommodation Is in respect of an Eligible Admitted Private Patient. Admitted Private Patient admitted acute or subacute: Adjustment Same Day: 0.0524 NWAU adjustment per diem Overnight: 0.0724 NWAU adjustment per diem
NB: Not applied for Queensland QWAU as all revenue sources are in the price weight.
11 National - IHPA Multidisciplinary Clinic Adjustment In respect of a non-admitted service event where three or more health care Non-admitted Patient: 46% loading providers (each of a different specialty) are present, as identified using the non- admitted ‘multiple health care provider indicator’ 12 National - IHPA Emergency Care Age Adjustment Is in respect of an Emergency Department patient, with the rate of adjustment Emergency Department Patient who is aged: dependent on the person’s age. 65 to 79 years: 13% loading Over 79 years: 20% loading
13 National - IHPA Hospital Acquired Complications Is in respect of an Admitted Acute Episode where one or more hospital acquired Refer to https://www.ihpa.gov.au/publications/national-pricing-model-technical-specifications-2019-20 Adjustment complications (HAC) are present. NB: also applies to SNAP episodes in Queensland QWAUs If more than one HAC is present, the larger of the HAC adjustments applies.
PI Queensland localisation Out-of-scope Services Admitted acute and admitted Mental Health patient episodes with the out-of- Zero “0” QWAU scope procedures of a purely cosmetic nature, unless one of listed clinical exemptions are present. Refer list in the E27 (Also refer Scope of Publicly Funded Services Policy and Publicly Funded Services Guideline on Department of Health policies website).
PI Queensland localisation Emergency Department Did Not Wait Emergency department patient attendance with Episode end status of 'Did Not Zero “0” QWAUs Wait' (DNW). Refer to 2019-20 purchasing specifications on QHEPS
PI Queensland localisation Hospital in the Home (HITH) Admitted acute patient episodes with the following DRGs: Admitted acute patient episodes with the specified DRGs E62, F62B, J64 or L63: Adjustment1: DRG specific - E62 (Respiratory Infection and Inflammations); - with a specified Principal Diagnosis and a HITH component: 100% of DRG price weight - F62B (Heart Failure and Shock Minor Complexity) or - with a specified Principal Diagnosis and without a HITH component: 80% of DRG price weight - J64 (Cellulitis); - with another principal diagnosis regardless of HITH component: 100% price weight - L63 (Kidney and Urinary Tract Infections) Refer to 2019-20 purchasing specifications on QHEPS+E29.
PI Queensland localisation Hospital in the Home (HITH) Admitted acute patient episodes with other DRGs that involve a HITH component Admitted acute patient episodes with other DRGs that involve a HITH component and: Adjustment 2: LOS exceeds inlier and have a length of stay (LOS) that exceeds the DRG inlier period. - LOS is within ≤ DRG inlier period: 100% DRG price including HITH days Refer to 2019-20 purchasing specifications on QHEPS. - LOS exceeds > DRG inlier period: 85% of long stay per diem rate
PI Queensland localisation Pre-Operative Elective Bed Days Admitted elective patient episodes with surgical DRGs (between 0 and 59) that Reduce number of long stay days by the number of pre-operative bed days, have both pre-operative days and long stay days (above high trim point less ICU up to a maximum of three (3) days. days). Refer to 2019-20 purchasing specifications on QHEPS.
Please note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 11.Adjustments ‐ Localisations qld‐nep‐abf‐priceweights_1920_v3.0
2019-20 ABF Model adjustments and localisations Back to INDEX See NOTES
Order of application Adjustment Type Name Criteria Adjustment or Loading PI Queensland localisation Fractured Neck of Femur timely Admitted patient episodes with specific attributes, who do not receive surgery Reduce DRG price weight by 20% surgical access within two (2) days of admission. Refer to 2019-20 purchasing specifications on QHEPS.
PI Queensland localisation Stroke Care Admitted acute patient episodes with a specific stroke principal diagnosis and 10% loading to DRG inlier rate patient aged ≥ 18 years admitted to a stroke unit endorsed by Statewide Stroke Clinical Network (standard ward code STKU) for a minimum of four (4) hours within their admitted acute episode. (Some exclusions apply - see specification sheet). Refer to 2019-20 purchasing specifications on QHEPS.
PI Queensland localisation Smoking Cessation Admitted acute and admitted Mental Health patient episodes with QWAU loading equivalent to $37 per in-scope episode of care SMOKE_PTHWAY='Y' and SMOKE_STATUS='1'. Refer to 2019-20 purchasing specifications on QHEPS.
LCZ (always) Queensland localisation Mental Health (Care type 12) or Admitted inpatient episodes with whole or partial days in a ‘PY**’ Standard Unit Days outside a 'PY**' Standard Unit at an average Mental Health day rate (0.2422 QWAU) plus a per diem episodes in a ‘PY**’ Standard Unit will be funded based on the per diem rate payment for the number of days in the rate for 'PY**' Standard Unit. standard unit.
LCZ (always) Queensland localisation Bilateral Cochlear implants Admitted Acute and Admitted Mental Health with procedure code 41617-05 5.353 QWAU per bilateral episode (Implantation of cochlear prosthetic device, bilateral)
LCZ (always) Queensland localisation Neonatal Intensive Care Unit (NICU) Qualified Newborn (Care type 05) episodes admitted to a Neonatal Intensive 0.0055 QWAU/hour spent by that patient within the Specified NICU. Care Unit (standard ward code NSV6) in the following facilities: - 00003 Mater Mother’s Hospital - 00200 The Townsville Hospital - 00201 Royal Brisbane & Women’s Hospital - 00936 Gold Coast University Hospital.
LCZ (always) Queensland localisation Kidney & Liver transplant Admitted Acute and Admitted Mental Health episodes with: 50% loading to DRG inlier rate - Transplant DRGs H09Z (liver), L10A (kidney), L10B (kidney) or - ICD codes Z94.0 (kidney) or Z 94.4 (Liver) admitted to facility 00011 Princess Alexandra Hospital
LCZ (always) Queensland localisation Spinal - Acute Admitted Acute and Admitted Mental Health episodes with spinal DRGs (B03A, 50% loading to DRG inlier rate B03B, B83A and B83B) admitted to facility 00011 Princess Alexandra Hospital
LCZ (always) Queensland localisation Spinal - SNAP Admitted SNAP episodes to SIU ward at facility 00011 Princess Alexandra 16% to AN-SNAP inlier rate Hospital
LCZ (1) Queensland localisation Transplant Support Admitted Acute and Admitted Mental Health episodes 60% loading to DRG inlier rate - with transplant ICD code Z94.1 (heart), Z94.2 (lung) or Z94.3 (heart and lung) - and not in DRG H09Z,E03Z, F23Z, R05A, R05B, R06A, R06B, L10A or L10B)
LCZ (2) Queensland localisation Neurosurgery Admitted Acute and Admitted Mental Health episodes with any of the following 20% loading to DRG inlier rate ACHI procedure codes: - 35412-00 (Endovascular occlusion of cerebral aneurysm or arteriovenous malformation) , or - 40801-00 (Functional intracranial stereotactic procedure), or - 40803-00 (Intracranial stereotactic localisation)
AND the AR-DRG code starting with ‘B’.
Please note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 11.Adjustments ‐ Localisations qld‐nep‐abf‐priceweights_1920_v3.0
2019-20 ABF Model adjustments and localisations Back to INDEX See NOTES
Order of application Adjustment Type Name Criteria Adjustment or Loading LCZ (3) Queensland localisation Trauma Admitted Acute and Admitted Mental Health episodes with SRG 51 Non 5% loading to DRG inlier rate Subspecialty Surgery and either ESRG 5105 Injuries Non-surgical or ESRG 5106 Other Non-specialty surgery with an Elective Status as Emergency and admitted to the following facilities: - 00011 Princess Alexandra Hospital - 00200 The Townsville Hospital - 00201 Royal Brisbane & Women’s Hospital - 00936 Gold Coast University Hospital.
LCZ (4) Queensland localisation Cystic Fibrosis Admitted Acute and Admitted Mental Health episodes with ICD-10-AM diagnosis 35% loading to DRG inlier rate code E84, E84.0, E84.1, E84.8, E84.9 and not in a cystic fibrosis DRG E60A or E60B
LEGEND: LCZ (always) = Localisations (always) LCZ (1) = Localisations assigned based on the highest qualification of patient criteria LCZ (4) = Localisations assigned based on the highest qualification of patient criteria
Please note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 11.Adjustments ‐ Localisations Appendix 12 Funding adjustments for Hospital Acquired Complications 2019-20
Complexity Group Complication Low Moderate High
1. Pressure injury 12.1% 2.8% 1.7%
2. Falls resulting in fracture or other intracranial injury 2.5% 1.4% 0.3%
3. Healthcare associated infection 8.3% 2.4% 1.6%
4. Surgical complications requiring unplanned return to theatre 13.0% 10.4% 8.8%
5. Unplanned intensive care unit admission Nil Nil Nil
6. Respiratory complications 15.6% 10.4% 8.1%
7. Venous thromboembolism 11.0% 7.9% 6.7%
8. Renal failure 20.5% 9.6% 6.1%
9. Gastrointestinal bleeding 9.1% 7.3% 6.4%
10. Medication complications 8.7% 4.8% 2.8%
11. Delirium 9.1% 6.8% 5.4%
12. Persistent incontinence 3.4% 2.6% 2.0%
13. Malnutrition 6.5% 5.5% 4.6%
14. Cardiac complications 10.8% 7.4% 5.8%
15. Third and fourth degree perineal laceration during delivery Nil Nil Nil
16. Neonatal birth trauma Nil Nil Nil
Source: IHPA National Efficient Price Determination 2019-20 Price Weight Tables and based on National HAC list version 1.1 No funding adjustment for 'Unplanned intensive care unit admission' (5) will be applied in 2019-20 as it cannot be identified in current data sets. No funding adjustment for 'Third and fourth degree perineal laceration during delivery' (15) and 'Neonatal birth trauma' (16) will be applied in 2019-20 due to small patient cohorts or other issues which have prevented development of a robust risk adjustment approach at this time.
Queensland Health Funding Policy and Principles 2019-20 111
Appendix 13 Specified Intensive Care Units 2019-20
HHS Facility Name 2019-20
Cairns and Hinterland Cairns Base Hospital
Central Queensland Rockhampton Base Hospital
Children’s Health Queensland Queensland Children’s Hospital19
Darling Downs Toowoomba Hospital
Gold Coast Gold Coast University Hospital
Gold Coast Robina Hospital
Mackay Mackay Base Hospital
Mater Mater Adult Hospital
Metro North Caboolture Hospital
Metro North Redcliffe Hospital
Metro North Royal Brisbane & Women's Hospital
Metro North The Prince Charles Hospital
Metro South Logan Hospital
Metro South Princess Alexandra Hospital
Sunshine Coast Sunshine Coast University Hospital
Townsville The Townsville Hospital
West Moreton Ipswich Hospital
Wide Bay Bundaberg Base Hospital
Wide Bay Hervey Bay Hospital
For a full description of the type and level of public health service provided by each HHS excluding Mater Health Services, refer to the relevant HHS in Clinical Services Capability Framework HHS self-assessment summary sheets.
19 Lady Cilento Children's Hospital was formally renamed to the Queensland Children’s Hospital on 9 November 2018
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Appendix 14 Radiotherapy procedures codes eligible for adjustment
Radiotherapy ICD-10-AM 11th Edition codes - sourced Source: National Efficient Price Determination 2019-20 Appendix B List of radiotherapy codes
Procedure Codes Description 15000-00 Radiation treatment, superficial, 1 field 15003-00 Radiation treatment, superficial, >= 2 fields 15100-00 Radiation treatment, orthovoltage, 1 field 15103-00 Radiation treatment, orthovoltage, >= 2 fields 15224-00 Radiation treatment, megavoltage, 1 field, single modality linear accelerator 15239-00 Radiation treatment, megavoltage, >= 2 fields, single modality linear accelerator 15254-00 Radiation treatment, megavoltage, 1 field, dual modality linear accelerator 15269-00 Radiation treatment, megavoltage, >= 2 fields, dual modality linear accelerator 15600-00 Stereotactic radiation treatment, single dose 15600-01 Stereotactic radiation treatment, fractionated 15600-02 Hemi body irradiation 15600-03 Total body irradiation 15600-04 Total skin irradiation 15303-00 Brachytherapy, intrauterine, low dose rate 15304-00 Brachytherapy, intrauterine, high dose rate 15311-00 Brachytherapy, intravaginal, low dose rate 15312-00 Brachytherapy, intravaginal, high dose rate 15319-00 Brachytherapy, combined intrauterine and intravaginal, low dose rate 15320-00 Brachytherapy, combined intrauterine and intravaginal, high dose rate 90764-00 Brachytherapy, intracavitary, low dose rate 90764-01 Brachytherapy, intracavitary, high dose rate 15327-00 Brachytherapy with implantation of removable single plane, low dose rate 15327-01 Brachytherapy with implantation of removable single plane, pulsed dose rate 15327-02 Brachytherapy with implantation of removable multiple planes or volume implant, low dose rate 15327-03 Brachytherapy with implantation of removable multiple planes or volume implant, pulsed dose rate 15327-04 Brachytherapy with implantation of permanent implant, < 10 sources 15327-05 Brachytherapy with implantation of permanent implant, >= 10 sources 15327-06 Brachytherapy with implantation of removable single plane, high dose rate 15327-07 Brachytherapy with implantation of removable multiple planes or volume implant, high dose rate 15338-00 Brachytherapy, prostate 15360-00 Brachytherapy, intravascular 15339-00 Removal of sealed radioactive source
Q ueensland Health Funding Policy and Principles 2019-20 113
Procedure Codes Description 15012-00 Brachytherapy, eye 90766-00 Brachytherapy using surface applicators, other sites 16003-00 Administration of a therapeutic dose of Yttrium 90 16009-00 Administration of a therapeutic dose of Iodine 131 16012-00 Administration of a therapeutic dose of Phosphorous 32 16015-00 Administration of a therapeutic dose of Strontium 89 16018-00 Administration of a therapeutic dose of 153 SM-Lexidronan 90960-00 Administration of a therapeutic dose of other unsealed radioisotope 15342-00 Construction and application of radioactive surface mould 15351-00 Construction and application of eye applicator 90765-00 Construction and fitting of immobilisation device, simple 90765-01 Construction and fitting of immobilisation device, intermediate 90765-02 Construction and fitting of immobilisation device, complex 90765-03 Construction and fitting of customised blocks 90765-04 Construction and fitting of treatment accessories 15500-00 Radiation field setting using simulator, simple 15503-00 Radiation field setting using simulator, intermediate 15506-00 Radiation field setting using simulator, complex 15506-01 Radiation field setting using dedicated CT scanner 15506-02 Radiation field setting for intensity modulated radiation therapy [IMRT] 15509-00 Radiation field setting using diagnostic x-ray unit 15550-00 Radiation field setting for three dimensional conformal radiation therapy [3DCRT] 15518-00 Dosimetry by CT interfacing computer, simple 15521-00 Dosimetry by CT interfacing computer, intermediate 15524-00 Dosimetry by CT interfacing computer, complex 15524-01 Dosimetry by CT interfacing computer for intensity modulated radiation therapy [IMRT] 15527-00 Dosimetry by non-CT interfacing computer, simple 15530-00 Dosimetry by non-CT interfacing computer, intermediate 15533-00 Dosimetry by non-CT interfacing computer, complex 15536-00 Brachytherapy planning, simple 15536-01 Brachytherapy planning, intermediate 15536-02 Brachytherapy planning, complex 15539-00 Brachytherapy planning, prostate 15541-00 Brachytherapy planning, intravascular 15556-00 Dosimetry by CT interfacing computer for three dimensional conformal radiation therapy [3DCRT] 15556-01 Dosimetry by non-CT interfacing computer for three dimensional conformal radiation therapy [3DCRT] 37217-01 Implantation of fiducial markers 96256-00 Removal of brachytherapy applicator, prostate
Q ueensland Health Funding Policy and Principles 2019-20 114
Appendix 15 Dialysis codes eligible for adjustment
Procedure Codes Description
13100-00 Haemodialysis 13100-01 Intermittent Haemofiltration
13100-02 Continuous Haemofiltration
13100-03 Intermittent Haemodiafiltration 13100-04 Continuous Haemodiafiltration
13100-05 Haemopurfusion
13100-06 Peritoneal dialysis, short term 13100-07 Intermittent peritoneal dialysis, long term
13100-08 Continuous peritoneal dialysis, long term
Dialysis ICD-10-AM 11th Edition codes - sourced National Efficient Price Determination 2019-20 Appendix C List of dialysis codes
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Appendix 16 Specified Grants 2019-20
HHS Category Agreed $ 19-20 Cairns and Hinterland High Cost Outliers $2,779,168 Cairns and Hinterland Limited Indication Medication Scheme $530,452 Central Queensland High Cost Outliers $1,178,346 Central Queensland Limited Indication Medication Scheme $224,908 Children's Health Blood Clotting factors $6,562,626 Queensland Children's Health Haemophilia Centre $607,020 Queensland Children's Health High Cost Outliers $3,808,688 Queensland Children's Health Limited Indication Medication Scheme $726,954 Queensland Children's Health Paediatric Retrieval Service $4,989,536 Queensland Children's Health Queensland Paediatric Rehabilitation $4,606,701 Queensland Service20 Children's Health Statewide Children Services $4,102,872 Queensland Darling Downs High Cost Outliers $1,677,027 Darling Downs Limited Indication Medication Scheme $320,090 Gold Coast High Cost Outliers $5,032,789 Gold Coast Limited Indication Medication Scheme $960,595 Mackay High Cost Outliers $1,309,625 Mackay Limited Indication Medication Scheme $249,965 Mater Health Services Breast Reconstruction $953,153 Mater Health Services Comprehensive Epilepsy Service $820,000 Mater Health Services Consultation Liaison Psychiatry $615,000 Service Mater Health Services High Cost Outliers $1,870,209 Mater Health Services Plastic Surgeon $184,500 Metro North Blood Clotting factors $10,429,137 Metro North Comprehensive Epilepsy Program $646,134 Metro North Genetic Health Queensland $5,899,162 Metro North High Cost Outliers $9,565,457 Metro North Limited Indication Medication Scheme $1,825,733 Metro North Neonatal Retrieval Service $5,105,131 Metro North Paediatric Adolescent gynaecology $1,090,994 Metro North PET/FDG production $1,566,563
20 Queensland Paediatric Rehabilitation Service (formerly known as Qld Cerebral Palsy Service)
Q ueensland Health Funding Policy and Principles 2019-20 116
HHS Category Agreed $ 19-20 Metro North Qld Centre for Gynaecological $1,117,987 Oncology Metro North Statewide AMS Service $1,203,751 Metro North Statewide Haemophilia Centre $1,144,065 Metro South Genomic Testing $1,448,128 Metro South High Cost Outliers $8,806,083 Metro South Limited Indication Medication Scheme $1,680,794 North West High Cost Outliers $399,470 North West Limited Indication Medication Scheme $76,246 Sunshine Coast High Cost Outliers $2,901,275 Sunshine Coast High Cost Outliers $553,759 Townsville High Cost Outliers $3,146,906 Townsville Limited Indication Medication Scheme $600,642 Townsville Neonatal and paediatric retrieval $416,538 West Moreton High Cost Outliers $1,568,159 West Moreton Limited Indication Medication Scheme $299,310 Wide Bay High Cost Outliers $1,256,665 Wide Bay Limited Indication Medication Scheme $239,856 $107,098,169
Q ueensland Health Funding Policy and Principles 2019-20 117
Appendix 17 Clinical education and training grants
Hospital and Health Service Hospital Name 2019-20 Cairns and Hinterland Atherton Hospital $971,569 Cairns and Hinterland Cairns Base Hospital $20,914,148 Cairns and Hinterland Innisfail Hospital $691,332 Cairns and Hinterland Mareeba Hospital $1,067,384 Central Queensland Capricorn Coast Hospital $340,535 Central Queensland Emerald Hospital $454,642 Central Queensland Gladstone Hospital $2,118,280 Central Queensland Rockhampton Hospital $9,879,965 Children’s Health Queensland Children’s $14,932,586 Queensland Hospital21 Darling Downs Dalby Hospital $805,092 Darling Downs Kingaroy Hospital $1,325,934 Darling Downs Toowoomba Hospital $12,759,033 Darling Downs Warwick Hospital $2,151,658 Gold Coast Gold Coast University Hospital $35,613,410 Gold Coast Robina Hospital $5,268,096 Mackay Mackay Base Hospital $12,229,591 Mackay Proserpine Hospital $707,466 Mater Health Services Mater Adult Hospital $9,676,117 Mater Health Services Mater Mothers' Hospital $4,231,238 Metro North Caboolture Hospital $7,602,020 Metro North Kilcoy Hospital $86,841 Metro North Redcliffe Hospital $11,193,251 Metro North Royal Brisbane & Women's $41,002,098 Hospital Metro North The Prince Charles Hospital $19,940,480 Metro South Beaudesert Hospital $701,751 Metro South Logan Hospital $18,626,697 Metro South Princess Alexandra Hospital $36,739,193 Metro South Queen Elizabeth II Jubilee $6,482,282 Hospital Metro South Redland Hospital $6,365,916 North West Mount Isa Base Hospital $3,771,540 Sunshine Coast Caloundra Hospital $254,787 Sunshine Coast Gympie Hospital $1,508,371 Sunshine Coast Nambour General Hospital $3,623,984
21 Lady Cilento Children's Hospital was formally renamed the Queensland Children’s Hospital on 9 November 2018
Q ueensland Health Funding Policy and Principles 2019-20 118
Hospital and Health Service Hospital Name 2019-20 Sunshine Coast Sunshine Coast University $19,421,273 Public Hospital Townsville The Townsville Hospital $27,823,077 West Moreton Ipswich Hospital $16,189,284 Wide Bay Bundaberg Base Hospital $6,152,806 Wide Bay Hervey Bay Hospital $5,371,335
Wide Bay Maryborough Hospital $1,218,081 Total $370,213,144
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Appendix 18 HHS hospitals and facilities by funding model 2019-20
Hospital & Health Hospital or facility PHE ID Fund model Block funded sub-
Service name group Cairns and Hinterland Atherton Hospital 310000211 ABF
Cairns and Hinterland Babinda Hospital 310000212 Block-NEC Small rural and MPHS Cairns and Hinterland Cairns Adult Step Up 310083001 Block-NEC Community Mental Step Down Unit Health Cairns and Hinterland Cairns Youth Step Up 310083005 Block-NEC Community Mental Health Step Down Unit Cairns and Hinterland Cairns Base Hospital 310000214 ABF
Cairns and Hinterland Cairns Community 310082008 Block-NEC Community Mental Care Unit Health Cairns and Hinterland Gordonvale Hospital 310000220 Block-NEC Small rural
Cairns and Hinterland Herberton Hospital 310000221 Block-NEC Small rural
Cairns and Hinterland Innisfail Hospital 310000222 ABF
Cairns and Hinterland Mareeba Hospital 310000223 ABF
Cairns and Hinterland Mossman Hospital 310000224 Block-NEC Small rural and MPHS Cairns and Hinterland Tully Hospital 310000227 Block-NEC Small rural
Central Queensland Baralaba Hospital 310000132 Block-NEC Small rural and MPHS Central Queensland Biloela Hospital 310000133 Block-NEC Small rural
Central Queensland Birribi (Rockhampton) 310000616 Block-Other1 Res-Other IHU Central Queensland Blackwater Hospital 310000134 Block-NEC Small rural and MPHS Central Queensland Capricorn Coast 310000144 ABF Hospital Central Queensland Central Queensland 310083004 Block-NEC Community Mental Step Up Step Down Health Unit Central Queensland Emerald Hospital 310000135 ABF
Central Queensland Eventide 310000692 Block-Other Res-Other (Rockhampton) Aged Care Facility Central Queensland Gladstone Hospital 310000136 ABF
Queensland Health Funding Policy and Principles 2019-20 120
Hospital & Health Hospital or facility PHE ID Fund model Block funded sub- Service name group Central Queensland Mount Morgan 310000139 Block-NEC Small rural and Hospital MPHS Central Queensland Moura Hospital 310000140 Block-NEC Small rural
Central Queensland North Rockhampton 310000613 Block-Other Res-Other Aged Care Facility Central Queensland Rockhampton 310082010 Block-NEC Community Mental Health Community Care Unit Central Queensland Rockhampton Hospital 310000141 ABF
Central Queensland Springsure Hospital 310000142 Block-NEC Small rural and MPHS Central Queensland Theodore Hospital 310000143 Block-NEC Small rural and MPHS Central Queensland Woorabinda Hospital 310000145 Block-NEC Small rural and MPHS Central West Alpha Hospital 310000131 Block-NEC Small rural and MPHS Central West Barcaldine Hospital 310000152 Block-NEC Small rural and MPHS Central West Blackall Hospital 310000153 Block-NEC Small rural
Central West Longreach Hospital 310000156 Block-NEC Small rural
Central West Winton Hospital 310000159 Block-NEC Small rural and MPHS Children's Health Ellen Barron Family 310000017 Block-NEC Major city SS Queensland Centre Children's Health Lady Cilento Children's 310000202 ABF Major city SS Queensland Hospital (Children's) Darling Downs Baillie Henderson 340000701 Block-NEC Specialist MHS Hospital Darling Downs Cherbourg Hospital 310000063 Block-NEC Small rural
Darling Downs Chinchilla Hospital 310000091 Block-NEC Small rural
Darling Downs Dalby Hospital 310000092 ABF
Darling Downs Dr E A F McDonald 310000614 Block-Other Res-Other Aged Care Facility Darling Downs Forest View Aged 310000623 Block-Other Res-Other Care Facility Darling Downs Goondiwindi Hospital 310000093 Block-NEC Small rural
Darling Downs Inglewood Hospital 310000094 Block-NEC Small rural and MPHS Darling Downs Jandowae Hospital 310000095 Block-NEC Small rural
Queensland Health Funding Policy and Principles 2019-20 121
Hospital & Health Hospital or facility PHE ID Fund model Block funded sub- Service name group Darling Downs Karingal Aged Care 310000607 Block-Other Res-Other Facility Darling Downs Kingaroy Hospital 310000070 ABF
Darling Downs Miles Hospital 310000097 Block-NEC Small rural
Darling Downs Millmerran Hospital 310000098 Block-NEC Small rural and MPHS Darling Downs Milton House Aged 310001344 Block-Other Res-Other Care Facility Darling Downs Mt Lofty Aged Care 310000611 Block-Other Res-Other Facility Darling Downs Murgon Hospital 310000075 Block-NEC Small rural
Darling Downs Nanango Hospital 310000076 Block-NEC Small rural
Darling Downs Oakey Hospital 310000099 Block-NEC Small rural
Darling Downs Stanthorpe Hospital 310000100 Block-NEC Small rural
Darling Downs Tara Hospital 310000101 Block-NEC Small rural
Darling Downs Taroom Hospital 310000102 Block-NEC Small rural
Darling Downs Texas Hospital 310000103 Block-NEC Small rural and MPHS Darling Downs The Oaks Aged Care 310000618 Block-Other Res-Other Facility Darling Downs Toowoomba 310082009 Block-NEC Community Mental Health Community Care Unit Darling Downs Toowoomba Hospital 310000104 ABF
Darling Downs Warwick Hospital 310000105 ABF
Darling Downs Wondai Hospital 310000077 Block-NEC Small rural
Gold Coast Gold Coast University 310000936 ABF Hospital Gold Coast Robina Base Hospital 310000934 ABF
Mackay Bowen Hospital 310000192 Block-NEC Small rural
Mackay Clermont Hospital 310000171 Block-NEC Small rural and MPHS Mackay Collinsville Hospital 310000194 Block-NEC Small rural and MPHS Mackay Dysart Hospital 310000176 Block-NEC Small rural
Queensland Health Funding Policy and Principles 2019-20 122
Hospital & Health Hospital or facility PHE ID Fund model Block funded sub-
Service name group Mackay Mackay Base Hospital 310000172 ABF
Mackay Mackay Step Up Step 310083000 Block-NEC Community Mental Down Unit Health Mackay Moranbah Hospital 310000173 Block-NEC Small rural
Mackay Proserpine Hospital 310000174 ABF
Mackay Sarina Hospital 310000175 Block-NEC Small rural
Mater Mater Adult Hospital 310000001 ABF Brisbane Mater Mater Mothers' 310000003 ABF Hospital Metro North Caboolture Hospital 310000030 ABF
Metro North Cooinda House Aged 310000615 Block-Other Res-Other Care Facility Metro North Eventide (Sandgate) 310000691 Block-Other Res-Other Aged Care Facility Metro North Halwyn Centre IHU 310000605 Block-Other1 Res-Other
Metro North Jacana Centre - ABI 310000601 Block-Other Res-Other Rehab Unit Metro North Kilcoy Hospital 310000046 ABF
Metro North Pine Rivers 310082001 Block-NEC Community Mental Health Community Care Unit Metro North Redcliffe Hospital 310000016 ABF
Metro North Redcliffe-Caboolture 310082002 Block-NEC Community Mental Health Community Care Unit Metro North Royal Brisbane & 310000201 ABF Women's Hospital Metro North Somerset Villas 310082003 Block-NEC Community Mental Health Community Care Unit Metro North The Prince Charles 310000004 ABF Hospital Metro South Bayside Community 310082005 Block-NEC Community Mental Health Care Unit Metro South Beaudesert Hospital 310000041 ABF
Metro South Casuarina Lodge 310000625 Block-Other Res-Other
Metro South Coorparoo Community 310082000 Block-NEC Community Mental Care Unit Health Metro South Logan Community 310082006 Block-NEC Community Mental Care Unit Health
Queensland Health Funding Policy and Principles 2019-20 123
Hospital & Health Hospital or facility PHE ID Fund model Block funded sub-
Service name group Metro South Logan Hospital 310000029 ABF
Metro South Princess Alexandra 310000011 ABF Hospital Metro South QE II Hospital 310000022 ABF
Metro South Redland Residential 310001404 Block-Other Res-Other Care Facility Metro South Redland Hospital 310000028 ABF
North West Cloncurry Hospital 310000243 Block-NEC Small rural and MPHS North West Doomadgee Hospital 310000252 Block-NEC Small rural
North West Julia Creek Hospital 310000245 Block-NEC Small rural
North West McKinlay Shire Multi 310001672 Block-Other MPHS Purpose Health Service North West Mornington Island 310000249 Block-NEC Small rural Hospital North West Mount Isa Base 310000246 ABF Hospital North West Normanton Hospital 310000247 Block-NEC Small rural
South West Augathella Hospital 310000111 Block-NEC Small rural and MPHS South West Charleville Hospital 310000112 Block-NEC Small rural
South West Cunnamulla Hospital 310000113 Block-NEC Small rural
South West Dirranbandi Hospital 310000114 Block-NEC Small rural and MPHS South West Injune Hospital 310000115 Block-NEC Small rural and MPHS South West Mitchell Hospital 310000116 Block-NEC Small rural and MPHS South West Mungindi Hospital 310000117 Block-NEC Small rural and MPHS South West Quilpie Hospital 310000118 Block-NEC Small rural and MPHS South West Roma Hospital 310000119 Block-NEC Other standalone
South West St George Hospital 310000120 Block-NEC Small rural
South West Surat Hospital 310000121 Block-NEC Small rural and MPHS
Queensland Health Funding Policy and Principles 2019-20 124
Hospital & Health Hospital or facility PHE ID Fund model Block funded sub- Service name group South West Waroona Aged Care 310000621 Block-Other Res-Other Facility South West Westhaven Aged Care 310000622 Block-Other Res-Other Facility Sunshine Coast Caloundra Hospital 310000043 ABF
Sunshine Coast Gympie Hospital 310000068 ABF
Sunshine Coast Maleny Hospital 310000048 Block-NEC Small rural
Sunshine Coast Mountain Creek 310082004 Block-NEC Community Mental Community Care Unit Health Sunshine Coast Nambour (Glenbrook) 310000612 Block-Other Res-Other Aged Care Facility Sunshine Coast Nambour General 310000049 ABF Hospital Sunshine Coast Sunshine Coast 310000032 ABF University Hospital Torres and Cape Bamaga Hospital 310000213 Block-NEC Small rural
Torres and Cape Cooktown Hospital 310000216 Block-NEC Small rural and MPHS Torres and Cape Thursday Island 310000226 Block-NEC Other standalone Hospital Torres and Cape Weipa Hospital 310000228 Block-NEC Small rural and MPHS Townsville Ayr Hospital 310000191 Block-NEC Small rural
Townsville Charters Towers 310000193 Block-NEC Small rural Hospital Townsville Charters Towers 340000703 Block-NEC Specialist MHS Rehabilitation Unit Townsville Eventide (Charters 310000693 Block-Other Res-Other Towers) Aged Care Facility Townsville Home Hill Hospital 310000195 Block-NEC Small rural
Townsville Hughenden Hospital 310000244 Block-NEC Small rural and MPHS Townsville Ingham Hospital 310000196 Block-NEC Small rural
Townsville Joyce Palmer Hospital 310000197 Block-NEC Small rural
Townsville Kirwan Mental 340000715 Block-NEC Specialist MHS Rehabilitation Unit Townsville Parklands Aged Care 310000619 Block-Other Res-Other Facility
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Hospital & Health Hospital or facility PHE ID Fund model Block funded sub- Service name group Townsville Richmond Hospital 310000248 Block-NEC Small rural and MPHS Townsville Townsville Hospital 310000200 ABF Major city SS (Children's) West Moreton Boonah Hospital 310000042 Block-NEC Small rural
West Moreton Esk Hospital 310000044 Block-NEC Small rural
West Moreton Gailes Community 310082011 Block-NEC Community Mental Care Unit Health West Moreton Gatton Hospital 310000045 Block-NEC Small rural
West Moreton Ipswich Hospital 310000015 ABF
West Moreton Laidley Hospital 310000047 Block-NEC Small rural
West Moreton The Park Centre For 340000751 Block-NEC Specialist MHS Mental Health Wide Bay Biggenden Hospital 310000061 Block-NEC Small rural and MPHS Wide Bay Bundaberg Base 310000062 ABF Hospital Wide Bay Childers Hospital 310000064 Block-NEC Small rural and MPHS Wide Bay Eidsvold Hospital 310000065 Block-NEC Small rural and MPHS Wide Bay Gayndah Hospital 310000066 Block-NEC Small rural
Wide Bay Gin Gin Hospital 310000067 Block-NEC Small rural
Wide Bay Hervey Bay Hospital 310000069 ABF
Wide Bay Maryborough Hospital 310000071 ABF
Wide Bay Monto Hospital 310000072 Block-NEC Small rural
Wide Bay Mundubbera Hospital 310000074 Block-NEC Small rural and MPHS Wide Bay Wide Bay Step Up 310083003 Block-NEC Community Mental Step Down Unit Health Wide Bay Wide Bay Community 310082007 Block-NEC Community Mental Care Unit Health Total ABF: 39 Total Block 121 funded:
Total 160 facilities
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Queensland Health Funding Policy and Principles 2019-20 127
Appendix 19 2019-20 ABF and Non-ABF Service Category Definitions
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Department of Health ABF & Non-ABF Service Category Definitions 2019-20 version 1.0 Legend: ABF (%) - % are applied to Cost Centre(s) in DSS to estimate the Costs related to ABF activity Non-ABF (%) - % are applied to Cost Centre(s) in DSS to estimate the Costs related to this non-ABF category Non-ABF (Actual costs) - actual expenses excluded from ABF by specific GL accounts --- NB % are not required if coded correctly Non-ABF - category unavailable for this year
** For noting: BreastScreen and Oral health services are funded on an activity basis but for the purposes of costing and Cost Centre alignment they remain Non-ABF
Cost Service examples Category Service Category Definitions (List not exhaustive for each service type) Type • Admitted and non-admitted care Queensland Health facilities: All activities undertaken by ABF facilities within Queensland • clinical support Health • HITH (Hospital in the Home) • staff development / training / education Private Facilities: Services provided by contract with a private provider that otherwise would equal ABF activity if delivered in an ABF facility e.g. Noosa Hospital contracted • non-clinical support service ABF services. • hotel services (e.g. cleaning, catering & wards persons) NB the only expenses which may reasonably be excluded from the ABF pool are those: • business management (including Finance, HR, media staff, etc.) • specifically identified as exclusions (e.g. Depreciation, Patient Transport etc) • facility & grounds management & maintenance • related to a defined Non-ABF service (e.g. Community Mental Health, Research, • including (as overheads) any appropriate share of HHS management costs Residential Care etc. ) • that portion of HHS overhead costs deemed appropriate • Home Enteral Nutrition, Total Parenteral Nutrition • Organ/Tissue donor retrievals • Nurse Navigators Private Provider contracts (outsourced public activity) • The Park ABF equivalent hospital services provided in small facilities i.e. IHPA In Scope facilities • Charters Towers Rehabilitation Unit inder the National Efficient Cost (NEC) model. ABF Equivalent Activity in Block • Kirwan Rehabilitation Unit Non-ABF Funded Public Facilities This includes defined Mental Health Facilities and small hospitals that are not in scope for • Baillie Henderson Hospital ABF. • Ellen Barron Family Centre • small hospitals not in scope for ABF Non-ABF Aged Care Assessment Program Services provided under the Commonwealth Aged Care Assessment Program. • Consultation & Liaison • Counselling • Needle & Syringe Program Non-ABF Alcohol and Other Drugs Services targeted at the treatment of substance abuse and misuse. • Opioid Treatment Program • Police Diversion • Residential Rehabilitation & Detox
Note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 1 of 7 ABF Non‐ABF Service Category Definitions 2018‐19 version 1.0
Cost Service examples Category Service Category Definitions (List not exhaustive for each service type) Type Specific breast screening service programs (excludes opportunistic screening services, Non-ABF Breast Screen ** • Breast screening mental health, child and youth) Community services that involve coordination of other services to achieve the optimal • Community Hospital Interface Program (CHIP) or similar community based co- outcomes for a non-admitted client. (those services that do not meet the definition for Tier ordination services (out of scope for Tier 2) Non-ABF Care Co-ordination 2 clinic recording) • Interim care • Liaison services including indigenous liaison officers Includes contractual arrangements for the provision of interim care.
Community services provided principally for an infant, child or a young person under 18 • Child development assessment, treatment and rehabilitation years of age. Whilst the service may be provided to a parent or guardian the focus is on supporting the health or development of the child or young person. Includes child • Child Protection Services protection services. • Community Clinic Services (out of scope for Tier 2) Non-ABF Child & Youth • Hearing Screening (including Healthy Hearing programs) Excludes: • oral health services (refer to Oral Health category) • Parenting support programs • mental health services to clients under 18yrs (see Community Mental Health - Child & Youth) • School based health nurses
Community services provided to identify and manage an illness or medical condition that Non-ABF Chronic Disease lasts over a long period (e.g. more than 12 months) and sometimes causes a long-term • Community Services (out of scope for Tier 2) change in the body, out of scope of Tier 2 clinic coding.
Costs associated with the operation of Commercial businesses and activities that are off- • Cafeterias and canteens set by revenue sources external to the HHS Commercial Activities Includes: • Commercial Carparks - user pays activities (e.g. canteen, cafeterias, car parking etc.) Non-ABF (NOTE: Funding is not provided for these • Foundation costs - costs recovered either from outside entities or other HHSs for recovery of Salaries or functions, it is a match to HHS reported consumables OSR/budget) • Recoveries of staff or clinical support (e.g. equipment hire or supplies)
Excludes: HHS expenses offset by internal re-distribution practices • Trust accounts (including those for Research) Community based surveillance and treatment of communicable and infectious diseases, including immunisations. • Includes immunisations relevant for this service Non-ABF Communicable Diseases • activity pertaining to general communicable or infectious disease prevention, Excludes: sexually transmitted diseases (see Sexual Health) and Staff vaccinations (align detection and response with facility expenses) [ Allied Health services for people 18 years and older provided in the community or in a clinic setting - previously identified by provide discipline e.g. Physio, Podiatry etc. ] ## category no longer available Non-ABF Community Allied Health (expenses to be aligned to the service area) NOTE: those activities that do not align to Tier 2 clinics for Allied Health are aligned to Primary Health Care.
Note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 2 of 7 ABF Non‐ABF Service Category Definitions 2018‐19 version 1.0
Cost Service examples Category Service Category Definitions (List not exhaustive for each service type) Type Services provided under the State government Community Care Program. These services are provided under a contractual arrangement with the Department of Community Care Program Non-ABF Communities Child Safety and Disability services. • Services provided primarily to persons under 65 years or 50 years and younger (DCCSDS funded) for people from an Aboriginal and Torres Strait Island background It includes direct service delivery and purchased services from a non-government provider. (Excludes mental health services). • Acute care services • Community Forensic Outreach services • Mobile Intensive Rehabilitation Treatment Teams, Older persons psychiatric Specialised mental health care provided in the community by community and hospital teams, mobile assessment and treatment services, outreach and consultation liaison. Includes forensic and prison services. Community Mental Health – Adult & based community/ambulatory care services for people aged 18 years and older. Non-ABF • Services to Offenders/Prisoners Older persons Including expenses related to mental health services provided to Prisoners and others in • Community Care Units (established from 1 July 2017) detention. • Multidisciplinary community care services • Services provide assessment, diagnosis, treatment, rehabilitation or care of non- admitted patients including but not limited to case management, crisis assessment and treatment services. • Adolescent day programs • Child and Youth Forensic Outreach Services Community Mental Health – Child & • Multidisciplinary Child and Youth Mental Health Services Non-ABF Specialised mental health care provided in the community by community and hospital Youth based community/ambulatory care services for people under the age of 18 years of age. • Services provide assessment, diagnosis, treatment, rehabilitation or care of non- admitted inpatients, including but not confined to crisis assessment and treatment services, mobile assessment and treatment services.
Community palliative care services provided in the community or a patient's home. Non-ABF Community Palliative Care • Community Services (out of scope for Tier 2) Includes care services purchased through non-government providers and palliative care equipment hire Community based rehabilitation services for children and/or adults provided in a community setting (i.e. patients home or community centre) and usually, but not always, Non-ABF Community Rehabilitation following a hospital event. • Community Services (out of scope for Tier 2)
Includes: care services purchased through non-government providers and equipment hire.
Services aimed at providing clinical advice and general information to the public. Services • 13HEALTH Consumer Information Services • Child Health Information Line Non-ABF may be delivered by Registered Nurses, Allied Health professionals and/or administration (state-wide) officers. The services will often be supplemented with online access options for • Queensland Poisons Information Centre consumers and are generally primary or preventative health orientated. • Quitline Residential services targeted specifically to people under the age of 65 years typically with Non-ABF Disability Residential Care Services a physical, mental or cognitive disability.
Note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 3 of 7 ABF Non‐ABF Service Category Definitions 2018‐19 version 1.0
Cost Service examples Category Service Category Definitions (List not exhaustive for each service type) Type • Food safety Public health initiatives to safeguard the community from potential harm or illness caused Non-ABF Environmental Health • Health risk assessment of environmental hazards by exposure to environmental hazards or harmful practices. • Water and waste
Services provided under the Commonwealth Home and Community Care Program. These services are provided under the contractual arrangement with the Commonwealth Home and Community Care (HACC) principally for people 65 years and older (50 years and older for people from an Aboriginal Non-ABF • Personal Care; domestic assistance; respite Program and Torres Strait Island background) and includes State contributions.
Includes direct service delivery and purchased services from a non-government provider.
Only management and administrative support expenses dedicated to delivery of the Medical Aids and Appliances services (i.e. labour and office costs related to the • MASS co-ordinator - labour and office expenses Home and Community Medical Aids Non-ABF administration of MASS scheme) & Appliances (MASS) NOTE: Clinical Supplies expense will be captured by the relevant GL account code - see Non-ABF Actual $ below
Services provided under the Commonwealth Home Care Package program formerly Home Care Packages Non-ABF known as Community Aged Care Packages and Extended Aged Care at Home Packages. • persons receiving the service will be 65 years and older and 50 years and older (EACH, CACPs) for Aboriginal and Torres Strait Island persons Includes: community care services provided as part of an MPHS.
Services specifically block funded as in-scope under the general list of services (A17 General list by IHPA) including Home Ventilated Services. Movement to block funded for home ventilation services from 2017-18 Non-ABF IHPA Block-Funded Services Excludes: Mental Health CCUs - although identified in the Funding Guidelines as 'Block • therapy costs of acute lymphoblastic leukaemia (Specialist cancer treatment Funded under NEC', these are managed as Community Mental Health (2019-20 commencement)
HHS payments to other jurisdictions (States) for services provided to Queensland Non-ABF Interstate Hospital Charges residents.
Community based pre-natal and post-natal services provided to women/parents. Non-ABF Maternal Health • Community Services (out of scope for Tier 2) Excludes parenting support programs (see Child and Youth community health service type).
Multi-Purpose Health Service Non-ABF Multi-purpose Health Services (those services which attract MPHS funding ) (MPHS) Primary and community health services provided to offenders/prisoners. Non-ABF Offender Health Services • any community health service where the client is an offender / prisoner Excludes Prisoner Mental Health Services (funded under Community Mental Health Services - Adult)
Note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 4 of 7 ABF Non‐ABF Service Category Definitions 2018‐19 version 1.0
Cost Service examples Category Service Category Definitions (List not exhaustive for each service type) Type • Emergency dental services Oral health services provided to eligible children and adults via community and school- • General dental services Non-ABF Oral Health ** based mobile and fixed public dental clinics including health promotion and disease prevention activities. • School dental services • Specialist dental services Only management and administrative support expenses directly related to delivery of the patient transport services i.e. labour and other costs dedicated to coordinating this • Patient travel co-ordinator - labour and office expenses service for an HHS. Non-ABF Patient Transport NOTE: Actual patient transport costs are captured by the relevant GL account codes - see Non-ABF Actual $ below Services targeted at the broader population to improve health. Includes: services with a State-wide or Hospital and Health Service area focus. Non-ABF Preventative Health Services Excludes: small group or individual services and services required to be provided under a NPA or Legislation.
GP type services provided in the community. • Primary Care Clinics (out of scope Tier 2 clinics) Non-ABF Primary Health Care Includes: services to Medicare ineligible clients • Refugee Health • Section 19 (2) Services Services targeted at establishing or examining a body of knowledge or practice. The research should be a formal program with a dedicated cost centre. Non-ABF Research Includes the resources and consumables dedicated to a research program. Costs associated with the operation of State-government operated residential aged care Non-ABF Residential Aged Care facilities (excludes Multi-purpose Health Services) • Complex STIs Services provided in the community to provide testing, support, education and advice for • Non-Stable HIV Non-ABF Sexual Health sexual health including transmission of sexually transmitted diseases and management • Post Exposure Prophylaxis for HIV and referral for sexual assault. • Sexual Assault Services • Viral based services including HEP C treatment
• Transitioning & Service Ramping The primary purpose of this category is for the Non-ABF portion of funding adjustments (to reduce administrative workload to apportion across multiple NABF categories) Specific Allocations - reported here for [Backlog Maintenance ] - not related to ABF or NEC hospitals the purchasing model/Funding The purpose of ABF-NABF Cost Centre alignment is to capture costs of services. Non-ABF alignment only [EB & NLE funding ] - non-ABF component Expenses related to these funding allocations e.g. EB; QGIF; etc will generally be (Not available for cost centre %) embedded in the cost centres related to services and facilities. Where a discrete cost [HSIA & HSQ] - non-ABF component centre is used for these expenses, the cost centre should be apportioned to various NABF service categories. [Insurance - Premiums (QGIF) and Claims] - non-ABF component
Note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 5 of 7 ABF Non‐ABF Service Category Definitions 2018‐19 version 1.0
Cost Service examples Category Service Category Definitions (List not exhaustive for each service type) Type • Clinical Networks - Chairs
Costs associated with specifically negotiated budget for delivery of State-wide non-patient • Clinical Skills Development Centre (Metro North) functions. i.e. costs hosted by a single HHS for delivery of support to all HHSs such as • Cunningham Centre (Darling Downs) State-Wide Functions staff development • PHC Information Systems Support - FERRET (Torres & Cape) Non-ABF (Corporately 'sponsored' functions ‐ see • Queensland Cancer Control Analysis Team (Metro South) (only those services listed as examples are allowable) specific inclusions) • Queensland Centre for Mental Health Learning (West Moreton) • Queensland Centre for Mental Health Research (West Moreton) • Rural and Remote Medical Officer Credentialling and PHC Standards, previously known as Office of Rural and Remote (TAC HHS) Services provided under the Commonwealth State funded Transition Care Program for the short-term support and active management of Older People at conclusion of a hospital Non-ABF Transition Care episode
Includes: costs of direct service provision as well as any contractual arrangements. Community health services targeted to women or men for specific gender related health issues. Non-ABF Women’s and Men’s Health • Community Services (out of scope for Tier 2) Excludes: diagnostic screening Non-ABF Depreciation As recorded by the General Ledger Account codes for Depreciation (Actual $) As recorded by the General Ledger Account codes for Medical Aids & Appliances • Spinal Cord Injury Response • Queensland Artificial Limb Service (QALS) Aids and appliances refers to equipment provided by health services to people on a • Spectacle Supply Scheme temporary or permanent basis to: (a) assist with their discharge from hospital, and/or (b) prevent readmission to hospital, and/or • Aids and appliances include, infusion pumps and long term ongoing Non-ABF Home and Community Medical Aids (c) support treatment or rehabilitation in the home or community setting; and/or requirements include wheelchairs, wheeled walkers, continence products, oxygen, (Actual $) & Appliances (MASS) (d) assist with managing a permanent health condition or disability in the home artificial limbs etc. environment in order to avoid hospitalisation or admission to residential aged care.
Aids and appliances may be supplied ad-hoc or where the condition is permanent and stabilised. • Cystic fibrosis program Excludes: palliative care equipment hire (refer to Palliative Care).
As recorded by the General Ledger Account codes for Interstate Patients Non-ABF Interstate Hospital Charges • Charges for Qld residents treated Interstate (Actual $) HHS payments to other jurisdictions (States) for services provided to Queensland residents.
Note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 6 of 7 ABF Non‐ABF Service Category Definitions 2018‐19 version 1.0
Cost Service examples Category Service Category Definitions (List not exhaustive for each service type) Type
As recorded by the General Ledger Account codes for patient travel • Aeromedical services including Fixed Wing • Hospital based ambulance services Non-ABF Patient Transport i.e. Cost of patient accommodation and transport to services provided by a Hospital and • Queensland Health Authorised Transport (Actual $) Health Service. • Administration of Patient Transport Subsidy Scheme
Note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to QHEPS for updates. 7 of 7
Acronyms and Glossary
ABF Activity Based Funding
ACHI Australian Classification of Health Interventions
ACS Australian Coding Standards
ACSQHC Australian Commission on Safety and Quality in Health Care
ADL Activity of Daily Living
AIHW Australian Institute of Health and Welfare
ALOS Average Length of Stay
AMHCC Australian Mental Health Care Classification
AN-SNAP Australian National Subacute and Non Acute Patient Classification
AR-DRG Australian Refined Diagnosis Related Groups
BSA BreastScreen Australia
BSQ BreastScreen Queensland
BSQR BreastScreen Queensland Registry
CCC Corporate Clinic Code
CCU Coronary Care Unit
CET Clinical education and training
CIMHA Consumer Integrated Mental Health Application
COAG Council of Australian Governments
CSCF Clinical Services Capability Framework
DNW Did Not Wait
DRG Diagnosis Related Group
DSS Data Set Specification
DSS Decision Support System
DVA Department of Veterans’ Affairs
ED Emergency Department
Queensland Health Funding Policy and Principles 2019-20 137
EDC Emergency Data Collection
EDIS Emergency Department Information System
ES Emergency Services
FIM Functional Improvement Measure
GEM Geriatric Evaluation and Management
GEN-WAU Generated Weighted Activity Unit system calculates the State and National funding formulae at patient and aggregate levels. Is used for funding and reporting activity performance, both for the State and National collections.
HBCIS Hospital Based Corporate Information System
HHS Hospital and Health Service
HITH Hospital in the Home
HIU Healthcare Improvement Unit
HoNOS Health of the Nation Outcome Scales
HPF Healthcare Purchasing and Funding Branch
ICD-10-AM International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification
ICU Intensive Care Unit
IHPA Independent Hospital Pricing Authority
LCZ Localisations
LOS Length of Stay
MAC Monthly Activity Collection
MAIC Motor Accident Insurance Commission
MBS Medicare Benefits Schedule
MDB Major Diagnostic Block (used in Urgency Related Groups – URGs)
METeOR Metadata Online Registry
MPHS Multipurpose Health Services
NAS National Accreditation Standards
NBEDS National Best Endeavours Dataset
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NDIS National Disability Insurance Scheme
NEC National Efficient Cost
NEP National Efficient Price
NGO Non-government Organisation
NHCDC National Hospital Cost Data Collection
NHFP National Health Funding Pool
NHRA National Health Reform Agreement
NICU Neonatal Intensive Care Unit
NIIS National Injury Insurance Scheme
NMDS National Minimum Data Set
NOCC National Outcomes and Casemix Collection
NoF Neck of Femur
NPHED National Public Hospital Establishment Database
NWAU National Weighted Activity Unit (applicable nationally)
OHS Oral Health Services
OoS Occasions of Service
OSR Own Source Revenue
PBS Pharmaceutical Benefits Scheme
PI Purchasing incentives
PICU Paediatric Intensive Care Unit
QEP Queensland Efficient Price
QHAPDC Queensland Health Admitted Patient Data Collection
QHEPS Queensland Health Electronic Publishing Service or intranet
QHNAPDC Queensland Health Non-Admitted Patient Data Collection
QIP Quality Improvement Payment
QWAU Queensland Weighted Activity Unit (used in Queensland Health)
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RUG Resource Utilisation Groups
SMF State Managed Fund
SNAP Subacute and Non-Acute Patient
SSB Statistical Services Branch
TTR Teaching, Training and Research
UDG Urgency Disposition Groups
URG Urgency Related Groups
WAU Weighted Activity Unit
WOOS Weighted Occasions of Service
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Bibliography
Administrator National Health Funding Pool, ‘Data Plans’, retrieved June 2019, https://www.publichospitalfunding.gov.au/Publications/data-plans ‘Operational documents’, retrieved June 2019, https://www.publichospitalfunding.gov.au/Publications/operational-documents ‘Pay’, retrieved September 2019, https://www.publichospitalfunding.gov.au/public- hospital-funding/pay, retrieved September 2019 Australian Institute of Health and Welfare, ‘Home’, retrieved June 2019, https://www.myhospitals.gov.au/ Council of Federal Financial Relations, ‘National Health Reform’, retrieved June 2019, http://www.federalfinancialrelations.gov.au/content/national_health_reform.aspx Independent Hospital Pricing Authority, ‘Activity Based Funding’ retrieved June 2019, https://www.ihpa.gov.au/what-we- do/activity-based-funding ‘Pricing Framework’, retrieved June 2019, https://www.ihpa.gov.au/what-we- do/pricing-framework ‘Classifications’, retrieved June 2019, https://www.ihpa.gov.au/what-we- do/classifications ‘Costing’, retrieved June 2019, https://www.ihpa.gov.au/what-we-do/costing ‘Pricing’, retrieved June 2019, https://www.ihpa.gov.au/what-we-do/pricing ‘Publications’, retrieved June 2019, https://www.ihpa.gov.au/publications Queensland Government, ‘Queensland Budget 2019-20 Service Delivery Statements Queensland Health’, Budget Paper 5 - Service Delivery Statements’, Queensland Budget 2019-20, Queensland Government, retrieved June 2019, https://budget.qld.gov.au/budget- papers/#budget-paper-5 Queensland Health, Queensland Government, ‘Clinical Services Capability Framework’, retrieved June 2019, Queensland Health: https://www.health.qld.gov.au/clinical-practice/guidelines-procedures/service- delivery/cscf/about ‘Statistical Services Branch Data Collections’, retrieved June 2019, https://www.health.qld.gov.au/hsu/collections/dchome ‘Queensland public hospital services purchasing and funding models’, retrieved June 2019, https://www.health.qld.gov.au/system-governance/health- system/managing/funding-model
Queensland Health Funding Policy and Principles 2019-20 141
‘Service agreements and deeds of amendment’, retrieved June 2019, https://www.health.qld.gov.au/system-governance/health- system/managing/agreements-deeds
Queensland Health Funding Policy and Principles 2019-20 142
Department of Health
Queensland Health Funding Policy and Principles 2019-20 www.health.qld.gov.au
Queensland Health Funding Policy and Principles 2019-20 143