Table 3. MDS+/MEDPAR Crosswalk.
| RUG-III Group | MDS + | MEDPAR | ||
|---|---|---|---|---|
|
| ||||
| ICD-9-CM or MEDPAR Source Code | Descriptor | |||
|
| ||||
| Items Used | Criteria | |||
| Rehabilitation | ||||
| Very High Intensity, Multidisciplinary | N,1, b, (a, b, c) Box A and B a. Speech b. Occupational Therapy c. Physical Therapy |
Box A - Two of the 3 = 1+ and one of the 3 = 5+ Box B - Sum of a + b + c = 450 |
OT, PT, Speech V57.0 to V57.9 | Covered Charge $250+ Covered Charge $3,501 + 2 of 3 Therapies and 1 Therapy > $1,500 |
| High Intensity | N, 1, b, (a, b, c) Box A and B a. Speech b. Occupational Therapy c. Physical Therapy |
Box A - Combination of a + b + c = 5+and Box B - Sum of a + b + c = 300 |
V57.0 to V57.9 | Covered Charge $2,001 - $3,500 and 2 Therapies or $2,001 + and Only 1 Therapy |
| Medium Intensity | N, 1, b, (a, b, c) Box A and B a. Speech b. Occupational Therapy c. Physical Therapy |
Box A - Combination of a + b + c = 5+and Box B - Sum of a + b + c = 150 |
V57.0 to V57.9 | Covered Charge $1,001 - $2,000 and Any Combination of Therapies |
| Low Intensity | N, 1, b, (a, b, c) Box A and B a. Speech b. Occupational Therapy c. Physical Therapy N, 2, (a, b, c, f, g, h, i, j) a. Range of Motion (Passive) c. Splint/brace Assistance f. Locomotion/Mobility g. Dressing/Grooming h. Eating/Swallowing i. Transfer j. Amputation Care |
Box A - Combination of a + b + c = 3+ and Box B - Sum of a + b + c = 45 and N, 2 - Any two = 5 + (a, b, c, f, g, h, i, j) |
V57.0 to V57.9 | Covered Charge $250 - $1,000 and Any Combination of Therapies |
| Extensive Services | At Least One Checked | |||
| Parenteral Feeding | L, 4, a (Parenteral/IV) N, 1, a,(d, e, j) |
V46.9 | Unspecified Machine Dependence (IV Pump) | |
| Suctioning | d. Suctioning | V46.0 | Aspirator | |
| V55 | Attention Artificial Opening | |||
| Tracheostomy | e. Trach Care | V44.0 | Tracheostomy | |
| Ventilator/Respirator | j. Ventilator/Respirator | V46.1 | Respirator | |
| Special Care | At Least One Checked or Answered as Specified | |||
| Burns | J, 4, c (Burns) | 940 to 949.5 | All Types and Locations | |
| Coma | B, 1, 1 (Coma) | 780 | Coma Excludes 780.3 Eclampsia Excludes 779.2 Newborn | |
| 586 | ||||
| 345.3 | Grand Mal, Status, Epileptic | |||
| Fever With: | ||||
| Vomiting | K, 3, e and K, 3, m or L, 3, b or | 008.8 | ||
| Weight Loss | K, 1 or L, 2, c = 1 | 783.2 | Abnormal Weight Loss, Feeding Difficulties, and Nutritional Deficiencies | |
| 783.3 | ||||
| 260-263.0 | ||||
| Pneumonia | 480-487 | See ICD-9-CM Volume 1 for Exclusions | ||
| Dehydration | 276.5 | Volume Depletion | ||
| 276.0 | Hypertonic | |||
| 276.1 | Hypotonic | |||
| Multiple Sclerosis | K, 1, I (Multiple Sclerosis) | 340 | Multiple Sclerosis | |
| Pressure Ulcers | J, 2, c or d = 1+ (Stage 3 or 4 Pressure Ulcer) | 707.0 to 707.9 | Pressure Ulcers | |
| Quadriplegia | H, 4, d (Quadriplegia) | 344.0 | Quadriplegia | |
| Septicemia | 038-038.9 | |||
| 998.5 | Postoperative | |||
| 999.3 | Following Infusion, Injection, Transfusion | |||
| IV Medication | No List | N, 1, a, f (IV Medications) | ||
| RadiationTreatments | N, 1, a, b (Radiation Treatments) | V15.3 | Irradiation (Aftercare) | |
| V58.0 | Radiotherapy | |||
| V66.1 | Following Radiotherapy | |||
| Tube Feeding | L, 4, b (Feeding Tube) | V44.1 | Tube Feeding | |
| Clinically Complex | At Least One Checked or Answered as Specified | |||
| Aphasia | K, 1, j (Aphasia) | 784.3 | ||
| Aspiration | K, 3, j (Lung Aspirations) | 507.0 | ||
| Cerebral Palsy | I, 12, b (Cerebral Palsy) | 343.0 to 343.9 | ||
| Dehydration | L, 3, b (Dehydration) | 276.5 | Volume Depletion | |
| 276.0 | Hypertonic | |||
| 276.1 | Hypotonic | |||
| Hemiplegia | H, 4, c (Hemiplegia) | 342.0 to 342.9 | Excludes Congenital and Infantile | |
| Internal Bleeding | K, 3, g (Internal Bleeding) | 578 to 578.9 | Excludes Newborn | |
| Pneumonia | K, 1, o (Pneumonia) | 480 to 487 | See ICD-9-CM Volume 1 for Exclusions | |
| Stasis Ulcer | J, 1 = 1 (Stasis Ulcer) | 434.0 to 454.9 | ||
| Terminal Illness | K, 1, z (Experiencing Terminal Illness) | No List | Death Within 60 Days | |
| Urinary Tract Infection | K, 1, e e (Urinary Tract Infection) | 599.0 | ||
| Chemotherapy | N, 1, a a (Chemotherapy) | V58.1 | Maintenance Chemotherapy | |
| V66.2 | Following Chemotherapy | |||
| Dialysis | N, 1, a c (Dialysis) | V45.1 | Renal Dialysis Status | |
| V56 to V56.8 | Excludes Billysis Status | |||
| V58.8 | Other Specified Aftercare | |||
| V58.9 | Unspecified Aftercare | |||
| Respiratory Therapy | N, 1, be Box A = 1 + (Respiratory Therapy) | Only Part Time Breathing Exercises | ||
| Transfusions | N, a g (Transfusions) | V58.2 | Blood Transfusion Without Reported Diagnosis | |
| Wound Care Other Than Pressure Ulcer | J, 4, (d, e, or f) and J, 5, (d, or e) or J, 7, c (Foot Dressings) |
V58.3 | Attention to Dressing/Sutures, Dressing Changes | |
| Physician Visits | N, 6 = 4+ (Physician Visits) | No List | Does Not Apply at Admission | |
| Impaired Cognition | All Three Answered as Specified | |||
| Impairment in All: Decisionmaking Recall Short-Term Memory |
B, 2, a = 1 (Short-Term Memory) and B, 3, a, b, c, or d Not Checked and B, 4 = 1 or More |
290.0 | ||
| Behavior Problems | E, 3, a or b or c or d = 2 or K, 3, f (Hallucinations/Delusions) E, 3, a (Wandering) E, 3, b (Verbally Abusive) E, 3, c (Physically Abusive) E, 3, d (Socially Inappropriate) |
Any One of “E” Variables = 2 or K, 3, f Checked | Not Used | |
| Reduced Physical Function | H, 1, a (Bed Mobility) H, 1, b (Transfer) H, 1, f (Toilet use) H, 2, a b f (Support) |
Self-Performed Score 0 or 1 = 1 (0 - Independent) (1 - Supervision) Self-Performed Score 2 = 3 (2 - Limited Assistance) Self-Performed Score 3 or 4 and Support Score 2 = 3 (3 - Extensive Assistance) (4 - Total Dependence) Support (2 - One Person) Self-Performed Score 3 or 4 and Support Score 3 = 4 (3 - Extensive Assistance) (4 - Total Dependence) Support (2 - Two Persons) |
Not Used | |
| H, 1, e (Eating) | Self-Performed Score 0 or 1 = 1 (0 - Independent) (1 - Supervision) Self-Performed Score 2 = 2 (2 - Limited Assistance) Self-Performed Score 3 or 4 = 3 (3 - Extensive Assistance) (4 - Total Dependence) (8 - Not Feed and L4 a or b Checked - IV or Tube Feeding) |
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NOTES: MDS+ is Minimum Data Set Plus. MEDPAR is Medicare provider analysis and review. ICD-9-CM is International Classification of Diseases, 9th Revision, Clinical Modification. OT is occupational therapy. PT is physical therapy. IV is intravenous.
SOURCE: Cornelius, E., Health Care Financing Administration, Feldman, J., Allied Technology Group, Inc., Marsteller, J.A., and Liu, K., Urban Institute, 1994.