Table 4a.
Kidney, simultaneous kidney-pancreas and kidney-liver service line analysis and their corresponding International Classification of Disease- 10th Revision-Clinical Modification (ICD-10-CM) codes.
| DEFINITIONS | |
|---|---|
| Phase and Codes | Data Location |
| Pre-transplant/Evaluation Services | |
| Kidney transplant acquisition salaries, benefits, medical director fees, operating costs | Cost Center (CC) Organ Acquisition Center (OAC) |
| Pancreas transplant acquisition salaries, benefits, medical director fees, operating costs | CC OAC |
| Exclude organ costs | Organ costs are pulled out of CC's and added to inpatient case costs |
| Pre-Transplant evaluation/Waitlist management - Outpatient revenue and direct and indirect expenses | Patient accounts |
| The fiscal year (FY) Evaluated patient list and waitlist patient names from Transplant EMR (EPIC Phoenix). All testing is done for FY | |
| Living Donor workup revenue and direct and indirect expenses | Z00.5 and FY patient names from Transplant electronic medical record (EMR) |
| Pre-Transplant Human Leukocyte Antigen (HLA) lab revenue and direct expenses | FY Evaluated patient list and waitlist patient names from Transplant EMR. All testing is done for FY |
| HLA outside revenue and direct expenses | CC Revenue |
| Total Pre-transplant | |
| Inpatient Phase (transplant event) | |
| Deceased Donor Kidney Transplant episode (hospital transplant event) | MS-DRG: 652 Kidney |
| Living Donor Kidney Transplant episode (hospital transplant event) | MS-DRG: 652 Kidney |
| Kidney-Pancreas Deceased Donor Transplant episode (hospital transplant event) | MS-DRG: 008 SPK (simultaneous kidney-pancreas), 010 Pancreas alone |
| Living Donor nephrectomy | Expenses under donor/recipient name. |
| Simultaneous Kidney/Liver (L/K) Transplant episode (hospital transplant event) | MS-DRG: 005 Liver transplant with major complicating co-morbidities (MCC). Medicare only recognizes the liver but pays for both organs in OAC |
| Transplant Patient List from Transplant EMR | |
| Inpatient Revenue | Patient accounts |
| Medicare Reimbursement | Obtain revenue from Cost Report Department |
| Organ Costs | Pull out organ costs from Transplant Department CCs |
| Inpatient Care Direct Expenses | Exclude entire organ acquisition charge on all recipient patient accounts as all expenses in organ costs or in transplant cost centers |
| Indirect Expenses | Formula provided by finance/expense allocation |
| Total Inpatient Phase (transplant event) | |
| Post-Transplant | |
| Outpatient Post Transplant Follow up Revenue and Direct and Indirect expenses | Patient Accounts |
| FY Post transplant patient list from Transplant EMR | |
| Diagnosis codes | |
| T86.10 | Unspecified complication of kidney transplant |
| T86.11 | Kidney transplant rejection |
| T86.12 | Kidney transplant failure |
| T86.13 | Kidney transplant infection |
| T86.19 | Other complications of Kidney transplant |
| Z49.83 | Pancreas transplant status |
| Z94.0 | Kidney transplant status |
| Z52.4 | Kidney donor status |
| Inpatient Post Transplant Readmissions Revenue and direct and indirect expenses | Patient Accounts |
| FY Post-transplant readmission patient list from Transplant EMR | |
| T86.11 | Kidney transplant rejection |
| T86.12 | Kidney transplant failure |
| T86.13 | Kidney transplant infection |
| T86.19 | Other complications of Kidney transplant |
| T86.899 | Complications pancreas transplant |
| FY Post-transplant readmission patient list from Transplant EMR | |
| Z49.83 | Pancreas transplant status |
| Z94.0 | Kidney transplant status |
| Z52.4 | Kidney donor status |
| Total Post Transplant | |
| Transplant Surgeon non Transplant Cases | |
| Inpatient and outpatient non transplant surgical cases revenue and direct and indirect expenses | Patient Accounts |
| Surgeon IDs or names | |
| Total Transplant Surgeon non Transplant Cases | |
| Non-Acquisition Expenses | |
| All direct expenses hitting this cost center including physician practice subsidy expenses for transplant work and global contracting distribution gain/loss | Transplant non-acquisition CCs capture marketing and physician subsidy expenses. Subsidy expense written off monthly to CCs includes contracting gain/loss |
| Total Non-Acquisition Expenses | |
| Total Kidney Transplant Service Line | |
Abbreviations: OAC= Organ Acquisition Cost Center; ICD-10-CM= International Classification of Disease- 10th Revision-Clinical Modification; CC = Cost center; FY = Fiscal year; K/L = Kidney / Liver; MS-DRG= Medicare Severity Diagnosis Related Group; HLA= Human Leukocyte Antigen; MCC = Major complicating co-morbidities.