Table 4b.
Liver transplant 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 | |
| Liver Transplant Acquisition Salaries, benefits, Medical Director fees, operating costs | Cost Center (CC) Organ Acquisition Center (OAC) |
| Exclude organ costs | Organ costs are pulled out of OAC CC and added to inpatient care costs |
| Pre-Transplant Evaluation/Waitlist Management - Inpatient and Outpatient Revenue and direct and indirect expenses | Patient Accounts |
| Fiscal Year (FY) Evaluated patients list and waitlist patient names from Transplant Department electronic medical record (EMR) | |
| All inpatients admitted by transplant hepatologists revenue and direct and indirect expenses | Patient Accounts/ |
| Hepatologist IDs or names | |
| Inpatient and Outpatient Hepatology list provided by the Transplant Department | |
| Diagnosis codes | |
| Exclude Surgeons and transplant cases | |
| Pre-Transplant Management IP/OP (Hospitalists) | Inpatient and Outpatient Hepatology list provided by the Transplant Department |
| All inpatients referred for admission and clinically managed by hepatologists but admitted by Hospitalists/internists | Diagnosis codes |
| Exclude Surgeons and transplant cases | |
| Total Pre-Transplant/Evaluation Services | |
| Inpatient Phase Transplant Event | |
| Liver Transplant episode (hospital transplant event) | Medicare Severity Diagnosis Related Group (MS-DRG) 05 Liver Transplant with major complicating co-morbidities (MCC) and DRG 06 Liver transplant without MCC. |
| Transplant Patient List from Transplant EMR (EPIC Phoenix) | |
| Inpatient Revenue | Patient Accounts |
| Medicare Reimbursement | Obtain revenue from Cost Report department |
| Organ costs | Pull out organ costs from transplant dept CC or where organ costs are paid |
| Inpatient Care Direct Expenses | Exclude entire organ acquisition charge on all recipient patient accounts as all expenses in organ costs or transplant department CC |
| Indirect Expenses | Formula provided by finance/expense allocation |
| Inpatient Phase Kidney Liver Transplant Event | |
| Liver Transplant episode (hospital transplant event) | MS-DRG 05 Liver Transplant with MCC and DRG 06 Liver transplant without MCC. |
| Kidney Liver transplant episode | MS-DRG 05 Liver Transplant with MCC |
| Transplant Patient List from transplant department EMR (EPIC Phoenix) | |
| Inpatient Revenue | Patient Accounts |
| Medicare Reimbursement | Obtain revenue from Cost Report department |
| Organ costs | Pull out organ costs from transplant department CC or where organ costs are paid |
| Inpatient Care Direct Expenses | Exclude entire organ acquisition charge on all recipient patient accounts as all expenses in organ costs or transplant department CC |
| Indirect Expenses | The formula provided by finance/expense allocation |
| Total Inpatient Phase/Transplant Event | |
| Post-Transplant | |
| Post-Transplant Outpatient Revenue and direct and indirect expenses | Patient Accounts |
| Post-Transplant Inpatient Revenue and direct and indirect expenses | Patient Accounts |
| FY Post transplant patient list from transplant dept. EMR | |
| Diagnosis codes | |
| T86.40 | Unspecified complication of liver transplant |
| T86.41 | Liver transplant rejection |
| T86.42 | Liver transplant failure |
| T86.43 | Liver transplant infection |
| T86.49 | Other complications of liver transplant |
| Z09, Z48.298, Z48.23, Z94.4 | Post liver Fu |
| Z94.4 | Liver transplant status |
| Total Post Transplant | |
| Downstream Liver Disease or Liver Transplant Management. Out or Inpatient and outpatient primary surgeon cases | |
| Other system hospitals and facilities outpatient revenue and direct and indirect expenses | Patient Accounts |
| Outpatient Hepatology list provided by Transplant Department | |
| Diagnosis codes | |
| Include Surgeons and transplant cases | |
| Other system hospitals inpatient and outpatient surgical cases performed by Transplant Surgeons | Surgeon IDS assigned by the hospital or by name |
| Total Downstream | |
| Transplant Surgeon non-Transplant Cases | |
| Inpatient and Outpatient non transplant surgical cases revenue and direct and indirect expenses | Patient Accounts |
| Surgeon IDS assigned by the hospital or by name | |
| Exclude liver transplant inpatient and outpatient cases | |
| Total Downstream | |
| Liver Program Administration | |
| All expenses are hitting transplant department CCs, including physician practice expenses. Global Contracting gain/loss distribution is also included | CC marketing and Transplant Physician Practice subsidy expenses. Expense is written off monthly to CC. consists of the Global contracting gain/loss revenue |
| Total Liver Program Administration | |
| Outpatient/Specialty Pharmacy Revenue | |
| Medication Therapy Management Clinic Revenue and Direct Expenses related to Hepatitis C other Liver Disease Management Patients and Transplant Medications | CCs |
| Salary and Drug Direct Expenses related to transplant hospital management referrals | Transplant Surgeons, Transplant Hepatologists and Transplant ID ordering physicians |
| Total Outpatient/Specialty Pharmacy Revenue | |
| Total Liver 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.