1. Gender : Male
Age : 59
Disposition : Home Health Service (6)
Admit Date
LOS :6
Disch Date
APR (all versions) DRG Information
163 CARDIAC VALVE PROC WO CATH
APR wt 3.6712 Low Trim 2 High Trim 12
Status: Low LOS Outlier
Severity of Illness
1 Minor Severity of Illness
Risk of Mortality
1 Minor Risk of Mortality
Principal Diagnosis
*4412 Thoracic aneurysm without rupture
*SOI=P Principal diagnosis used for SOI calculation
*ROM=P Principal diagnosis used for ROM calculation
Secondary Diagnoses
99811 Hemorrhage complicating a procedure
SOI=2 Moderate
ROM=1 Minor
4241 Aortic valve disorder
*SOI=1 Minor
*ROM=1 Minor
Principal Procedure
*3511 Open heart valvuloplasty without replacement, aortic valve
*SOI
Other Procedures
3403 Reopening of recent thoracotomy site
3845 Resection of vessel with replacement, thoracic vessel (aorta)
3961 Extracorporeal circulation auxiliary to open heart surgery
I certify that the narrative descriptions of the principal and secondary diagnoses and the
major procedures performed are accurate and complete to the best of my knowledge.
______________________________ ____________
Physician's Signature Date