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This variable is contained in the following files:
SAS Name
CLM_DRG_OUTLIER_STAY_CD
On an institutional claim, the code that indicates the beneficiary stay under the prospective payment system (PPS) which, although classified into a specific diagnosis related group, has an unusually long length (day outlier) or exceptionally high cost (cost outlier).
| Code | Code value |
|---|---|
| 0 | No outlier |
| 1 | Day outlier (condition code 60) |
| 2 | Cost outlier (condition code 61) |
| 6 | Valid diagnosis related groups (DRG) received from the intermediary *** Non-PPS Only *** |
| 7 | CMS developed DRG *** Non-PPS Only *** |
| 8 | CMS developed DRG using patient status code *** Non-PPS Only *** |
| 9 | Not groupable *** Non-PPS Only *** |
Source: NCH