Under Medicare's fee-for-service and bundled payment models, the basic unit of hospital payment for inpatient hospitalizations is determined by the Medicare Severity Diagnosis Related Group (MS-DRG) coding system. Primary total joint arthroplasties (hip and knee) are coded under MS-DRG code 469 for hospitalizations with a major complication or comorbidity and MS-DRG code 470 for those without a major complication or comorbidity. However, these codes do not account for the indication for surgery, which may influence the cost of care.Questions/purposes We sought to (1) quantify the differences in hospital costs associated with six of the most common diagnostic indications for THA (osteoarthritis, rheumatoid arthritis, avascular necrosis, hip dysplasia, posttraumatic arthritis, and conversion arthroplasty), (2) assess the primary drivers of cost variation using comparisons of hospital charge data for the diagnostic indications of interest, and (3) analyze the median length of stay, discharge destination, and intensive care unit use associated with these indications.

中文翻译：

---

针对骨关节炎以外的适应症进行选择性 THA 与成本和资源使用增加相关：一项针对 135,194 项索赔的医疗保险数据库研究。

在医疗保险按服务收费和捆绑支付模式下，住院患者住院费用的基本单位由医疗保险严重诊断相关组（MS-DRG）编码系统确定。初次全关节置换术（髋关节和膝关节）对于有重大并发症或合并症的住院治疗，编码为 MS-DRG 代码 469；对于没有重大并发症或合并症的住院治疗，编码为 MS-DRG 代码 470。然而，这些代码没有考虑手术适应症，这可能会影响护理费用。问题/目的我们试图 (1) 量化与六种最常见的 THA 诊断适应症（骨关节炎、类风湿关节炎、股骨头坏死、髋关节发育不良、创伤后关节炎和关节置换术），(2) 通过比较感兴趣的诊断指征的医院收费数据来评估成本变化的主要驱动因素，以及 (3) 分析中位住院时间、出院目的地以及与这些适应症相关的重症监护病房使用情况。