Flag Criteria ,,
NC means no change in nonCC/CC/MCC designation,,
1+ means the sdx is currently a NonCC and a potential candidate for bumping up,,
2+ means the sdx is currently a CC and a potential candidate for bumping up a level,,
2- means the sdx is currently a CC and a potential candidate for bumping down a level,,
3- means the sdx is currently a MCC and a potential candidate for bumping down,,
,,
The criteria for the flag is as follows:,,
,,
"NC Criteria:        cnts1 > 200 and impact 1 <= 1.50 and level =NCC, and cnts2 <=200 and impact2<=2.25",,
                                or,,
"               cnts1>200 and impact1<=1.75 and level =NCC, and cnts2>200 and impact2<=2.00",,
                                or,,
               ((cnts1>200 and impact1 <= 2.25 and level =CC and cnts2>200 and impact2<= 2.75,,
                                or,,
                             cnts1>200 and impact1<=2.00 and level =CC and (impact2<=2.50) and (impact3<=3.00)),,
                                   and,,
               (cnts1>200 and impact1 >= 1.20 and level =CC and cnts2>200 and impact2>=2.1)),,
                                   or,,
((cnts1>200 and impact1>=1.6 and level =MCC) and ((cnts2>200 and impact2>=2.5) or (cnts3>200 and impact3>=3.1))),,
,,
"1+ Criteria:      cnts1>200 and impact1 > 1.50 and level =NCC, and cnts2 >200 and impact2>2.25",,
                                or,,
"             cnts1>200 and impact1>1.75 and level =NCC, and cnts2>200 and impact2>2.00",,
,,
2+ Criteria:      cnts1>200 and impact1 > 2.25 and level =CC and cnts2>200 and impact2> 2.75,,
                              or,,
                           cnts1>200 and impact1>2.00 and level =CC and (impact2>2.50) and (impact3>3.00),,
,,
2- Criteria:       cnts1>200 and impact1 < 1.20 and level =CC and cnts2>200 and impact2<2.1,,
,,
3- Criteria:        (cnts1<200 or (cnts1>200 and impact1<1.6 and level =MCC)) and ((cnts2>200 and impact2<2.5) ,,
                                 or ,,
                              (cnts3>200 and impact3<3.1)),,
,,
Counts 1: count of patients discharge claims with the sdx but with no other secondary diagnosis or with all other secondary diagnoses a NonCC,,
Impact 1: is the “C1” impact on resource use of the secondary diagnosis for patient discharge claims in cnts1,,
,,
Counts 2: count of patients discharge claims with the sdx and with at least one other secondary diagnosis that is a CC but none that is a major CC,,
Impact 2: is the “C2” impact on resource use of the secondary diagnosis for patient discharge claims in cnts2,,
,,
Counts3: count of patient discharge claims with the sdx and with at least one other secondary diagnosis that is a major CC ,,
Impact 3: is the “C3” impact on resource use of the secondary diagnosis for patient discharge claims in cnts3,,
