RCS-1 - The Disappearing Clinical Category

The new PT/OT classification system in RCS has five categories:

  1. Major Joint Replacement or Spinal Surgery
  2. Other Orthopedic
  3. Acute Neurologic
  4. Non-Orthopedic Surgery
  5. Medical Management

The technical document lists all the analysis that went into studying payments and DRG codes to map the DRG codes to the five categories. The groupings are supposed to keep similarly priced DRG codes together.

There is a table at the end of the document that lists all the DRG codes and how they map to the five categories. Here is the count of DRG codes per category:

  • Acute Neurologic - 42
  • Major Joint Replacement/Spinal Surgery - 20
  • Medical Management - 304
  • Non-Orthopedic Surgery - 297
  • Other Orthopedic - 0

Either I am missing something or there is no way to get PT/OT RUGs TG-TL. Anyone else notice this?