Diagnosis Complexity Level (DCL) and the Episode Clinical Complexity Score (ECCS)
Like AR-DRG Version 8.0, Version 9.0 is based on the Episode Clinical Complexity Score (ECCS).
The primary element of the ECCS is the Diagnosis Complexity Level (DCL), which is a complexity
weight estimating the relative cost of each diagnosis within a particular Adjacent DRG (ADRG).
The ECCS is the measure of the cumulative effect of DCLs for a specific episode.
Calculating the ECCS is a streamlined process. In AR-DRG Version 9.0, each diagnosis is assigned
a DCL value found in a matrix that has 399 ADRGs (406 ADRGs in Version 8.0) as columns and all
valid diagnoses codes (16,953 for Tenth Edition and 16,826 for the Ninth Edition of ICD-10-AM)
as rows. The matrix incorporates in itself a DCL = 0 for diagnoses that were unconditionally
excluded from contributing to resource use (e.g. external causes). A DCL = 0 is also assigned
in three other circumstances:
- if a diagnosis code is a duplicate
- if a diagnosis is invalid for ICD-10-AM Tenth Edition for AR-DRG Version 9.0 (or ICD-10-AM Ninth Edition for AR-DRG Version 8.0)
- if a diagnosis is a conditional exclusion (i.e. a certain code has its DCL set to 0 if another (excluding) code is present.
Full details of the process is documented in Appendix C of the AR-DRG Version 8.0 and Version 9.0 Definitions Manuals.
The DCL/ECCS Calculator
The DCL/ECCS Calculator is a user friendly web application to assist end users in understanding the
process of finding a DCL for each diagnosis and then the computation of the ECCS for an individual
acute admitted episode of care.
Note that the application is not a grouper. That is, the data items used in the grouping process for
assignment to an ADRG (such as intervention codes and length of stay) are not accounted for in the
DCL/ECCS Calculator. Additionally, as the principal diagnosis (PDx) code is now considered in the
complexity calculation, it is essential that the PDx code used is appropriate for the selected ADRG.
For further information, please refer to the AR-DRG Version 8.0 and Version 9.0 Definitions Manuals.
Episode with one code
Episode with a Duplicate code
Episode with Excluding code
- Enter the AR-DRG version for which DCL/ECCS are to be calculated. Either AR-DRG Version 9.0 (ICD-10-AM Tenth edition codes) or AR-DRG Version 8.0 (ICD-10-AM Ninth edition codes).
- Enter the ADRG into the box, or select from the dropdown list. The ADRG description will display next to the box.
- Enter the ICD-10-AM Ninth or Tenth Edition code for the PDx, or select from the dropdown list (ensure the PDx code is appropriate for the selected ADRG. Enter the alphanumeric characters and the dot in the code). The ICD-10-AM Ninth or Tenth Edition code and code description will populate in the Patient Episode table and display the DCL value.
- Enter any additional diagnosis codes as above. The calculator will compute the ECCS as each code is added.
- Duplicated codes will be indicated by a 1 under the Duplicate heading in the Patient Episode box.
- Dagger codes that are conditionally excluded will have the Excluding Code (asterisk) displayed in the respective column.
- Codes can be removed by clicking the Delete link in the Patient Episode table.
- The AR‐DRG Version 8.0 or Version 9.0 DCL/ECCS Calculation Results can be printed by clicking on the printer icon.
- When you have finished entering and calculating, you can click the Create New Episode button to begin calculating a new patient episode.
Please direct enquiries regarding the use of the DCL/ECCS Calculator to firstname.lastname@example.org.