Diagnosis Complexity Level (DCL) and the Episode Clinical Complexity Score (ECCS)
AR-DRG Version 8.0 is based on a new measure of episode clinical complexity - 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. Each diagnosis is assigned a DCL value found in a matrix that has 406 ADRGs as columns and all valid diagnoses codes (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:
a. if a diagnosis code is a duplicate
b. if a diagnosis is invalid for ICD-10-AM Ninth Edition
c. 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 are documented in Appendix C of the AR-DRG Version 8.0 Definitions Manual.
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 Definitions Manual.
Episode with one code
Episode with a Duplicate code
Episode with an Invalid code
Episode with Excluding code
1. Enter the ADRG into the box, or select from the dropdown list. The ADRG description will display next to the box.
2. Enter the ICD-10-AM Ninth 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 only (i.e. omit the dot in the code). The ICD-10-AM Ninth Edition code and code description will populate in the Patient Episode table and display the DCL value.
3. Enter any additional diagnosis codes as above. The calculator will compute the ECCS as each code is added.
4. Duplicated codes will be indicated by a 1 under the Duplicate heading in the Patient Episode box.
5. Dagger codes that are conditionally excluded will have the Excluding Code (asterisk) displayed in the respective column.
6. If a code is not a valid ICD-10-AM Ninth Edition code the words “** Invalid ICD-10-AM Ninth edition code **” will appear in the description column.
7. Codes can be removed by clicking the Delete link in the Patient Episode table.
8. The AR‐DRG V8.0 DCL/ECCS Calculation Results can be printed by clicking on the printer icon.
9. 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.