DRG 272: does it provide adequate burn center reimbursement for the care of patients with Stevens-Johnson syndrome and toxic epidermal necrolysis?

Patients with Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TENS) often are referred to burn centers for wound and intensive care management. Unless they undergo a surgical procedure, patients with this diagnosis are assigned to DRG 272 to determine hospital reimbursement. In 2002, this DRG had an average length of stay of 5.2 days and an average national Medicare reimbursement of $4,416. The purpose of this study was to compare demographics, resource utilization, and hospital charges and reimbursement for all patients assigned to this DRG and to evaluate the effect of the extent of surface area involvement on resource utilization, hospital costs, and reimbursement. We reviewed the records of all patients admitted to our burn centers who were assigned to DRG 272 from January 1998 through December 2002. Patients with dermatologic diagnoses assigned to this DRG were compared with patients with SJS and TENS from our institutions and the American Burn Association National Burn Repository for calendar years 2000 and 2001. Patients assigned to DRG 272 with TENS involving >or=20% TBSA had significantly greater mortality, ventilator days, intensive care unit days, and length of hospital stay than patients with dermatologic conditions or SJS who were assigned to this DRG. In addition, patients with TENS had significantly greater hospital charges and costs than patients with dermatologic diagnoses and SJS. This study supports the need for a reassessment of the adequacy of DRG 272 for the reimbursement of burn center hospitals caring for patients with TENS. This would likely require modification of the current ICD-9-CM diagnosis codes to better quantify the extent of cutaneous involvement and the frequently associated comorbid conditions that accompany the cutaneous manifestations.