Diagnosis Related Groups (DRG’s) are the basis for hospital reimbursement from Medicare, certain state Medicaid plans, and some non-government payers. The 504 DRG (Extensive Burns with Skin Grafts) is commonly used by burn center hospitals for reimbursement when patients have burns involving >20% total body surface area (TBSA) and full-thickness (3rd degree) burns involving >10% TBSA. Unlike the other DRG’s for burn injury, which take into account the presence of inhalation injury, this DRG does not do so. The hypothesis of this study is that patients with extensive burns requiring skin grafts have greater hospital resource consumption when there is an associated inhalation injury and that this results in inadequate hospital reimbursement for patients with this condition and co-morbid diagnosis.

We would therefore like to perform a chart review of all patients admitted to The University Hospital from January 2000 through December 2002 who were assigned DRG 504 to examine the differences in the clinical diagnoses, treatment, and outcome of those patients with and without burn injuries. Our hypothesis is that DRG 504 does not adequately reflect the extensive resource utilization for patients with smoke inhalation injury who are more likely to require prolonged ventilatory support and ICU care.