The DRG segment contains diagnoses-related grouping information of various types. The DRG segment is used to send the DRG information, for example, for billing and medical records encoding.
Figure 6-3. DRG attributes
SEQ |
LEN |
DT |
OPT |
RP/# |
TBL# |
ITEM# |
ELEMENT NAME |
1 |
60 |
CE |
O |
0055 |
00382 |
Diagnostic Related Group |
|
2 |
26 |
TS |
O |
00769 |
DRG Assigned Date/Time |
||
3 |
2 |
ID |
O |
0136 |
00383 |
DRG Approval Indicator |
|
4 |
2 |
IS |
O |
0056 |
00384 |
DRG Grouper Review Code |
|
5 |
60 |
CE |
O |
0083 |
00385 |
Outlier Type |
|
6 |
3 |
NM |
O |
00386 |
Outlier Days |
||
7 |
12 |
CP |
O |
00387 |
Outlier Cost |
||
8 |
1 |
IS |
O |
0229 |
00770 |
DRG Payor |
|
9 |
9 |
CP |
O |
00771 |
Outlier Reimbursement |
||
10 |
1 |
ID |
O |
0136 |
00767 |
Confidential Indicator |
6.4.3.0 DRG field definitions
Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (ST)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (ST)>
Definition: This field contains the DRG for the transaction. Interim DRGs could be determined for an encounter. For the identifier component, refer to user-defined table 0055- DRG code for suggested values. For the name of coding system component, send the grouper version and type.
Definition: This field contains the time stamp to indicate the date and time that the DRG was assigned.
Definition: This field indicates if the DRG has been approved by a reviewing entity. Refer to HL7 table 0136 - Yes/no indicator for valid values.
Definition: Refer to user-defined table 0056 - DRG grouper review code for suggested values. This code indicates that the grouper results have been reviewed and approved.
Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (ST)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (ST)>
Definition: Refer to user-defined table 0083 - Outlier type for suggested values. Refers to the type of outlier that has been paid.
User-defined Table 0083 - Outlier type
Values |
Description |
D |
outlier days |
C |
outlier cost |
Definition: This field contains the number of days that have been approved as an outlier payment.
Components: <price (MO)> ^ <price type (ID)> ^ <from value (NM)> ^ <to value (NM)> ^ <range units (CE)> ^ <range type (ID)>
Definition: This field contains the amount of money that has been approved for an outlier payment.
Definition: This field indicates the associated DRG Payor. Refer to user-defined table 0229 - DRG payor for suggested values.
User-defined Table 0229 - DRG Payor
Value |
Description |
M |
Medicare |
C |
Champus |
G |
Managed Care Organization |
Components: <price (MO)> ^ <price type (ID)> ^ <from value (NM)> ^ <to value (NM)> ^ <range units (CE)> ^ <range type (ID)>
Definition: Where applicable, the outlier reimbursement amount indicates the part of the total reimbursement designated for reimbursement of outlier conditions (day or cost).
Definition: This field indicates if the DRG contains a confidential diagnosis. Refer to HL7 table 0136 - Yes/no indicator for valid values.
Y the DRG contains a confidential diagnosis
N the DRG does not contain a confidential diagnosis