Previous Page TOC Index Next Page

6.4.3 DRG - diagnosis related group segment

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

6.4.3.1 Diagnostic related group (CE) 00382

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 DRG’s 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.

6.4.3.2 DRG assign date/time (TS) 00769

Definition: This field contains the time stamp to indicate the date and time that the DRG was assigned.

6.4.3.3 DRG approval indicator (ID) 00383

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.

6.4.3.4 DRG grouper review code (IS) 00384

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.

6.4.3.5 Outlier type (CE) 00385

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

6.4.3.6 Outlier days (NM) 00386

Definition: This field contains the number of days that have been approved as an outlier payment.

6.4.3.7 Outlier cost (CP) 00387

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.

6.4.3.8 DRG payor (IS) 00770

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

6.4.3.9 Outlier reimbursement (CP) 00771

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).

6.4.3.10 Confidential indicator (ID) 00767

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

Previous Page TOC Index Next Page