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Using ICD-10-AM, ACHI, ACS
Casemix and Diagnosis Related Group (DRG) Allocation – AR-DRG v6.0
DRG codes are calculated by the Ministry of Health. They are not reported to the National Minimum Data Set (NMDS) by hospitals. The current DRG grouper is AR-DRG version 6.0, which uses up to 30 diagnoses and up to 30 procedures in its calculations. External cause codes are not used by the grouper. It is recommended that hospitals prioritise diagnoses and procedure codes within the current Sixth Edition coding standards and guidelines in order to present the grouper with the most serious diagnoses and procedures.
The Ministry of Health groups all events with an event end date on or after 1 July 2011 to AR-DRG v6.0.
AR-DRG v6.0 accepts ICD-10-AM Sixth Edition codes; therefore no back mapping is involved in the grouping process as occurred in the previous years.
For further information about DRGs and Casemix rules refer to the New Zealand Casemix Framework for Publicly Funded Hospitals document available on http://www.nzhis.govt.nz/moh.nsf/pagesns/300
Clinical coders are reminded that it is unacceptable to manipulate the Australian Coding Standards (ACS) and/or code assignment when trying to problem-solve an error DRG. Consultation with the Ministry of Health is important in order to maintain the integrity, consistency and accuracy of the data collection.
Below are the three Unrelated DRGs and the three Error DRGs from AR-DRG v6.0:
Unrelated DRGs
- 801A OR Procedures Unrelated to Principal Diagnosis with Catastrophic CC
- 801B OR Procedures Unrelated to Principal Diagnosis with Severe or Moderate CC
- 801C OR Procedures Unrelated to Principal Diagnosis without CC
Error DRGs
- 960Z Ungroupable
- 961Z Unacceptable Principal Diagnosis
- 963Z Neonatal Diagnosis Not Consistent W Age/Weight
If you have a case that has grouped to one of the six Unrelated/Error DRGs and you think the error may reflect a problem in the grouper logic, please contact the Senior Analyst – Classification and Terminology at the Ministry of Health via email: coding_helpdesk@moh.govt.nz
Listed below are the known cases grouping to one of the three Unrelated DRGs in AR-DRG version 6.0.
1. Endometriosis of bladder with resection
The assignment of diagnosis code N80.8 Other endometriosis for endometriosis of the bladder with any of the procedure codes from block [1100] Endoscopic resection of bladder lesion or tissue group to an unrelated DRGs 801*.There may be other cases where endometriosis of another specified site has been diagnosed and a procedure has been performed eg, biopsy, that group to the unrelated DRG 801*.
2. Injury brachial artery with repair
The assignment of a diagnosis code for injury of brachial artery S451 Injury of brachial artery with the procedure 3381801 [709] Repair of brachial artery by direct anastomosis group to an unrelated DRG 801*.For information on the cases grouping to one of the error DRGs in AR-DRG v5.0, see link:
Casemix and Diagnosis Related Group (DRG) Allocation – AR-DRG v5.0 (Word, 73 KB)
Page last updated 28 September 2011
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