Tuesday, December 5, 2017

How Indicate Exemption When Calling Our Software

QUESTION
Please, can you tell me which are the valid values for variable “Exempt” for version 34? I was not able to find anything in the grouper documentation.
 
ANSWER

When the Hospital Acquired Condition (HAC) rules were introduced, some organizations were exempt from them. This meant that our APIs to our DRG Assignment Engine (DAE) had to expanded to accommodate this concept.

As laid out in this post here, there are three different levels of exempt:
  1.  Organization (batch) level: put the exempt flag in the version and all the records will be assumed to be exempt.
  2. Record level: put the exempt flag in the record sent to the DAE and that particular record will be exempt.
  3. Diagnosis level: make the PoA flag for a given Dx code the "exempt" value and that particular Dx code will be exempt.
To send the exempt flag at the batch level, append a lowercase 'e' to the version number, eg '33e'.

To send the record level flag to any API which allows it, pass Exempt flag parameter as nothing (not exempt) or as X. To send the record level flag to DRGFilt, set the "exmp" flag to either X or 1.

To send the exempt flag at the code level, check out this post here.

Monday, December 4, 2017

DRG Return Code of 9

QUESTION

I have a doubt with the return code “9”, whose description in the manual says “means that the DRG to be labelled is too high for the specified DRG version or that there was a HAC violation”, while in the web grouper the description is “ERROR: Grouper error 9 (DRG number too high)”. I don’t know exactly how to understand this description. I made some tests and found that sometimes the problem is with the POA not informed, but this is not always the explanation. I’m working with version 34.


ANSWER

The short answer is that the description of return code 9 that you are getting is out of date. Starting with our support of ICD10 (v33), the description should be the one you see below:

    "Bad principal diagnosis.",         /* 1 */
    "Bad prin dx for MDC ....",         /* 2 */
    "Invalid age ............",         /* 3 */
    "Invalid sex ............",         /* 4 */
    "Invalid discharge status",         /* 5 */
    "Unspecified DRG error...",         /* 6 */
    "Invalid prin diagnosis..",         /* 7 */
    "No DRG file this version",         /* 8 */
    "HAC POA invalid.........",         /* 9 */
    "DRG number too high.....",         /* 10 */
    "Error in DRG file ......"          /* 11 */


HAC stands for Hospital-Acquired Condition and POA stands for Present on Admission. So an RC of 9 means that you wanted HAC processing (ie you did not specify that the organization is "exempt") but there was something wrong with the POA flag (either missing or an illegal value or was presented in a way which our DRG Assignment Engine could not parse).