V34 Initial Implmentation Is Done

We have a DRG Assignment Engine (DAE) which supports v34, the version which was released three days ago. Last night we completed our initial implementation (Linux) and validated it with DRGFilt10 on the CMS data set in fixed-width mode, in CSV mode and in CGI mode.

Now we are hard at work creating versions of our products based on this DAE. We expect to have them for sale by the end of today (3-Oct-2016) or sometime tomorrow at the latest, barred any technical difficulties.

While we code off of the CMS pseudo-code logic definition, we validate against their data set. We are a bit perturbed about having to deviate from the logic version in the following ways in order to correctly group their data set:

• relax the Invalid Sex check for MDC 25 and MDC 8
• assume a Principal Dx is invalid if there is no MDC and no Dx category

However, since we can group their data set correctly, we are moving on with our process. If you have an interesting test cases which address the above topics, or any comments on them, please submit them below.

APR or MS DRGs?

QUESTION

what version of DRGs are being used in your batch filter program APR or MS ?

ANSWER

We support only the US Federal DRG assignment algorithm. This algorithm is also called the "MS DRGs" (Medicare & Medicaid Services) and the "CMS DRGs" (Center for Medicare and Medicaid Services).

We used to support New York state DRGs and a few others, but we got out of that business a while ago.

APR (All Payor, Refined) DRGs are a 3M thing and you find more information on their web site:

http://solutions.3m.com/wps/portal/3M/en_US/3M_Health_Information_Systems/HIS/Products/APRDRG_Software/

ICD10 Transition?

QUESTION

How are you handling the transition to ICD10, especially the years that both ICD9 and ICD10 are supported?

ANSWER

The prototype ICD10 grouper we built was x28 -- FY2011 ICD-10 codes and grouper logic equivalent to f28. The FY2012 ICD-10-PCS (procedure) codes are published, and the FY2012 ICD-9 MS-DRG grouper (f29) will be available in early October 2011, but the FY2012 ICD-10-CM diagnoses are not going to be released by NCHS until December 2011. Hence, no FY2012 ICD-10 MS-DRG grouper (x29) can be produced before January 2012.

The plan is that starting FY2013, there will be no changes to ICD-9 and the FY2013 ICD-10 codes will be available on or before October 1, 2012, so f30 will be the same as f29 and x30 will be available for the start of FY2013. For testing purposes, users coding in ICD-10 will have to code in the FY2011 ICD-10 and use the x28 grouper until January 2012.

Where Is DRG Algorithm?

QUESTION

On your page at http://www.drggroupers.com/drgs.html you mention that the CMS DRG grouping algorithm is public.  I assume the same is true for the APC grouping algorithm.  How can one find or purchase a description of the algorithm (human readable)?

ANSWER

The CMS DRG grouping algorithm is available from 3M. We don't deal with APC DRGs, so we cannot help you there.