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The short answer is that the description of return code 9 that you are getting is out of date.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).