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.