ICD10 Readiness

QUESTION

As a business partner, we are contacting you to establish what your
current ICD-10 readiness posture is and if your organization has a
comprehensive action plan designed to assure that your systems and data
will be able to accurately transact both ICD-9 and ICD-10 codes.

ANSWER

We are well on our way to full ICD10 support; we expect to maintain backward compatibility for ICD9. For details, see the "ICD10-Based DRG Prototype" link at the top of this page.

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/

How Many DX Codes?

QUESTION

Your documentation states that the groupers currently only utilize up to nine diagnosis codes. Are you planning on increasing that number to 25 in conjunction with the recent changes CMS has implemented?

ANSWER

Our ICD9-based DRG Assignment Engine supports up to 15 diagnosis codes. Our ICD10 prototype currently supports 30 diagnosis codes, but we only commit to supporting the expected 25.

Annual Release Dates

QUESTION

I just wanted to get a status update on the release date of the new grouper for this year and get on the list to obtain it as soon as possible.

ANSWER

Our products track with the US Federal (CMS) versions. They release on or about October 1st every year. We try to release as close to October 1st as we can. We usually release within five business days of October 1st. On rare occasion, we are later or earlier.

We cannot guarantee a release date as the CMS releases vary greatly in size and complexity.

We are aware that many of our customers need the release to be as close to October 1st as possible, so we are working hard this year to make sure that this happens, even as ICD10 looms over us.

Codes Used in DRG Assignment?

QUESTION

Hi Tech Support,

The PDF is very informative but it appears to be missing explanation of a couple of the output codes. I get ten bits of info but only first eight appear to be documented in the grouper's documentation PDF ("UNIX Embeddable Grouper API": pages 31-32). Those are .......

1. Grouper return code
2. Major Diagnostic category of assigned DRG
3. DRG assigned to patient encounter
4. DRG version number used to assign DRG
5. The weight of the DRG
6. Geometric mean length of stay for DRG
7. PorM flag
8. DRG description

The string I had returned to me by the grouper was....
0^1^57^28^0.9350^0.00^ ^DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC ^1^0

It's the last two fields of "1" and "0" that appear to be undocumented.

The last question I have is regarding the significance of diagnosis codes. When feeding a list of diagnosis codes into the grouper, is there a way to determine which of the diagnosis codes were significant in the grouper's decision making? I ran across something like that on page 22 (section labeled "Output") of the PDF that you folks package with the grouper.

Thanks so much for all of your assistance.

ANSWER

The lack of documentation for these fields is definitely an oversight, thank you for pointing this out. We will include these fields in the updated manual when we release it this coming October.

Those two fields are ASCII-ified bit strings of which codes were used in the DRG assignment. The first field is a string of diagnosis bits and the second string is a string of procedure bits. The strings consist of either an ASCII '1' or an ASCII '0'. A one means "this code was used" and a zero means "this code was not used."

The strings are positional: 1001 means that the first code was used, codes two and three were not but code four was.

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.

CGI Demo Version

QUESTION

I am interested in your product CGI-DRG (f24) for Windows, but your demo does not work. Can I get a trial version before buying?
Thanks.

ANSWER

We find that keeping a CGI script working on an ISP's host is a constant struggle. We should probably give up. We are happy to send you an F10 CGI-DRG for you to try; just remember to tell us whether you are running under Windows or Unix.