DRGs and ABF For Coders - Health Information Management ...

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Key Abbreviations • NEP National Efficient Price • NWAU National Weighted Activity Unit • OR Operating Room • PCCL Patient Clinical Complexity Level Clinical Coding Services Pty Ltd
DRG Assignment Data items used by Grouper include: • ICD-10-AM diagnosis codes • ACHI procedure codes • Sex • Age • Separation mode • Length of stay • Same day status • Admission weight for infants • Mental health legal status • Hours on mechanical ventilation • Leave days Clinical Coding Services Pty Ltd
Page 1 and 2: October 2012
Page 3 and 4: What is …. • DRG = Diagnosis Re
Page 5 and 6: History of Casemix 1970’s DRGs fi
Page 7 and 8: Grouper Versions • AN-DRG • Aus
Page 9 and 10: AR-DRG v6.x • For example: • E6
Page 11: Key Abbreviations • DRG Diagnosis
Page 15 and 16: 1. Editing (demographic and clinica
Page 17 and 18: Example • Age Y : 45 | Sex : F
Page 19 and 20: 2. MDC Assignment • The first Alp
Page 21 and 22: 3. Pre MDC Processing b) Changes MD
Page 23 and 24: Example • MDC: 01 Nervous System
Page 25 and 26: 4. MDC Processing • The partition
Page 27 and 28: 5. Adjacent DRG Assignment • Adja
Page 29 and 30: Example • MDC: 06 Digestive Syste
Page 33 and 34: Clinical Coding Services Pty Ltd
Page 35 and 36: 6. CCL/PCCL Assignment • CCL valu
Page 37 and 38: CCL Values • 0 = not a CC; code f
Page 41 and 42: 6. CCL/PCCL Assignment • Once CCL
Page 43 and 44: PCCL Calculation Clinical Coding Se
Page 45 and 46: Example Clinical Coding Services Pt
Page 51 and 52: 7. DRG Assignment • ‘splits’
Page 53 and 54: To Summarise: Documentation + Codin
Page 55 and 56: Choices….. • B70A • Stroke an
Page 57 and 58: Exercise 2 • 40 y.o. male, femora
Page 59 and 60: Answers 2 • 40 y.o. male, femoral
Page 61 and 62: Choices…. • F72B Unstable Angin
Page 63 and 64:
STRETCH!!! Clinical Coding Services
Page 65 and 66:
Example • G01B Rectal resection w
Page 67 and 68:
NWAU Development • Costs for a ra
Page 69 and 70:
NWAU Assignment Process • 13 vari
Page 71 and 72:
NWAU Assignment Summary 1. Calculat
Page 73 and 74:
Example • G60B Digestive malignan
Page 75 and 76:
2. Apply Adjustments • Paediatric
Page 77 and 78:
2. Apply Adjustments • Indigenous
Page 79 and 80:
Clinical Coding Services Pty Ltd
Page 81 and 82:
Page 83 and 84:
Page 85 and 86:
Private Patient Accommodation Adjus
Page 87 and 88:
3. Identify Episodes In-scope For A
Page 89 and 90:
Page 91 and 92:
Page 93 and 94:
STRETCH!!! Clinical Coding Services
Page 95 and 96:
Coding - Casemix/ABF • Coders sho
Page 97 and 98:
Coding check - Answer 1 • ADx - J
Page 99 and 100:
Coding check - Answer 2 • Require
Page 101 and 102:
Coding check - Answer 3 > PDx - O80
Page 103 and 104:
Coding check - Answer 4 > ADx - N18
Page 105 and 106:
Activity Targets • Hospital activ
Page 107 and 108:
Code of Ethics for Clinical Coders
Page 109 and 110:
Are You ABF Ready? • Do you have
Page 111:
Andrea Groom 0418 129 543 andreagro
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