Coding for AR-DRG analysis and funding

1. Coding for AR-DRG analysis and funding Linda Best 14.00 - 14.45 Tuesday, 6th December 2011

2. What are coded data used for? Many uses, including: Casemix, diagnosis related groups (DRGs) Research National morbidity statistics Health services planning and evaluation Quality assurance activities Epidemiology

3. The building blocks • ICD-10-AM and ACHI codes are the building blocks of AR-DRGs used in many settings as health care funding mechanisms. • The principal diagnosis, additional diagnoses and interventions, as documented in the clinical record, are converted into ICD-10-AM and ACHI codes. These codes are then used in the grouping process.

4. Calculatingan AR-DRG: Data Items Required ICD-10-AM/ACHI Codes • Principal diagnosis • Additional diagnoses, such as complications and comorbidities • Procedure/s Sex Length Of Stay • Or Admission and Separation Dates Same-day Status Mode of separation (discharge status) • Includes died, transferred Newborn admission weight • For age 28 days or less, plus older if less than 2500 grams

5. If it’s not written, it didn’t happen! • The production of quality clinical data is a collaborative effort • Channels of communication between clinicians and clinical coders should be open and frequently used • Quality documentation supports quality coding which results in appropriate AR-DRG allocation

6. Good clinical documentation The most appropriate AR-DRG can only be assigned to an episode of patient care when relevant clinical information is accurately documented in the clinical record

7. Good clinical documentation cont. • Need clear and complete documentation • Important for clinical specialties to understand what information can impact on DRG assignment

8. Dementia – impact on DRG assignment Age 69 years Gender Male Diagnosis Cognitive impairment Principal diagnosis R41.8 Other and unspecified symptoms and signs involving cognitive functions and awareness MDC 23 Factors influencing health status and other contacts with health services DRG Z61A Signs and symptoms AR-DRG cost weight 0.67 ALOS 2.71 days Reimbursement $2,617

9. Dementia – impact on DRG assignment cont. Diagnosis Mild cognitive disorder Principal diagnosis F06.7 Mild cognitive disorder MDC 01 Diseases and disorders of the nervous system DRG B64B Delirium without catastrophic complication and/or comorbidity AR-DRG cost weight 1.40 ALOS 6.03 days Reimbursement $5,452

10. Dementia – impact on DRG assignment cont. Diagnosis Cognitive change due to dementia Principal diagnosis F03 Unspecified dementia MDC 01 Diseases and disorders of the nervous system DRG B63Z Dementia and other chronic disturbances of cerebral function AR-DRG cost weight 2.70 ALOS 12.82 days Reimbursement $10,562