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ICD-9-CMDRG

? ?. ICD-9-CM?????????????????????????????????????????. DRG??DRGs???????DRG??????????????????VS??????. ??????. ???????. ?????????????????????????????????????????????????????????,????????????????????????????????????????????. ???????. ???????????????????,?????????????????????????

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ICD-9-CMDRG

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    1. ICD-9-CM???DRG?? ???? ???? ????? ??? ??? ?????????2006-11-09 & 16

    2. ? ? ICD-9-CM?? ?????????? ?????? ?????? ????????? ???????? DRG?? DRGs??????? DRG??? ?????????? ?????VS???? ??

    3. ??????

    4. ??????? ????????????????????? ????????????????????????????????????,??????????????????? ?????????????????????????

    5. ??????? ???????????????????,????????????????????? ?????????? ?????????????????? ??????????????????? ????????????

    6. ????????-1 1891~1893?,????????????Bertillon?????????????,??????????? 1900?—ICD-1; 1909?—ICD-2 1920?—ICD-3; 1929?—ICD-4 1938?—ICD-5; 1948?—ICD-6 1955?—ICD-7; 1965?—ICD-8 1975?—ICD-9

    7. ????????-2 1946??WHO????,??????(Morbidity? Mortality)????????? 1948?????????????????????;?????????????ICD??????? 1968?????????WHO (1965??) ICD-8??ICD-A,??????????????????? 1977?,WHO??????ICD-9????1979???ICD-9-CM?

    8. ????????-3 1989?,??Medicare??????????ICD-9-CM??????? 1992?,????????ICD-9-CM????????? 1998?,???????????????ICD-9-CM??????????? 1993?,ICD-10 ????,??????????

    9. ??????-I ICD-9-CM (International Classification of Diseases, 9 th Revision Clinical Modification ????????????? Volumes I ???????? Volumes II ???????? Volumes III ?????????????

    10. ??????-II ICD-10 (International Statistical Classification of Diseases and Related Health Problem ??????????????? ?????? ?????? ??? ??? ??????? ??????(ICPM) ????????????(ICIDH) ?????????? ??????(IND) ??????? ????:??????

    11. ICD-10??????

    12. ??????-I Volumes I:Tabular List of Diseases and Injuries ????????? ?????? (001~999),???????????????????? ???? ????V-Code (V01~V82) ??????E-Code (E800~E999) ?? (???)

    13. Volumes I ?? Appendix A:???????? Appendix B:?????????? Appendix C:?????????????ICD-9-CM??????????? Appendix D:????????????????

    14. ???????-I ??? Category number:???(001~999) ,?:Normal delivery 650 ???? Subcategory number:???????,?????????????,?xxx.0~xxx.9???????:Acute appendicitis 540.9 ????:???????,????????:Diabetes mellitus 250.00

    16. ??????-1 M-Code????????,?????M8000/0~M9970/1 ?????(??M)???????????,????(“/”????)???????????????: /0:Benign?? /1:Uncertain behavior benign or malignant ?????????? Borderline malignancy ????

    17. ??????-2 /2:Carcinoma in situ;Noninvasive ????????? /3:Malignant;primary ?????? /6:Malignant;metastatic site secondary ??????? /9:Unspecified ??????????? ?????

    19. ??????-II Volumes II:Alphabetic Index of Diseases ?????? ?????????(?A to Z ????) ??? (Hypertension) ?? (Neoplasm) ?????????? ?????????? ??:?Index?????????????????????,???????????

    21. ??????-III Volumes III:Tabular List and Alphabetic Index of Procedures ??????????????? ???????????? (01~86) ????????????? (87~99)

    22. ?????????-II ??? Category number:???(01~99) ???? Subcategory number:???????,?: Tracheostomy 31.1 ????:???????,????????: Myomectomy 68.29

    24. ?????????-I ?????????? (American Health information Management Association; AHIMA) ???????(Registered Health Information Administrator;RHIA) ???????(Registered Health Information Technician;RHIT) ??????(Certified Coding Specialist;CCS) ????????(Certified Coding Specialist-Physician-based;CCS-P)

    25. ?????????-II ????????(??????) ???????????? ????????? ???????? ????1:100

    26.

    27. ????????? ???????

    28. ???????-1 Uniformed Hospital Discharge Data Set; UHDDS The condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care. ?????????????????????????:???????????????????????

    29. ???????-2 ????(Principal Diagnosis) ????,??????????????????(????????????????????????????????)   ????(Principal procedure) ????????????,?????????,???????????????????? 

    30. ???????? ??????????????????? Ex:????: Diabetes mellitus, juvenile type CAD Myocardial infarction, acute (anterior wall) ????: Possible myocardial infarction ???????????? Myocardial infarction

    31. ????780~799????(symptoms)???(signs)??????????,??????????????,??????????? Ex:Hematemesis due to acute gastritis ????”Acute gastritis”,Hematemesis ??????,?????????

    32. ???Volumes I?????????????????????????? Ex:Acute myocarditis due to tuberculosis “Acute myocarditis” (422.0) ????, ????”tuberculosis” (017.9x) ??????,?422.0??????017.9x???

    33. ??????,????????,??????,??????????,??????????....... Ex 1:Acute on chronic renal failure ? Acute renal failure 584.9?????, Chronic renal failure 585?????? Ex 2:Chronic B type hepatitis with acute exacerbation 070.32

    34. Failure Renal Acute 584.9 Chronic 585 Hepatitis Viral Type B (acute) 070.30 Chronic 070.32

    35. ??????????????(multiple injuries) ??????,???????????? Ex:Multiple contusions & abrasion wound Brain concussion with loss of consciousness for 2 hours Diabetes mellitus,adult-onset type ?”Brain concussion”???????, ???????

    36. ??????????????????,?????????,??????????? Ex:Bladder neck stricture s/p V-Y plasty of bladder Bladder neck diverticulum s/p diverticulectomy of bladder ??Bladder neck stricture????, ??????

    37. ????????????,???????? ???,?????(960-979)?????, ????????????? Ex:severe diarrhea due to Diupres taken in error ????974.3?????, ”severe diarrhea”?????,????? ????? E-code? PS:?????:???+???+E-code

    38. ????????????????????? ???,???????????? Ex:Eruption of drug due to Codeine ?” Eruption of drug ”?????,???? ??????????????? PS:????:???+E-code (??????)

    39. ???????????????????? ???????????,?????? ???????? Ex:Wound dehiscence s/p appendectomy 3 day ago?998.3????? ??E-code & M-code??????, ???????

    40. ???????? ????????????????? Ex:????:Uterine leiomyoma ??:D & C Total abdominal hysterectomy ?”Total abdominal hysterectomy”?????,”D & C”?????????

    41. ???????????????????????,?????????????,?????????????????? Ex:????:Chronic pyelonephritis ????:Recurrent inguinal hernia,direct ??:Retrograde pyelogram Right inguinal herniorrhaphy ???”inguinal hernia”???, “ herniorrhaphy”??????

    42. ??????????????????????,???????????(class I-->class II-->class III-->class IV)?????? Ex:????:Chronic renal failure ??:Peritoneal dialysis(class II) Renal dialysis(class I) ???class I??renal dialysis??????

    43. ?????????????????????????????????????,????????: Class I:?????????,??????? ???????????? Class II:????????????? Class III:???????? Class IV:???????????????? ??????:class I >class II >class III >class IV

    44. Correct ICD-9-CM coding is essential to correct DRG assignment.

    45. DRG ?? ICD-9 CM 2001 ?????? ?? ?? ??

    46. ICD-9-CM???DRG?? DRG???????????????? ?????????ICD-9-CM 2001???? ??????(comorbidity)???? (complications)??????????????????????????? ICD-9-CM ????? ??????-????????? ??IRP-??????????? ICD-9-CM??????? ????????(???) ???????(???) ????????(???)

    47. DRGs?????

    48. ????????? American Hospital Association (AHA) American Health Information Management Association (AHIMA ) Center for Medicare and Medicaid Services (CMS) National Center for Health Statistics (NCHS)

    49. ???????????? ??????????????? ???????????????,??????????????,????? ???????????????????????????

    50. ?????-1 (Diagnosis Related Groups, DRGs) ????????????? (Utilization Review) ??????(Case Mix) ?? ???????????????,??????????????? ??????????????????????????????? (one DRG, one price)

    51. ?????-1 (Diagnosis Related Groups, DRGs) ??????????????DRG? ???? ????????? (Comorbidity & Complication) ???? --?????? ?? ?? ???? --???? ????????(Relative Weight),?????????,??????????????????

    52. ICD-A DRGs????? ????: N.J.118????50????????,??Yale-New Haven???PSRO???

    53. Base on ICD-9-CM?DRGs????? ????: 1979??332???????????140??,???????39???????

    55. DRGs??

    56. Definitions Manual The DRGs were therefore developed as a patient classification scheme consisting of classed of patients who were similar clinically and in terms of their consumption of hospital resources.

    57. Pre-MDC Heart, Liver, bone marrow, lung transplants are very resource intensive and can be performed for diagnoses in many different MDCs. Tracheostomies are performed primarily for patients on long term ventilator support and therefore such patients are very resource intensive.

    58. Pre-MDC Transplantation Heart ( DRG10301~10302 ) Liver ( DRG48001~48002 ) Lung ( DRG49501~49502 ) Bone marrow ( DRG48101~48102 ) ??? Kidney transplant Tracheostomy (DRG 48201~48302)

    59. Formation of the DRG-1 The process of forming the DRGs was begun by dividing all possible principal diagnoses into 23 mutually exclusive principal diagnosis areas referred to as Major Diagnostic Categories(MDCs). Two new MDCs (24&25)were created in the eighth version of the DRGs. (HCFA-8,1991)

    60. Formation of the DRG-2 Principal diagnosis linked to anatomical system (MDCs). Patient’s surgical status Principal diagnosis (nonsurgical DRG) or Extent of surgical procedure (surgical DRG) Comorbidities/Complications, Age, Discharge status

    61. Complications & Comorbidities;CC-1 A complications is a condition which did not exist prior to the admission A comorbidities is a condition which existed prior to the admission A significant complications or comorbidities (CC) is a secondary diagnosis which would be expected to extend the patient’s length of stay by at least one day in at least 75 percent of patient’s.

    62. Complications & Comorbidities;CC-2 ???(Comorbidity)(???) ????????,??????????,????????????????? Ex: Fracture of femur, DM ???(Complication) ????????????,????????????????? Ex:S/P Appendectomy, Wound infection

    63. DRGs???? ????????(DRG 468?469?470) 468 ???????????????? Extensive O.R. Procedure Unrelated to Principal Diagnosis 469 ??????????????? Principal Diagnosis Invalid as Discharge Diagnosis 470 ??????? Ungroupable

    64. DRG???? ???? ????????? ????????? ????????? ??--????2005-3-?6?1?

    68. ??????? ?CMS-DRG????? 25 MDCs?511 DRGs 498 (499) ?DRGs--- ?????????-DRG 351?362?437(436) ????DRG-DRG3(512)?57(513)?400(514) ?91?4??????(91.4.25) ?????????(????)

    69. ???????-1 ?CMS-DRG????? DRG?????--- ???????CV?(>100)?DRG????,?MDC??????24???????,????498???962? ?????CC?? ??CC???????,????962???1264? ?????1???????,??976?DRG

    70. ???????-2 ?????????--- ?Principal Diagnosis ?OR procedure ?CC (Comorbidity & Complication) ?Age ????DRG?????,?DRG10401~10408 ?? ??????????DRG?? ??????????????????,????? ??,?????????“0”?,????????????

    71. DRG????? ???DRG???499 ???DRG???976 ???DRG???969

    74. DRG????? ???DRG?????:DRG001 ???DRG??????:DRG00101~00102?MDC15???????????????????DRG????N??,N01~N19? ???DRG:??????AIDS????????????????? ??MDC19?????????? MDC20??????????????????

    75. ??????

    77. DRGs ???? Major Diagnosis Category; MDC Comorbidity & Complication; CC Relative Weight; RW Case Mix Index; CMI Hospital Base Rate; BR

    78. ?????? (Major Diagnostic Category,MDC) MDC:??MDC01?MDC25??Pre-MDC??26? Pre-MDC?????????????????? MDC24??????????? MDC25??????????????)(?????) ??????????????????????MDC1~MDC23 (??MDC19?20)

    79. ???? (Relative Weight) ??

    81. ?????? (Case-Mix Index) ??

    82. ????-1

    83. Base Rate ???????????????? ??

    84.

    85. ????? ? ??????

    86. ????? Case Payment 1995.7-????????? 1997.10-?????22? (??????????????????) ????????? 1999.3-???????AP-DRGs?29? CC & MCC ????46?;??7?

    87. ?????????? ???? (Principal Diagnosis) ???? (Principal Procedure) ???? DRG???(0359A~0359F) ?? (Age) ????? (Major Diagnosis Categories) ??????? (Comorbidity & Complication) ????????? (Major CC)

    90. ????? AP-DRG ????? ??????? ?????,outlier ????????????????? ???????????????????????? ??????? ?????? CMS-DRG All in-patient ??????(Case mix)??? ???CC?? 1)??????????,???? 2)???????????: (??) RW*(SPR*25%+HBR*75%) (1+??????*25%+????) (1+????????) 3)??????????: ??+????*0.8 ??????(?)

    94. ?????????-???????

    95. Tw-DRG???? ????????? “??”?????????,?”??”??,???????????????????,?????????????,???????????????? ????????SARS???? ?????????????RW,?????? ??????????,?????,????DRG???????,????? ??????????????

    96. DRG?????? DRG???? ???????? ????? ??????????? DRG????? ??????????????? ???/?????????????? DRG?? ??????????

    97. ????????????

    98. ??DRG????? ???????? ?????,?????? ??????????? ?????????? ????(???)?????????? ????????? ???????????? ????????? ???????????? ????????

    99. ??DRG????? ????:????,???????,???? ????:???????,????,???? ????:up coding,??miss coding,?????,???????? ??????,???? ??????????????????? ??????,??????,??????? ????? ???????,??????

    100. ?????? ????????????????? ???????????????? ?????????????? ???????????????? ??? ???????????(????)

    101. ?????? ?????????? ????????????????????? ????? ????????????????????? ????? ?????????? ???????????????????? ????? ???????????????? ?????“Ditto”???? ?????????????????????? ??????????

    103. ?????????

    104. ??????

    105. ?????? ????

    106. ? ? ?????:???????????? ????--??????(??=$$$$) ?????--?????????????????? (???????= $$$$) ?????????????? There is gold in your data/medical record ?????coding???,????????????? ??????????????? ??????,????????coding????grouping

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