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  1. FHIR Specification Feedback
  2. FHIR-26925

Replace CARIN BB MS-DRG Value Set with CMS DRG

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    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Highest Highest
    • US CARIN Blue Button (FHIR)
    • 0.1 [deprecated]
    • Financial Mgmt
    • (NA)
    • Terminology
    • Hide

      Delete Value Set CARINBBMSDRG

       

      Define Value Set: 

      Defining URL: Define a Value Set http://hl7.org/fhir/us/carin-bb/ValueSet/CMS3MDRG 
      Name: CMSMS3MAPAPRDRG
      Title: CMS MS 3M AP APR DRG
      Definition: This value set defines three sets of DRGs, MS-DRGs (Medicare Severity Diagnosis Related Groups) AP-DRGs (All Patient Diagnosis Related Groups) and APR-DRGs (All Patient Refined Diagnosis Related Groups).  MS-DRGs are owned by CMS; AP-DRGs and APR-DRGs are owned by 3M.  Assignment of a DRG is defined by a particular set of patient attributes, which include principal diagnosis, specific secondary diagnoses, procedures, sex and discharge status.  Identifying a DRG code requires a version. 
      Copyright: The Centers for Medicare & Medicaid Services (CMS) maintain the MS-DRGs used throughout the US health care industry.  Use of AP_DRGS and APR-DRGs requires a license.  Reference https://www.3m.com/3M/en_US/health-information-systems-us/drive-value-based-care/patient-classification-methodologies/apr-drgs/.   As HL7 is working with the owning authorities to finalize the urls, the urls are subject to change.
      Logical Definition: This value set includes codes from the following code systems:
      ·       Include all codes defined in www.cms.gov/Medicare/Coding/ms-drg/MS-DRG
      ·       Include all codes defined in www.3M.com/AP-DRG  
      ·       Include all codes defined in www.3M.com/APR-DRG  

       

      Bind with binding strength Required to the slice drg, data element supportinginfo.code, in the Inpatient Institutional Profile. 

       

      Define a Code System:     

      Defining URL: www.cms.gov/Medicare/Coding/ms-drg/MS-DRG
      Name: CMSMSDRG
      Title: CMS MS DRG
      Definition: MS-DRGs (Medicare Severity Diagnosis Related Groups).  MS-DRGs are owned by CMS.  Assignment of a DRG is defined by a particular set of patient attributes, which include principal diagnosis, specific secondary diagnoses, procedures, sex and discharge status.  Identifying a DRG code requires a version. 
      Copyright: The Centers for Medicare & Medicaid Services (CMS) maintain the MS-DRGs used throughout the US health care industry. 

      Define a Code System:  

      Defining URL: www.3M.com/AP-DRG  
      Name: THREEMAPDRG
      Title: 3M AP DRG
      Definition: AP-DRGs (All Patient Diagnosis Related Groups).  AP-DRGs are owned by 3M.  Assignment of a DRG is defined by a particular set of patient attributes, which include principal diagnosis, specific secondary diagnoses, procedures, sex and discharge status.  Identifying a DRG code requires a version. 
      Copyright: Use of AP-DRGs require a license.  Reference https://www.3m.com/3M/en_US/health-information-systems-us/drive-value-based-care/patient-classification-methodologies/apr-drgs/.   As HL7 is working with the owning authorities to finalize the urls, the urls are subject to change.

       

      Define a Code System:  

      Defining URL: www.3M.com/APR-DRG  
      Name: THREEMAPRDRG
      Title: 3M APR DRG
      Definition: APR-DRGs (All Patient Refined Diagnosis Related Groups).  APR-DRGs are owned by 3M.  Assignment of a DRG is defined by a particular set of patient attributes, which include principal diagnosis, specific secondary diagnoses, procedures, sex and discharge status.  Identifying a DRG code requires a version. 
      Copyright: Use of APR-DRGs require a license.  Reference https://www.3m.com/3M/en_US/health-information-systems-us/drive-value-based-care/patient-classification-methodologies/apr-drgs/.   As HL7 is working with the owning authorities to finalize the urls, the urls are subject to change.
      Show
      Delete Value Set CARINBBMSDRG   Define Value Set:  Defining URL: Define a Value Set http://hl7.org/fhir/us/carin-bb/ValueSet/CMS3MDRG   Name: CMSMS3MAPAPRDRG Title: CMS MS 3M AP APR DRG Definition: This value set defines three sets of DRGs, MS-DRGs (Medicare Severity Diagnosis Related Groups) AP-DRGs (All Patient Diagnosis Related Groups) and APR-DRGs (All Patient Refined Diagnosis Related Groups).  MS-DRGs are owned by CMS; AP-DRGs and APR-DRGs are owned by 3M.  Assignment of a DRG is defined by a particular set of patient attributes, which include principal diagnosis, specific secondary diagnoses, procedures, sex and discharge status.  Identifying a DRG code requires a version.  Copyright: The Centers for Medicare & Medicaid Services (CMS) maintain the MS-DRGs used throughout the US health care industry.  Use of AP_DRGS and APR-DRGs requires a license.  Reference https://www.3m.com/3M/en_US/health-information-systems-us/drive-value-based-care/patient-classification-methodologies/apr-drgs/ .   As HL7 is working with the owning authorities to finalize the urls, the urls are subject to change. Logical Definition: This value set includes codes from the following code systems: ·       Include all codes defined in www.cms.gov/Medicare/Coding/ms-drg/MS-DRG ·       Include all codes defined in www.3M.com/AP-DRG   ·       Include all codes defined in www.3M.com/APR-DRG     Bind with binding strength Required to the slice drg, data element supportinginfo.code, in the Inpatient Institutional Profile.    Define a Code System:      Defining URL: www.cms.gov/Medicare/Coding/ms-drg/MS-DRG Name: CMSMSDRG Title: CMS MS DRG Definition: MS-DRGs (Medicare Severity Diagnosis Related Groups).  MS-DRGs are owned by CMS.  Assignment of a DRG is defined by a particular set of patient attributes, which include principal diagnosis, specific secondary diagnoses, procedures, sex and discharge status.  Identifying a DRG code requires a version.  Copyright: The Centers for Medicare & Medicaid Services (CMS) maintain the MS-DRGs used throughout the US health care industry.  Define a Code System:   Defining URL: www.3M.com/AP-DRG   Name: THREEMAPDRG Title: 3M AP DRG Definition: AP-DRGs (All Patient Diagnosis Related Groups).  AP-DRGs are owned by 3M.  Assignment of a DRG is defined by a particular set of patient attributes, which include principal diagnosis, specific secondary diagnoses, procedures, sex and discharge status.  Identifying a DRG code requires a version.  Copyright: Use of AP-DRGs require a license.  Reference https://www.3m.com/3M/en_US/health-information-systems-us/drive-value-based-care/patient-classification-methodologies/apr-drgs/ .   As HL7 is working with the owning authorities to finalize the urls, the urls are subject to change.   Define a Code System:   Defining URL: www.3M.com/APR-DRG   Name: THREEMAPRDRG Title: 3M APR DRG Definition: APR-DRGs (All Patient Refined Diagnosis Related Groups).  APR-DRGs are owned by 3M.  Assignment of a DRG is defined by a particular set of patient attributes, which include principal diagnosis, specific secondary diagnoses, procedures, sex and discharge status.  Identifying a DRG code requires a version.  Copyright: Use of APR-DRGs require a license.  Reference https://www.3m.com/3M/en_US/health-information-systems-us/drive-value-based-care/patient-classification-methodologies/apr-drgs/ .   As HL7 is working with the owning authorities to finalize the urls, the urls are subject to change.
    • Pat Taylor/Bob Dieterle: 21-0-0
    • Correction
    • Compatible, substantive

    Description

      Ballot feedback was that the Terminology Section of the IG requires a major overall, renaming the Value Sets and Code Systems and updating links.  Following is a recommended resolution for the DRG:

      1)  Delete Value Set CARINBBDRG

      2)  Define CMSDRG

      3)  Title:  CMS-DRG

      4) Description:  DRGs (Diagnosis Related Group) are any of the payment categories that are used to classify patients and especially Medicare patients for the purpose of reimbursing hospitals for each case in a given category with a fixed fee regardless of the actual costs incurred.  (There are several DRGs, such as MS (Medicare Severity)-DRGs, or AP (All Patient)-DRGs, requires defining their specific Value Sets and Code Systems.)

      coding.system = url of the code system
      coding.version = DRG Version Code
      coding.code = the code value; e.g. '090'
      coding.display = concept associated with the code; e.g. 'CONCUSSION WITHOUT CC/MCC'

      5) Value Set for the MS DRG: http://hl7.org/fhir/us/ValueSet/cms-ms-drg

      6)  Code System for the MS DRG URI (new): http://www.cms.gov/ms-drg.  Submit a request to define an OID named cms-ms-drg-cs.

      7)  Code System Definition:

      https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/MS-DRG-Classifications-and-Software.html  The link takes one to a list of files.   The code set is owned by CMS and is available for use.

      8)  Bind the ValueSet to DRG.supportingInfo.code in the Inpatient Facility Profile 

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            taylorpatriciab Patricia Taylor
            Patricia Taylor
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              Updated:
              Resolved: