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  1. FHIR Specification Feedback
  2. FHIR-34666

Define DRG as .supportingInfo on Institutional Profile

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    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Medium Medium
    • US Da Vinci Patient Cost Transparency (PCT) (FHIR)
    • 0.1.0 [deprecated]
    • Financial Mgmt
    • STU
    • (NA)
    • 7.6.1.1
    • Hide

      Remove all constraints and guidance on pct-gfe-Institutional Claim.diagnosis.packageCode (including MS, short, and comment on all slices)

      Create slice on pct-gfe-Institutional Claim.supportingInfo: 

      • Name: drg
      • supportingInfo[drg] 0..1
      • supportingInfo[drg].category = PCTSupportingInfoType|drg
      • supportingInfo[drg].code from USClaim-DRG-Codes (required)

       

      TO PCTSupportingInfoType Code System add:

      Code Display Definition
      drg DRG DRG (Diagnosis Related Group), including the code system, the DRG version and the code value

       

      Add a VS to include all codes from MS-DRGs - AP-DRGs - APR-DRGs
      Proposed VS Name: USClaim-DRG-Codes

      This value set should include codes based on the following rules:
      Include all codes defined in https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/MS-DRG-Classifications-and-Software 
      Include all codes defined in http://uri.hddaccess.com/cs/apdrg 
      Include all codes defined in http://uri.hddaccess.com/cs/aprdrg 

       

      This ValueSet, if and when incorporated in THO, will be used as the binding for the AEOB ExplanationOfBenefit.supportingInfo[drg].code (required)

       

      Do not add the requested invariant.

      Show
      Remove all constraints and guidance on pct-gfe-Institutional Claim.diagnosis.packageCode (including MS, short, and comment on all slices) Create slice on pct-gfe-Institutional Claim.supportingInfo:  Name: drg supportingInfo [drg] 0..1 supportingInfo [drg] .category = PCTSupportingInfoType|drg supportingInfo [drg] .code from USClaim-DRG-Codes (required)   TO PCTSupportingInfoType Code System add: Code Display Definition drg DRG DRG (Diagnosis Related Group), including the code system, the DRG version and the code value   Add a VS to include all codes from MS-DRGs - AP-DRGs - APR-DRGs Proposed VS Name: USClaim-DRG-Codes This value set should include codes based on the following rules: Include all codes defined in https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/MS-DRG-Classifications-and-Software   Include all codes defined in http://uri.hddaccess.com/cs/apdrg   Include all codes defined in http://uri.hddaccess.com/cs/aprdrg     This ValueSet, if and when incorporated in THO, will be used as the binding for the AEOB ExplanationOfBenefit.supportingInfo [drg] .code (required)   Do not add the requested invariant.
    • Corey Spears / Vanessa Candelora : 20-0-1
    • Correction
    • Non-compatible

    Description

      DRGs are not diagnosis package codes.  Instead, they are a classification of hospital inpatient admissions according to their reason for admission, severity of illness and risk of mortality.  The assignment of a DRG depends on the following variables:

      • Principal diagnosis
      • Secondary diagnosis(es)
      • Surgical procedures performed
      • Comorbidities and complications
      • Patient's age and sex
      • Discharge status

      Remove DRG mapping, Must Support to packageCode.

      Define DRG as claim.supportingInfo.drg.  Define as CodeableConcept to category.code with extensible binding to http://hl7.org/fhir/us/carin-bb/ValueSet/CMSMS3MAPAPRDRG.  Mark as Must Support.  Define an invariant allowing for use only when .subtype = 'inpatient'.

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            taylorpatriciab Patricia Taylor
            Patricia Taylor
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              Created:
              Updated:
              Resolved: