DRG - Diagnosis Related Group Segment

The DRG segment contains diagnoses-related grouping information of various types. The DRG segment is used to send the DRG information, for example, for billing and medical records encoding.

HL7 Attribute Table - DRG - Diagnosis Related Group Segment

Seq#	Data Element Name	DataType	Usage	Vocabulary	Cardinality	Item #	Length	C.LEN	Flags
DRG
1	Diagnostic Related Group	CNE	O	0055 Diagnosis Related Group	[0..1]	00382
2	DRG Assigned Date/Time	DTM	O		[0..1]	00769
3	DRG Approval Indicator	ID	O	0136(R) Yes/no Indicator(Required)	[0..1]	00383
4	DRG Grouper Review Code	CWE	O	0056 DRG Grouper Review Code	[0..1]	00384
5	Outlier Type	CWE	O	0083(S) Outlier Type(Suggested)	[0..1]	00385
6	Outlier Days	NM	O		[0..1]	00386
7	Outlier Cost	CP	O		[0..1]	00387
8	DRG Payor	CWE	O	0229 DRG Payor	[0..1]	00770
9	Outlier Reimbursement	CP	O		[0..1]	00771
10	Confidential Indicator	ID	O	0136(R) Yes/no Indicator(Required)	[0..1]	00767	[1..1]
11	DRG Transfer Type	CWE	O	0415(R) Transfer Type(Required)	[0..1]	01500
12	Name of Coder	XPN	O		[0..1]	02156
13	Grouper Status	CWE	O	0734 Grouper Status	[0..1]	02157
14	PCCL Value Code	CWE	O	0728(R) CCL Value(Required)	[0..1]	02158
15	Effective Weight	NM	O		[0..1]	02159		5	#
16	Monetary Amount	MO	O		[0..1]	02160
17	Status Patient	CWE	O	0739 DRG Status Patient	[0..1]	02161
18	Grouper Software Name	ST	O		[0..1]	02162		100	#
19	Grouper Software Version	ST	O		[0..1]	02282		100	#
20	Status Financial Calculation	CWE	O	0742(S) DRG Status Financial Calculation(Suggested)	[0..1]	02163
21	Relative Discount/Surcharge	MO	O		[0..1]	02164
22	Basic Charge	MO	O		[0..1]	02165
23	Total Charge	MO	O		[0..1]	02166
24	Discount/Surcharge	MO	O		[0..1]	02167
25	Calculated Days	NM	O		[0..1]	02168		5	#
26	Status Gender	CWE	O	0749(S) DRG Grouping Status(Suggested)	[0..1]	02169
27	Status Age	CWE	O	0749(S) DRG Grouping Status(Suggested)	[0..1]	02170
28	Status Length of Stay	CWE	O	0749(S) DRG Grouping Status(Suggested)	[0..1]	02171
29	Status Same Day Flag	CWE	O	0749(S) DRG Grouping Status(Suggested)	[0..1]	02172
30	Status Separation Mode	CWE	O	0749(S) DRG Grouping Status(Suggested)	[0..1]	02173
31	Status Weight at Birth	CWE	O	0755 Status Weight At Birth	[0..1]	02174
32	Status Respiration Minutes	CWE	O	0757 DRG Status Respiration Minutes	[0..1]	02175
33	Status Admission	CWE	O	0759(S) Status Admission(Suggested)	[0..1]	02176

DRG-1: Diagnostic Related Group (CNE) 00382

Definition: This field contains the DRG for the transaction. Interim DRG's could be determined for an encounter. Refer to Externally-defined Table 0055 – Diagnosis Related Group in Chapter 2C, Code Tables, for suggested values.

DRG-2: DRG Assigned Date/Time (DTM) 00769

Definition: This field contains the time stamp to indicate the date and time that the DRG was assigned.

DRG-3: DRG Approval Indicator (ID) 00383

Definition: This field indicates if the DRG has been approved by a reviewing entity. Refer to HL7 Table 0136 - Yes/no Indicator for valid values.

• Y    the DRG has been approved by a reviewing entity

• N    the DRG has not been approved

DRG-4: DRG Grouper Review Code (CWE) 00384

Definition: This code indicates that the grouper results have been reviewed and approved. Refer to User-defined Table 0056 - DRG Grouper Review Code in Chapter 2C, Code Tables, for suggested values.

DRG-5: Outlier Type (CWE) 00385

Definition: Refers to the type of outlier (i.e., period of care beyond DRG-standard stay in facility) that has been paid. Refer to User-defined Table 0083 - Outlier Type in Chapter 2C, code Tables, for suggested values.

DRG-6: Outlier Days (NM) 00386

Definition: This field contains the number of days that have been approved as an outlier payment.

DRG-7: Outlier Cost (CP) 00387

Definition: This field contains the amount of money that has been approved for an outlier payment.

DRG-8: DRG Payor (CWE) 00770

Definition: This field indicates the associated DRG Payor. Refer to User-defined Table 0229 - DRG Payor in Chapter 2C, Code Tables, for suggested values.

DRG-9: Outlier Reimbursement (CP) 00771

Definition: Where applicable, the outlier reimbursement amount indicates the part of the total reimbursement designated for reimbursement of outlier conditions (day or cost).

DRG-10: Confidential Indicator (ID) 00767

Definition: This field indicates if the DRG contains a confidential diagnosis. Refer to HL7 Table 0136 - Yes/no Indicator in Chapter 2C, Code Tables, for valid values.

• Y    the DRG contains a confidential diagnosis

• N    the DRG does not contain a confidential diagnosis

DRG-11: DRG Transfer Type (CWE) 01500

Definition: This field indicates the type of hospital receiving a transfer patient, which affects how a facility is reimbursed under diagnosis related group (DRG's), for example, exempt or non-exempt. Refer to User-defined Table 0415 - DRG Transfer Type in Chapter 2C, code Tables, for suggested values.

DRG-12: Name of Coder (XPN) 02156

Definition: This field holds the name of the person ("coder") who supervised or undertook the determination of the DRG code.

DRG-13: Grouper Status (CWE) 02157

Definition: This field indicates the grouper status in general. Refer to Externally-defined Table 0734 - Grouper Status in Chapter 2C, Code Tables, for suggested values.

DRG-14: PCCL Value Code (CWE) 02158

Definition: This field indicates the PCCL (Patient Clinical Complexity Level) value for the calculated DRG as a single value. This value is calculated based on all individual CCL values calculated so far in relation to the basic DRG. Refer to Externally-defined Table 0728 - CCL Value in Chapter 2C, Code Tables, for suggested values.

DRG-15: Effective Weight (NM) 02159

Definition: This field contains the effective weight as calculated for this DRG. When exceeding the upper or lower trim point the effective weight is lower or higher.

DRG-16: Monetary Amount (MO) 02160

Definition: This field contains the monetary amount as calculated for this DRG, i.e., the sum of money the insurance company will pay.

DRG-17: Status Patient (CWE) 02161

Definition: This field contains the status of the patient concerning the financial aspects. It indicates whether the length of stay is normal or respectively shorter or longer than normal. Refer to User-defined Table 0739 – DRG Status Patient in Chapter 2C, Code Tables, for suggested values.

This field is also used along with DRG-23 and DRG-24 as an indication of whether a surcharge (long length of stay) or a discount (short length of stay) has been determined.

DRG-18: Grouper Software Name (ST) 02162

Definition: This field contains the name of the software used for grouping.

DRG-19: Grouper Software Version (ST) 02282

Definition: This field contains the version information of the software used for grouping.

DRG-20: Status Financial Calculation (CWE) 02163

Definition: This field contains the status of the DRG calculation regarding the financial aspects. Refer to User-defined Table 0742 – DRG Status Financial Calculation in Chapter 2C, Code Tables, for suggested values.

DRG-21: Relative Discount/Surcharge (MO) 02164

Definition: There will be a discount/surcharge for the calculated price due to a very short stay, early referral or a very long stay. This field contains the discount or surcharge that is included in the final price.

DRG-22: Basic Charge (MO) 02165

Definition: The basic charge is calculated as a multiplication of the relative weight with the base rate.

DRG-23: Total Charge (MO) 02166

Definition: This field contains the total charge including surcharges or discounts.

DRG-24: Discount/Surcharge (MO) 02167

Definition: This field contains the discount/surcharge as determined for this DRG. The addition/reduction is indicated by DRG-17 - Status Patient.

DRG-25: Calculated Days (NM) 02168

Definition: This field contains the number of days, for which a surcharge/discount has been determined. The addition/reduction is indicated by DRG-17 - Status Patient.

DRG-26: Status Gender (CWE) 02169

Definition: This field contains the status of the use of the gender information for DRG determination. Refer to User-defined Table 0749 – DRG Grouping Status in Chapter 2C, Code Tables, for suggested values.

DRG-27: Status Age (CWE) 02170

Definition: This field contains the status of the use of the age information for DRG determination. Refer to User-defined Table 0749 – DRG Grouping Status in Chapter 2C, Code Tables, for suggested values.

DRG-28: Status Length of Stay (CWE) 02171

Definition: This field contains the status of the DRG calculation for the length of stay information. Refer to User-defined Table 0749 – DRG Grouping Status in Chapter 2C, Code Tables, for suggested values.

DRG-29: Status Same Day Flag (CWE) 02172

Definition: This field contains the status of the use of the same day information for DRG determination. Refer to User-defined Table 0749 – DRG Grouping Status in Chapter 2C, Code Tables, for suggested values.

DRG-30: Status Separation Mode (CWE) 02173

Definition: This field contains the status of the use of the separation mode information for DRG determination. Refer to User-defined Table 0749 – DRG Grouping Status in Chapter 2C, Code Tables, for suggested values.

DRG-31: Status Weight at Birth (CWE) 02174

Definition: This field contains the status of the use of the weight at birth information for DRG determination. Refer to User-defined Table 0755 – DRG Status Weight At Birth in Chapter 2C, Code Tables, for suggested values.

DRG-32: Status Respiration Minutes (CWE) 02175

Definition: This field contains the status of the use of the respiration minutes information for DRG determination. Refer to User-defined Table 0757 – DRG Status Respiration Minutes in Chapter 2C, Code Tables, for suggested values.

DRG-33: Status Admission (CWE) 02176

Definition: This field contains the admission status for the DRG determination. Refer to User-defined Table 0759 – Status Admission in Chapter 2C, Code Tables, for suggested values.