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VA Code in Flight Submission - DRG Redesign Patch ICD*18*89 v2
Please use this identifier to cite or link to this publication: http://hdl.handle.net/10909/11240
Submitted by OI&T EPMO Lean Systems Engineering Open Source Coordination Office on 09-20-2016.
Medicare Severity Diagnosis Related Group (MS-DRG) Grouper software is based on the Medicare Grouper requirements as defined by the Centers for Medicare and Medicaid Services (CMS) and as reported in the Federal Register. Each Diagnostic Related Group (DRG) represents a class of patients who are deemed medically comparable and who require approximately equal amounts of health care resources. Software uses diagnostic and operation/procedure codes to determine DRGs based on the combination of codes, age, sex, discharge status, and occurrence of death. VA Health Information Management (HIM) has identified significant Veterans Health Information Systems and Technology Architecture (VistA) DRG calculation errors beginning October 1, 2015. The VistA DRG application utilizes International Classification of Diseases (ICD) diagnosis and procedure codes to calculate and provide DRG values used in the Admission Discharge Transfer (ADT), Patient Treatment File (PTF), and Integrated Billing (IB) Packages. Due to the errors found by HIM, the Diagnostic Re-Design Project was stood up to re-engineer the DRG calculation process in order to resolve all calculation issues.

The DRG Re-Design Project will enhance the DRG Grouper to improve the process used by Veterans Health Administration (VHA) staff to bill veterans for hospital stays. The DRG is a system used by VHA to classify any inpatient stay and is used for payment by third party insurance payers. The enhancements to the DRG will allow VHA staff to properly record DRGs and determine case mix for inpatient care and to bill third party insurance payers for hospital stays. The enhancements will increase efficiency and reduce the potential for errors, improving the quality services provided to veterans and their beneficiaries.

This patch, the DRG Re-Design Project, creates new data files and routines to calculate a Diagnostic Related Group (DRG) value for a patient record coded with International Classification of Diseases, Tenth Revision (ICD-10) diagnostic and procedure codes.

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