This document provides the definitions for inclusion of hospital events in casemix funding together with information related to the calculation of cost weights for these events and the assignment of events to service units. The changes from the previous version embodied in this document arise from two sources, namely:
- the request from coders to move to ICD-10-AM 3rd Edition
- the need to review the relativities of the existing cost weights and to also adapt them to AR-DRG 5.0.
This version includes the following changes:
- Coding in ICD-10-AM 3rd Edition
- Grouping to AR-DRG v5.0 with now just one DRG split:
- L61Y is retained from the existing DRG set
- The previous splits for bone marrow transplants are no longer necessary as AR-DRG v5.0 now incorporates these.
- A review of the exclusion codes
- Termination of Pregnancy – acute cases are now included in casemix
- The exclusion rule for non-acute colposcopy procedures that are purchased outside of casemix has been broadened slightly to include two more procedure codes
- Revised cost weights calculation for low outliers
- Mechanical Ventilation (MV) copayments have been extended to some DRGs that were previously excluded from this process
- The new coding classification contains an expanded block of anaesthetic codes which have been incorporated in some of the inclusion rules, mainly for the ‘scope rules
- The rule for radiotherapy has been changed
- Simultaneous Pancreas and Kidney Transplants are included as casemix events
- There are two new copayments associated with DRGs F08A, F08B, and F19Z that should be allowed for in cost weight calculations
- The back mapping of ICD codes in 2004/05 is no longer necessary now that a DRG set is being used that is adapted to coding in ICD 10-AM v3.