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 purchase units. WIESNZ11 uses AR-DRG 6.0 which is based on ICD-10-AM 6th Edition codes. A new set of cost weights are provided in the WIESNZ11 weights table.
This version includes the following major changes from the previous year:
- WIESNZ11 is based on ICD-10-AM 6th Edition and AR-DRG 6.0. This is a change from earlier versions which were based on ICD-10-AM 3rd Edition and AR-DRG 5.0.
- Created a new rule for capsule endoscopies as ICD-10-AM 6th Edition has a specific procedure code (M25008).
- In ICD-10-AM 6th Edition the term ‘Chemotherapy’ has been replaced with the term ‘Pharmacotherapy’.
- Removed the exclusion rule for non-cancer pharmacotherapy because ICD-10-AM 6th Edition classification rules and guidelines do not allow the PCT drugs to be uniquely identified from non-PCT pharmacotherapy.
- NZ DRGs associated with AR-DRG v5.0 for Peritoneal Dialysis (L61Y), Extracranial Vascular Procedures (B04M), Obesity (K04A/K04B), and Mastoid Procedures (D06A/D06B) have been retired because AR-DRG v6.0 includes new DRGs that resolve the problems that led to these NZ DRGs in the earlier DRG version.
- A new exclusion rule has been created for Skin Lesion Procedures (MS02016). Elective counting requirements give these events an NZDRG with a specific cost weight corresponding to the non-casemix price.
- A new exclusion rule has been created for Ophthalmology Injections (S40004). Elective counting requirements give these events an NZDRG with a specific cost weight corresponding to the non-casemix price.
- New facilities have been added to the WIES eligible table for St Marks Road Surgical Centre (8977) and Rotorua Eye Clinic (8979) for the 2010/11 financial year. These were added 29 March 2011.
- The exclusion rule for sleep apnoea events applying in earlier years is now omitted. These events will be casemix-funded from 1 July 2011.
- The exclusion rule for Blood Transfusions now accurately identifies the possible NNPAC purchase units for these excluded events.