WIESNZ12 cost weights

Summary

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. WIESNZ12 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 WIESNZ12 weights table.

This version includes the following major changes from the previous year:

  • Added three procedure codes 3049103, 3049104 [975], 9029701 [880] to the Aggregated Gastroenterology Block, see 5.2.29.  Procedure codes 3049103, 3049104 [975] have been added to ERCP block and procedure code 9029701 [880] has been added to the Gastro block.
  • ERCP, Colonoscopy and Gastroscopy exclusions are limited to events with at most three procedure codes. The rule has been further restructured to be independent of the order of procedure coding, and to assign their XPUs by a cost hierarchy.
  • Adjusted Skin Lesion Procedures (MS02016) exclusion rule so events excluded can have at most four procedure codes.  This means the skin graft condition is no longer needed, see 5.2.34.
  • Adjusted Ophthalmology Injections (S40004) exclusion rule to include events where both eyes have been injected in the same event, and there are at most three procedures, see 5.2.33.
  • Weight schedule – adjusted low boundary points and introduced one day weights for AR-DRGs F10B Interventional Coronary Procedures W AMI W/O Catastrophic CC and O01B Caesarean Delivery W/O Catastrophic or Severe CC.  Weights for the NZDRGs C03W and J11W have been recalculated to reflect new outpatient pricing for FY 12/13.
  • Adjusted the heading descriptions for Surgical Termination of Pregnancy 1st and 2nd Trimesters to align them with the ICD-10-AM classification parameters.
  • Adjusted Scoliosis rule in Box 1c – changed ‘or’ to ‘and’ (in the second “OR” statement) so the description is consistent with the SAS programming, see 4.4.4.
  • From 1 July 2012 a new field (Funding Agency) will be added to the NMDS.  When ‘agency’ is used in this document it refers to this new field – Funding Agency.
  • A new health specialty code for General Practitioners (G01) has been added for records with an event end date (discharge date) on or after 1 July 2012.  Events with a G01 health specialty code that fall into casemix will be mapped to health specialty code M05 (Emergency Medicine).  Events that fall outside of casemix will be assigned an excluded purchase unit in the same way as all other excluded NMDS events.
  • Following a restructure within the Ministry of Health during November 2011, Information Delivery and Operations Group has been merged with another group and re-named Information Group.

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