$TXT Created by YORTY,M. ROBERT at MNTVBB.FO-ALBANY.MED.VA.GOV (KIDS) on Tuesday, 12/17/02 at 14:22 ============================================================================= Run Date: DEC 30, 2002 Designation: ICD*18*5 Package : ICD - DRG GROUPER Priority: Mandatory Version : 18 SEQ #5 Status: Released Compliance Date: JAN 06, 2002 ============================================================================= Associated patches: (v)ICD*18*4 <<= must be installed BEFORE `ICD*18*5' Subject: ANNUAL DRG GROUPER UPDATE/RECLASSIFICATION Category: - Routine Description: ============ This patch provides the annual update to the DRG Grouper v20.0. It is the second phase of the 2003 ICD/DRG Update and is the follow up to patch ICD*18*4. There will be no new version package release. All necessary changes are covered by this patch. No code files are included in the patch, as all changes are handled programmatically through the pre-init routine. The changes were published in the Federal Register, Vol.67, No.148, dated August 1, 2002, with the effective date of October 1, 2002. DRG Reclassification changes are in pp.49985-50008. Changes include: I. New/revised DRG codes (file #80.2). II. DRG Reclassification changes to the Grouper. III. Miscellaneous modifications to the Grouper, discovered in the course of internal testing. IV. New DRG Weights & Trims. A summary of the additions/changes made follows: I. CODES NEW DRGs for FY 2003 -------------------- 524 = TRANSIENT ISCHEMIA 525 = HEART ASSIST SYSTEM IMPLANT 526 = PERCUTANEOUS CARDIOVASCULAR PROCEDURE WITH DRUG-ELUTING STENT WITH AMI 527 = PERCUTANEOUS CARDIOVASCULAR PROCEDURE WITH DRUG-ELUTING STENT WITHOUT AMI REVISED DRGs for FY 2003 ------------------------ 1 = CRANIOTOMY AGE>17 W CC 2 = CRANIOTOMY AGE>17 W/O CC 14 = INTRACRANIAL HEMORRHAGE & STROKE W INFARCT 15 = NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT 483 = TRACH W MECH VENT 96+ HRS OR PDX EXCEPT FACE,MOUTH & NECK DIAG II. DRG RECLASSIFICATION (GROUPER) The numbering follows the Federal Register, beginning on p.49985 1. General. 4 new DRGs. 5 DRGs renamed. Reshuffling of ICD codes to accommodate. 2. MDC 1. (a) Revise titles for DRGs 1 and 2 (b) Revise titles for DRGs 14 and 15. New DRG 524. Remove code 436 from DRG 14 and reassign it to DRG 15. Move codes 437.3 and 784.3 from DRG 14 to DRGs 34/35. Remove codes 435.0, 435.1, 435.2, 435.3, 435.8, 435.9 from DRG 15 and place them in the newly created DRG 524. Move code 437.1 from DRGs 16/17 and move into DRG 524. 3. MDC 5. (a) New DRG 525 (Heart Assist System Implant). Consists of any principal diagnosis in MDC 5, plus one of the following surgical procedures: 37.62 37.63 37.65 37.66 (b) Move Diagnosis Code 398.91 from DRG 125 to DRG 124. (c) Assignment of code 92.27 (when reported as the only procedure) to DRG 120 in MDC 5. 4. MDC 10. New principal diagnosis codes: 277.02 in DRGs 79, 80, 81 in MDC 4. 277.03 in DRGs 188, 189, 190 in MDC 6. 277.09 in DRGs 296, 297, 298 in MDC 10. 5. MDC 11. (a) Designate code 86.07 as an O.R. procedure under MDC 11 and assigned to DRG 315 when combined with the following principal diagnosis codes from DRG 316: 403.01 403.11 403.91 404.02 404.12 404.92 584.5 584.6 584.6 584.7 584.8 584.9 585 586 788.5 958.5 (b) Classify code 57.87 as a major bladder procedure and assign to DRG 303, 304, and 305. 7. MDC 23. Adding code V10.53 to list of secondary diagnosis in DRG 465, effective for discharges occurring on or after October 1, 2002. 8. Pre-MDC: Tracheostomy Modify DRGs 482 and 483 to differentiate the assignment to either DRG based on the mechanical ventilation that lasts more than 96 hours (code 96.72). Change to definition of DRG 483 so that patients who have (code 96.72) would be assigned DRG 483. Retitle DRG 483 "Tracheostomy/Mechanical Ventilation 96+ Hours Except Face, Mouth, and Neck Diagnosis." Proposed: change in definition of DRG 483 and the proposed change to add code 96.72 to DRG 483. 10. Surgical Hierarchies New DRGs 526 and 527. Reordering the following DRGs in MDC 5 DRG 525 above 104 DRG 115 and 116 above DRG 526 DRG 526 above DRG 527 DRG 527 above DRG 517 DRG 517 above DRG 518 DRG 518 above DRG 478 and 479 11. Refinement of Complications and Comorbidities (CC) using ICD-9-CM DRGs Ver 20.0 provided by 3M. 12. Review of Procedure Codes in DRGs 468, 476, and 477 III. Other problems. a). Spelling corrections on diagnosis codes E922.5, E955.7, and E985.7 sent with patch ICD*18*4. IV. New DRG Weights & Trims. New weight, high trim and ALOS values for each DRG have been added to the DRG file #80.2 for the 2003 Fiscal Year. These values were obtained from the Centers for Medicare and Medicaid Services (CMS). More specifically, this FY 2003 update revises these fields for each DRG: Relative Weight ALOS (average length of stay) Low & High trim Trim values, sent this year by CMS with a .0 value, have been "seeded" with last year's trim value. The new values will be used for all discharges since October 1, 2002 and can be seen when DRG reports are obtained for such cases, or when current DRG calculations are made using the following options: ICD DRG GROUPER (DRG Grouper) DG DRG CALCULATION (DRG Calculation) DG PTF DRG INFORMATION (DRG Information Report) This patch addresses the following E3R(s): ------------------------------------------ There are no E3Rs associated with this patch. This patch addresses the following NOIS message(s): --------------------------------------------------- There are no NOIS messages associated with this patch. Participating test sites: ------------------------- DANVILLE, IL VAMC WEST LOS ANGELES VAMC NASHVILLE VAMC Thanks also to Seattle and Providence for their input. =======================INSTALLATION INSTRUCTIONS========================== This patch can be loaded with users on the system. However, it would be preferable if Medical Records coders were off the system. If installed during the normal workday it is recommended that the following menu options (File #19) and all of their descendants be disabled to prevent possible conflicts while running the KIDS Install. Other VISTA users will not be affected. ICD DRG GROUPER DRG Grouper DG DRG CALCULATION DRG Calculation DG PTF DRG INFORMATION DRG Information Report Install Time - 5 to 10 minutes. Please ensure that your programming variables are set, including your DUZ(0)="@", otherwise installation will abort. This patch does not involve global file restoration. Nonetheless, we suggest you create global saves on files #80 (^ICD9), #80.1 (^ICD0) and #80.2 (^ICD) in the event problems develop during the install. If it became necessary to use the saved files, you should first kill all the records (except the zero node) before applying the global restores. 1. LOAD TRANSPORT GLOBAL --------------------- Choose the PackMan message containing this patch and invoke the INSTALL/CHECK MESSAGE PackMan option. 2. DISABLE ROUTINE MAPPING (DSM for Open VMS sites only) ----------------------- Disable routine mapping on all systems for the routines listed in step 3 below. NOTE: If the routines included in this patch are not currently in your mapped routine set, please skip this step. 3. COMPONENTS SENT WITH PATCH -------------------------- The following is a list of the routines included in this patch. The second line of each of these routines now looks like: ;;18.0;DRG Grouper;**[patch list]**;Oct 13,2000 CHECK^XTSUMBLD results Routine name Before Patch After Patch Patch List =========== ============ =========== ========== ICD185EN N/A 464682 5 ICD185P N/A 4964205 5 ICD185P1 N/A 1998615 5 ICD185P4 N/A 6616183 5 ICD185P5 N/A 3051186 5 ICD185PA N/A 3359989 5 ICD185PB N/A 3362129 5 ICD185PC N/A 2125993 5 ICDDRG5 6038771 6116849 2,5 ICDDRGX 6942815 7314853 1,2,5 ICDTLB6 9865771 10129739 2,5 Total number of routines - 11 4. START UP KIDS ------------- Start up the Kernel Installation and Distribution System Menu [XPD MAIN]: Edits and Distribution ... Utilities ... Installation ... Select Kernel Installation & Distribution System Option: INStallation --- Load a Distribution Print Transport Global Compare Transport Global to Current System Verify Checksums in Transport Global Install Package(s) Restart Install of Package(s) Unload a Distribution Backup a Transport Global Select Installation Option: 5. Select Installation Option: -------------------------- NOTE: The following are OPTIONAL - (When prompted for the INSTALL NAME, enter ICD*18.0*5): a. Backup a Transport Global - This option will create a backup message of any routines exported with this patch. It will not backup any other changes such as DD's or templates. b. Compare Transport Global to Current System - This option will allow you to view all changes that will be made when this patch is installed. It compares all components of this patch (routines, DD's, templates, etc.). c. Verify Checksums in Transport Global - This option will allow you to ensure the integrity of the routines that are in the transport global. 6. Select Installation Option: Install Package(s) ------------------ a. Choose the Install Package(s) option to start the patch install. b. When prompted "Want KIDS to INHIBIT LOGONs during the install? YES//'. answer NO. c. When prompted 'Want to DISABLE Scheduled Options, Menu Options, and Protocols? YES//', answer 'YES'. d. When prompted 'Enter options you wish to mark as 'Out of Order':' Enter the following options: ICD DRG GROUPER DRG Grouper DG DRG CALCULATION DRG Calculation DG PTF DRG INFORMATION DRG Information Report e. When prompted 'Enter protocols you wish to mark as "out Of Order':' press , 7. REBUILD MAPPED ROUTINE(S) (DSM for Open VMS sites only) ========================== NOTE: This step is only necessary if you performed step 2 or if you wish to include the routines in your mapped set. 8. Following installation of this patch, it is necessary to run the DG PTF UPDATE TRANSFER DRGs option in order to make the transfer DRGs correspond to the appropriate grouper. This option updates/recalculates the transfer DRGs for PTF records opened during the current fiscal year (since 10/1/2002). The option is locked with the DG PTFSUP security key. The Menu path is PTF Menu/Update DRG Information Menu/Update Transfer DRGs for current FY. 9. Delete the global save made at the beginning of these installation instructions. 10. All routines ICD185* can be deleted after the patch has been successfully installed. Below are the messages generated by the installation: Running Pre-Install Routine: ^ICD185P >>> Adding New DRGs - Please verify that 4 added DRG524 TRANSIENT ISCHEMIA added. DRG525 HEART ASSIST SYSTEM IMPLANT added. DRG526 PERCUTANEOUS CARDIOVASCULAR PROCEDURE WITH DRUG-ELUTING STENT WITH AMI added. DRG527 PERCUTANEOUS CARDIOVASCULAR PROCEDURE WITH DRUG-ELUTING STENT WITHOUT AMI added. >>> Revising DRG records in the DRG file (#80.2)... Edited: DRG1 to CRANIOTOMY AGE>17 W CC Edited: DRG2 to CRANIOTOMY AGE>17 W/O CC Edited: DRG14 to INTRACRANIAL HEMORRHAGE & STROKE W INFARCT Edited: DRG15 to NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT Edited: DRG483 to TRACH W MECH VENT 96+ HRS OR PDX EXCEPT FACE,MOUTH & NECK DIAG >>> ...completed. 5 record(s) revised. >>> Beginning DRG Reclassification changes... >>> DRG Reclassification complete. >>> Adding FY 2003 Weights & Trims... >>>Updating Diagnoses w/complications/comorbidities Updating Routine file... Updating KIDS files... ICD*18.0*5 Installed. Routine Information: ==================== Routine Name: - ICD185EN Routine Checksum: Routine Name: - ICD185P Routine Checksum: Routine Name: - ICD185P1 Routine Checksum: Routine Name: - ICD185P4 Routine Checksum: Routine Name: - ICD185P5 Routine Checksum: Routine Name: - ICD185PA Routine Checksum: Routine Name: - ICD185PB Routine Checksum: Routine Name: - ICD185PC Routine Checksum: Routine Name: - ICDDRG5 Routine Checksum: Routine Name: - ICDDRGX Routine Checksum: Routine Name: - ICDTLB6 Routine Checksum: ============================================================================= User Information: Entered By : YORTY,M ROBERT Date Entered : OCT 27, 2002 Completed By: RYAN,DOLORES G Date Completed: DEC 30, 2002 Released By : ALEXANDER,DIANNE Date Released : DEC 30, 2002 ============================================================================= Packman Mail Message: ===================== $END TXT