============================================================================= Run Date: SEP 24, 2003 Designation: ICD*18*7 Package : ICD - DRG GROUPER Priority: Mandatory Version : 18 SEQ #7 Status: Released Compliance Date: OCT 15, 2003 ============================================================================= Associated patches: (v)ICD*18*6 <<= must be installed BEFORE `ICD*18*7' Subject: CSV UPDATES FOR THE DRG GROUPER Category: - Data Dictionary - Routine - Enhancement (Mandatory) - Informational Description: ============ Description: =========== ********************************************************************************** * THIS PATCH MUST BE INSTALLED AT ALL SITES BY * * SEPTEMBER 30, 2003 * ********************************************************************************** ************************************************************************** ************************************************************************** This patch supports Code Set Versioning, mandated under the Health Information Portability and Accountability Act (HIPAA). It contains routines, data, and data dictionary changes to recognize code sets for the Current Procedural Terminology (CPT) and Health Care Financing Administration (HCFA) Common Procedure Coding System (HCPCS). When implemented, applications will be able to retrieve appropriate CPT and HCPCS codes based upon a date that a clinical event occurred. This patch is contained in the MULTIPLE BUILD DISTRIBUTION: CSV MS 1.0 Installing the CSV MS 1.0 build provides all of the updates listed below. Sites will use the Multi-Build Distribution to ensure the proper order of installation for the VISTA Packages in the Management Systems Product Line. ************************************************************************** ************************************************************************** I. OVERVIEW --------------------- Gail Graham, Director of Information Assurance, requested modifications to the VHA Information Systems and Technology Architecture (VISTA) Patient Information Management System (PIMS) package that allows the use of multiple versions of the code sets employed in financial transactions. The Health Insurance Portability and Accessibility Act (HIPPA) stipulates that diagnostic and procedure codes used for billing purposes must be the codes that were applicable at the time the service was provided. This initiative is commonly referred to as the Code Set Versioning (CSV) project. For this project, four code sets required by HIPPA legislation are date sensitive and needed modification. These include: * International Classification of Diseases-9-Clinical Modifications (ICD-9-CM) * Diagnostic Related Group (DRG) codes, which is part of the ICD-9 code set * Clinical Procedure Terminology-4 (CPT-4), and * Healthcare Common Procedural Coding System (HCPCS) Level II Codes. This patch addresses the changes done within the DRG Grouper package in compliance to the specifications of CSV. Modifications were done within the DRG Grouper application to assure the validity of CPT codes, ICD diagnosis and CPT procedure codes, and DRG codes, by utilizing API's that return codes for a given date. In the case of DRG codes, new API's were created to return the correct codes for a given date. New fields were also added to the DRG file (#80.2) to accommodate the new information required for CSV. This included adding an inactive flag, active date, and inactive date to the .01 level of the file and creating a new effective date multiple level that contains the status flag for the effective date along with the MDC# and Surgery flag. A string of DRG codes were also added to the effective date multiple field in the ICD OPERATION/PROCEDURE file (#80.1) and the ICD DIAGNOSIS file (#80). This consisted of DRGa through DRGf fields added. II. TECHNICAL a. All Direct Global Accesses (DGA's) to the ICD OPERATION/PROCEDURE file (#80.1) or the ICD DIAGNOSIS file (#80) were changed to use newly-developed Application Program Interfaces (API's). The API's are passed the ICD/CPT code and the "effective date" and the proper information is returned. These new API's also check to verify that the ICD/CPT code is active for the given date. b. All DGA's to the DRG file (#80.2) were changed to use a newly-developed API. These API's determine the correct DRG code for the effective date and verify that the DRG code is active for the given date c. The following new fields were added to the EFFECTIVE DATE multiple (#66) of both the ICD DIAGNOSIS file (#80) and the ICD OPERATION/PROCEDURE file (#80.1) - DRGa (#60) DRGb (#61) DRGc (#62) DRGd (#63) DRGe (#64) DRGf (#65) d. File #80.2 was updated to add an ACTIVATION DATE (14), INACTIVE (15), and INACTIVATION DATE (16) to the .01 level of the file. e. A new EFFECTIVE DATE multiple (#66) was added to the DRG file (#80.2). New fields within the multiple are - EFFECTIVE DATE (#.01) STATUS (#.03) MDC# (#.05) SURGERY (#.06) f. Post-Install Routine (ICD187PT) This routine: 1. Populates the "DRG" level of the ICD DIAGNOSIS (#80) and the ICD OPERATION/PROCEDURE (#80.1) files. See (c) above. This data is taken from the existing DRG codes in the DRGa (#60) through DRGf (#65) data fields. 2. Populates the EFFECTIVE DATE multiple (#66) in the DRG file (#80.2) See (e) above. The MDC# (#.05) is set equal to the MDC# field (#5) in the 0 node. and the SURGERY field (#.06) is set to the SURGERY field (#.06) in the 0 node. STATUS and EFFECTIVE DATES are determined by the FISCAL YEAR ("FY") entries that already exist in the file. A WEIGHT of 0.00 in the FY entry will result in an EFFECTIVE DATE entry with a STATUS of INACTIVE, otherwise the STATUS will be ACTIVE. STATUS (#.03) has a default of ACTIVE and the EFFECTIVE DATE (#.01) has a default of 10/1/82. If the DRG code has a WEIGHT (#2) of 0.0 then its STATUS (#.03) is INACTIVE and the EFFECTIVE DATE (#.01) is set to October 1 of the first Fiscal Year that has a WEIGHT of 0.0. III. Functional --------- * The users will be prompted for an "effective date" when calculating the DRG using the DRG Grouper * All calculations of ICD/CPT/DRG codes will be based on an effective date that was either entered by the user or extracted from the patient's data EXAMPLES Run the DRG Grouper menu option. The first question now is "Effective Date" (with the default of today). If you want to calculate the DRG for a date other than today, enter that date. All other functionality is the same. The DRG will be calculated using the entered date. ROUTINE SUMMARY: ================ The following is a list of the routine(s) included in this patch. The second line of each of these routine(s) will look like: ;;18.0;DRG Grouper;**[patch list]**;Oct 20, 2000 CHECK^XTSUMBLD results Routine name Before Patch After Patch Patch List ============ ============ =========== ========== ICD187PT N/A 11418263 7 ICDCOD 2304573 3554932 7 ICDDRG 9700215 10470305 2,7 ICDDRG0 12389990 12552788 1,2,7 ICDDRG5 6116849 6210421 2,7 ICDDRGM 13582256 15096754 7 ICDDRGX 7314853 7600411 1,2,5,7 ICDGTDRG N/A 13362323 7 ICDTLB5 9783009 9942147 7 GLOBAL SUMMARY --------------------------- The following globals are included in the patch: ^DD(80.2 ^DD(80.066 ^DD(80.166 SOFTWARE AND DOCUMENTATION RETRIEVAL ==================================== The software for this patch is being distributed in host file CSV_MS_1_0.KID. The host file will contain nine KIDS builds. The builds contained in the CSV MS 1.0 multi-package distribution are: Package Patch(es) ------- --------- AICS IBD*3.0*51 Ambulatory Care DG*5.3*511 SD*5.3*295 DRG Grouper ICD*18.0*7 Event Capture EC*2.0*47 Fee Basis FB*3.5*55 Integrated Billing IB*2.0*210 PCE PX*1.0*121 Registration (PTF) DG*5.3*510 Please refer to the 'Software and Documentation Retrieval' section of the EC*2*47 patch description for instructions on how to acquire the patch software and documentation. INSTALLATION INSTRUCTIONS: ========================== Please refer to the Health Insurance Portability and Accountability Act (HIPAA) Code Set Versioning (CSV) Installation Guide for details of the installation procedure for this patch. The HIPAA CSV Installation Guide can be found in the following [ANONYMOUS.SOFTWARE] directories: Preferred Address ------------------------- First available FTP server download.vista.med.va.gov Specific Field Office FTP Address --------------------- ------------------------ Albany ftp.fo-albany.med.va.gov Hines ftp.fo-hines.med.va.gov Salt Lake City ftp.fo-slc.med.va.gov File Name Description Format FTP Protocol -------------- ------------- --------- ------------ CSV_1_0_IG.DOC Install Guide MS Word Binary Routine Information: ==================== Routine Name: - ICDDRG UPDATE FOR CODE SET VERSIONING PROJECT Routine Checksum: Routine Name: - ICDCOD UPDATE FOR CODE SET VERSIONING PROJECT Routine Checksum: Routine Name: - ICDDRG5 UPDATE FOR CODE SET VERSIONING PROJECT Routine Checksum: Routine Name: - ICDDRGX UPDATE FOR CODE SET VERSIONING PROJECT Routine Checksum: Routine Name: - ICDTLB5 UPDATE FOR CODE SET VERSIONING PROJECT Routine Checksum: Routine Name: - ICD187PT POST INSTALL ROUTINE THAT CREATES THE NEW EFFECTIVE DATE MULTIPLE IN THE DRG FILE (#80.2) AND ADDS THE DRG CODES TO THE MULTIPLE FIELD LEVEL IN THE ICD OP/PROC CODE FILE (#80.1) AND ICD DIAG CODE FILE(#80) Routine Checksum: Routine Name: - ICDDRGM UPDATE FOR CSV PROJECT Routine Checksum: Routine Name: - ICDGTDRG NEW ROUTINE FOR CSV PROJECT - DRG API'S Routine Checksum: Routine Name: - ICDDRG0 UPDATED FOR CODE SET VERSION PROJECT Routine Checksum: ============================================================================= User Information: Entered By : KRAUTER,DARYL Date Entered : APR 09, 2003 Completed By: LENART,ANTHONY D Date Completed: SEP 04, 2003 Released By : NELSON,VICKI M Date Released : SEP 24, 2003 ============================================================================= Packman Mail Message: ===================== No routines included