ABF and Implications for Coding Helen Nolan
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1 ABF and Implications for Coding Helen Nolan 11 th May
2 ABF explained What is ABF What are DRGs What are MDCs 2
3 What is Activity Based Funding (ABF) ABF is a way of funding hospitals for the number and mix of patients they treat. ABF also takes into account the fact that some patients are more complicated to treat than others. 3
4 ABF explained What is Activity Based Funding ABF and STARS_720P.mp4 4
5 The Coder 5
6 DRG s out 6
7 What is a DRG Classification system used to structure acute inpatient episodes of care into groups that are clinically similar and therefore are anticipated to consume comparable levels of hospital resources 7
8 ADRG R 60 AB R indicates the major diagnostic category to which DRG belongs 60 Indicates partition to which DRG belongs, surgical, other, medical B Ranks the resource consumption of a DRG R60A R60B Acute Leukaemia, Major Minor Complexity Relative Value
9 The grouping process The grouper performs the following tasks Demographic and clinic edits MDC assignment Pre MDC processing MDC processing ADRG assignment DCL assignment and ECCS scoring DRG assignment 9
10 Demographic and clinic edits The demographic edits check age, sex, Adm weight, LOS, sameday status and mode of separation. The clinical edits validate all diagnosis and procedurescombined with patients age and sex. The Pdxis also checked to ensure that it is acceptable as a Pdxand that it is not listed on the Unacceptable Principal Diagnosis List (e.g. external cause of injury codes etc). 10
11 MDC assignment The grouper assigns an episode of care to an MDC (Major Diagnostic Category). This is done on the basis of the PDx (some exceptions). B is MDC 01 Diseases and disorders of the nervous system F is MDC 05 Diseases and disorders of the circulatory system 11
12 Pre MDC processing It identifies and assigns eleven very high cost ADRG s. A05Z Heart transplant A06C Tracheostomy and/or Ventilation>=96hrs, Minor complexity 12
13 MDC Processing The partition is denoted by the 2 numbers in the DRG Surgical: Range Other: Range Medical: Range
14 MDC Processing Splits the MDC into: Surgical: at least one OR procedure considered significant by the DRG classification Other: no OR procedure but at least one non-or procedure e.g. colonoscopy, cardiac catheter Medical: no OR ornon-or procedures 14
15 Example Surgical MDC: 06 Digestive System DRG: G01B Rectal Resection, Intermediate Complexity Principal Diagnosis: C20 Malignant neoplasm of rectum Procedures: Low anterior resect rectum 15
16 Example Other MDC: 06 Digestive System DRG: G48B Colonoscopy, Minor Complexity Principal Diagnosis: C20 Malignant neoplasm of rectum Procedures: Fibreoptic colonoscopy to caecum 16
17 Example of Medical MDC: 06 Digestive System DRG: G60B Digestive Malignancy, Minor Complexity Principal Diagnosis: C20 Malignant neoplasm of rectum Procedures: IV admin of pharmac agent antineoplastic 17
18 ADRG assignment Episodes are assigned to ADRGs mainly on the basis of the diagnosis and intervention codes for the episode. 18
19 DRGs DRGs within an ADRG are organised hierarchically on the basis of clinical complexity. The fourth character is used to identify subgroups of patients within an ADRG that are separated by different levels of clinical complexity. A highest clinical complexity B second highest clinical complexity C third highest clinical complexity D fourth highest clinical complexity Z no split for the ADRG (no subgroups identified) 19
20 ADRGs ADRG B70 Stroke and Other Cerebrovascular Disorders is split into three complexity DRGs and one split on separation mode. B70A Stroke and Other Cerebrovascular Disorders, Major Complexity B70B Stroke and other Cerebrovascular Disorders, Intermediate Complexity B70C Stroke and other Cerebrovascular Disorders, Minor Complexity B70D Stroke and other Cerebrovascular Disorders, Transferred <5 days 20
21 How accuracy of code assignment impacts on DRG assignment 21
22 Patient admitted with LRTI and has a background of COPD Principal diagnosis J22 Unspec acute lwr resp infection Additional diagnosis J449 Chronic obstructive pulmonary disease, unspecified Z720 Tobacco use, current DRG E75B Oth Respir System Disorders, Minor Complexity RV (Relative Value) 0.48 Principal diagnosis Additional diagnosis J44.0 Chronic obstructive pulmonary disease with acute lwr respiratory infection Z720 Tobacco use, current DRG E65B Chronic Obstruct Airway Dis, Minor Complexity RV (Relative Value)
23 Patient admitted with infective exacerbation of Asthma and has a background of COPD Principal diagnosis Additional diagnosis J45.9 Asthma, unspecified Z720 Tobacco use, current DRG E69B Bronchitis & Asthma, Minor Complexity RV (Relative Value) 0.45 Principal diagnosis Additional diagnosis J440 Chronic obstructive pulmonary disease with acute lower respiratory infection Z720 Tobacco use, current DRG E65B Chronic Obstruct Airway Dis, Minor Complexity RV (Relative Value)
24 Importance of correct principal diagnosis Principal diagnosis Additional diagnosis R296 Tendency to fall G20 Parkinsonism DRG B81B Other Dsrd of Nervous Sys, Minor Complexity RV (Relative Value) 0.65 Principal diagnosis Additional diagnosis G20 Parkinsonism DRG B67C Degnrtv Nerv Sys Dis, Minor Complexity RV (Relative Value)
25 Importance of coding additional diagnosis Principal diagnosis Additional diagnosis N390 Urinary tract infection I489 Atrial fibrillation and atrial flutter, unspecified DRG L63B Kdny& UnryTrctInf-CSCC RV (Relative Value) 0.55 Principal diagnosis Additional diagnosis N390 Urinary tract infection I489 Atrial fibrillation and atrial flutter, unspecified F03 Unspecified dementia DRG L63A Kdny& UnryTrctInf+ CSCC RV (Relative Value)
26 Importance of coding additional diagnosis Principal diagnosis Additional diagnosis DRG J690 Aspiration pneumonia R568 Other and Unspecified convulsions Q909 Down's Syndrome unspecified F03 Unspecified Dementia E62B Respiratory infection & Inflamm, Minor complexity RV (Relative Value) 0.72 Principal diagnosis Additional diagnosis DRG J690 Aspiration pneumonia R568 Other and Unspecified convulsions Q909 Down's Syndrome unspecified F03 Unspecified Dementia R32 Unspecified Urinary Incontinence R15 Faecal Incontinence E62A Respiratory infection & inflamm, Major complexity RV (Relative Value)
27 Importance of coding additional diagnosis Principal diagnosis Additional diagnosis N179 Acute kidney failure, unspecified E119 Type 2 diabetes mellitus without complication DRG L60C Kidney Failure, Minor Complexity RV (Relative Value) 0.7 Principal diagnosis Additional diagnosis N179 Acute kidney failure, unspecified E1129 Type 2 diabetes mellitus with other specified kidney complication DRG L60B Kidney Failure, Intermediate Complexity RV (Relative Value)
28 28
29 Thank you 29
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