10 what is a grouper a drg grouper is a computer

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10. WHAT IS A GROUPER? A DRG Grouper is a computer program or module which takes those 5 clinical and demographic data as input and gives a corresponding Diagnosis Related Group as output. The diagnoses and procedures are encoded as ICD9cm codes (International Committee on Diseases, version 9, Clinical Modifications). The age is a small integer from 0 to 129. The gender is encoded as 1 for male, 2 for female and 3 for unknown (don’t ask). The discharge disposition, also known as "discharge status," is usually encoded either using UHDDS or UB82 (both medical billing standards). For a PDF from CHIMA common discharge status codes, follow this link or go straight to the source at The standard CMS (formerly HCFA) grouper, ours included, will accept up to 10 diagnoses, which are presumed to be in order of significance, from the Primary diagnoses (number 1) on down the line. Like- wise, up to 15 procedures are accepted, but their significance is determined by the grouping process, so their order is not important. <IMG SRC="grouping.gif" ALT="Grouping Flowchart"> The relevance of any diagnosis or procedure code is determined by its mask , which is a bitstring of condi- tions. The masks guide the grouper in its use of any giv en code; for instance, the masks say whether or not a code is gender-specific, or if it is allowed as a primary diagnosis. In addition to the information encoded in the mask, the grouper applies logic to actually classify any giv en inpatient stay into a single DRG. 11. WHAT ARE DRG PROPERTIES? Any inpatient stay can be classified into a CMS (formerly HCFA) Diagnosis Related Group. Any CMS DRG for a given version has certain properties, determined empirically by CMS from the MedPar database. Those properties are: DRGGroupers.Com - 3 - DRGGroupers.Com
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DRG FAQ A DRG description (70 characters wide, version-dependant) An MDC (see below for details) A Geometric Mean Length of Stay (GMLOS) A Weight (a normalized prediction of resource consumption) A Category: either "Surgical" or "Medical" A low "trim point" (the LOS below which lie the low outliers) A high "trim point" (the LOS above which lie the high outliers) The DRGGroupers.com grouper returns all these and more: a bit string for each of the Diagnosis Codes and Procedure Codes so that the caller can determine which codes were actually significant to the group- ing. 12. WHAT ARE MDCS? MDC stands for "major diagnostic category" and is a sort of pre-DRG classification of inpatient stays. MDC Description 1 Diseases & Disorders of the Nervous System 2 Diseases & Disorders of the Eye 3 Diseases & Disorders of the Ear, Nose, Mouth & Throat 4 Diseases & Disorders of the Respira- tory System 5 Diseases & Disorders of the Circula- tory System 6 Diseases & Disorders of the Digestive System 7 Diseases & Disorders of the Hepato- biliary System & Pancreas 8 Diseases & Disorders of the Muscu- loskeletal System & Conn Tissue 9 Diseases & Disorders of the Skin, Sub- cutaneous Tissue & Breast 10 Endocrine, Nutritional & Metabolic Diseases & Disorders 11
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  • Fall '18
  • Diagnosis-related group, DRGs

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